How is it performed? of Biopsy

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There are many different ways of obtaining a biopsy sample. The method depends on the type of tissue being collected and where in the body it is taken from.

Scraping cells

In some cases, a scraping of the surface layer of cells can be enough to provide a sample for examination. A common example of this is the cervical smear test, which is a biopsy of the cells around a womanâ€™s cervix, the neck of the womb. Every woman in the UK over the age of 25 is invited to have regular smear tests at their GP or local GUM clinic. A plastic or metal tube called a speculum is inserted into your vagina, and then a special stick called a spatula is used to gently scrape a sample of cells from the cervix. The sample cells are then tested for abnormalities. If abnormalities are found, it could be a sign that cancer may develop in the cervix (but it is not a test for cancer). This type of scraping biopsy can be uncomfortable but not painful so no anaesthetic is required.

Skin samples

A sample of the surface of the skin may be used to diagnose skin conditions, for example to investigate a mole that your doctor thinks may be cancerous. You may have a punch biopsy, when a special surgical instrument (a punch biopsy tool) makes a small hole in your skin and removes samples of the top layers of tissue. Alternatively, a scalpel (sharp tool) can be used to cut off a small amount of surface skin, and then the wound is stitched back together. Usually a local anaesthetic to numb the area is given during these procedures.

Needle biopsies

To get a sample of tissue that is under the surface of the skin, such as a lump in the breast, a special needle can be pushed through to the area that requires examination, to suck out some tissue. This usually takes place using a local anaesthetic to numb the area so you canâ€™t feel any pain. An ultrasound scan or X-ray will often be used to guide the doctor or surgeon so that they insert the needle in exactly the right place. For some biopsies such as a bone marrow sample, you may be given a sedative (a drug to make you drowsy), to help you cope with discomfort, nerves and anxiety.

A thin hollow needle is used for some biopsies, such as examining breast lumps. This procedure is called fine needle aspiration. The needle is pushed into the lump and a sample of the lump tissue is taken for testing.

A thicker hollow needle is used for taking biopsies of organs such as the liver or kidneys. You will be asked to breathe in and hold your breath while the needle is inserted through your abdomen into organs such as your liver, and a small sample of tissue will be taken in a few seconds. You will usually have a local anaesthetic for this type of biopsy because you need to be awake to breathe in.

Similarly, a thick hollow needle is used to take samples of the bone marrow (a spongy substance inside your bones). Bone biopsies are usually taken from the top of the pelvis bone, just below your waist. The needle is twisted as it is inserted into the bone, to force a sample of the marrow into the hollow centre of the needle, so that it can be removed. You will usually have a local anaesthetic and some people also have a sedative, a drug to help them relax.

Endoscopy

Doctors often use a thin, bendy, fibre optic microscope to see inside your body. Tiny surgical tools can be attached to the end of the tube to enable them to take a sample of tissue without needing to carry out a major operation. The viewing tubes, called endoscopes, are inserted through existing entry points such as your throat or anus, or through small cuts that are purpose-made by a surgeon. Where the endoscope is inserted depends on the part of your body being examined, for example it might be sent down your throat to look at your lungs, or through the vagina and cervix to look at your womb. Tiny lights on the end of the tubes enable the surgeon to look around inside your body, and to guide microscope tools that are passed down the tubes to take a small sample of tissue.

Capsule biopsy

Capsule biopsy is an alternative to endoscopy when a biopsy of the intestine lining needs to be taken. You swallow a small capsule attached to a thin tube and an X-ray is taken to see when it has reached the correct point in your gut. When the capsule has reached the correct point pressure is created in the tube, so that a small portion of the intestine lining is sucked into the capsule, and can be pulled back out of the body.

Surgical excision

Excision means cutting out or removal. A surgical biopsy or excision is when an operation is performed to remove the whole of a tissue, usually a lump, which needs examining. This may be performed under local or general anaesthetic, depending on where in the body the lump is located.

If a lump is found or is exposed during surgery, a sample of tissue can be frozen and a thin slice taken from the frozen block for immediate checking, while the operation is still in progress. The surgeon can use the results from this frozen section to decide on the best course of treatment, and if the patient is still under anaesthetic and has given consent, this may be carried out on the spot.