Tissue Test: Biopsy Fundamentals and How to Prepare for One
A biopsy is also known as a human tissue test. Simply put, a sample of your body's tissue will be taken for tests and close examination. Just the sound of that can be a bit alarming. Your doctor is going to remove living tissues from your body after all and that sounds something really serious.
What is a Tissue Test or Biopsy?
A tissue test may be required by your doctor for further assessment. It's called a biopsy because they are going to take a very small sample of living tissue. This medical procedure is usually recommended by a doctor if the initial tests that were performed for you may hint that there are cells or bodily tissues that are not normal.
Physicians make use of a variety of terms to refer to these abnormally growing tissues in our bodies. You may have heard some of them already. They may call it a mass, a tumor, or a lesion.
Remember that these are general terms. Your doctor (or any other health worker for that matter) will use them to emphasize the fact that the nature of the tissues being tested is unknown.
These terms also denote that these tissues are suspicious, which is why your doctor will order a tissue test. Other than a physical examination, another option is via an imaging test. If that doesn't help then a tissue test will become necessary.
Why Would a Doctor Suggest or Require a Biopsy?
Your doctor, a pathologist, or other medical expert may require tissue tests for patients who are experiencing symptoms that are usually associated with any type of cancer. If your doctor has pin pointed an area on the body that is suspect then a tissue test will be ordered.
A biopsy or tissue test is necessary to determine if the mass of abnormally growing bodily tissues is cancerous or not. Take note that a biopsy is currently the only sure way to properly and accurately diagnose the majority of known cancers.
As it was mentioned earlier, there are other methods such as imaging tests but they are not as accurate. Some of these imaging tests include X-rays and CT scans. They can help identify certain suspect areas on the body but they can't identify or confirm the presence of cancerous or non-cancerous cells.
Don't Panic-It Doesn't Mean You Already Have Cancer
When your doctor brings you the gloomy news that a biopsy will be required a lot of people will feel certain apprehensions. Of course that kind of thing can make anyone worry, right?
However, you should relax and be patient. It doesn't automatically mean that you already have cancer. Just because a medical condition warrants a tissue test that you have a life-threatening condition. The best course of action is to learn more about the procedure that will be performed. The more you understand it the less worrisome it becomes.
A tissue test will determine if the abnormal growth of tissue is caused by cancer or something else. Yes, other medical conditions can also cause such growths.
Here's a common example. After a physical breast exam, a woman finds that there is a lump growing in one of her breasts. Her doctor orders an imaging test to confirm the growth in her breast.
The image test will determine if there is a growth underneath and nothing more. If there is undergrowth there, her doctor will then require a tissue test. If not then there is no need for one.
If it is confirmed through the image tests that lump is a growth tissues that aren't normal, then the biopsy will determine if it is caused by cancerous cells or not. An example of a non-cancerous condition that can cause lumps to form is polycystic fibrosis.
Other Purposes of Biopsies
Most doctors will use biopsies in order to find cancer cells. Apart from that, these tissue tests can also be used to identify other conditions as well.
These tests answer a lot of important medical questions. Here are a few examples:
- If a patient has chronic hepatitis, a biopsy can be used to determine the presence of cirrhosis.
- It can be used to check for the presence of melanomas when a mole on the skin has recently changed shape, size, or form.
- Doctors can use biopsies to check for the probability of breast cancer in case a mammogram displays a mass or lump.
- Biopsies can also be used to check bodily tissues that appear to be normal. This type of tissue test is used to test whether a newly transplanted organ has been accepted by the host or if it is rejected.
Note that in most cases when your doctor orders a biopsy, your medical practitioner is using it as a diagnostic tool in order to determine the best mode of therapy.
One of the methods of conducting a biopsy is via open surgery. That is one way to get tissue samples for tests that will be conducted.
However, in the majority of cases there is no need for that. Tissue samples can be obtained from the body via interventional radiology.
These medical procedures don't have to be very complex. In fact, there are some tissue tests that can be performed right in your doctor's office.
Of course, there are biopsies that require a sterile environment. And that is why sometimes your doctor will require that the procedure should be done in a hospital.
The majority of biopsies will require the use of anesthetics. Some of these medical procedures on the other hand will require sedation, which is why a patient may have to be hospitalized.
The following are some of the medical uses of biopsies or tissue tests.
