Guide To Different Types Of Biopsies

Female Cancers



What Is A Biopsy?
Types Of Biopsies
Tissue Analysis Methods
Female Specific Biopsies


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What Is A Biopsy?

A biopsy is a medical procedure to remove a sample of tissues from the body for examination under a microscope. There are quite a few different types of biopsies and they vary in complexity, technique, how much tissue is taken and whether or not anesthesia is needed. A biopsy is an important part of the cancer diagnosis process, but it can also be used to diagnose other conditions as well. For example biopsies are also performed to check for heart disease, anemia, chronic hepatitis, causes of infertility and inflammations of the arteries (temporal arteritis).

Biopsy Types

Skin Biopsy
This is the easiest and quickest kind of biopsy. It involves cutting out the area of skin under suspicion (such as a suspicious mole or freckle). If the entire abnormality and a little of the normal surrounding skin is removed, it can also be considered a complete treatment as well.

Needle Biopsy
This procedure uses a very fine needle attached to a hollow syringe which is inserted into the suspected area and draws out fluid or sample tissue for analysis. If only a small sample is required, then a fine needle aspiration (FNA) biopsy is performed. If the suspicious area (or tumor) cannot be felt near the surface then an ultrasound scan or CT scan may be needed to guide the needle to the correct zone. No surgical incision is required although the doctor may apply a topical anesthetic before inserting the needle. If cancer is invasive a larger needle may need to be used. This is known as core needle biopsy. This will collect more tissue sample and can necessitate a local anesthetic, particularly if the tumor is deep below the surface of the skin.

Surgical Biopsy
This type of biopsy allows the largest tissue sample to be taken. It is carried out under general anesthetic (unless the woman requests a local anesthetic) on an outpatient basis. It is sometimes performed if the results of a needle biopsy are not clear, or if a needle biopsy is not possible because the tumor is too deep in the body or too solid for the needle to remove a sufficient sample. Surgeons cut through the skin with a scalpel and with the aid of an endoscopic instrument remove part of or the entire tumor. If part is removed this is known as an incisional biopsy and an excisional biopsy is where the full tumor is removed. The tissue will be sent to a pathology lab for analysis. Surgical biopsies do leave small scars but they have the highest accuracy rate of all biopsy types.

Punch Biopsy
Commonly used for diagnosing vaginal cancer, cancer of the vulva and cervix cancer. This technique involves punching out a sample of tissue from the suspected area with a device that looks like a paper punch. Sometimes several punches are necessary and in such instances it is known as a multiple punch biopsy. If the doctor tells the woman to cough when he is about to 'punch' she may avoid the brief sharp pain. This procedure can usually be carried out in a doctor’s office and does not require hospitalization. Most gynecologists will use a colposcope with this procedure. A colposcope is a lighted instrument which acts as a magnifying lense. It allows the doctor to take a pinhead size specimen of tissue.

Cone Biopsy
Also known as conization or a cold knife biopsy, a cone biopsy can both diagnose and treat cervical abnormalities. This is a standard procedure after an abnormal Pap smear test result. A gynecologist removes tissue in the shape of a cone from the center of the cervix, rather like taking out the core of an apple. The surrounding area is then stitched (sutured) or cauterized. If the biopsy removes the cells under suspicion (dysplasia) it can also be considered a cure. If there is evidence of pre-cancer (carcinoma in situ - see cervix cancer stages), then a hysterectomy may be recommended. A cone biopsy is relatively expensive and is carried out under local or general anesthesia. Heavy bleeding is common immediately after surgery or after about 10 days when the stitches are absorbed. With the advent of colposcopes which can identify small abnormal areas of cell growth for punch biopsies, cone biopsies are becoming less common. Rare complications include cervical incompetence if too much tissue is removed. If untreated this can lead to pregnancy difficulties such as premature labor and increases the odds of miscarriage.

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Tissue Analysis Methods

The tissue obtained in a biopsy is sliced into thin sections by a pathologist, placed on glass slides and preserved with chemicals and staining dyes. This is called permanent section and the procedure can be painstakingly slow. The process takes about 24 hours and results can take 2 or 3 days. Another option, which may still be valuable in some situations but is less common now than it used to be, is a frozen section. This is where the tissue is rapidly frozen and stained. It can yield immediate results so that the surgeon will know if more tissue needs to be removed for a 'clear margin' around a cancerous lump while the patient is still under anesthesia. Thus a second operation can be avoided as the biopsy and treatment can be performed in one go. The main disadvantage is that it is not as accurate as a permanent section, resulting in many false negatives. Hospital administers also consider it an inefficient use of operating theatre and staff time. And in reality, for most cancers there is little to be lost in waiting a few days after a diagnosis before beginning cancer treatment.

Female Specific Biopsies

Cervical Biopsy
If a pap smear test reveals abnormal results a punch biopsy is usually performed. If this shows abnormalities beyond the tip of the cervix a colposcopy and endocervical curettage may be necessary. If there is any contradiction in the findings a cone biopsy will be necessary. Loop Electrosurgical Excision Procedure (LEEP) can be a simpler alternative to a cone biopsy. See cervix cancer diagnosis for more details.

Endometrial Biopsy
Also called a uterine biopsy this involves taking a sample of the endometrium, or uterus lining. It can be ordered to investigate heavy periods, uterus cancer, endometrial hyperplasia, endometrial polyps and some types of infertility. A small thin tube is inserted through the vagina into the uterus and using suction a tissue sample is aspirated. It can be completed in a doctor’s office and does not require anesthesia. See also, diagnosis of endometrial cancer for more information.

Vulva Biopsy
If there is any lesion or growth on the vulva a punch biopsy will be performed. Sometimes however a larger sample is required which means surgical cutting with a scalpel or scissors. As the vulva has lots of blood vessels, bleeding is very common. To prevent this, a paste of ferrous sulfate may be applied to the cut or silver nitrate sticks for cauterization may be used.

Breast Biopsy
If a lump is discovered sometimes a FNA biopsy is performed (see breast biopsy), particularly if the lump could be caused by a fluid filled cyst. If the lump is solid and does not collapse a surgical biopsy will need to be performed for a breast cancer diagnosis. Years ago, before the advent of lumpectomy, the tissue sample was analyzed during surgery using the frozen section method. If cancer was discovered the breast was removed. This process fortunately is no longer necessary but it explained the anguish associated with breast biopsies - not knowing if you were going to wake up with your breasts or not. Sometimes, before a surgical biopsy, a core needle biopsy is performed. This can give more detail than a FNA, mammogram or ultrasound. If the lump is close to the skin surface a freehand needle biopsy may suffice. If it is deeper other possible methods include stereotactic needle biopsy, vacuum-assisted biopsy and ultrasound-guided needle biopsy.

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