Diagnostic Biopsy

Diagnostic Biopsy

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    A bone biopsy is the removal of a small piece of bone to examine it under a microscope. During a bone biopsy, a doctor inserts a special kind of hollow needle through the skin and into the bone that is to be sampled. The doctor may use an imaging scan, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), to guide the needle directly to the correct spot in the bone. If you need to undergo a bone biopsy using a needle, you will likely be mildly sedated and your doctor will apply a local anesthetic, as well.

    Another type of bone biopsy is called an open biopsy. If you undergo this type of biopsy, you will be given general anesthesia so you are asleep during the procedure. Your doctor will make a full incision into the skin to remove a piece of bone surgically, and when the procedure is completed, the incision will be stitched closed.

    Your doctor might recommend a bone biopsy to:
    • identify the cause of bone pain or tenderness
    • determine if bone lesions are malignant (cancerous)
    • investigate an abnormality seen on an x-ray
    • determine the cause of an infection
    • diagnose a bone abnormality
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    A biopsy for liver cancer is done by directly inserting a needle into your liver and taking a sample of tissue. It can also be done by either laparoscopic surgery or open surgery. Laparoscopic surgery involves making a small incision and using a laparoscope to collect a tissue sample. In open surgery, a tissue sample is collected through a large incision. Liver biopsies are usually not performed because they are usually unnecessary and can be dangerous.

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    A liver biopsy is a medical procedure in which a doctor removes a small piece of the liver for examination under a microscope. A liver biopsy is usually done after tests such as imaging scans and blood tests indicate a problem with the liver. A liver biopsy can diagnose liver diseases and estimate the degree of liver damage as well as help a doctor determine the best treatment for the problem.

    A liver biopsy is performed in one of three ways.
    • In a percutaneous liver biopsy, a hollow needle is inserted through the abdomen to the liver to extract a piece of liver tissue. This type of biopsy is usually done using a local anesthetic (although pain medication and sedatives may be offered if needed), and while using an ultrasound scan to help the doctor guide the needle to the targeted spot on the liver.
    • A transvenous liver biopsy (or transjugular venous biopsy) is also done using local anesthesia and pain medication and/or sedatives if needed. In this procedure, a small incision is made in the neck and a sheath is threaded into the jugular vein and into one of the veins of the liver. A dye is put into the sheath and picked up by the vein in the liver so that an x-ray can be taken that will create an image of the veins of the liver. Then a biopsy needle is threaded into the sheath and used to extract one or more tissue samples from the liver. The needle and sheath are then withdrawn and the doctor applies a bandage to the small incision.
    • A laparoscopic liver biopsy is done with the patient under general anesthesia given through a vein in the arm. The doctor inserts a lighted tube called a laparoscope through a small cut in the abdomen until it reaches the liver. The laparoscope sends images of your liver to a computer monitor. The doctor watches the monitor and inserts instruments into the laparoscope to take tiny tissue samples from the liver. Recovery from a liver biopsy usually takes one or two days.
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    Two of the most common risks with a liver biopsy are bleeding and infection.

    • The liver is a very vascular organ, meaning that it has a lot of blood flow, which increases the risk of bleeding. Before a liver biopsy, you may be asked to stop taking any anticoagulants that increase the risk of bleeding such as aspirin, Plavix, or Coumadin. Anticoagulant or "blood thinning" medications are usually stopped at least five days before the procedure. Also, an INR is drawn on everyone before the biopsy to help determine whether you are at risk for bleeding. The higher the result of the INR, the greater you are at risk for bleeding. If your INR is too high, the doctor performing the biopsy may cancel the biopsy.
    • Infection is another risk of a liver biopsy. Liver biopsies are sterile procedures, which makes the risk of infection very small. You will be educated about signs and symptoms of infection before you are discharged.
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    During a needle biopsy for lung cancer, the doctor places a needle through the chest wall. A chest x-ray, computed tomography (CT) scan or real-time x-ray (fluoroscopy) helps guide him to the tumor. A sample of tissue is removed from the tumor. The sample is examined under a microscope to see if cancer cells are present.

    A biopsy is necessary for your doctor to confirm a cancer diagnosis. It also helps identify the specific type of cancer and its spread (or stage).

