A biopsy is a procedure done to remove tissue (called a sample) from an area that may be cancer. A doctor looks at the sample under a microscope to see if there are cancer cells in it. Some biopsies may need to be done during surgery. But many types of biopsies are done by removing small pieces of tumor through a thin needle or through a flexible lighted tube called an endoscope. Biopsies are often done by surgeons, but they can be done by other doctors, too. Some of the more common ways to do a biopsy are described here.
Fine needle aspiration biopsy
Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to pull out small bits of tissue. If the tumor can’t be felt near the surface of the body, the needle can be guided into the tumor by looking at it using an imaging test, like an ultrasound or CT scan.
The main advantage of FNA is that there is no need to cut through the skin, so there is no surgical incision (in-sih-zhun). A drawback is that in some cases the needle can’t take out enough tissue for an exact diagnosis. A more invasive type of biopsy (one that involves larger needles or a cut in the skin) may then be needed.
Core needle biopsy
This type of biopsy uses a larger needle to take out a core of tissue. A core biopsy sample can be removed with a needle if the tumor can be felt at the surface. Core biopsies can also be guided by imaging tests if the tumor is too deep to be felt.
The advantage of core biopsy is that it usually collects enough tissue to find out whether the tumor is cancer.
Excisional or incisional biopsy
For these biopsies a surgeon cuts through the skin to remove the entire tumor (excisional biopsy) or a small part of the tumor (incisional biopsy). They can often be done with local or regional anesthesia. This means numbing drugs are used just in the area where the biopsy will be done. If the tumor is inside the chest or belly (abdomen), drugs that put you into a deep sleep and keep you from feeling pain (general anesthesia) may be needed.
Endoscopy
This procedure uses a long, thin, flexible tube with a viewing lens or a video camera and a fiber optic light on the end. If a video camera is used, it’s connected to a TV screen. This allows the doctor to clearly see any tumors in the area. Endoscopes (end-uh-scopes) can be passed through natural body openings to look at areas of concern in places such as those listed below. Any of these procedures can be called an endoscopy (end-ah-skuh pee), but the more specific name is given as well:
- Pharynx (throat) – pharyngoscopy (fair-in-GAH-skuh-pee)
- Larynx (voice box) – laryngoscopy (lair-in-GAH-skuh-pee)
- Esophagus (swallowing tube) – esophagoscopy (eh-sof-uh-GAH-skuh-pee)
- Stomach – gastroscopy (gas-trah-skuh-pee)
- Small intestine – duodenoscopy (due-odd-en-AH-skuh-pee)
- Colon (large intestine) – colonoscopy (ko-lun-AH-skuh-pee)
- Sigmoid colon (lower part of colon) – sigmoidoscopy (sig-moid-AH-skuh-pee)
- Bladder – cystoscopy (sis-TAH-skuh-pee)
- Respiratory tract (windpipe, smaller breathing tubes, and lungs) – bronchoscopy (brong-kah-skuh-pee)
Some of the advantages of endoscopy are:
- The doctor can look right at the tumor and get a good idea of where it is and how big it is.
- A sample of tissue can be taken through the scope to find out if the tumor is cancer.
- An open surgical cut (incision) and drugs to put you in a deep sleep (general anesthesia) are usually not needed.
Local numbing medicines are needed before some types of endoscopy. Medicines may also be given to make you relax or go into a light sleep.
Ultrasonography
Ultrasound devices can be attached to the end of some endoscopes. This allows doctors to make pictures of the layers of the swallowing tube (esophagus), main breathing tubes (trachea and bronchi), and parts of the bowel (large intestine) by using sound waves. Nearby lymph nodes can be seen, too. Using the ultrasound pictures to guide it, a needle can be put through the endoscope and cells can be taken from tissues that do not look normal.
Laparoscopy, thoracoscopy, or mediastinoscopy
Laparoscopy (lap-uh-RAHS-kuh-pee) is much like endoscopy, but a small cut (incision) is made in the skin of the belly (abdomen). A thin tube called a laparoscope (LAP-uh-ruh-scope) is then put through the cut and into the belly to look for areas that may be cancer. If any are seen, they can be biopsied using a needle that is put in through the laparoscope. General anesthesia is most often used for laparoscopy (you are given drugs to out you into a deep sleep while it is done).
When this type of procedure is done to look inside the chest it may be called a thoracoscopy (thuh-rahs-kuh-pee) or mediastinoscopy (me-dee-uh-stine-AH-skuh-pee). General anesthesia is also used for this procedure. The scope is put in the body through a small cut next to or above the top of the breastbone, or a small cut between the ribs. Biopsies are taken through the scope.
Open surgical exploration (laparotomy or thoracotomy)
A laparotomy (lap-uh-ROT-uh-mee) may be needed when easier, less invasive explorations do not give enough information about an area of concern in the belly (abdomen). In this procedure, a surgeon makes a cut (incision), usually from the bottom of the breastbone (sternum) down to the lower part of the belly to look directly at the area in question. The location and size of the tumor and the nearby areas can be seen, and biopsies can be taken. This is a major surgical procedure, so the patient is given medicines to cause a deep sleep and prevent pain (general anesthesia).
An operation much like this can be done to open and look inside the chest. This is called a thoracotomy (thor-uh-KOT-uh-me).
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