What is a biopsy?

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A biopsy is a procedure in which a small sample of tissue or cells are taken from the body to be examined under a microscope by a pathologist and/or for further laboratory testing.1 The histopathologic evaluation under the microscope can give information such as whether cancer is present and if it is, what type and grade of cancer it is. Cancers which appear more like normal tissue under the microscope are classified as low-grade. Those cancers which don’t look much like normal tissue are called high-grade. These tend to grow and spread more quickly than low-grade cancers.2

Where is a biopsy performed?

Depending on the type of biopsy that is required, it may be performed in hospital, in a specialist’s office/rooms, or in a radiology clinic.1

What do I need to do before my biopsy?

Usually you will not need to do any special preparation before a biopsy.3 However, in some instances you may be advised by your doctor to not eat or drink for a number of hours beforehand. If this is necessary, your doctor or a ward nurse will let you know.4

You should discuss any medications or supplements that you are taking with your doctor prior to having a biopsy. When taking your history, your doctor will ask if you are taking any medications or supplements that thin the blood, such as aspirin and warfarin. As they can increase bleeding, your doctor may advise you to stop taking them prior to the biopsy.4 If you smoke, you should discuss this with your doctor as smoking can slow the healing of wounds. They may advise you to stop smoking in the weeks leading up to, and after, the biopsy.5

What are the different types of biopsies?

Excisional biopsy

An excisional biopsy is a surgery in which the entire tumour is removed by first making a cut through the skin.6 Depending on the location (site) of the tumour, local or general anaesthesia may be required. Excisional biopsies are commonly performed for skin cancers like melanoma.7

Incisional biopsy

With an incisional biopsy, only a small part of the tumour is removed. Again, depending on the site of the tumour, local or general anaesthetic may be used.6 An incisional biopsy may be performed for some soft tissue tumours.8

Fine needle aspiration

Fine needle aspiration is a less invasive type of biopsy. It involves a thin needle being placed into the site of the tumour, through which a sample of cells can be removed. The doctor may apply a local anaesthetic prior to the biopsy to help numb the skin. It is often performed for tumours of the thyroid and breast.10

Core biopsy

During a core biopsy, a large needle is placed into the tumour through which small pieces of tissue are removed.11 The needle that is used for a core biopsy is larger than the needle used for fine needle aspiration. A core biopsy is performed under local anaesthetic.5

What do I have to do after my biopsy?

What you have to do after your biopsy depends on what type of biopsy was performed. For some procedures you will usually be asked to rest in bed for at least 4-6 hours. During this time, you will be monitored to make sure that you are recovering appropriately.4 If your biopsy was performed in a day surgery you will be able to return home the same day. If your biopsy was performed under general anaesthetic you may be required to stay overnight.12 Fine needle aspiration is usually relatively quick, taking around 15 minutes, and you should be able to leave straight away.9 In the days after your biopsy, you may be required to rest and to avoid strenuous activity. Your doctor will advise you on how long you should rest for.13

What are the possible complications of a biopsy?

All medical procedures entail some risk of complications, including biopsies.

If you experience any of the following symptoms after your biopsy, it is very important that you speak to your doctor immediately:14

  • Bruising, redness, swelling, bleeding or other drainage from around the site of the biopsy;
  • Increased pain around the site of the biopsy;
  • Fever or chills.

Can a biopsy cause cancer to spread?

While it is extremely rare, there is a very small risk of cancer spreading from a biopsy or fine needle aspiration. There have only been a few cases reported in the medical literature.15 The risks are not the same for different tumour types or methods of biopsy.16 However, a recent study of over 2,000 patients with pancreatic cancer has shown that patients who have a biopsy have improved overall survival than patients who do not have a biopsy performed. In other words, the benefits of having a biopsy done greatly outweigh the potential risks involved.15

You should discuss any concerns that you have with your doctor.

Are there alternatives to a biopsy for diagnosis?