For Cancer Treatment
Doctors and pathologists can apply a variety of tissue tests for suspect or confirmed cancer tissues. For example, the removal of an entire lesion is called an excisional biopsy.
After the removed tissue has been examined, the tissues surrounding the source will also be examined. This is done to determine if the cancer has spread elsewhere in the body. This extra area that will be tested is called the surgical margin.
A pathological examination (i.e. performed by a pathologist or a specialist) will determine if the sample tissue is malignant (i.e. cancerous) or not (i.e. benign). Biopsies may also be used to eradicate known lesions from the body.
Some would not consider liquid biopsies as actual biopsies since you are not actually taking samples of human tissue. In the case of liquid biopsies, they are more like blood tests. They are used for testing for circulating tumor cells.
Liquid biopsies offer some advantages over other types of tissue tests. Other biopsies are invasive, which means the process of collecting tissues will cause some damage to the body. That means they can't be used repeatedly.
Liquid biopsies on the other hand are non-invasive and can be repeated over and over. On top of that since doctors can take samples repetitively they can more accurately check how the tumor progresses over time.
Detecting Changes in Renal Function
In the case of kidney diseases, biopsies can be used in diagnosis.
Testicular biopsies are performed to check men's fertility. A doctor may require a testicular tissue test to check for low sperm quality which can happen even if a man's hormone levels are normal.
Metabolic Disease Testing
There are medical conditions that can affect the entire body. Tissue tests can be performed to check for such conditions but will only involve certain areas of the body especially those parts that are easier to access.
Types of Tissue Tests
Tissue tests help to determine if a mass or tumor is cancerous (i.e. malignant) or not. It can also help doctors find out the cause of an inflammation or an infection.
There are of course different types of biopsies or tissue tests that doctors can perform. They include the following:
- Skin biopsy
- Shave biopsy
- Endoscopic biopsy
- Cardiac biopsy
- Bone marrow aspiration and biopsy
- Endometrial biopsy
- Excisional and incisional biopsy
- Fine-needle aspiration biopsy
- Core biopsy
- Image Guided Biopsy
- Sentinel lymph node biopsy
- Punch biopsy
- Open biopsy
- Needle biopsy
- Lymph node biopsy
Bone Marrow Biopsy
This type of tissue test is called a bone marrow aspiration and biopsy. It is a rather painful procedure since the tissue samples that need to be collected include a small piece of the person's actual bone, blood, and also bone marrow.
Of course, the doctor will only use a small needle to extract these tissue samples. But the procedure can still hurt a lot. The samples will be taken either from the breast bone or the hip bone. To be precise, they can be taken from the sternum (i.e. from the breast bone), from either side of the hip bone, or from the lower back.
The tissue test procedure begins with the cleansing of the skin and the application of anesthesia on a local area of the body. The anesthetic of course is used to numb the spot where an incision is going to be made.
After that, the doctor will insert a rigid needle that is long enough to reach all the way to the marrow. Marrow cells and other tissue samples are then aspirated or sucked out for testing and study. A small chip of a bone will then be removed after that part of the procedure.
Just imagining that can cause one to wince and your doctor will be the first to admit that this procedure is uncomfortable at the very least. The tissue samples will then be tested and observed by a pathologist. The goal is to check the blood, bone, and blood for signs of cancer.
This type of tissue test is used to test for cancer in the bones. One option to perform this type of biopsy is with the use the CT scan technique. Another option to have it performed by a specialist-i.e. an orthopedic surgeon.
A core biopsy is a type of tissue test that is a bit similar to the previous one that was described. It also involves the removal of tissue using a needle with an application of a local anesthetic.
The difference is that the needle used for core biopsies are wider. This medical procedure usually does not require a general anesthetic. Most of the time with a core biopsy you will just go home with a band aid on your skin. This is one of those tissue tests that may be performed in your doctor's clinic.
As you may have already guessed, a cardiac biopsy is a tissue test that is performed on the human heart. With the current medical technology available to us today, this is the only means by which a doctor can confirm if your body hasn't rejected a newly transplanted heart.
Your cardiologist will perform this type of tissue test within schedule intervals. These biopsies will be performed after a heart transplant especially if a heart rejection is suspected. These tests are also used to test the progress and efficacy of anti-rejection therapy being applied.
