Overview

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

A tissue sample can be taken from almost anywhere on or in your body, including the skin, organs and other structures.

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

When a biopsy may be needed

A biopsy can be used to investigate abnormalities, which can be:

• functional – such as kidney or liver problems
• structural – such as swelling in a particular organ

When the tissue sample is examined under the microscope, abnormal cells may be identified, which can help to diagnose a specific condition.

If a condition has already been diagnosed, a biopsy can also be used to assess its severity (such as the degree of inflammation) and grade (such as the aggressiveness of a cancer).

This information can be very useful when deciding on the most appropriate treatment, and assessing how well a person responds to a particular type of treatment.

It can also be useful in helping to determine a person's overall prognosis (outlook).

Examples of conditions where a biopsy may be helpful include:

• cancer
• inflammation, such as in the liver (hepatitis) or kidney (nephritis)
• infection, such as in lymph nodes – for example, tuberculosis
• various skin conditions

It's not usually possible to tell whether a lump or growth on your skin or inside your body is cancerous (malignant) or non-cancerous (benign) by clinical examination alone, which is why a biopsy is often required.

Types of biopsy

There are various types of biopsy that can be used to help identify a wide range of health conditions.

Different types of biopsy include: 

• a punch biopsy – a special instrument punches a small hole in the skin to obtain a skin sample to investigate a skin condition
• a needle biopsy – a special hollow needle, guided by X-ray, ultrasound, CT scan or MRI scan, is used to obtain tissue from an organ or from tissue underneath the skin
• an endoscopic biopsy – an endoscope is used to remove tissue, such as from the stomach during a gastroscopy
• an excision biopsy – surgery is used to remove a larger section of tissue
• perioperative biopsy – if consent has been given, a perioperative biopsy can be carried out during surgery; in certain circumstances, the sample may be tested straightaway to help guide the surgery or further treatment

How a biopsy is carried out will depend on where the tissue sample is being taken from.

Before the procedure, CT or MRI scanning is often used as a guide to help with this decision.

After the tissue sample is taken, it will be examined under a microscope to help identify the nature of the problem. This often means that a definite diagnosis can be made.

The type of stains and tests that are used when the tissue is examined under the microscope will depend on the medical condition being investigated.

Recovery

Most biopsies will only require local anaesthetic, which means you won't need to stay in hospital overnight.

But an overnight stay is usually required when the procedure is carried out under general anaesthetic.

Most types of biopsy are painless once the anaesthetic starts to work, although this depends on where the sample is taken.

You may experience a dull ache, which can be treated with painkillers on the advice of your doctor or surgeon.

Some types of biopsy may involve staying in hospital for a few hours.

You may need to have stitches or a dressing applied before you leave.

Getting your results

How quickly you get the results of a biopsy will depend on the urgency of your case and your local hospital's policy.

Results are often available within a few days. But this is difficult to predict, because further tests may be needed after the first examination of the sample.

It's sometimes necessary to send the microscope slides away to get another specialist opinion.

If a biopsy is carried out during surgery, in some cases a different processing method may be used, known as a frozen section.

This enables the surgeon to get a preliminary result, which can be used to help guide treatment while it's in progress.

Your GP, hospital consultant or practice nurse will give you your results and explain what they mean.

A biopsy is sometimes inconclusive, which means it hasn't produced a definitive result.

In this case, the biopsy may need to be repeated, or other tests may be required to confirm your diagnosis.

How is it performed?

There are many ways of getting a tissue sample, depending on the type of tissue being collected and where in the body it's being taken from.

Imaging techniques, such as X-ray, ultrasound, CT scanning or MRI scanning, are often used to guide many types of biopsy.

Punch biopsy

A punch biopsy can be used to investigate a variety of skin conditions.

During a punch biopsy, a special surgical instrument is used to make a small hole in the skin and remove samples of the top layers of tissue.

If you have a punch biopsy, you'll usually be given 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.

Needle biopsy

A fine-needle aspiration (FNA) biopsy is often used to take cell samples from organs or from lumps that are below the surface of the skin.

If a larger sample is needed, a core needle biopsy (CNB) will be used instead.

For core biopsies, after local anaesthetic has been given, a hollow needle is inserted through the skin and into the area being examined.

X-ray, ultrasound, CT or MRI scanning will often be used to help guide the needle to exactly the right place.

