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Why is a biopsy needed?
A scan can show an abnormal area, but it often cannot establish exactly what it is. A biopsy collects cells or tissue for laboratory examination. This can distinguish cancer from infection, inflammation or a benign growth, identify the cancer type and provide material for tests that guide treatment.
The best sample is not necessarily from the largest lump. Your team considers which area is accessible, safe and most likely to answer the clinical question. Sometimes an accessible lymph node or another affected site is sampled. Tell the team about previous biopsies so existing tissue can be assessed before another procedure is arranged.
Different ways to obtain a sample
- Fine-needle aspiration (FNA/FNAC): a thin needle withdraws cells or fluid. It can answer some questions, but may not provide the tissue structure or quantity needed for every diagnosis.
- Core-needle biopsy: removes small cylinders of tissue, preserving more of its structure. Several cores may be collected for pathology and additional tests.
- Endoscopic biopsy: samples can be taken through a camera used to examine the stomach, bowel or airways. Endoscopic ultrasound can guide sampling of deeper structures, including areas near the pancreas.
- Surgical biopsy: removes part of an abnormality or, in selected circumstances, the whole lump when a needle sample is unsuitable or insufficient.
- Bone marrow sampling: an aspirate and/or a small tissue core may be needed for suspected blood or marrow disorders. The team explains why one or both are required.
Ultrasound- and CT-guided biopsy
Image guidance helps the specialist position the needle in the intended area while planning a route around important structures. Ultrasound provides live images without ionising radiation and is useful for many visible breast, neck, lymph-node, liver and soft-tissue abnormalities. Local anaesthetic is commonly used.
CT guidance uses cross-sectional X-ray images and can help reach deeper lesions, including selected lung, abdominal or bone abnormalities. You may need to lie in a particular position and briefly hold your breath while the needle is positioned. CT guidance does not mean a larger operation; it describes how the target is located.
For some breast abnormalities, mammography-guided or MRI-guided sampling is more suitable. The choice depends on where the abnormality is best seen, not on one technique being universally better.
Does a biopsy make cancer worse or cause it to spread?
A biopsy does not usually make a cancer more aggressive or cause it to spread. Avoiding a recommended biopsy because of this fear can delay an accurate diagnosis and appropriate treatment.
It is understandable to feel concerned. Cancer spreading as a result of a biopsy is very rare, and the benefits of getting a clear diagnosis generally far outweigh this small risk. Your specialist will choose the most suitable approach for you and explain any precautions needed. Please share any worries with your team so they can talk them through with you.
Preparing safely
- Bring previous scan images as well as reports, and details of earlier sampling.
- Tell the team about blood thinners, bleeding problems, allergies, pregnancy or possible pregnancy, and all medicines or supplements. Do not stop prescribed medicines yourself.
- Ask whether fasting, blood tests, a medicine adjustment or an accompanying adult is needed. Instructions depend on the biopsy and whether sedation is planned.
- Ask what anaesthetic will be used, how discomfort will be managed and whether you should plan time away from work.
Recovery and symptoms to report
Expectations differ by site and technique. Mild soreness or bruising can occur. Bleeding, infection and injury to nearby structures are possible; a lung biopsy can sometimes cause an air leak around the lung, called a pneumothorax. The specialist should explain your individual risks and observation period.
Follow the written instructions about dressings, bathing, activity and restarting medicines. Sedation for a biopsy may require someone to take you home. Follow your team’s advice about when you can drive again. Seek urgent medical assessment for severe breathlessness, chest pain, heavy bleeding, fainting or rapidly worsening symptoms. Contact the team promptly for fever, increasing redness, swelling or worsening pain.
Results and repeat sampling
Agree who will explain the result and when to contact the team if it has not arrived. A preliminary result may be followed by additional stains or molecular tests. A non-diagnostic sample means the laboratory could not answer the question reliably; it does not mean cancer has been excluded.
Repeat sampling may be needed if too little tissue was obtained, the sample does not explain the scan finding, or further tests require more material. Your team should explain what another biopsy is expected to add.
What happens to your biopsy in the laboratoryContinue exploring
Arranging investigations through CTI
Contact CTI to coordinate the appropriate investigation with the hospital team. Confirm the procedure, preparation and location before travelling; specialised tests may involve another department or a referral laboratory.
