Biopsy

Page last reviewed: 13/07/2011

A biopsy is a medical procedure that involves taking a small sample of tissue so it can be examined under a microscope.

The term biopsy is often used to refer to the act of taking the sample and the tissue sample itself.

Types of biopsy

A tissue sample can be taken from almost anywhere on (or in) your body, such as your skin, stomach, kidneys, liver and lungs.

A number of different types of biopsy can be used to help identify a wide range of different health conditions. Types of biopsy include:

  • scraping cells: removing cells from the surface layer of tissue, such as from the inside of the mouth, or from inside the cervix (neck of the womb)
  • a punch biopsy: for diagnosing skin conditions
  • a needle biopsy: for obtaining tissue from the body's organs, or from tissue underneath the skin
  • an endoscopic biopsy: where a medical instrument known as an endoscope is used to take a tissue sample
  • a capsule biopsy: used when a sample from the intestine lining needs to be taken
  • an excisional biopsy: where surgery is used to take a larger section of tissue

How the biopsy is carried out will depend on where the tissue sample is being taken from. See 'How it is performed' above, for more information about the different types of biopsy and how they are performed.

What is a biopsy used for?

Biopsies are used to identify abnormal cells. The result of a biopsy can often help healthcare professionals to diagnose a wide range of conditions including:

  • cancer
  • peptic ulcers (ulcers that affect the digestive system)
  • hepatitis (inflammation of the liver)
  • kidney disease
  • endometriosis (where cells that usually line the womb are found elsewhere in the body)

Biopsies are commonly used to check whether a breast lump is benign (non-cancerous) or malignant (cancerous).

After the tissue sample has been taken, the cells will be closely examined under a microscope to see whether or not they appear abnormal, and to check for any unusual cell activity.

The cells may also be tested using various chemicals to see how they respond. The type of tests used will depend on the medical conditions that are being investigated.

Biopsy

A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Liver

The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.

Lungs

Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

Anaesthetic

Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.

Page last reviewed: 13/07/2011

Healthcare professionals often use biopsies to investigate the cause of a person's symptoms or to confirm a diagnosis that they already suspect due to other test results. A biopsy can also be used to measure the severity of a condition. For example, how severely an organ, such as the liver, is inflamed.

Biopsies are used to diagnose a wide range of health-related conditions, including cancer. If you have a lump or growth on your skin or inside your body, it is impossible to tell whether it is malignant (cancerous) or benign (non-cancerous) just by looking at it or feeling it. A biopsy will be able to provide that information.

Testing a tissue sample

After a tissue sample has been taken, it will be sent to a laboratory so that it can be examined under a microscope and the tissue's cells can be tested.

Cells are the building blocks that make up your body. By closely examining them, scientists can see whether they are normal or abnormal. Cancerous cells, for example, look and behave differently from normal cells.

As well as a visual examination, chemical or genetic tests can also be carried out on the tissue sample. For example, a chemical test is sometimes used to diagnose cystic fibrosis. This is an inherited condition where thick secretions are produced in the lungs, making breathing difficult. If the gene for cystic fibrosis is present in the cells, a chemical reaction will occur.

Chorionic villus sampling

Tests for cystic fibrosis and other genetic conditions can even be carried out on a cell sample that is taken from an unborn baby. The cell sample is taken from the placenta using a pre-natal biopsy called chorionic villus sampling (CVS).

During CVS, a small piece of the placenta is removed using a fine needle that is passed through the abdomen (stomach) using ultrasound to guide it. Once a cell sample has been obtained, a chromosome (genetic) analysis will be carried out to determine whether the gene that is responsible for cystic fibrosis is present.

It usually takes between 10 to 14 days for CVS test results to become available. The results can be used to help parents decide whether they wish to terminate a pregnancy or continue with it. See the Useful links section for more information about cystic fibrosis and CVS.

Glossary

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Malignant
Malignant is a term used to describe a life-threatening or worsening condition. In the case of tumours, malignant means cancerous.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Gene
Genes contain information that you inherit from your parents, such as eye or hair colour. They are carried by chromosomes.
Benign
Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous.

Page last reviewed: 13/07/2011

There are many different ways of getting a tissue sample. The method that is used will depend on the type of tissue being collected and where in the body it is being taken from.

Scraping cells

In some cases, scraping cells from the surface layer of tissue, such as from inside the mouth, is enough to provide a suitable sample for examination. This type of 'scraping biopsy' can sometimes be uncomfortable but it is not painful so anaesthetic is not required.

A cervical screening test is a procedure where a spatula, or small brush-like instrument, is used to gently remove a sample of cells from a woman's cervix (the neck of the womb). The cells are then examined under a microscope for any abnormal changes (dysplasia).

If the cells display abnormal changes, it may mean that they are cancerous, or that there is an increased likelihood that they will become cancerous. When the results of your cervical screening test are available, your GP will be able to discuss your treatment options with you, or whether further tests are required.

See the Useful links section for more information about cervical screening tests.

Punch biopsy

A punch biopsy can help to diagnose skin conditions, such as skin cancer. During a punch biopsy, a special surgical instrument is used to make a small hole in your skin and remove samples of the top layers of tissue. If you have a punch biopsy, you will usually be given a local anaesthetic to numb the area.

Alternatively, a scalpel (a sharp medical knife) may be used to remove a small amount of surface skin. The wound will be closed using stitches. As with a punch biopsy, a local anaesthetic will be used for this procedure.

Needle biopsy

Needle biopsies are often used to take tissue samples from organs, or from lumps below the surface of the skin.

To obtain the sample, a special, hollow needle is inserted through your skin and into the area being examined. Ultrasound, or X-rays, will be used to help the doctor or surgeon, guide the needle to exactly the right place.