Note that routine cardiac tissue testing is usually conducted weekly. This applies for both adults and children. This is the schedule for the first four weeks after a transplant. The frequency of the biopsies will reduce in frequency after the first month.
After six months after the operation scheduled biopsies will only be conducted every quarter (i.e. every three months). The need for further biopsies during the lifetime of the patient is usually indefinite.
Cardiac biopsies are performed either in a cardiac cath lab or in an operating room in a hospital. The actual operation only takes half an hour on average. Your doctor will administer an anesthetic to make an area around your neck numb.
A small incision will then be made on the right side of the neck. After that a long catheter tube (also known as a bioptome) will be inserted through that incision.
The catheter will be made to pass through the veins in the neck. If those veins are not accessible then the bioptome will be made to pass through the groin also traveling through the veins.
To help doctors make the catheter travel through the veins, a fluoroscopy (i.e. a kind of x-ray) will be used. Remember that the catheter tube will be made to pass through the jugular vein (or the femoral vein if entering through the groin) to the right ventricle of the heart.
Image Guided Biopsy
Image guided biopsy (also known as a needle biopsy) refers to any kind of tissue test that makes use of imaging technology to guide the operation. Examples of imaging technologies that can be used include the following:
- CT Scan
These imaging technologies are used to see deep inside the body. The objective in using these pieces of equipment is to aid the doctor more accurately locate target tissues that need to be sampled.
The sample collection process will make use of a core needle, a fine needle, and may also involve vacuum assisted biopsy. The collected sample is usually a small amount of bodily tissue.
This is one of the tissue tests that can be performed in your doctor's clinic as long as there is imaging equipment available. Note that this kind of biopsy is usually very safe.
Your surgeon can avoid other structures along the way such as vital organs and even blood vessels as the needle reaches towards the targeted tissues. Patients are also spared from a lot of pain, complications, and scarring from open surgery.
Note that the recovery period for this type of tissue testing is very short. In fact, you can get back to work within the day after the biopsy has been performed.
In this type of biopsy, skin tissues are tested using only small samples of a patient's skin. The skin is examined using a microscope and one goal is to determine if there is any presence of a melanoma.
A local anesthetic is applied on the skin where the sample will be taken. During the procedure, you will only feel a small needle prick. A slight burning feel will also be experienced by the patient but it usually lasts only a minute.
The pain and burning feeling is from the anesthetic. However you will not feel any pain during as the sampling procedure is performed.
A shave biopsy is also a skin biopsy where skin tissue samples are tested. Instead of using a needle or some other instrument to obtain the tissue sample, the skin is instead shaved and the top layer is removed. The shaved skin serves as the samples for tissue testing. This type of biopsy is also performed with the application of a local anesthetic.
Sentinel Lymph Node Biopsy
This type of tissue test involves the removal of the first lymph node where the cancer is most likely to spread. To make an accurate extraction, the surgeon will inject either a blue dye or a radioactive tracer.
This will be injected near the target area where the tumor is located. The injection procedure is performed before the actual biopsy/surgery is performed.
Note that the dye and the radioactive tracer flow through the body's lymph channels. If your doctor will opt for a radioactive tracer, the injection will be performed in a Nuclear Medicine Department or an equivalent facility.
A punch biopsy is also another kind of skin tissue test. What makes this procedure unique is the fact that the skin tissue sample is deeper and it will look something like an apple core or cylinder shape.
The sampling procedure begins with the application of a local anesthetic where the tissue sample will be taken. The instrument used to take the skin sample rotates as it cuts through all the three layers of the patient's skin all the way to the dermis (i.e. the fatty layer of your skin).
This medical procedure makes use of an open surgery ergo its name. That means, in order to obtain a tissue sample, a doctor will make an incision on the patient's skin and expose the target tissue (e.g. like a tumor for instance).
A tissue sample is either scraped off or cut away from the suspected area. Further surgery may then be performed depending on the results of the tests performed on the sample tissue.
Lymph Node Biopsy
This type of tissue test refers to any kind of biopsy that involves the removal of an entire lymph node or just a part of it. The tissue samples will then be tested by pathologists for the presence of cancer cells.
There are two types of lymph node biopsies, which are:
- Excisional Biopsy – the entire lymph node is removed
- Incisional Biopsy – only a part of the lymph node is removed
FNA stands for Fine-Needle Aspiration. This type of biopsy involves the use of a fine needle to take very small samples of tumor, fluid, or any other kind of tissue.