When the needle is in position, it'll cut out a small sample of tissue. For core biopsies, local anaesthetic is usually used to numb the area, so you won't experience any pain or discomfort.

Breast lumps

In many cases, a needle biopsy can be used to get more information about a breast lump.

The needle is inserted into the lump and a sample of tissue will be taken for testing.

A core needle biopsy (CNB) is often used to obtain a larger tissue sample. In some cases, when a cyst (a benign fluid-filled swelling) is suspected, a fine needle will be used to drain the fluid and the cells are sent for examination (cytology).

Organs

A thicker, hollow needle is used for taking organ biopsies, such as of the liver or kidneys. 

These are often carried out with imaging guidance (ultrasound or CT), and you may be asked to hold your breath for a few seconds while the needle is inserted into your abdomen (tummy).

Bone marrow

A thick needle is used to take samples of bone marrow (the soft, jelly-like tissue found in the hollow centre of large bones).

Bone marrow biopsies can be carried out for a number of different reasons, including to find out why you have a low or high number of:

• red blood cells
• white blood cells
• platelets (blood-clotting cells)

A large number of different health conditions may be responsible for these types of blood abnormalities.

Where a diagnosis has already been made, samples of marrow may be taken to check how well treatment is working – for example, in leukaemia.

Samples of bone 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 (what stage it's at).

Bone marrow biopsies are usually taken from the top of the pelvic bone, just below your waist.

You'll usually have a local anaesthetic to numb the area, and you may also be given a sedative to help you relax and cope with any discomfort or anxiety.

Endoscopic biopsy

An endoscope is a medical instrument used to look inside your body. It's a thin, flexible tube with a light and a camera at one end.

Small cutting tools can also be attached to the end of an endoscope to allow the endoscopist (surgeon, doctor or nurse specialist) to take a tissue sample.

An endoscope can be inserted down your throat (upper gastrointestinal) or from below through the anus (lower gastrointestinal), depending on the area being examined.

The type of anaesthetic used will also depend on the area of the body being investigated and the entry point of the endoscope.

Excisional biopsy

An excisional biopsy is used to remove a larger area of tissue, such as a lump, for closer examination.

The type of anaesthetic used will depend on where the tissue is.

Perioperative biopsy

A biopsy is sometimes carried out during an operation for a related or unrelated reason.

A tissue sample is taken during surgery and can be checked immediately (known as a frozen section) so the surgeon can get the results while the operation is in progress. This can help them decide how to manage the treatment.

A lump found during surgery may be removed completely if the person is still under anaesthetic, provided previous consent has been given.

Testing the tissue sample

After a tissue sample has been taken, it'll be sent to a laboratory to be examined under a microscope.

Closely examining the cells in the tissue sample enables histologists (doctors who specialise in studying the structure of tissues) to determine whether they're normal or abnormal.

For instance, cancerous cells look and behave differently from normal cells.

As well as looking at the tissue sample, chemical or genetic tests may also be carried out, if needed.

In cystic fibrosis, for example, a chemical test can be used to help diagnose the condition.

Recovery

Biopsies are usually straightforward procedures that are carried out using local anaesthetic.

In most cases, biopsies are outpatient procedures, so you won't need to stay in hospital overnight.

But occasionally some types of biopsy, such as those where a tissue sample needs to be taken from an internal organ, may require a general anaesthetic.

In this instance, you'll need to stay in hospital overnight to recover from the anaesthetic.

After having a biopsy, you won't usually feel any pain. But if you have had a tissue sample taken from a major organ, such as your liver or bone marrow, you may feel a dull ache or some slight discomfort.

Your doctor or surgeon may recommend painkillers to help relieve this.

If a cut (incision) is needed to remove a tissue sample – for example, during an excision biopsy – stitches may be needed to close the wound, or a dressing may need to be applied.

If tissue is removed from an internal organ, such as your liver or kidneys, you'll need to stay in hospital for a few hours after the procedure.

This is so you can rest and hospital staff can make sure there's no internal bleeding.

It's rare for serious bleeding to occur after having a biopsy, but if it does, you may need to have an operation or a blood transfusion. In rare cases, another procedure or operation may be needed.

Women who have had tissue samples taken from their reproductive system, such as the lining of the cervix (neck of the womb), may experience some temporary light vaginal bleeding. Painkillers can be used to treat any cramping.