When the needle is in position, it is used to 'suck out' a sample of tissue. If you have a needle biopsy, a local anaesthetic will usually be used to numb the area so that you will not be able to feel any pain or discomfort.

Breast lumps

A thin, hollow needle is used for some types of biopsy, such as examining breast lumps. A breast lump biopsy is known as a fine-needle aspiration biopsy. The needle is inserted into the lump and a sample of tissue is taken for testing.

Organs

A thicker, hollow needle is used for taking biopsies of organs, such as the liver or kidneys. You will be asked to breathe in and hold your breath while the needle is inserted into your abdomen. It takes a few seconds for a small sample of tissue to be taken. A local anaesthetic will usually be used for this type of biopsy because you need to be awake in order to breathe in.

Bone marrow

A thick needle is also used to take samples of bone marrow (the soft, jelly-like tissue that is found in the hollow centre of all large bones). Bone marrow biopsies are carried out for a number a different reasons including:

  • to find out why you have a low or high number of red blood cells (anaemia)
  • to find out why you have a low or high number of white blood cells (leucopenia)
  • to find out why you have a low or high number of platelets (blood-clotting cells)

A number of different health conditions may be responsible for these types of blood abnormalities, such as leukaemia (cancer of the bone marrow and white blood cells), or other types of blood disorders.

Samples of blood marrow are also sometimes taken to check how well treatment for leukaemia is working, or to determine how far certain types of cancer have progressed.

Bone marrow biopsies are usually taken from the top of the pelvis bone, just below your waist. You will usually be given a local anaesthetic and some people also have a sedative (medication) to help them relax and cope with any discomfort, nerves or anxiety.

Endoscopic biopsy

An endoscope is a medical instrument that is used to look inside your body. It is a thin, bendy tube with a light and a camera at one end. Tiny cutting tools can also be attached to the end of an endoscope to allow the surgeon to take a sample of tissue.

An endoscope can be inserted through existing entry points in your body, such as through your throat, anus (back passage), or through small cuts that are made by the surgeon.

Depending on the area of the body that is being investigated, and the entry point that is used for the endoscope, an endoscopic biopsy may be performed under either local or general anaesthetic.

Where the endoscope is inserted will also depend on the part of your body that is being examined. For example, it might be inserted down the throat in order to look at the lungs or, for female patients, through the vagina and cervix to examine the womb.

Capsule biopsy

A capsule biopsy is an alternative to an endoscopic biopsy. It is used when a sample of the lining of your intestine needs to be taken.

During a capsule biopsy, you will be given a small capsule to swallow that is attached to a thin tube. X-ray images will be used to determine when the capsule has reached the correct point in your gut.

When it has reached the correct point, pressure is created in the tube, so that a small piece of your intestine lining is sucked into the capsule, before being removed from your body.

Excisional biopsy

An excisional biopsy is where surgery is used to remove a larger area of tissue, such as a lump, for closer examination. Excision means 'cutting out', or 'removal'.

Depending on where in the body the lump is located, an excisional biopsy may be performed under either a local or a general anaesthetic.

Sometimes, a biopsy is performed during surgery that is being carried out for another, unrelated reason. A tissue sample is taken during surgery and is checked immediately so that the surgeon gets the results quickly and is able to decide how to progress with treatment.

A lump that is found during surgery may be removed completely if the patient is still under anaesthetic and has given their consent (approval).

Glossary

Breast lumps
A breast lump may be a solid mass or a fluid-filled cyst found in the tissue of the breast. Only a small portion of breast lumps are cancerous.
Bone marrow
Bone marrow is the soft, spongy tissue in the centre of bones that produces blood cells.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Numb
Numbness refers to a lack of sensation in a part of the body.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Page last reviewed: 13/07/2011

Biopsies are usually straightforward procedures that can often be carried out as outpatient procedures using local anaesthetic. In such cases, you will not need to stay in hospital overnight.

Some types of biopsy, such as those that involve taking a tissue sample from an internal organ, will require a general anaesthetic. If you need a general anaesthetic, you may need to stay in hospital overnight.

After having a biopsy, you will not usually experience any pain. However, if you have had a sample taken from a major organ, such as your liver, or from your bone marrow, you may have a dull ache, or a slightly uncomfortable feeling. Your doctor or surgeon will be able to advise you about the painkillers that you can take in order to relieve this.

If an incision (cut) is required in order to remove a tissue sample. For example, during an endoscopic biopsy or an excisional biopsy, the wound may need to be closed using stitches, or you may need to have a dressing put on the wound.

If you have had a biopsy where tissue has been taken from an important organ, such as your liver or kidneys, you will need to stay in hospital for a few hours after the procedure. This is so that you can rest and hospital staff can ensure that there is no internal bleeding. It is rare for serious bleeding to occur following a biopsy but if it does, you may need to have an operation or a blood transfusion.

Women who have had samples taken from their reproductive system, such as their womb lining or cervix (neck of the womb) may experience some light vaginal bleeding. Men who have had a prostate biopsy may have blood in their urine.

Glossary

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Painkillers
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.

Page last reviewed: 13/07/2011

How quickly you get the results of your biopsy will depend on the hospital where you have had the procedure and the urgency of your case.

The results of routine cervical smear tests usually take between 10-14 days to become available, while the results of biopsies that are carried out because your doctor suspects a serious condition, such as cancer, may be available within a few days.

In cases where a biopsy is performed during surgery, a result is often available within minutes so that the right treatment can be given while the surgery is in progress.

Your GP, hospital consultant or practice nurse, will give you your results and explain what they mean. Sometimes, a biopsy will not be conclusive, which means that it has not produced a definitive result. If this is the case, the process may need to be repeated or you may require further tests in order to double check your diagnosis.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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