Biopsy: what it is and types (breast, prostate, cervix)

What is biopsy?

A biopsy is an examination performed on living material, taken from the patient’s body and analyzed in the laboratory. It is usually used to identify cellular and tissue changes, complementing imaging and biochemical tests.

It offers a precise image of the analyzed material, which can be skin, saliva, mucosa, pieces of organs or even whole organs.

This is an accurate examination that checks the integrity of cells. It can indicate cancers, infections and other conditions, giving details about several particularities of the disease, such as the stage of the cancer , its aggressiveness, or, in the case of infections, what type of bacteria is causing the disease.

The biopsy is not an exclusive cancer test , so if your doctor asks for one, ask him or her why. He will be able to answer your questions and explain your specific case.

What is the biopsy for?

Biopsy is a detailed and accurate examination. Several diseases cannot be diagnosed by imaging and blood tests alone, and some can even be identified, but the certainty of what the results represent only arises when there is a biopsy.

The exam looks at the appearance of cells and tissues and can describe the extent of a cell injury, changes in cells and the malignancy of a possible cancer.

In addition, it is able to differentiate conditions that are very similar when excluding those that do not modify cells (or those that modify, if the cells are normal), among other things.

 

Some of the diseases that this exam can identify are:

Cancer

All cancer is a change in cell tissue and can only be properly identified through biopsy, which closely analyzes the condition of cells.

An image exam, such as an ultrasound or an MRI scan, can identify a tumor or uneven growth, but only a biopsy can tell whether this tumor is benign or malignant.

Infections

Several types of infection can be found through this type of examination. For example, bacteria like H. pylori  can be diagnosed through endoscopic biopsy. The bacteria can be observed directly in this method of examination.

Infection with the human papilloma virus, HPV , is diagnosed through uterine biopsy, which examines cells in the uterus for the virus.

Autoimmune diseases

Autoimmune diseases can be diagnosed by biopsy. For example, autoimmune hepatitis causes cirrhosis , but does not leave the cells with signs common to alcohol consumption and other common causes of cirrhosis. This lack of signs, along with other symptoms, indicates an autoimmune disease.

How is the biopsy done?

Biopsy is always a surgical procedure, depending on the type, more or less invasive. Hospitalization is rarely necessary. For the realization, it is necessary to have the withdrawal of the material to be analyzed. Each type of material has a different type of biopsy, which changes according to the way it is collected.

Once the material is acquired, it is placed in formaldehyde and taken to the laboratory for analysis. Some techniques can take up to an entire month while others need only a few days to work.

The pathologist  does the exam. The fabric is dipped in paraffin so that it can be cut into thin microscopic slices in which dye is added. These slices are placed on glass plates that are observed under the microscope in search of changes in relation to the normal cells of that tissue.

From this observation under the microscope, it is possible for the pathologist to see cellular changes, bacteria, signs that bacteria were there, in addition to being able to add chemical materials for specific reactions to happen, identifying compounds that would not be there unless a specific condition was present.

The surgeon himself can perform a biopsy on the operating table, thus achieving an approximation of the result, but the definitive diagnosis is only acquired after a few days, when more specific tests are made.

Types

There are several types of biopsy, each varying in the way of extraction and in the type of cells that are removed for the exam. The types are:

External biopsy

Usually performed on the skin or mucosa, the external biopsy is superficial. Skin cancers are usually diagnosed through this type of examination, which cuts a small piece of tissue under suspicion.

Internal biopsy

This type of biopsy removes tissues from Organs internal organs. For this type of examination, incisions, blind puncture (often using touch), guided by image (ultrasound) or endoscopy can be performed.

Extemporaneous or perioperative biopsy

This type of biopsy is performed during surgery. It can be done while removing a tumor suspected of being cancer, for example, or of a cancer that has not yet been fully identified. It also serves, for example, to identify infections.

Incisional biopsy

An incisional biopsy removes only part of the lesion. It can be done on skin cancers or internal tumors whose complete removal can be risky. In these cases, a benign tumor that does not show rapid growth does not need to be removed, but a malignant tumor may be worth the risk of removal. Only after the autopsy will you be sure.

Excisional biopsy

An excisional biopsy is performed in all cases of surgical removal of tumors and cancers, whether from the skin or any organ. The complete lesion is removed for examination.

In the case of cancer, a safety margin is removed next to the tumor, to ensure that no small part has been left behind, causing the disease to return.

Aspiration biopsy

Aspiration biopsies use a needle and syringe to remove part of the tissue for examination. It is possible that it is performed by touch or ultrasound to identify the region to be examined. This type of biopsy is divided into two types:

Fine needle puncture and aspiration (FNAP)

This puncture removes cells and liquids from tumors, often from glands such as the thyroid or the breast. This test is quick and not very painful, and can be performed without anesthesia. A fine needle is inserted into the tissue to be examined and the contents are drawn into a syringe.

