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Biopsy

Introduction

A biopsy is a medical procedure that involves taking a small sample of tissue so that it can be examined under a microscope.

The term ‘biopsy’ is often used to refer to the act of taking the sample and the tissue sample itself.

Types of biopsy

A tissue sample can be taken from almost anywhere on (or in) your body, such as your skin, stomach, kidneys, liver, and lungs.

A number of different types of biopsy can be used to help identify a wide range of different health conditions. Types of biopsy include:

  • scraping cells - removing cells from the surface layer of tissue, such as from the inside of the mouth, or from inside the cervix (neck of the womb),
  • a punch biopsy - for diagnosing skin conditions,
  • a needle biopsy - for obtaining tissue from the body’s organs, or from tissue underneath the skin,
  • an endoscopic biopsy - where a medical instrument known as an endoscope is used to take a tissue sample,
  • a capsule biopsy - used when a sample from the intestine lining needs to be taken, and
  • an excisional biopsy - where surgery is used to take a larger section of tissue.

How the biopsy is carried out will depend on where the tissue sample is being taken from. See ‘how it is performed’ for further information about the different types of biopsy and how they are performed.

What is a biopsy used for?

Biopsies are used to identify abnormal cells. The result of a biopsy can often help healthcare professionals to diagnose a wide range of conditions including:

  • cancer,
  • peptic ulcers (ulcers that affect the digestive system),
  • hepatitis (inflammation of the liver),
  • kidney disease, and
  • endometriosis (where cells that usually line the womb are found elsewhere in the body).

Biopsies are commonly used to check whether a breast lump is benign (non-cancerous) or malignant (cancerous).

After the tissue sample has been taken, the cells will be closely examined under a microscope to see whether or not they appear abnormal, and to check for any unusual cell activity. The cells may also be tested using various chemicals to see how they respond. The type of tests that are used will depend on the medical conditions that are being investigated.

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Why is it necessary?

Healthcare professionals often use biopsies to investigate the cause of a person’s symptoms, or to confirm a diagnosis that they already suspect due to other test results. A biopsy can also be used to measure the severity of a condition. For example, how severely an organ, such as the liver, is inflamed.

Biopsies are used to diagnose a wide range of health-related conditions, including cancer. If you have a lump, or growth, on your skin, or inside your body, it is impossible to tell whether it is malignant (cancerous) or benign (non-cancerous) just by looking at it, or feeling it. A biopsy will be able to provide that information.

Testing a tissue sample

After a tissue sample has been taken, it will be sent to a laboratory so that it can be examined under a microscope and the tissue’s cells can be tested.

Cells are the ‘building blocks’ that make up your body. By closely examining them, scientists can see whether they are normal or abnormal. Cancerous cells, for example, look and behave differently from normal cells.

As well as a visual examination, chemical, or genetic, tests can also be carried out on the tissue sample. For example, a chemical test is sometimes used to diagnose cystic fibrosis, which is an inherited condition where thick secretions are produced in the lungs, making breathing difficult. If the gene for cystic fibrosis is present in the cells, a chemical reaction will occur.

Tests for cystic fibrosis and other genetic conditions can even be carried out on a cell sample that is taken from an unborn baby. The cell sample is taken from the placenta using a pre-natal biopsy called chorionic villus sampling (CVS).

During CVS, a small piece of the placenta is removed using a very fine needle that is passed through the abdomen (stomach) using ultrasound to guide it. Once a cell sample has been obtained, a chromosome (genetic) analysis will be carried out to determine whether the gene that is responsible for cystic fibrosis is present.

It usually takes between 10-14 days for CVS test results to become available. The results can be used to help parents decide whether they wish to terminate a pregnancy or continue with it. See the ‘selected links’ section for more information about cystic fibrosis and CVS.

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How is it performed?

There are many different ways of obtaining a tissue sample. The method that is used will depend on the type of tissue that is being collected and whereabouts in the body it is being taken from.

Scraping cells

In some cases, scraping cells from the surface layer of tissue, such as from inside the mouth, is enough to provide a suitable sample for examination. This type of ‘scraping biopsy’ can sometimes be uncomfortable, but it is not painful so anaesthetic is not required.

A cervical screening test is a procedure where a spatula, or small brush-like instrument, is used to gently remove a sample of cells from a woman’s cervix (the neck of the womb). The cells are then examined under a microscope for any abnormal changes (dysplasia).

If the cells display abnormal changes, it may mean that they are cancerous, or that there is an increased likelihood that that they will become cancerous. When the results of your cervical screening test are available, your GP will be able to discuss your treatment options with you, or whether further tests are required.

See the ‘selected links’ section for more information about cervical screening tests.

