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Biopsy

Biopsy is the removal of cells or tissues for examination by a specialist physician called a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. According to the National Cancer Institute (NCI), microscopic examination of biopsy samples is the way a positive diagnosis of cancer can be made. (Read about "Cancer: What It Is") Biopsy can also be used to test for other diseases or conditions. The doctor will discuss the procedure, and let you know if there will be any discomfort. The doctor will also discuss what type, if any, anesthesia will be used. (Read about "Anesthesia")

Below are just some of the different types of biopsies.

Bone marrow biopsy - Bone marrow is the soft, sponge-like tissue in the center of larger bones. It produces white blood cells, red blood cells and platelets. The removal of a sample of tissue from the bone marrow with a needle for examination by a pathologist is called a bone marrow biopsy. During the procedure, the doctor inserts a biopsy needle into the bone. A sample of tissue is removed and given to a pathologist for examination under a microscope and/or other tests. The procedure can be used to test for blood abnormalities such as certain types of anemia (Read about "Anemia"), as well as certain cancers such as leukemias, multiple myeloma and others. (Read about "Leukemia" "Multiple Myeloma & Plasmacytoma") It can also be used to determine if cancer has metastasized or spread. (Read about "Cancer: What It Is")

Cone biopsy - Surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal is called a cone biopsy or conization. Cone biopsy may be used to diagnose or treat cervical conditions such as cervical cancer. (Read about "Cervical Cancer")

Core biopsy - When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy, core biopsy or fine-needle aspiration (FNA). During the procedure, the doctor inserts a biopsy needle into the abnormal area. A sample of tissue is removed and given to a pathologist for examination under a microscope and/or other tests. If the suspicious area is deep in the body or cannot be felt, an imaging device such as CT scan or ultrasound (Read about "CT Scan - Computerized Tomography" "Ultrasound Imaging") can be used to position the needle before taking the sample. FNA is particularly useful for the evaluation of breast masses.

Endoscopic biopsy - An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool that can be used to biopsy or remove tissue. A pathologist can then examine the tissue under a microscope for signs of disease. Depending on what part of the body is being looked at, the endoscope may be inserted through an opening such as the mouth, anus or vagina. In some cases, the endoscope is inserted through a small skin incision. (Read about "Endoscopy")

Excisional biopsy - When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy.

Fine-needle aspiration biopsy (FNA) - When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy, core biopsy or fine-needle aspiration. During the procedure, the doctor inserts a biopsy needle into the abnormal area. A sample of tissue is removed and given to a pathologist for examination under a microscope and/or other tests. If the suspicious area is deep in the body or cannot be felt, an imaging device such as CT scan or ultrasound (Read about "CT Scan - Computerized Tomography" "Ultrasound Imaging") can be used to position the needle before taking the sample.

Frozen section - The frozen section was developed in order to make a fast diagnosis of a mass or tumor during surgery. During a frozen section, the surgeon removes a portion of the tissue mass. The pathologist then freezes and stains this tissue so that it can be examined under the microscope. A frozen section isn't usually the final diagnosis. The pathologist will create a permanent section (usually fixed in paraffin wax) and re-examine the tissue samples under a microscope. This process usually takes 24 hours.

Incisional biopsy - When only a sample of tissue is removed, the procedure is called an incisional biopsy.

Laparoscopic biopsy - Laparoscopic biopsy examines organs in the abdomen and pelvis. It is a special type of endoscopic biopsy. For a laparoscopic biopsy, the physician inserts a special tube called a laparoscope through an incision in the abdomen. The laparoscope sends images to a monitor. The physician watches the monitor and uses instruments in the laparoscope to remove tissue samples that can be viewed under a microscope or tested for disease. Laparoscopic biopsy can be used to test for disease in internal organs, such as the liver and the ovaries (Read about "Endoscopy" "The Liver" "The Ovaries")

Lymph node biopsy or dissection - Lymph nodes, which are part of the body's lymphatic system (Read about "The Lymph System"), are small, round collections of lymphatic tissue that trap cancer cells, bacteria or other harmful substances. (Read about "Microorganisms") Groups of lymph nodes are found in the neck, underarms, chest, abdomen and groin. Lymph nodes can be removed and examined under a microscope to determine whether cancer cells are present in two ways:

• Sentinel lymph node biopsy - The sentinel lymph node is the first lymph node to which cancer is likely to spread from the primary tumor. Cancer cells may appear in the sentinel node before spreading to other lymph nodes. Sentinel lymph node biopsy is a procedure in which one sentinel lymph node (sometimes more than one and sometimes just a portion of one) is removed and examined under a microscope to determine whether cancer cells are present. The idea is that cancer cells spread (metastasize) in an orderly way from the primary tumor to the sentinel lymph node(s), then to other nearby lymph nodes. Lymph node biopsy can be done surgically (open biopsy) or by needle, depending on the location of the area being tested and the reason it is being tested.
• Lymph node dissection - This is a surgical procedure in which a group or chain of lymph nodes are removed and examined to see whether they contain cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. It is also called lymphadenectomy.

Needle biopsy - When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy, core biopsy or fine-needle aspiration. During the procedure, the doctor inserts a small needle into the abnormal area. A sample of tissue is removed and given to a pathologist for examination under a microscope and/or other tests. If the suspicious area is deep in the body or cannot be felt, an imaging device such as CT scan or ultrasound (Read about "CT Scan - Computerized Tomography" "Ultrasound Imaging") can be used to position the needle before taking the sample.

Pap smear - This is a procedure in which cells are gently scraped from the cervix for examination under a microscope. It is used to detect cancer and changes that may lead to cancer. A Pap smear or Pap test can also show noncancerous conditions, such as infection or inflammation. (Read about "Cervical Cancer")

Punch biopsy - A punch biopsy is used to obtain a deep cylindrical core of skin and underlying tissue. Large punch biopsies may require a suture to close. A punch biopsy is used in the diagnosis of many skin disorders. (Read about "Skin")

Shave biopsy - A shave biopsy is a procedure in which a skin abnormality and a thin layer of surrounding skin are removed with a small blade for examination under a microscope. A shave biopsy is used in the diagnosis of many skin disorders. (Read about "Skin") Stitches are not needed with this procedure.

Stereotactic biopsy - Stereotactic biopsy is a procedure that uses a computer and a 3-dimensional scanning device to precisely locate a tumor site and guide the removal of tissue for examination under a microscope. It is often used to biopsy a suspicious mass in the breast or brain. (Read about "Breast Cancer" "Brain Tumors")

Transvenous biopsy - Transvenous biopsy involves inserting a tube called a catheter into a vein. The physician then puts a biopsy needle into the catheter and guides it to the area to be biopsied. A sample of tissue is removed and given to a pathologist for examination under a microscope and/or other tests.