Types of biopsies used to look for cancer

Tissue or cell samples can be taken from almost any part of the body. How samples are taken depends on where the tumor is and what type of cancer is suspected. For instance, the methods used for skin biopsies are very different from those used for brain biopsies.

Some types of biopsies remove an entire organ. These are done only by surgeons. Other types of biopsies remove tumor samples through a thin needle or through an endoscope (a flexible lighted tube that’s put into the body). These biopsies are often done by surgeons, but can also be done by other doctors.

The most common biopsy types used in cancer diagnosis are discussed here. For more details, go to the diagnosis information on specific type of cancer you want to learn about.

Needle biopsy

There are 2 types of needle biopsies:

• Fine needle biopsy (also called fine needle aspiration)
• Core needle biopsy (also called core biopsy)

Fine needle aspiration

Fine needle aspiration (FNA) uses a very thin, hollow needle attached to a syringe to take out a small amount of fluid and very small pieces of tissue from the tumor. The doctor can aim the needle while feeling the tumor, if it’s near the surface of the body. If the tumor is deeper inside the body and can’t be felt, the needle can be guided while being watched on an imaging test such as an ultrasound or CT scan.

The main advantages of FNA are that the skin doesn’t have to be cut, and in some cases it’s possible to make a diagnosis the same day. The disadvantage is that sometimes this needle can’t remove enough tissue for a definite diagnosis. Although FNA is a type of biopsy, it’s also classified as a cytology test.

Core biopsy

Needles used in a core biopsy are slightly larger than those used in FNA. They remove a small cylinder of tissue (about 1/16 inch in diameter and 1/2 inch long). The core needle biopsy is done with local anesthesia (drugs are used to make the area numb) in the doctor’s office or clinic. Like FNA, a core biopsy can sample tumors that the doctor can feel as well as smaller ones that must be seen using imaging tests.

Doctors sometimes use special vacuum tools to get larger core biopsies from breast tissue. (For more on this, see our breast biopsy information.)

Processing core biopsy samples usually takes longer than FNA biopsies, so getting the results of those tests also might take longer.

Excisional or incisional biopsy

In this type of biopsy, a surgeon cuts through the skin to remove the entire tumor (called an excisional biopsy) or a small part of a large tumor (called an incisional biopsy). This is often done using local or regional anesthesia (drugs are used to numb the area). If the tumor is inside the chest or abdomen (belly), general anesthesia is used (drugs are used to put the patient into a deep sleep so they will feel no pain).

Endoscopic biopsy

An endoscope is a thin, flexible, lighted tube that has a lens or a video camera on the end. It allows a doctor to look inside different parts of the body. Tissue samples can also be taken out through the endoscope.

Different types of endoscopes are used to look at different parts of the body. For example, one type of endoscope is used to look at the inside of the nose, sinuses, and throat. Another type of endoscope is used to look at the upper part of the digestive tract: the esophagus (the tube that connects the throat to the stomach), stomach, and first part of the intestine.

Some endoscopes are named for the part they are used to look at. For instance, a bronchoscope is used to look inside the lungs and bronchi (breathing tubes), and a colonoscope is used to look inside the colon and rectum (large intestine).

Laparoscopic, thoracoscopic, and mediastinoscopic biopsy

Laparoscopy is much like endoscopy but uses a slightly different scope (a laparoscope) to look inside the abdomen (belly) and remove tissue samples. A small cut is made in the abdomen, and the laparoscope is passed through it to see inside. Procedures like this that look inside the chest are called thoracoscopy and mediastinoscopy.

Laparotomy and thoracotomy

A laparotomy is a type of surgery that cuts into the abdomen (belly). It’s usually a vertical cut from upper to lower abdomen. This may be done when a suspicious area can’t be diagnosed with simpler tests (like a needle biopsy or laparoscopy).

During the laparotomy, a biopsy sample can be taken from a suspicious area. The doctor can also look at the size of the area and its location. Nearby tissues can be checked, too. General anesthesia is used (drugs are used to put the patient into a deep sleep so they will feel no pain). A similar operation that opens the chest is called thoracotomy.

Skin biopsies

There are many ways to biopsy the skin. Your doctor will choose the one best suited to the type of skin tumor suspected. Shave biopsies remove the outer layers of skin and are fine for some basal cell or squamous cell skin cancers, but usually they aren’t used for suspected melanomas of the skin. Punch biopsies or excisional biopsies (as discussed previously) remove deeper layers of the skin, and can be used to find out how deeply a melanoma has gone into the skin – an important factor in choosing treatment for that type of cancer.

Sentinel lymph node mapping and biopsy

Lymph node mapping helps the surgeon know which lymph nodes to remove for biopsy. Sentinel node mapping and biopsy has become a common way to find out whether a cancer (especially melanoma or breast cancer) has spread to the lymph nodes. This procedure can find the lymph nodes that drain lymph fluid from where the cancer started. If the cancer has spread, these lymph nodes are usually the first place it will go. This is why these lymph nodes are called sentinel nodes (meaning that they stand watch over the tumor area, so to speak).

To find the sentinel lymph node (or nodes), the doctor injects a small amount of slightly radioactive material into the area of the cancer. By checking various lymph node areas with a machine that detects radioactivity (like a Geiger counter), the doctor can find the group of lymph nodes the cancer is most likely to travel to. Then the doctor injects a small amount of a harmless blue dye into the site of the cancer. After about an hour, a surgeon makes a small cut in skin to see the lymph node area that was found with the radioactive test. Those lymph nodes are then checked to find which one(s) turned blue or became radioactive. (Sometimes the dye and the radioactive material may be mixed together, or either part may be used alone.)

When the sentinel node has been found, it’s removed (an excisional biopsy) and looked at under a microscope. If the sentinel node does not contain cancer cells, no more lymph nodes need to be taken out because it’s very unlikely the cancer would have spread beyond this point. If cancer cells are found in the sentinel node, the rest of the lymph nodes in this area are removed and looked at, too. This is called a lymph node dissection.