In diagnosing the presence of cancer, there are a number of tests that may be performed including laboratory tests (e.g. blood and urine sample tests), imaging tests (such as a CT scan or MRI) and tissue biopsy. However, most of the time cancer is diagnosed by looking at cells or tissue from the tumour under a microscope. This tissue is obtained through biopsy.17

Liquid biopsy is a technique that involves taking a sample of blood to measure circulating tumour cells or nucleic acids, such as circulating cell-free DNA (cfDNA), in order to try to diagnose the presence of a tumour. However, liquid biopsy has a much lower sensitivity than traditional biopsy and its use in clinical practice is still relatively unproven. It has been recommended that liquid biopsy should only be considered when there is insufficient tissue, or the risks of a traditional biopsy are too high. In terms of using liquid biopsy for tumour profiling purposes, there is also little data available showing how effective treatment is based on the results of a liquid biopsy. Further research in this area is required before it can be used routinely in oncology clinical practice.18

Caris Molecular Intelligence tumour profiling can only be performed on a solid sample of the tumour. If you have recently had a biopsy of your tumour (up to 6-12 months) and the tissue is of good quality, this may be able to be used, meaning you would not have to have another biopsy.

What happens to the tissue after biopsy?

After biopsy, the tumour sample must be sent to a pathology laboratory where it is fixed in a substance called formalin. This preserves the tissue, making sure it remains as biologically similar as it was at the time of biopsy. After fixation in formalin, the tissue is then embedded in paraffin to allow it to be cut into pieces as required.18

All tissue samples intended for Caris Molecular Intelligence must be fixed in formalin. A paraffin block at least 5mm x 5mm big is preferred, but unstained slides (44 slides) are also acceptable.

Tissue from the most recent tumour biopsy is recommended for Caris Molecular Intelligence (6-12 months old) as this ensures that the results produced are the most clinically relevant.

For full details of the specimen requirements for Caris Molecular Intelligence, click here.

References

  1. Cancer Council NSW. Diagnostic tests for breast cancer. 2016 (accessed 14 October 2017). Available from: [URL Link]
  2. American Cancer Society. What do doctors look for in biopsy and cytology specimens? 2015 (accessed 14 October 2017). Available from: [URL Link]
  3. Guy’s and St Thomas NHS Foundation Trust. Having a biopsy (tissue sample). Undated (accessed 5 January 2018). Available from: [URL Link]
  4. Imperial College Healthcare NHS Trust. Having a biopsy. 2016 (accessed 6 January 2018). Available from: [URL Link]
  5. The Newcastle upon Tyne Hospitals NHS Foundation Trust. Information prior to having a skin biopsy or skin excision. Undated (accessed 5 January 2018). Available from: [URL Link]
  6. American Cancer Society. Types of biopsies used for cancer. 2015 (accessed 14 October 2017). Available from: [URL Link]
  7. Clarke P. Nonmelanoma skin cancers: Treatment options. Australian Family Physician. 2012; 41(7): 476-480. [Full Text]
  8. Clayer M. Open incisional biopsy is a safe and accurate technique for soft tissue tumours. ANZ J Surg. 2010; 80(11):786-8. [Abstract]
  9. Cancer Research UK. Fine needle aspiration. 2014 (accessed 14 October 2017). Available from: [URL Link]
  10. Murtagh J. General Practice (3rd edition). Sydney: McGraw-Hill; 2003.
  11. Government of Western Australia Department of Health. BreastScreen WA information for women: Core biopsy. 2010 (accessed 14 October 2017). Available from: [URL Link]
  12. NHS Choices. Biopsy: Recovery. 2015 (accessed 6 January 2018). Available from: [URL Link]
  13. American Cancer Society. Core needle biopsy of the breast. 2017 (accessed 6 January 2018). Available from: [URL Link]
  14. Johns Hopkins Medicine. Breast biopsy. Undated (accessed 7 January 2018). Available from: [URL Link]
  15. Ngamruengphong S, Swanson KM, Shah ND, Wallace MB. Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer. Gut. 2015; 64: 1105-1110. Available from: [Abstract]
  16. Shyamala K, Girish HC, Murgod S. Risk of tumor cell seeding through biopsy and aspiration cytology. J Int Soc Prev Community Dent. 2014; 4: 5-11. [Full Text]
  17. American Cancer Society. How is cancer diagnosed? 2015 (accessed 6 January 2018). Available from: [URL Link]
  18. Sholl L, Aisner D, Allen T, et al. Liquid biopsy in lung cancer. Arch Pathol Lab Med. 2016; 140: 825-9. [Full Text]
  19. American Cancer Society. What happens to biopsy and cytology specimens? 2015 (accessed 7 January 2018). Available from: [URL Link]
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