Biopsy, General

Biopsy

Posted on by Prof. Dr. Özgür KILIÇKESMEZ

A biopsy is a medical procedure in which a tissue or cell sample is collected for microscopic examination. It is widely used to confirm or exclude cancer, infections, or inflammatory conditions, providing essential diagnostic accuracy in clinical practice.

Different types of biopsy include fine-needle aspiration, core needle biopsy, and excisional biopsy. The choice depends on the suspected disease, organ involved, and the level of diagnostic precision required by the physician.

Biopsy complications are uncommon and usually minor, such as local bleeding, mild infection, or temporary discomfort at the sampling site. Modern imaging techniques have increased biopsy safety and diagnostic yield.

Biopsy plays a crucial role in early detection and treatment planning of many diseases. By providing definitive pathological information, it guides therapeutic decisions and ensures appropriate patient management.

What Is a Biopsy?

A biopsy is a procedure used by doctors to diagnose diseases by taking tissue samples from the body. With this method, a suspicious mass or tissue can be examined clearly. It is generally performed for the accurate diagnosis of various diseases, especially cancer. The method varies depending on the type and location of the disease:

Needle biopsy:

A small tissue sample is taken using a fine needle.

Excisional biopsy:

The entire suspicious tissue is removed.

Incisional biopsy:

Only a part of the tissue is removed.

How Is a Biopsy Performed?

Biopsy plays a key role in diagnosing diseases. A tissue or cell sample is taken from the body and examined under a microscope. This process is performed using different techniques depending on the type and location of the tissue. Types and characteristics of biopsy are as follows:

Needle Biopsy

Fine Needle Aspiration:

Fluid and tissue samples are taken from the tumor using a thin needle. It is performed under local anesthesia and, when necessary, with imaging techniques.

Core Needle Biopsy (Full-Thickness/Tru-cut Biopsy):

A thicker needle is used to remove a small tissue cylinder. This procedure is also performed under local anesthesia and is generally preferred for deeper tissues.

Endoscopic Biopsy

An endoscope is inserted into the body for visual examination of internal organs. This device is equipped with small cutting tools to obtain tissue samples. The procedure can be performed via the mouth, anus, or through small incisions.

Why Is a Biopsy Performed?

Biopsy is an important tool that enables doctors to understand diseases. Cell and tissue samples taken from the body are examined under a microscope to provide valuable information about health status. This process is especially vital for diagnosing certain health issues.

Cancer:

To identify various types of cancer and assess the aggressiveness and spread of the disease.

Infections:

To detect infections caused by various microorganisms.

Inflammatory or Autoimmune Diseases:

To clarify conditions where the body mistakenly attacks its own tissues.

Other Diseases:

To reveal health problems such as amyloidosis that cannot be detected by other tests.

What Are the Preparations Before Biopsy?

Preparations before the biopsy procedure are very important for patient safety and the success of the procedure. First, medication management should be considered. Some medications such as blood thinners are stopped a few days before the procedure upon the doctor’s recommendation. Also, the doctor must be informed about other medications being used.

Fasting may vary depending on the type of biopsy. Some procedures require the patient to avoid food and drink for a certain period. The doctor’s instructions on fasting must be followed.

Antibiotics may be required for some types of biopsy to reduce the risk of infection. Especially in procedures such as prostate biopsy, antibiotics recommended by the doctor must be taken for the specified duration.

The patient’s medical history, allergies, and current conditions should be reported. This information is used to assess potential risks that may arise during the procedure.

How Are Biopsy Results Interpreted?

The biopsy process first involves sampling tissue. Various techniques are used at this critical step, and the sample is sent to the pathology laboratory. Processes that begin in the laboratory extend to detailed microscopic examination. Here, the pathologist stains tissue sections to increase contrast and make cell structures more prominent. At the end of the examination, the pathologist presents the findings in a report.

The pathology report is the main document in which biopsy results are interpreted and includes the following details:

Diagnosis:

Determines whether the sample is normal, inflamed, infected, or cancerous.

Cell Type:

Explains the type of cells observed and any abnormalities present.

Grade (Stage):

In cancer, evaluates how aggressive the cells are on a scale from 1 to 4.

Margins:

Provides information on whether cancer cells are present at the edges of the sample.

Advanced Tests:

Tests such as immunohistochemistry that provide further information about the disease are included in the report.

What Is the Recovery Process After Biopsy?

