NHS 24 Health Library

How is it performed?

There are many different ways of obtaining a biopsy sample. The method used depends on the type of tissue being collected and where in the body it is being taken from.

Scraping cells

In some cases, a scraping of the surface layer of cells can be enough to provide a sample for examination. This type of scraping biopsy can be uncomfortable but not painful so no anaesthetic is required.

A common example of this type of biopsy is the cervical smear test, which is a biopsy of the cells around a womans cervix (the neck of the womb). Every woman in the UK over the age of 25 is invited to have regular smear tests at their GP or local GUM clinic. A plastic or metal tube called a speculum is inserted into the vagina, and then a special stick called a spatula is used to gently scrape a sample of cells from the cervix. The sample cells are then tested for abnormal changes. If cell changes are found, it could be a sign that cancer may develop in the cervix (although the smear test itself is not a test for cancer).

Skin samples

A sample of the surface of the skin may be used to diagnose skin conditions, for example to investigate a mole that your doctor thinks may be cancerous. You may have a punch biopsy, when a special surgical instrument (a punch biopsy tool) makes a small hole in your skin and removes samples of the top layers of tissue. Alternatively, a scalpel (a small, sharp, medical knife) can be used to cut off a small amount of surface skin, and then the wound is stitched back together. A local anaesthetic is usually given to numb the area during these procedures.

Needle biopsy

To get a sample of tissue that is under the surface of the skin, a special needle can be pushed through the skin to the area that requires examination and used to suck out some tissue. A local anaesthetic is usually given to numb the area during these procedures so you cant feel any pain.

An ultrasound scan or series of X-rays may be used to guide the doctor or surgeon so that they direct the needle to exactly the right place.

A thin, hollow needle is used for some biopsies, such as examining breast lumps. This procedure is called fine-needle aspiration biopsy. The needle is pushed into the lump and a sample of the lump tissue taken for testing.

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 through your abdomen, and a small sample of tissue will be taken in a few seconds. You will usually have a local anaesthetic for this type of biopsy because you need to be awake to breathe in.

A thicker needle is also used to take samples of bone marrow. Bone marrow biopsies are usually taken from the top of the pelvis bone, just below your waist. You will usually have a local anaesthetic and some people also have a sedative (a drug to help them relax), to help them cope with any discomfort, nerves or anxiety.

Endoscopic biopsy

A doctor can use a thin, bendy tube with a lighted camera at the end (an endoscope) to see inside your body. Tiny cutting tools can be attached to the end of the endoscope to enable the doctor to take a sample of tissue.

An endoscope can be inserted through existing entry points in your body such as your throat or anus, or through small cuts that are purpose-made by a surgeon. An endoscopic biopsy may be performed under local or general anaesthetic, depending on where in the body the lump is located and the entry point used for the endoscope. Where the endoscope is inserted depends on the part of your body being examined. For example, it might be sent down your throat to look at your lungs, or through the vagina and cervix to look at your womb.

Capsule biopsy

Capsule biopsy is an alternative to endoscopic biopsy when a sample of the lining of the intestine needs to be taken. You swallow a small capsule attached to a thin tube and an X-ray is then taken to see when it has reached the correct point in your gut. When the capsule has reached the correct point, pressure is created in the tube, so that a small portion of the intestine lining is sucked into the capsule, and can be pulled back out of the body.

Excision biopsy
 
Excision means cutting out or removal. An excision biopsy is when surgery is performed to remove the whole of a tissue - usually a lump - which needs examining. This may be performed under local or general anaesthetic, depending on where in the body the lump is located.

If a lump is found during surgery, a sample of tissue can be frozen and a thin slice taken from the frozen block for immediate checking, while the surgery is still in progress. The surgeon can then use the results to decide on how best to proceed with the surgery and, if the patient is still under anaesthetic and has given consent, the entire lump may be removed immediately in some cases.