The disadvantage of this type of biopsy is that because it is a fine needle, little material can be collected and the accuracy is low.

Puncture and aspiration with thick needle (PAAG)

Unlike the previous one, this type of puncture uses a thicker needle, capable of removing pieces of more than 1 cm. Local anesthesia is used for needle insertion and three to six glandular samples are taken for accurate diagnosis.

An automatic pistol suitable for the examination can be used.

Freezing biopsy

This type of examination seeks a quick diagnosis in order to preserve cell characteristics through freezing.

The chosen tissue is frozen and extracted during the surgery, in the operating room itself, then taken to the pathological laboratory to perform the staining and cut into slices for the exam, which will bring a quick result so that the decision to remove or not be taken of the affected organ.

It is customary to add a safety margin when the objective is simply the removal of a possible tumor and not a quick decision.

After thawing, the tissue is analyzed again to confirm results.

What are the most frequent biopsies?

Some biopsies are more famous and frequent than others, so it’s worth learning a little bit about them. Are the following:

Prostate biopsy

Prostate biopsy consists of extracting a piece of the organ to perform the tests, often in search of evidence of prostate cancer , but it may involve several other conditions.

Breast biopsy

In search of a diagnosis of breast cancer , a biopsy can be performed by extracting a piece or the entire tumor.

Bone marrow biopsy

Bone marrow is a gelatinous liquid that is inside the bones. It is there that blood cells (red blood cells), platelets and white blood cells (part of the immune system) are produced. This test can identify anemias, lymphomas, myelomas and find cancer metastases.

Endoscopic biopsy

Endoscopic biopsy is performed through endoscopy, an examination where a camera is inserted through a tube through the patient’s throat, seeking visualization of the esophagus and stomach, in addition to the duodenum, the first portion of the small intestine.

This type of biopsy serves to find, for example, the bacterium H. pylori , which can cause stomach cancer.

Cervical biopsy

The biopsy of the cervix is ​​usually performed through curettage . It is a scraping of the uterus, in order to remove tissue so that it can be examined under a microscope. It serves to diagnose tumors or HPV infection.

Skin biopsy

A piece of skin can be scraped for a biopsy in order to identify infections and tumors in the skin, giving precision to the diagnosis of the possible disease.

When should the biopsy be done?

Biopsy is not indicated only when cancer is suspected. Several other diseases can be diagnosed by it. Biopsy is indicated when cell alterations are suspected, which can be caused by, in addition to tumors, bacteria and other types of infection or diseases.

Cirrhosis and hepatitis B and C can be diagnosed through this test, in addition to kidney problems, uterine and stomach infections, among others.

In addition, biopsy can be used to identify dermatitis and for differential diagnosis, which seeks to identify a disease when there are two suspicions with similar symptoms.

Contraindications

There are some cases in which biopsy should not be performed or is not recommended. Are they:

Uncontrolled diabetes

Patients whose diabetes is not controlled cannot perform surgical procedures, which prevents the biopsy.

This happens because, when the condition is not controlled, circulation problems caused by diabetes can limit the patient’s regeneration and healing, leaving him susceptible to infections and necrosis of the region affected by the surgery.

Definitive clinical diagnosis

Because it is an invasive procedure, biopsy is avoided when possible. If there is a certainty of what the diagnosis is without the examination, it should not be done as it is unnecessary.

Lack of biosafety

Biosafety are the procedures that guarantee the safety of the patient and those who perform the exam, in addition to the care with the collected material. When these criteria cannot be achieved, biopsy is not recommended.

Adverse effects

Some adverse effects of the biopsy can be expected since it is a surgery. Are they:

Ache

In some cases, the site from which the tissue is removed may experience pain that varies in intensity. Rest may be necessary, as well as pain medications in the most severe cases.

More invasive surgeries are more likely to experience pain as a result of tissue extraction.

Bleeding

There may be bleeding at the extraction site. It should end quickly, but if it doesn’t, a doctor should be consulted.

Inflammation

An inflammation is possible in the region where the tissue was extracted and this can be a sign of an onset of infection. If there is persistent redness, consult your doctor.

Infection

Infections are common in open cuts that are not well taken care of by both the patient and the medical team. If there are symptoms of infection, it is important to contact a doctor to prevent it from developing or spreading.

Scar

Depending on where and how big the cut was, there may be scar tissue after biopsy surgery.

Pre-examination and post-examination care

Everything depends on the type of biopsy that will be performed, since what defines the preparations is anesthesia.