The recovery process after biopsy varies according to the type of procedure. Most of these procedures are performed under local anesthesia, and patients can usually return home afterwards. The biopsy area should be kept clean and dry to reduce the risk of infection. The recovery process varies depending on the type of biopsy performed:

Skin Biopsy:

  • Minimal discomfort.
  • Recovery is usually fast.

Internal Organ Biopsy (e.g., liver or kidneys):

  • May require hospital admission.
  • Careful monitoring for internal bleeding is essential.

Bone Marrow Biopsy:

  • Mild pain and discomfort are common.
  • Rest is recommended.

Mild pain may occur afterwards; these are generally manageable with prescription painkillers. During the recovery process, patients are advised to follow these steps:

Rest:

Keep activity levels low for the first 24–48 hours.

Monitoring:

Watch for signs of infection or excessive bleeding at the biopsy site.

Pain Management:

Take prescribed painkillers as directed by the doctor.

Follow-up:

Attend scheduled follow-up appointments for biopsy results and further care.

Is a Biopsy Painful?

The pain experienced during a biopsy varies according to the type of anesthesia used and the biopsy method. In procedures performed under local anesthesia, patients generally feel only mild pressure. Sensitivity at the biopsy site differs depending on the type of biopsy:

Needle Biopsies:

  • Fine needle aspiration
  • Core needle biopsies

A short sting may be felt during anesthesia injection in needle biopsies. After the procedure, mild bruising and pain may occur, which can be easily managed with over-the-counter painkillers.

What Are the Risks of Biopsy?

Biopsy procedures are among the most frequently used diagnostic methods in medicine. However, as with any medical procedure, biopsy also carries certain risks. Risks vary depending on the region and method of the biopsy.

Bleeding and Bruising:

Needle biopsies often cause mild bleeding and bruising. More invasive biopsies may cause more severe bleeding.

Infection:

Although rare, infection may occur, especially with biopsies of internal organs. In such cases, antibiotic therapy may be applied to prevent infection.

Pain and Discomfort:

Pain lasting several days after a biopsy may occur. These pains are generally manageable with simple painkillers.

Damage to Surrounding Tissues:

Biopsies requiring surgical intervention may carry a risk of damage to surrounding tissues.

Allergic Reactions:

Allergic reactions to anesthesia or other medications may occur; these are rarely encountered risks.

Hematoma:

Hematoma, caused by blood leaking outside the vessel, can lead to swelling and discomfort.

Nerve Damage:

Biopsies performed in areas with high nerve density may cause temporary or permanent nerve damage.

Pneumothorax:

There is a risk of lung collapse during lung biopsies, which requires additional treatment.

Tumor Cell Seeding:

Although very rare, there is a risk of cancer cells spreading during biopsy.

When Are Biopsy Results Available?

The time to receive biopsy results varies depending on the type of procedure and the details of the samples examined. Basically, the methods and time frames for preparing biopsy results are as follows:

Needle biopsy:

This type of biopsy is usually the fastest to yield results. Results are generally available within one to three days.

Surgical biopsy:

As this procedure involves collecting larger tissue samples, results may take a little longer. It usually takes up to a week.

When Is a Biopsy Not Performed?

There are certain situations where biopsy is not the preferred diagnostic method. If advanced imaging technologies and noninvasive tests provide sufficient information, this procedure is avoided. In addition, diagnostic markers in some chronic diseases may clarify the nature of the disease, making biopsy unnecessary.

Low Diagnostic Yield:

If sufficient diagnostic information is already available, biopsy is not recommended.

High Risk of Complications:

If there are serious risks such as bleeding, the procedure may be avoided.

Alternative Diagnostic Methods:

If necessary diagnostic information can be obtained with less invasive methods, biopsy is not performed.

Advanced Stage of Disease:

If the disease is advanced and the biopsy result will not contribute to treatment, biopsy is unnecessary.

Patient Refusal:

If the patient is informed and refuses the procedure, biopsy is not performed.

Previous Diagnosis:

If diagnostic information obtained previously shows that a new biopsy is not needed, biopsy is not recommended.

Some Benign Conditions:

If a clear clinical diagnosis has been made and it will not change treatment, biopsy is unnecessary.

What Should Be Considered After Biopsy?

The post-biopsy period directly affects the quality of patient recovery. The main points to be considered during recovery include carefully following rest and personal care routines. The first 24 to 48 hours are especially important and rest is essential during this period. To conserve energy and allow the body to recover, avoid heavy physical activities.

Rest and Activity:

  • Resting for the first two days contributes to the body’s recovery process.
  • Avoid heavy exercise to allow the biopsy site to heal.

