What Are Biopsy and Their Types? Who Is It for and How to Do It?
A diagnosis of cancer can only be confirmed is by taking a biopsy. In this article, you can find information about how long a biopsy takes, the biopsy needles, types of biopsies, and side effects of having a biopsy.
What is Biopsy?
A biopsy is when cells and tissues are removed to analyze a disease. Biopsy aims to characterize the structural and histological features of the sample and in some cases to test the existence of certain molecular biomarkers. In oncology, a biopsy is important to determine whether cancer has existed and to evaluate the other features which will guide the decision of disease management.
Knowing what to expect is important for patients having a biopsy. Patients are typically concerned about pain and disorder during a biopsy. A study shows that expected pain before biopsy increases felt pain during the biopsy. In another study, it is also found that preparing patients for biopsy reduces anxiety and concern.
There are a few different kinds of biopsy; the types of biopsies vary on the amount of removed tissue and the cutting technique of tissue. Health professionals determine the type of biopsy based on its aim and where it is removed from.
What are the Types of Biopsies?
You can understand the differences between the types of biopsies with the following examples:
- While some cells are enough to say only if there is cancer or not, sometimes more tissue is needed for the analysis of biomarkers.
- Although it is enough to remove a part of tissue by tru-cut (core needle) from the lymph node to diagnose cancer whether if another solid cancer has metastases to a lymph node, it is common to remove a whole lymph node by excisional biopsy if lymphoma is suspected.
- The fine needle biopsy from the thyroid is sufficient for the diagnosis of thyroid cancer.
A new application that is being used more frequently is a liquid biopsy. Liquid biopsies are one of the non-invasive cancer analysis methods. In a liquid biopsy, a sample of body fluid such as blood or saliva is taken from the patient, and tumor cells, cell fragments, and DNA circulating in body fluids are analyzed. For this purpose, blood is commonly used. The purpose of liquid biopsies is to detect some genetic material, primarily DNA, that cancer cells release into the blood.
Does Biopsy Cause Metastasis (spread) of Cancer?
Patients and their relatives have been concerned that “if a knife touches cancer, it spreads”. But the essence of the matter is often that: particularly in the past, cancers were diagnosed when they were in the fourth stage, which means they had already spread to other organs, thus there was already metastasis when the biopsy was performed.
Modern biopsy techniques do not support that the concern about biopsy sowing the cells which can start metastasis like a seed. Research shows it has lots of potential but actually rare risks of actually that process happening.
In a meta-analysis of head and neck cancer from 7 research, it is calculated that cancer cells are cultured in only 0.00012% of cases performed by fine-needle biopsy and 0.0011% of cases performed by core needle biopsy. A systematic review of prostate cancer reported the risk of cancer metastasis is lower than 1% by biopsy.
Another breast cancer study reported that cancer cells cannot survive because the metastasis is not natural even if cancer cells are cultured by biopsy. In addition, the risk is even lower when a vacuum-assisted biopsy is used compared with traditional automatic tru-cut devices.
How to Do Biopsy?
Most biopsy practice is performed based in an outpatient setting and local anesthesia is used. However more complicated biopsies of deeper organs may require more comprehensive anesthesia. Patients should have instructions regarding whether a companion is needed for them, whether it is allowed to eat and drink before the operation, and on the day of the biopsy.
Most patients don’t experience pain during the biopsy. In a study on 136 patients who performed ultrasound-guided breast biopsy, 40% and 49% of the patients reported that respectively, they didn’t experience pain and experienced modest pain, and 12% of them experienced middle and severe pain during the biopsy. It is found that the patients who expected pain during biopsy have more potential to experience pain, which emphasizes the importance of getting information about what they should expect before the operation.
Healing after biopsy differs depending on the level of anesthesia and the location of the biopsy. For example, the patients undergoing a more complex biopsy (e.g. lung biopsy) may need a period of observation before they are discharged. Patients and companions should be known what they should expect right after the procedure, how long they will stay at the center where the operation is done, how long they will wait before patients work independently, and any limitations or requirements for physical activities.
The potential complications (adverse events that may occur due to the process) after biopsy also vary. Patients and care providers should be informed of which complications are normal and the signs and symptoms of complications after biopsy.
The most common potential complications after biopsy include pain and discomfort, bruising and/or bleeding in the region of the biopsy.
In a study on 351 women making to performed imaging-guided breast biopsy, it is reported that the pain following biopsy is low:
- The average grade is 2.3/10 with ultrasound-guided biopsy.
- The average grade is 3.1/10 with vacuum-assisted biopsy.
- The reported pain is lower as a doctor has gained experience; independently on which type of biopsy is used and how many biopsy pieces are removed.
In a study on more than 900 men making to performed prostate biopsy through transrectal ultrasound, it is reported that 44% of people reported the pain within 35 days after the biopsy, however, only 7% of them reported the pain is a middle and severe problem.
Patients should be informed of the potential bleeding, purpling, and swelling following biopsy since these symptoms (signs/complaints) can lead to concern. For example, hemospermia (bloody semen), haematuria (bloody urine), and haematochezia (bloody stool) are reported in the ratio of 93%, 66%, and 37%, respectively in a prostate biopsy study. People experiencing these kinds of side effects have reported more concern.
Result of Biopsy
Most patients comprehensibly want the results of the biopsy to be concluded fast as soon as possible. A multi-center study including 301 patients who performed a biopsy for potential melanoma found that 52% of these patients want to get the results fast by a method such as a phone call, voice message, e-mail, or online portal. If the results are abnormal, it is reported that about 70% of patients want this condition to be reported to them by phone and 25% of them prefer to face to face meetings. For the patients having normal results, about 32% of them said the voice message is acceptable, and about 28% and 24% said they prefer e-mail or phone call. The online portal was preferred by young patients and people having higher educational levels.
Although most patients prefer to get their results fast, some may prefer face-to-face meetings. This should be discussed and resolved before the biopsy. For the patients preferring a fast method to get the result, it should be provided in a moderate language of communication.
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- Miller SJ, Sohl SJ, Schnur JB, et al. Pre-biopsy psychological factors predict patient biopsy experience. Int J Behav Med. 2014.
- Soo AE, Shelby RA, Miller LS, et al. Predictors of pain experienced by women during percutaneous imaging-guided breast biopsies. J Am Coll Radiol. 2014.
- Mayo Clinic Staff. Biopsy: Types of biopsy procedures used to diagnose cancer. Mayo Clinic. mayoclinic.org - Published December 17, 2016. Accessed September 28, 2018.
- Volanis D, Neal DE, Warren AY, Gnanapragasam VJ. Incidence of needle-tract seeding following prostate biopsy for suspected cancer: a review of the literature. BJU Int. 2015.
- Minaga K, Takenaka M, Katanuma A, et al. Needle tract seeding: an overlooked rare complication of endoscopic ultrasound-guided fine-needle aspiration. Oncology. 2017.