Local anesthesia

In cases where anesthesia is local, it is likely that no preparation needs to be done. The doctor will ask about allergies, family history and look for skin infections to ensure that no unwanted microorganisms are taken into the body with the needle, but in general, the procedure is quick and smooth.

It is important not to force the affected area by inserting the needle or scraping material and to keep the area clean.

Fasting before the procedure can be ordered by the doctor.

Sedation

Sedation is the alteration of consciousness so that a medical procedure can be performed. It is different from general anesthesia, although someone who is anesthetized is also sedated.

Sedation can vary in intensity, being mild or deep. For biopsy, sedation can be used to remove tissue. Some anesthetists may prefer to perform general anesthesia. The type of extraction may also require this type of sedation, for example open cavity surgery.

When the procedure is more invasive and needs sedation, some care must be taken. Are they:

  • Inform your doctor of allergies;
  • Fast in the hours before the procedure (according to the doctor’s instructions);
  • Avoid blood thinning medications (such as aspirin);
  • Follow the doctor’s instructions.

Post-biopsy care

After biopsy, healing is necessary. The incision site should be cleaned daily until healing is complete. Some cases may require the use of antibiotics to prevent infections.

How to interpret the results?

Biopsy reports can be extensive and complicated. A lot of information can be present in these results, technical words from the medical field can be used and the most suitable for the interpretation of these exams is that your doctor sees and explains them.

In addition to having the pathological information, he also knows your case and can apply the results to your particularities. Among the information contained in the report are usually:

Clinical information

Clinical information is the patient’s history and information. The doctor, when requesting the biopsy, also sends information relevant to the diagnosis such as age, sex, diseases that the patient has and family history. These details can make a difference in the result.

Macroscopic description of the sample

The description of the sample is made by the pathologist, who will describe the material received. The size of the tissue removed, appearance, type of extraction, consistency, color and other information that vary depending on the type of sample.

For example, an entire tumor removed from a lung will have the tumor dimensions in its description, while a liquid sample may have in its description only the color and quantity of material.

Microscopic description of the sample

In the microscopic description, the cells visualized under the microscope are described. How different they are from healthy cells is one of the diagnostic criteria. Other descriptions such as the extent of the lesion, disposition of the injured cells and infiltrations, if any, are also carried out.

If there are other studies, they may have their own section or be described under microscopy.

Diagnosis

The most relevant part is the pathologist’s diagnosis. If the diagnosis is cancer, this section will describe the degree, stage, exact type of cancer and other information that may be relevant to your doctor, so that he can give you the appropriate treatment.

Pathologist Comments

The pathologist may leave comments on the report, expressing concerns or giving recommendations for other tests that may be necessary or indicated.

What can affect the results?

There are no foods or behaviors that you can have before a biopsy that will greatly influence the outcome. The cells are usually analyzed and hardly anything that is ingested or an effort will cause major cellular changes in a few hours, so there is not much need for care like these.

What affects results the most, however, is the sample size and collection. The place from which the biopsy sample is taken also influences its result, as well as the amount of material collected. The larger the area, the more accurate the examination can be.

In addition, the pathologist needs to be very attentive during the analysis, as he will check several cells and their appearance, which can be tiring and laborious.

Scratchs

Like any surgical procedure, biopsy has risks. Following the doctor’s instructions and informing everything necessary – such as allergies and family history – to him and the anesthesiologist greatly reduces the risks, among which are:

Bleeding

Depending on the type of test, bleeding can be a risk. It is more common in open cavity and prostate biopsies, although it is possible in the vast majority. Even so, it is not a frequent complication.

Infections

The materials used for biopsies must be sterilized before the procedure, so infections are rare, but it is a possibility.

Allergic reactions

Anesthesia allergy is a rare possibility, but the anesthesiologist must be prepared to deal with the situation.

Price

The price of a biopsy is extremely variable. This is because depending on the suspicions, more or less resources may be needed for the exam. In addition, biopsies on different organs have different prices. A breast biopsy is around R $ 900, while a prostate biopsy can reach R $ 1,500.

However, this exam is made available by the Unified Health System (SUS) free of charge, requiring only a medical report and referral.

Common questions

Biopsy only serves for cancer?

No!  Biopsy can be used for various diagnoses, seeking to find lesions and cellular changes, in addition to the presence of bacteria.

It hurts?

It depends on the type of biopsy. Most types are a bit invasive, so sedation is often used, and can vary from local to general anesthesia from case to case.

FNAP does not always use local anesthesia as the needle is very thin and sometimes the anesthesia can be more painful, but usually the maximum pain you feel is from the anesthesia, which is not very intense.


Biopsy is an essential test for finding cellular changes, especially those caused by cancer, but the test is not limited to that. Share this text with your friends so that they learn a little more about biopsy!

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