What is a Biopsy?
Most abnormalities found on imaging require a biopsy for definitive diagnosis. A biopsy is a procedure in which a sample of the abnormal tissue is obtained for pathologic evaluation. Using a tiny amount of tissue a pathologist can use different tests to precisely determine the cause of the abnormality (cancer, benign tumor, infection). This is important to know as it determines the treatment course. With respect to cancer, it is usually not enough just to know it is lung cancer or colon cancer, but it is important to know the specific type.
How is a biopsy performed?
Traditionally, major surgery was necessary for obtaining a biopsy. Fortunately, today, there are several ways of obtaining a biopsy:
Open surgery – An incision is created to get access to the abnormal tissue and a part of the tissue is removed. It is rarely performed these days, since the other methods are available.
Image guided – A radiologist uses imaging equipment (Ultrasound, CT scan, X-rays) to guide directly into the abnormal tissue. Through a needle a small piece of tissue or sometimes even a few cells are removed. This is currently the most common type of biopsy.
Endoscopy guided – This type of biopsy is performed during an endoscopy and usually involves biopsies of the GI tract. A gastroenterologist or a general surgeon usually performs these procedures. In some instances, the physician may use an ultrasound probe in the tip of these devices to guide biopsies in organs next to the bowel.
Bronchoscopy guided – A physician (usually a pulmonologist) inserts a camera through the mouth into the trachea and under direct visualization, or other guiding methods a small piece of tissue from a lung tumor or lymph node around the trachea is removed.
In this document, we will be talking about image-guided biopsy using mostly CT scan or ultrasound.
What are the risks?
With any biopsy the biggest risk is bleeding. Thankfully the overall risk is very small (<1%). However, depending on where the tumor is located, this risk can be higher. Another potential risk of biopsy is seeding or spreading of the tumor. Fortunately, this is also extremely rare (<0.1%). Infections are also a risk, but because the procedure site is just a small puncture, along with the use of sterile technique, it is very rare.
Certain types of biopsies have specific risks. For example, since the lung is an organ full of air, the most common complication associated with lung biopsy is a lung collapse (pneumothorax). This happens when air escapes from the lung filling the space between the lung and the chest wall, causing part of the lung to collapse. It happens overall in approximately 10% of lung biopsies. Fortunately, it is easily treated by placing a small plastic tube (low profile chest tube) in this space to remove the air. This plastic tub will need to stay in place for 24-48 until the air leak stops. Usually the patient will stay in the hospital if this happens for 1-2 days.
Another example would be a medical kidney biopsy where tissue is taken at the sites of the kidney where there are many small blood vessels. This increases the risk of a bleeding complication. Though still small, extra precautions are implemented, such as tight blood pressure control and overnight admission for observation.
Reasons to avoid this procedure?
Some things can be diagnosed based on blood tests or imaging studies and do not require biopsy. Your physician will evaluate your imaging studies to confirm you need a biopsy. Although most abnormalities can be biopsied using imaging guidance, some are in difficult locations and will require open or laparoscopic surgery for diagnosis.
If you have bleeding problems or if you are taking blood thinners you should not undergo a biopsy without proper evaluation.
How do you prepare?
Usually biopsy procedures are performed with IV sedation and local anesthesia. You will need to be fasting for 8 hours before the procedure if you will be getting IV sedation.
If you take blood thinners you likely need to stop them before the procedure. Please refer to pre-procedure instructions for detailed instructions about your medications and discuss with your physician.
How is the procedure done?
The procedure is performed at El Camino Hospital in the radiology department. An entire team will be taking care of you during the procedure including a radiology nurse, a radiology technologist and the physician. In the Interventional Radiology procedure room, the nurse will help you lay on an exam table. You will be connected to heart, blood pressure and oxygen monitors. Medicine may be given to relax you through your IV called moderate, also known as “twilight,” sedation. Your procedure area will be prepped and sterilized. A numbing medicine will be injected into the area (local anesthetic). Using imaging guidance, we will be able to introduce the biopsy devices precisely into the abnormal tissue. The imaging studies not only help us for accuracy, but also help us avoid important structures, like blood vessels and other organs. Once adequate enough tissue samples are obtained, the biopsy devices are removed and a sterile skin glue is applied to the puncture site, no stitches are needed.
The procedure time can vary based on the type of biopsy, but it usually takes about 15-30 minutes. Throughout the procedure, medication is given through your IV to keep you comfortable. Your oxygen saturation, blood pressure and pulse are checked closely during and after the procedure.
What can you expect after the procedure?
After the procedure you will go to the post surgical area for recovery where we will be able to monitor your vital signs and the site of the procedure. In general, you will be there for 30 mins up to 2 hours, depending on the type of biopsy. We want to be sure you do not have any problems before you go home.
Don’t worry. You will be able to eat and drink right after the procedure. You also will be able to see your family members soon after the procedure. If you feel well enough, you will be able to go home.
At home, we recommend that you take it slow the remaining day of the procedure. You should not drive, operate heavy machinery or consume alcohol until the following day after the procedure, if you received sedation.
How long does it take to recover?
Most patients should be able to return to their normal activities the day after the procedure.
We recommend no contact sports or extraneous activity for a period of approximately 1-week post-procedure to minimize the chance of bleeding.
What should you watch for?
You may be sore after the procedure. However, the pain should not be getting worse and should subside in 2-3 days. If you develop severe pain or if the pain is getting worse you should call us at 650-404-8445 and seek immediate medical attention.
Worsening of pain, redness, warmth, or discharge at the site of the procedure may be signs of infection.
Particularly after lung biopsies, if you develop shortness of breath or chest tightness you should contact us at 650-404-8445 and go to the nearest emergency room for evaluation.
How long does it take to get the biopsy results?
Usually, it takes 2 business days to get the results back. However, in some cases, it may take up to 1 week, if additional studies need to be performed. The results of your biopsy will go directly to the physician who referred you for the biopsy.