There are many different ways of getting a tissue sample. The method used will depend on the type of tissue being collected and where in the body it’s being taken from.
Scraping cells
In some cases, scraping cells from the surface layer of tissue, such as inside the mouth, is enough to provide a suitable sample for examination. This type of ‘scraping biopsy’ can be slightly uncomfortable but it’s not painful, so anaesthetic isn’t required.
A cervical screening test is a procedure in which a spatula, or small brush-like instrument, is used to gently remove a sample of cells from the neck of a woman’s womb (cervix). The cells are examined under a microscope for any abnormal changes (dysplasia).
If the cells display abnormal changes, it may mean that they’re cancerous or that there’s an increased risk that they will become cancerous.
Punch biopsy
A punch biopsy can often help to investigate skin conditions, such as deep spots and sores. During a punch biopsy, a special surgical instrument is used to make a small hole in your skin and remove samples of the top tissue layers. If you have a punch biopsy, you are usually given a local anaesthetic to numb the area.
Alternatively, a scalpel (a sharp medical knife) may be used to remove a small amount of surface skin. The wound will be closed using stitches. As with a punch biopsy, a local anaesthetic will be used for this procedure.
Needle biopsy
A fine-needle aspiration (FNA) biopsy is often used to take tissue samples from organs or from lumps that are below the surface of the skin. When a larger sample is needed, a core needle biopsy (CNB) may be used instead.
To obtain the sample, a special, hollow needle is inserted through your skin and into the area being examined. Ultrasound or X-rays will be used to help the doctor or surgeon guide the needle to exactly the right place.
When the needle is in position, it will ‘suck out’ a sample of tissue. If you have a needle biopsy, a local anaesthetic will usually be used to numb the area so that you won’t feel any pain or discomfort.
Breast lumps
A needle biopsy can be used in most cases to get more information about a breast lump. The needle is inserted into the lump and a sample of tissue is taken for testing. A core needle biopsy (CNB) is often used to gain a larger sample of tissue. In some cases a fine needle aspiration (FNA) biopsy may be used to drain a cyst.
Organs
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 into your abdomen. It takes a few seconds for a small sample of tissue to be taken. A local anaesthetic will usually be used for this type of biopsy because you need to be awake to breathe in.
Bone marrow
A thick needle is also used to take samples of bone marrow (the soft, jelly-like tissue that’s found in the hollow centre of all large bones). Bone marrow biopsies are carried out for different reasons, including:
- to find out why you have a low or high number of red blood cells (anaemia)
- to find out why you have a low or high number of white blood cells (leucopenia)
- to find out why you have a low or high number of platelets (blood-clotting cells)
A number of different health conditions may be responsible for these types of blood abnormalities, such as leukaemia (cancer of the bone marrow and white blood cells).
Samples of bone marrow are also sometimes taken to check how well treatment for leukaemia is working, or to tell how far certain types of cancer have progressed (what stage it’s at).
Bone marrow biopsies are usually taken from the top of the pelvis bone, just below your waist. You will usually have a local anaesthetic to numb the area, and may also be given a sedative (medication) to help you relax and cope with any discomfort, nerves or anxiety.
Endoscopic biopsy
An endoscope is a medical instrument that’s used to look inside your body. It’s a thin, flexible tube that has a light and a camera at one end. Tiny cutting tools can also be attached to the end of an endoscope to allow the surgeon to take a tissue sample.
An endoscope can be inserted through your throat, back passage (anus) or through small cuts made by the surgeon.
Depending on the area of the body being investigated and the entry point of the endoscope, either local or general anaesthetic may be used.
Excisional biopsy
An excisional biopsy is where surgery is used to remove a larger area of tissue, such as a lump, for closer examination.
Depending on where in the body the lump is located, an excisional biopsy may be performed under either a local or a general anaesthetic.
Perioperative biopsy
Sometimes, a biopsy is performed during surgery that is being carried out for another, unrelated reason. A tissue sample is taken during surgery and is checked immediately so that the surgeon gets the results quickly and can decide how to progress with treatment.
A lump that’s found during surgery may be removed completely if the patient is still under anaesthetic and has previously given their consent (approval).
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How a biopsy is performed