Punch biopsy

A punch biopsy can be useful for helping to diagnose skin conditions, such as skin cancer. During a punch biopsy, a special surgical instrument is used to make a small hole in your skin and remove samples of the top layers of tissue. If you have a punch biopsy, you will usually be 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, you will also have a local anaesthetic for this procedure.

Needle biopsy

Needle biopsies are often used to take tissue samples from organs, or from lumps that are below the surface of the skin.

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 is used to ‘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 will not be able to feel any pain or discomfort.

Breast lumps

A thin, hollow needle is used for some types of biopsy, such as examining breast lumps. A breast lump biopsy is known as a fine-needle aspiration biopsy. The needle is inserted into the lump and a sample of tissue is taken for testing.

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 in order to breathe in.

Bone marrow

A thick needle is also used to take samples of bone marrow (the soft, jelly-like tissue that is found in the hollow centre of all large bones). Bone marrow biopsies are carried out for a number a 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), or
  • 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), or other types of blood disorders.

Samples of blood marrow are also sometimes taken to check how well treatment for leukaemia is working, or to determine how far certain types of cancer have progressed.

Bone marrow biopsies are usually taken from the top of the pelvis bone, just below your waist. You will usually be given a local anaesthetic and some people also have a sedative (medication) to help them relax and cope with any discomfort, nerves, or anxiety.

Endoscopic biopsy

An endoscope is a medical instrument that is used to look inside your body. It is a thin, bendy tube with 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 sample of tissue.

An endoscope can be inserted through existing entry points in your body, such as through your throat, anus (back passage), or through small cuts that are made by the surgeon.

Depending on the area of the body that is being investigated, and the entry point that is used for the endoscope, an endoscopic biopsy may be performed under either local, or general, anaesthetic.

Where the endoscope is inserted will also depend on the part of your body that is being examined. For example, it might be inserted down the throat in order to look at the lungs or, for female patients, through the vagina and cervix to examine the womb.

Capsule biopsy

A capsule biopsy is an alternative to an endoscopic biopsy. It is used when a sample of the lining of your intestine needs to be taken.

During a capsule biopsy, you will be given a small capsule to swallow that is attached to a thin tube. X-ray images will be used to determine when the capsule has reached the correct point in your gut.

When it has reached the correct point, pressure is created in the tube, so that a small piece of your intestine lining is sucked into the capsule, before being removed from your body.

Excisional biopsy

An excisional biopsy is where surgery is used to remove a larger area of tissue, such as a lump, for closer examination. Excision means ‘cutting out’, or ‘removal’.

Depending on where in the body the lump is located, an excisional biopsy may be performed under either a local, or a general, anaesthetic.

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 is able to decide how to progress with treatment.

A lump that is found during surgery may be removed completely if the patient is still under anaesthetic and has given their consent (approval).

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Recovery

Biopsies are usually straightforward procedures that can often be carried out as outpatient procedures using local anaesthetic. In such cases, you will not need to stay in hospital overnight.

Some types of biopsy, such as those that involve taking a tissue sample from an internal organ, will require a general anaesthetic. If you need to have a general anaesthetic, you may need to stay in hospital overnight.

After having a biopsy, you will not usually experience any pain. However, if you have had a sample taken from a major organ, such as your liver, or from your bone marrow, you may have a dull ache, or a slightly uncomfortable feeling. Your doctor, or surgeon, will be able to advise you about the painkillers that you can take in order to relieve this.

If an incision (cut) is required in order to remove a tissue sample - for example, during an endoscopic biopsy, or an excisional biopsy - the wound may need to be closed using stitches, or you may need to have a dressing put on the wound.

If you have had a biopsy where tissue has been taken from an important organ, such as your liver, or kidneys, you will need to stay in hospital for a few hours after the procedure. This is so that you can rest and hospital staff can ensure that there is no internal bleeding. It is very rare for serious bleeding to occur following a biopsy but, if it does, you may need to have an operation or a blood transfusion.

Women who have had samples taken from their reproductive system, such as their womb lining, or cervix (neck of the womb) may experience a little light vaginal bleeding. Men who have had a prostate biopsy may have blood in their urine.

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Results

How quickly you get your results depends on the hospital and the urgency of your case. Routine cervical smear tests can take up to 6 weeks for results, while tests done because your doctor suspects a serious condition such as cancer can come back in a week or even a few days. In the case of biopsies done during surgery, a quick result can sometimes be given within minutes, in order that the right treatment can be given.

Your GP, hospital consultant, or practice nurse will give you your results and explain what they mean. Sometimes tests are not conclusive – this means they haven’t produced a definite result – so you might have to repeat the process or have further, different, tests, to double-check your diagnosis.

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