Pain management is critical for a comfortable recovery. Mild discomfort can be managed with over-the-counter painkillers.

Keeping the biopsy area clean and dry reduces the risk of infection. While small amounts of bleeding are normal, increased redness or discharge should prompt an immediate consultation with a doctor.

Bleeding and Infection:

  • Keep the area clean and dry to reduce infection risk.
  • Consult a doctor if you notice increasing redness or fever.

The evaluation of biopsy results and planning of further tests is carried out by examining the pathology report. The report details cell structures and any abnormalities found in the tissue sample.

Follow-up and Pathology Report:

  • Results are usually ready within a few days.
  • The report determines further tests or treatment options.

Each type of biopsy requires specific post-procedure care. For example, cold compress is useful after a breast biopsy, while light activity is recommended after a prostate biopsy.

Specific Biopsy Types:

  • Apply a cold compress after breast biopsy to reduce swelling.
  • Rest and opt for light activities after prostate biopsy.

Which Diseases Are Diagnosed by Biopsy?

Biopsy plays a major role in the early diagnosis of serious health problems. Many diseases and conditions can be identified with this method, among which cancer types stand out. Especially skin cancer can be easily detected with excisional biopsy, which allows access to deeper tissues. Life-threatening diseases such as breast cancer and lung cancer are also identified by needle and surgical biopsy methods.

Cancers:

Skin cancer:

Excisional biopsy.

Breast cancer:

\Needle and surgical biopsy.

Lung cancer:

Needle biopsy.

Lymphoma:

Lymph node biopsy.

Prostate cancer:

Prostate biopsy.

Leukemia:

Bone marrow biopsy.

In infectious diseases, biopsy allows direct observation of the causative agents. Viral diseases such as hepatitis can be detected with liver biopsy, and bone infections such as osteomyelitis can be diagnosed with bone biopsy.

Infectious Diseases:

Hepatitis:

Liver biopsy.

Bone infections:

Bone biopsy.

Inflammatory and Autoimmune Diseases:

Dermatitis:

Skin biopsy.

Muscular dystrophy:

Muscle biopsy.

Autoimmune Diseases:

Organ-specific biopsies.

Gastrointestinal and kidney diseases are also diagnosed by this method. Intestinal disorders such as celiac disease and Crohn’s can be clarified with colon biopsy, while kidney inflammation and failure are diagnosed with kidney biopsy.

Gastrointestinal Diseases:

Celiac disease:

Intestinal biopsy.

Crohn’s disease:

Colon biopsy.

Kidney Diseases:

Kidney inflammation and failure:

Kidney biopsy.

Neurological disorders and reproductive system conditions are also investigated by biopsy. Nerve and muscle biopsies are used for neuromuscular disorders, and endometrial biopsy is used for endometrial cancer and endometriosis.

Neurological Conditions:

Neuromuscular disorders:

Nerve or muscle biopsy.

Reproductive System Conditions:

Endometrial cancer and endometriosis:

Endometrial biopsy.

Male infertility:

Testicular biopsy.

What Is the Accuracy of Biopsy Results?

The accuracy of biopsy results varies according to the method used and the features of the condition examined. This variability is more pronounced in specific cases such as thyroid nodules and soft tissue tumors. Despite advances in technology, the accuracy of fine needle aspiration biopsy for thyroid nodules has not changed significantly over the years.

Fine Needle Aspiration Biopsy for Thyroid Nodules:

For soft tissue tumors, sensitivity rates vary according to the type of biopsy used. Incisional biopsy generally provides higher sensitivity than core needle biopsy.

For Soft Tissue Tumors:

  • Core Needle Biopsy Sensitivity: 97%
  • Incisional Biopsy Sensitivity: 96%
  • Accuracy for incisional biopsy under general anesthesia: 97.6%

For thyroid nodules, ultrasound-guided fine needle aspiration biopsy generally yields more accurate results than those guided by palpation.

What Tests Are Performed Before Biopsy?

Tests performed before biopsy aim to improve the safety and efficacy of the procedure. These preparations reduce potential risks and maximize the accuracy of the biopsy.

Blood Tests:

The patient’s bleeding tendency is assessed. Specific tests such as prothrombin time and international normalized ratio are used for this purpose. These tests measure the rate at which blood clots.

Imaging Tests:

Various imaging techniques are used to clearly identify the area to be biopsied. Methods include X-ray, CT scan, MRI, and ultrasound. These tests are critical for accurately identifying tissues in sensitive areas.

