A biopsy is a procedure that is performed to remove a small sample of tissue or cells from the body for analysis in a laboratory. If you have certain signs and symptoms or if the doctor identifies something that is a cause for concern, you may need to have a biopsy to determine if you have cancer or another disease.

While imaging tests, such as x-rays, are useful for detecting masses or abnormal areas, they can not differentiate cancer cells by themselves from those that are not. In the case of most types of cancer, the only way to give a definitive diagnosis is to perform a biopsy that removes cells for a more thorough examination.

These are some of the different types of biopsy that are used to diagnose cancer.

Bone Marrow Biopsy

A needle sucking liquid bone marrow from the hip bone
Your doctor may recommend a bone marrow biopsy if an abnormality is detected in your blood or if you suspect that the cancer has originated or has moved to your bone marrow.

Bone marrow is the spongy substance inside some of your large bones, where blood cells are made. Analyzing a sample of bone marrow may reveal what is causing the problem in your blood.

Bone marrow biopsy is commonly used to diagnose a variety of blood problems – including cancers of the blood, such as leukemia, lymphoma, and multiple myeloma. A bone marrow biopsy can also detect cancers that started elsewhere and moved to the bone marrow.

During a biopsy, your doctor, using a long needle, removes a sample of bone marrow from the back of the hip bone. In some cases, the doctor may perform a bone marrow biopsy of other bones in the body. You are given a local anesthetic before a bone marrow biopsy to reduce discomfort during the procedure.

Endoscopic Biopsy

During an endoscopy, the doctor uses a thin, flexible tube (endoscope) with a light on the end to see structures inside the body. Special tools are passed through the tube to take a small sample of tissue to be analyzed.

The type of endoscopic biopsy that takes place depends on the location of the suspected area. The tubes that are used in an endoscopic biopsy can be inserted into the mouth, rectum, urinary tract, or through a small incision in the skin. Examples of endoscopic biopsy procedures include cystoscopy to remove tissue from inside the bladder, bronchoscopy to remove tissue from inside the lung, and colonoscopy to remove tissue from the inside of the colon.

Depending on the type of endoscopic biopsy you undergo, you may be given a sedative or anesthetic before the procedure.

Needle Biopsy

In a needle biopsy, the doctor uses a special needle to remove cells from a suspicious area.

Often, needle biopsy is used in tumors that the doctor may feel through the skin, such as suspicious lumps in the breast and enlarged lymph nodes. When combined with a diagnostic imaging procedure, such as x-rays, needle biopsy can be used to remove cells from a suspicious area that can not be felt through the skin.

The procedures of a needle biopsy include:

Fine needle aspiration. In a fine needle aspiration, a long thin needle is inserted into the suspicious area. A syringe is used to extract fluid and cells for analysis.

Biopsy with a thick needle. In a thick needle biopsy, a larger needle with a cutting tip is used to remove a column of tissue from the suspected area.

Vacuum-assisted biopsy. In a vacuum-assisted biopsy, a suction device increases the amount of fluid and cells that are removed through the needle. This means that in order to obtain the correct sample, the needle must be inserted less often.

Biopsy guided by images. An image-guided biopsy combines a diagnostic imaging procedure, such as an x-ray, a computed tomography (CT), an MRI, or an ultrasound, with a needle biopsy.

Image-guided biopsy allows the doctor to access suspicious areas that can not be felt through the skin, such as abnormalities in the liver, lung or prostate. Using real-time images, the doctor can verify that the needle reaches the correct point.

Before the surgery, you will be given local anesthesia to numb the area of ​​the biopsy and reduce the pain.

Skin biopsy

In a skin (skin) biopsy, cells are removed from the surface of the body. In most cases, a skin biopsy is used to diagnose skin conditions, such as melanoma and other types of cancer. The type of skin biopsy that you will have to undergo depends on the supposed type of cancer and the size of the suspicious cells. The procedures of a skin biopsy include the following:

Scratch biopsy. In a scraped biopsy, the doctor uses a razor-like tool to scrape the surface of the skin.
Puncture biopsy In a puncture biopsy, the doctor uses a circular tool to remove a small part of the deeper layers of the skin.
Incisional biopsy In an incisional biopsy, the doctor uses a scalpel to remove a small part of the skin. Whether or not you have points to close the biopsy depends on the amount of skin that has been removed.

Excision biopsy. In an excisional biopsy, the doctor removes a whole nodule or an entire area of ​​abnormal skin. You are likely to get points to close the biopsy site.
You will be given local anesthesia to numb the biopsy site before the procedure.

Surgical biopsy

If you can not access the cells in doubt with other biopsy procedures or if the results of other biopsies have been inconclusive, your doctor may recommend a surgical biopsy.

During a surgical biopsy a surgeon makes an incision in your skin to access the suspicious area of ​​cells. Some of the types of surgical biopsies may be surgery to remove a breast nodule for a possible diagnosis of breast cancer and surgery to remove a lymph node for a possible diagnosis of lymphoma.

Surgical biopsy procedures can be used to remove part of an abnormal area of ​​cells (incisional biopsy). Or the surgical biopsy can be used to remove the entirety of an abnormal area of ​​cells (excisional biopsy).

You may be given a local anesthetic to numb the area of ​​the biopsy. Some surgical biopsies require general anesthesia with which you will be unconscious during the procedure. You may have to stay in the hospital for observation after the procedure.

Analysis and results of a biopsy

After the doctor obtains a tissue sample, it is sent to a laboratory for analysis. The sample can be chemically treated or frozen and cut into very thin sections. Sections are placed on slides, stained to increase contrast and studied under a microscope.

The results help the doctor determine if the cells are cancerous. If they are, with the results of the biopsy the doctor can know where the cancer originated: the type of cancer.

A biopsy also helps the doctor determine how aggressive the cancer is: the grade of the cancer. Sometimes, the grade is expressed as a number on a scale of 1 to 4 and is determined by the appearance of the cancer cells under the microscope.

In general, low-grade cancers (grade 1) are the least aggressive and high-grade (grade 4) cancers are the most aggressive. This information can help guide treatment options. Other special tests on cancer cells can also help guide treatment options.

In certain cases, for example, during surgery, a pathologist examines the cell sample immediately and the results are available to the surgeon in minutes. However, in most cases, the results of the biopsy are available in a few days. It is possible that the analysis of some samples takes more time. Ask the doctor how long you should wait to receive the results of the biopsy.

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