    Sometimes a needle biopsy will be done in another area of the body, such as the liver or adrenal gland, to determine if the cancer has spread.
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    A thyroid biopsy is a procedure in which a sample of cells is taken from the thyroid gland, located in the neck, for examination under a microscope. A biopsy is usually performed to check for thyroid disease or cancer if you have a lump or nodule on the thyroid and/or after an abnormal result on a blood test or an imaging scan.

    Before doing the biopsy, the doctor may apply local anesthesia to your neck area. Then the doctor will insert a thin needle into your neck and into your thyroid gland to extract a sample of fluid and cells for viewing by a pathologist in a laboratory. The needle is then taken out and your doctor will apply a bandage to the area.
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    An indeterminate result of a thyroid nodule biopsy means that doctors cannot be certain whether a thyroid nodule is benign or cancerous. Thyroid nodules may be found to be benign (non-cancerous), cancerous or indeterminate on fine needle aspiration biopsy. Within the indeterminate category, there are additional, more specific categories that are each associated with a risk of cancer. These include atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS); suspicious for follicular neoplasm (SFN) or suspicious for cancer. Indeterminate cases including AUS, FLUS and SFN, which carry a 10 to 30 percent risk of cancer, were traditionally managed with surgical removal of part of the thyroid in order to establish a definitive diagnosis. Now, molecular profile testing is available to provide additional genetic information on these nodules which may allow more patients to avoid surgery, in appropriate cases.
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    There are two main risks for a needle biopsy of the lung.

    • There is the risk of a pneumothorax. This is also referred to as a collapsed lung. This occurs because air gets into the space around the lung and makes it difficult for the lung to expand. Your risk of a pneumothorax increases when the area that is biopsied is difficult to get to or you have a history of lung disease. Generally, if a pneumothorax occurs, you will get a chest tube inserted that will help your lung re-expand and you will be admitted to the hospital. However, if the pneumothorax is small, meaning, the amount of air around the lung is small, the doctor performing the biopsy may decide to observe you for a while to see if the pneumothorax resolves on its own.
    • Infection is the other risk. The procedure is a sterile procedure, so the risk of infection is small. Prior to discharge, you should be educated about the signs and symptoms of infection (such as redness, swelling, drainage around the site) and who you should follow-up with if you have any of those symptoms.
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    A lung biopsy is a medical procedure in which a sample of tissue is removed from the lungs to be examined under a microscope to look for signs of cancer, infection or lung disease. Usually a biopsy is a follow-up test to an abnormal finding on an x-ray or computed tomography (CT) scan. There are several different types of lung biopsies.
    • Needle biopsy. A needle biopsy is performed after a local anesthetic is given, and in some cases a mild sedative is provided to relax you. It is generally done when the area of concern is believed to be unreachable by other diagnostic techniques, such as bronchoscopy. The doctor refers to a chest x-ray or chest CT scan to find the exact spot for the biopsy. With the imaging scan as a guide, the doctor inserts a needle through your chest wall into a suspicious area of the lung to obtain a tissue sample. This type of biopsy may also be referred to as a closed, transthoracic or percutaneous (through the skin) biopsy.
    • Transbronchial biopsy. This type of biopsy is performed through a fiberoptic bronchoscope (a long, thin tube that has a camera on the end for viewing) through the main airways of the lungs (bronchoscopy).
    • Video-assisted thoracic surgery (VATS). In this procedure, you are given a general anesthetic so you are asleep. The doctor makes two or more small cuts to insert an endoscope (a thin, lighted tube equipped with a camera) through the chest wall into the chest cavity. Different biopsy tools can be inserted through the endoscope to obtain lung tissue for examination. This method of biopsy tends to result in less pain and a faster recovery.
    • Open biopsy. An open lung biopsy is done in a hospital operating room under general anesthesia, which means you are asleep and pain-free during the surgery. A tube will be placed through your mouth and into the airway that leads to the lungs. The surgeon makes a cut in the chest area and removes a small piece of lung tissue. The wound is closed with stitches.
    All four types of biopsies carry certain risks and require at least a day or more to heal and recover after surgery. You and your doctor can discuss your options to pick the best type of lung biopsy for you.
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    There are four common types of skin biopsies:

    Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area. Incisional biopsy: The doctor uses a scalpel to remove part of the growth. Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it. Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth.

    This answer is based on source information from the National Cancer Institute.