Biopsy Procedures

Different types of biopsies and what to expect

A radiologist, a doctor who specializes in medical imaging, will usually perform the biopsy, either in a hospital or outpatient setting. You will receive local anesthesia to numb the area where the needle will be inserted. You may experience some pain and discomfort as the numbing agent is injected and again when the needle removes the sample of tissue or cells. The entire process usually takes less than one hour.

There are different types of biopsies, many of which are considered "needle biopsies," because they use a needle to extract the sample tissue. The four main types of needle biopsy include:

• Fine needle biopsy – performed with a very thin, hollow needle
• Core needle biopsy – performed with a larger needle able to collect larger tissue sample
• Image-guided biopsy – performed with image assistance from X-ray, ultrasound, MRI, CT scan or fluoroscopy
• Vacuum-assisted biopsy – performed with a device that allows "suctioning" of larger sample of tissue with just one insertion of the needle

Stereotactic needle biopsy, MRI-guided needle biopsy and ultrasound-guided needle biopsy are examples of image-guided biopsy, commonly used to detect breast cancer but may be recommended for accurate diagnosis of cancers in other parts of the body. Stereotactic needle biopsy allows the radiologist to find the exact area needing biopsy, using mammogram or 3D tomosynthesis guidance scan to visually display different angles and dimensions in breast tissue. Ultrasound-guided needle biopsy uses sound waves instead of radiation to accurately detect the area of abnormality for needle biopsy. MRI-guided biopsy uses a strong magnetic field to locate the tissue needing further examination.

Bone marrow biopsy helps detect and diagnose blood disorders and disease

Bone marrow is the spongy substance inside your bones that is responsible for producing red and white blood cells as well as platelets. A bone marrow biopsy may be ordered if you have a suspected blood disease, such as leukemia, or another type of disorder. The biopsy involves removal of a small piece of bone marrow from your pelvis bone by way of a needle inserted through your hip.

Skin and surgical biopsies detect melanoma and other cancers and conditions

Skin biopsies are usually performed when a lesion on the skin has changed shape, size or color, and skin cancer or another type of disease is suspected. The type of skin biopsy you'll have depends on the location and size of the lesion.

• Shave – involves scraping a sample of tissue from the lesion
• Punch – involves "punching" down into the skin with a special tool that extracts a circular sample of skin; punch biopsies may or may not need stitches, depending on the size of the wound
• Incisional – involves removing part of a larger skin lesion; may or may not need stitches, depending on how large the wound is
• Excisional – involves removing the entire skin lesion with a scalpel and closing the wound with stitches

Incisional and excisional biopsies are considered surgical biopsies. A surgical biopsy may be needed to remove a lump that is close to the surface of the skin, or that has been found in the breast, for example. Sentinel lymph node biopsy is a type of surgical biopsy that targets the lymph nodes that are closest to the tumor. Removal of the sentinel lymph node can help determine whether cancer has spread. The lymph node is then studied under a microscope to look for cancerous cells. If there is cancer, additional lymph nodes will have to be removed. If there's no cancer, no additional removal is needed.

At Main Line Health we have a number of convenient locations that offer biopsy procedures.