life and όψη
look/appearance) is a medical test
involving the removal of cells
for examination. The tissue is generally examined under a microscope
by a pathologist
, and can also be analyzed chemically (for example, using PCR
or gas chromatography
techniques). When only a sample of tissue is removed, the procedure is called an incisional biopsy
or core biopsy
. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy
. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle aspiration biopsy
Several methods for breast biopsy now exist. The most appropriate method of biopsy for a patient depends upon a variety of factors, including the size, location, appearance and characteristics of the abnormality.
• Fine Needle Aspiration
(FNA) Fine needle aspiration (FNA) is a percutaneous ("through the skin") procedure that uses
a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a
solid mass. With FNA, the cellular material taken from the breast is usually sent to the pathology
laboratory for analysis. FNA can also be used by the radiologist or surgeon to drain fluid from a benign cyst.
This procedure is called cyst aspiration. A Fine Needle Aspiration procedure is almost painless and
takes only a few minutes to perform.
• Core Needle Biopsy
A core needle biopsy is a procedure that removes small but solid samples of tissue using a hollow "core" needle.
For palpable (“able to be felt”) lesions, the physician is fixing the lesion with one hand and performing a freehand
needle biopsy with the other. In case of non-palpable lesions stereotactic mammography or ultrasound guidance
is used. With stereotactic mammography it is possible to pinpoint the exact location of a mass based on images
taken from two different angles of the x-ray machine. With ultrasound, the radiologist or surgeon can watch the needle
on the ultrasound monitor to help guide it to the area of concern. The needle used during core needle biopsy is larger
than the needle used with FNA. The core biopsy needle also has a special cutting edge allowing removal of a bigger
sample of tissue. With Core Needle Biopsy a relatively large samples can be removed through a small single incision
in the skin. First, the breast area is locally anesthetized with a small amount of anesthetic fluid. Then, the needle is
placed into the breast. As with FNA, the radiologist or surgeon will guide the needle into the area of concern by
palpating the lump. If the lesion can’t be felt the core needle biopsy is performed under image-guidance using either
stereotactic mammography, ultrasound or even magnetic resonance imaging (MRI). A core needle biopsy procedure
takes a few minutes to perform and is almost painless. Most patients are able to resume normal activity immediately
after the procedure.
• Vacuum Assisted Biopsy
Vacuum Assisted Biopsy is a version of Core Needle Biopsy using a vacuum technique to assist the collection of
the tissue sample. The needle normally has a lateral (“from the side”) opening and can be rotated allowing multiple
samples to be collected through a single skin incision. The Vacuum Assisted Biopsy procedure is similar to normal
Core Needle Biopsy.
• Open Surgical Biopsy
Open Surgical Biopsy means that a large mass or lump is removed during a surgical procedure. Surgical biopsy requires an approximately 3 to 5 centimeters incision and is normally performed in an operating room in sterile conditions. Open surgical biopsy in some cases can be performed with local anesthesia but in most cases general anesthesia may be necessary. Ten years ago, most breast biopsies were open surgical procedures. Today most patients are candidates for less invasive biopsy procedures such as core needle biopsy.
• Minimal Invasive Biopsy
With the Spirotome biopsy system a breast biopsy can be performed easy with minimal pain and with high quality and accurate results. Its unique helix formed cutting mechanism facilitates maximum sample volume through minimal skin incision and also reduces the number of samples necessary to get an accurate result.
The Spirotome is a fully manual biopsy system for biopsy procedures in hospitals or in an outpatient facility. The procedure is performed under local anesthesia, making it more or less painless.
One of the earliest diagnostic biopsies was developed by the Arab physician
AD). A needle was used to puncture a goiter
, and the material issuing was characterized.
When cancer is suspected, a variety of biopsy techniques can be applied. An excisional biopsy
is an attempt to remove the entire lesion. When the specimen is evaluated, in addition to diagnosis, the amount of uninvolved tissue around the lesion, the surgical margin
of the specimen is examined to see if the disease has spread beyond the area biopsied. "Clear margins" or "negative margins" means that no disease was found at the edges of the biopsy specimen. "Positive margins" means that disease was found, and a wider excision may be needed, depending on the diagnosis.