Review of Medical History and Medications:

The patient’s health status and medications are evaluated to manage bleeding risk. Especially the use of anticoagulant drugs is managed by the doctor.

Fasting and Anesthesia Preparation:

The duration of fasting required depends on the type of anesthesia. This is done to prevent potential complications during anesthesia.

Physical Examination:

The patient’s overall health and the physical conditions of the biopsy site are evaluated.

How Are Biopsy Samples Examined?

The examination of biopsy samples is a meticulous and multi-step process. First, the biopsy tissue is placed in small containers and fixed overnight. This stage allows the tissue to become a solid block in paraffin wax. These blocks are then cut into thin sections with a microtome and transferred to glass slides.

During the staining stage, tissue slices are processed with various dyes:

  • Stains such as hematoxylin and eosin (H&E) are used to highlight cell structure.
  • Immunohistochemistry (IHC) is performed with antibodies to detect specific proteins in cells.
  • Flow cytometry analyzes the physical and chemical properties of cells.

These staining techniques allow for more detailed examination of tissue sections under the microscope. Pathologists examine these sections in detail to detect abnormalities in the cells and identify the type of disease. In addition, special tests allow more specific classification of diseases such as cancer.

Special tests include:

  • Electron microscopy shows intracellular structures with ultra-high resolution.
  • Genetic and genomic tests analyze genetic changes and gene expression patterns.

Needle Biopsies

Needle biopsies are important diagnostic tools as minimally invasive techniques. Fine and core needle biopsies serve different medical needs. Fine needle aspiration biopsy is usually supported by imaging techniques such as ultrasound. This method is preferred for examining smaller structures such as the thyroid and lymph nodes. On the other hand, core needle biopsy allows the removal of larger tissue samples; it is ideal for more detailed examinations in organs such as the prostate, liver, and breast.

Advances in technology have increased the accuracy and reliability of needle biopsy. In particular, improvements in imaging technologies have significantly enhanced the sensitivity of the procedure. Guidance technologies enable more precise targeting of the tissue and reduce the risk of complications.

The clinical effectiveness of needle biopsy applications continues to increase. These methods are indispensable for the diagnosis of diseases at early stages. High sensitivity and specificity rates make needle biopsies essential, especially in cancer diagnosis.

Technological integrations and research are further expanding the potential of needle biopsies:

  • Use of deep learning algorithms
  • Integration of real-time ultrasound monitoring

These innovations contribute to shorter procedure times and increased diagnostic accuracy.

Market trends show that demand for needle biopsy techniques is increasing. The prevalence of chronic diseases such as cancer further highlights the importance of early diagnosis. In 2022, the US biopsy market reached a value of \$16.43 billion, and it is projected to reach \$21.40 billion by 2028. This growth is supported by technological advancements and the increasing need for early diagnosis.

Surgical Biopsies

Surgical biopsies hold a central place in the medical diagnostic process. They are used with great precision, especially in the diagnosis of serious diseases such as cancer. Tissues obtained by this method are sent to laboratories for pathological examination.

The evolution of techniques has made diagnostic processes more effective. In addition to traditional incisional and excisional biopsy methods, advanced technologies have also come into play. For example, image-guided biopsies performed using ultrasound, CT, and MRI allow more precise localization of tissues.

Skin Biopsies

Skin biopsies are indispensable tools in the diagnosis of skin diseases. Today, skin diseases are diagnosed more effectively using various biopsy techniques. Thanks to advanced biopsy methods, suspicious lesions on the skin are examined in detail. These methods include:

Shave biopsy:

A thin slice is taken from the superficial layer of the skin.

Punch biopsy:

Used for deeper tissue samples and provides a cylindrical section.

Excisional biopsy:

The entire suspicious lesion is removed without damaging the surrounding tissue.

Bone Marrow Biopsy

Bone marrow biopsy is considered an important diagnostic tool in medicine. It is indispensable in diagnosing hematological diseases. With this procedure, doctors can accurately evaluate changes occurring in the bone marrow.

Technological advances have made bone marrow biopsy procedures more effective. Advanced imaging techniques and artificial intelligence applications increase the sensitivity of the procedure and improve the diagnostic process.

Endoscopic Biopsy

Endoscopic biopsy is a prominent in-depth diagnostic tool in modern medicine. It is especially essential in the diagnosis of gastrointestinal system and liver diseases. This method offers less pain and a faster recovery process for patients because it is minimally invasive. Fine needle aspiration and fine needle biopsy performed under endoscopic ultrasound allow detailed examination of the internal structure of tissues and organs.

Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA):

  • Ideal for examining gastrointestinal lesions and lymph nodes.
  • High accuracy rates, especially up to 98% for pancreatic and liver lesions.

Endoscopic Ultrasound-Guided Fine Needle Biopsy (EUS-FNB):

  • Larger tissue samples are obtained from solid masses.
  • Provides richer information for histological examination.

Technological advances have increased the accuracy and safety of endoscopic biopsy methods. New generation needles and real-time imaging techniques allow accurate access to lesions. Thus, false positive or negative results are prevented, and correct diagnosis is facilitated. Innovative designs such as Franseen and fork-tip needles greatly improve the quality of samples obtained during biopsy.

Image-Guided Biopsies

In modern medicine, biopsy procedures are performed with the guidance of various imaging techniques, greatly increasing diagnostic sensitivity. Imaging methods allow doctors to accurately target even previously hard-to-reach areas. Technologies such as ultrasound, computed tomography, and magnetic resonance optimize needle placement for difficult-to-reach areas.

With these technologies, high-precision tissue sampling can be performed even in deeply located areas such as the abdomen and spine. The relevant techniques include:

Ultrasound:

Commonly preferred for breast and thyroid lesions.

Computed Tomography (CT):

Used for abdominal, spinal, and other deep tissue lesions.

Magnetic Resonance Imaging (MRI):

Prominent in the examination of soft tissue and nerve tissues.

Digital Breast Tomosynthesis (DBT):

Effective in detecting non-calcified lesions in breast cancer diagnosis.

Lymph Node Biopsy

Lymph node biopsy holds a very critical place in cancer diagnosis. With this procedure, doctors determine the spread and stage of the disease. Sentinel lymph node biopsy (SLNB) is particularly prominent in serious cancers such as breast cancer and melanoma. Advances in technology have increased the sensitivity of this procedure, allowing for more accurate results.

Heart Biopsy

Heart biopsy is important in diagnosing cardiovascular diseases. It usually starts with samples taken from the right ventricle; occasionally, the left ventricle is targeted. The bioptome used for this procedure ensures tissue samples are taken from the right place. Electroanatomic mapping and advanced imaging techniques guide the biopsy and increase diagnostic efficiency.

Advanced Imaging Techniques:

  • Cardiac magnetic resonance (CMR)
  • 18F-FDG PET scans

These techniques detect changes such as myocardial fibrosis, edema, and inflammation. Electroanatomic mapping plays a critical role in identifying the most affected regions. Developments in bioptomes have increased sensitivity and reduced the risk of complications. Intraoperative imaging during the procedure further enhances safety.

Endometrial Biopsy

Endometrial biopsy involves taking a tissue sample from the inner lining of the uterus. This procedure is used especially for evaluating abnormal bleeding and cellular abnormalities. Thanks to technological advances, endometrial biopsy procedures have become less invasive and patient experience has improved.

Technological Developments:

Newly developed minimally invasive techniques and advanced imaging technologies increase the accuracy of the procedure. Transvaginal ultrasound and hysteroscopy make sampling more precise.

Diagnostic Tools:

Detection of genomic biomarkers and molecular diagnostics are especially used for early diagnosis of endometrial cancer. These tools enable faster detection of the disease.

Open (Surgical) Biopsy

Open surgical biopsy holds an important place in clinical practice. This method, preferred in situations requiring in-depth pathological examination, minimizes the risk of misdiagnosis. Complication risks such as bleeding and infection require careful implementation of this method. The recovery process may be longer than with other types of biopsy.

Open biopsies are generally preferred in the following situations:

  • Diagnosis of breast cancer,
  • When needle biopsy results are inconclusive,
  • For lesions in organs such as liver, lung, and lymph nodes.

Reflectance Confocal Microscopy (RCM)

Reflectance Confocal Microscopy (RCM) is an innovative imaging technology in dermatology. This technique plays a critical role in dermatological diagnosis by providing high-resolution visualization of living tissues. This non-invasive method is an important tool for early diagnosis of skin cancers and inflammatory diseases. It illuminates the skin tissue with near-infrared light, and the reflected light is used to form a detailed image. This technology is effective especially in examining challenging skin conditions.

The use of the technology provides high accuracy in diagnosing skin cancer cases. With a sensitivity of about 95.3% and a specificity of 83.9%, RCM stands out as a reliable method in diagnostic processes. It is especially valuable for examining lesions that are difficult to detect with dermoscopy and visual examination.

Son Güncellenme: 3 September 2025

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