When intact removal is not indicated for a variety of reasons, a wedge of tissue may be taken in an incisional biopsy
. In some cases, a sample can be collected by devices that "bite" a sample. A variety of sizes of needle can collect tissue in the lumen (‘’core biopsy’’). Smaller diameter needles collect cells and cell clusters, fine needle aspiration biopsy
examination of a biopsy can determine whether a lesion is benign
, and can help differentiate between different types of cancer. In contrast to a biopsy that merely samples a lesion, a larger excisional specimen called a resection may come to a pathologist, typically from a surgeon attempting to eradicate a known lesion from a patient. For example, a pathologist would examine a mastectomy
specimen, even if a previous nonexcisional breast biopsy had already established the diagnosis of breast cancer. Examination of the full mastectomy specimen would confirm the exact nature of the cancer (subclassification of tumor and histologic "grading") and reveal the extent of its spread (pathologic "staging"
For easily detected and accessed sites, any suspicious lesions may be assessed. Originally, this was skin or superficial masses. X-ray
, then later CT
, and ultrasound
along with endoscopy
extended the range.
A biopsy of the temporal arteries
is often performed for suspected vasculitis
In inflammatory bowel disease
and ulcerative colitis
), frequent biopsies are taken to assess the activity of disease and to assess changes that precede malignancy.
Biopsy specimens are often taken from part of a lesion when the cause of a disease is uncertain or its extent or exact character is in doubt. Vasculitis, for instance, is usually diagnosed on biopsy.
Biopsy and fluorescence microscopy are key in the diagnosis of alterations of renal function.
Lymph node enlargement may be due to a variety of infectious or autoimmune diseases.
Some conditions affect the whole body, but certain sites are selectively biopsied because they are easily accessed. Amyloidosis
is a condition where degraded proteins accumulate in body tissues. In order to make the diagnosis, the gingival
Biopsies of transplanted organs
are performed in order to determine that they are not being rejected
or that the disease that necessitated transplant has not recurred.
A testicular biopsy is used for evaluating the fertility of men and find out the cause of a possible infertility
, e.g. when sperm quality
is low, but hormone levels still are within normal ranges.
Commonly biopsied sites
cells are formed in the bone marrow
, a bone marrow biopsy
is employed in the diagnosis of abnormalities of blood cells when the diagnosis cannot be made from the peripheral blood alone. In malignancies of blood cells (leukemia
) a bone marrow biopsy is used in staging the disease. The procedure involves taking a core of trabecular bone
using a trephine
, and then aspirating material.
enables access to the upper and lower gastrointestinal tract
, such that biopsy of the esophagus
via the mouth and the [rectum], colon
and terminal ileum
are commonplace. A variety of biopsy instruments may be introduced through the endoscope and the visualized site biopsied. Until recently, the majority of the small intestine could not be visualized for biopsy. The double-ballon “push-pull” technique allows visualization and biopsy of the entire gastrointestinal tract. .
Needle core biopsies or aspirates of the pancreas may be made through the duodenum or stomach.
Biopsies of the lung
can be performed in a variety of ways depending on the location.
, most biopsies are not used for diagnosis, which can be made by other means. Rather, it is used to determine response to therapy which can be assessed by reduction of inflammation and progression of disease by the degree of fibrosis
or, ultimately, cirrhosis
In Wilson's disease, the biopsy is used to determine the quantitative copper level.
Analysis of biopsied material
After the biopsy is performed, the sample of tissue that was removed from the patient is sent to the pathology laboratory
. A pathologist
is a physician
who specializes in diagnosing diseases
(such as cancer
) by examining tissue under a microscope
. When the laboratory receives the biopsy sample, the tissue is processed and an extremely thin slice of tissue
is removed from the sample and attached to a glass slide. Any remaining tissue is saved for use in later studies, if required. The slide with the tissue attached is treated with dyes that stain the tissue, which allows the individual cells
in the tissue to be seen more clearly. The slide is then given to the pathologist, who examines the tissue under a microscope, looking for any abnormal findings. The pathologist then prepares a report that lists any abnormal or important findings from the biopsy. This report is sent to the physician who originally performed the biopsy on the patient.
Bone marrow examination
Lymph node biopsy
- Mybiopsyinfo.com - What is a biopsy? How is a biopsy examination performed? This website gives you answers to these and many other questions.
- MyBiopsy.org - Information about biopsy results for patients. This site is created by pathologists, the physicians who diagnose cancer and other diseases by looking at biopsies under a microscope.
- RadiologyInfo - The radiology information resource for patients: Biopsy