This type of tissue testing rarely causes any form of discomfort if any and it also doesn't leave any scars. However, you may still request that an amount of anesthetic be used during the sampling procedure.
This type of test is also quite safe since the surgeon performing the procedure will be making use of imaging technology. This is a type of biopsy that is used for making a diagnosis.
The good news is that there is no surgical intervention involved. However, that being said, note that FNA is never used to test a mole that suspect for any kind of disease. On top of that, it isn't the procedure used for checking if a melanoma has spread.
Excisional and Incisional Biopsy
We have already mentioned these two types of biopsies in the discussion above. But they are also a separate category of tissue tests altogether apart from FNA biopsies.
An excisional biopsy is also called a wide local incision. This type of procedure calls for the removal of an entire tumor and also the other surrounding tissues. Yes, even though those tissues are normal they will still be removed. If only a part of the tumor will be removed then it is called an incisional biopsy.
The amount of surrounding bodily tissue that will be removed will depend on the size of the tumor. Skin grafts may then be placed on the area where the tumor has been removed. However, there are some excisional biopsies that do not require the placement of skin grafts.
This type of tissue test makes use of a fiber optic endoscope. A fiber optic endoscope is a long tube that is thin enough to travel through the different parts of the body's orifices or in some cases through an incision.
This thin tube is equipped with a close focusing telescope that allows physicians to get a direct view of the tissues. The type of endoscopic procedure will be named according to the part of the body that needs to be viewed.
Here are a few names that doctors might mention on the left and on the right of the table are the organs or parts of the body that will be targeted:
Type of Test
Targeted Body Part
middle area of the chest
Alimentary tract endoscopy
This type of tissue test is one where a tissue sample from the uterine lining is extracted. A tube is inserted into the patient's uterus and the tissue sample is extracted. This is a rather simple procedure and it can be done in your doctor's clinic.
How to Prepare for Your Biopsy
You can observe from the discussion above that biopsies vary in difficulty. It all depends on how much effort and care is required to obtain tissue samples. The more remote the body tissue is the more difficult the biopsy will become.
Your doctor will use the term "invasiveness" to describe how complicated things will be. The more invasive a procedure is the higher the risk will be involved.
We can say that most skin biopsies have minimal invasiveness. These tissue tests can be performed in a doctor's clinic. They also pose the smallest amount of risk for the patient.
Your doctor may also apply anesthetic to numb the area where the tissue sample will be taken. That will make the procedure almost painless.
A more invasive tissue test will have to be performed in a hospital, a specialized clinic, or a surgery center. The actual biopsy operation will be performed on a separate appointment other than the usual doctor's appointment.
During such procedures your doctor will also administer pain relief medication. In a lot of cases, the doctor will also give you a sedative to reduce the level of discomfort that you may feel.
How to Prepare for a Scheduled Tissue Testing
The way you prepare for a scheduled biopsy or tissue test will vary depending on the type of procedure that you will undergo. As it has been described, some testing procedures are more invasive than others.
For example, most types of needle biopsies will not require any form of preparation at all. Remember, they are one of the least invasive of any of the biopsies described in this guide.
However, your doctor may ask you to stop taking any blood thinning medications a few days before the actual tissue samples are extracted. So, it's going to be a bit different also from patient to patient.
Some biopsies will require you to stop taking aspirins one to three days before the scheduled tissue test and for others there will be no such requirement and your doctor can proceed on the same day as a regular appointment.
On top of that, your doctor may ask you to go on a fast-you are not to drink or eat anything several hours before the actual biopsy (that would be around 6 to 8 hours before the actual operation). But that will depend on the actual time the medical procedure will take place and what part of your body will be operated on.
If you are going to undergo a cardiac biopsy, this may come to you as a welcome treat. Your doctor may recommend that you eat a salty dinner the night before your biopsy operation (but no meals after midnight).
What's a good salty dinner? Well, pizza would be a good example. But of course you can eat other salty foods as well.
One more thing, you should remember that after your tissue test, you shouldn't lift any heavy objects.
How to Prepare for General Anesthesia and Sedation
You generally don't have to worry about feeling any pain during a surgery (that is if you have to undergo an invasive tissue testing procedure). Before the surgery goes underway your doctor will give you medicine to block the pain, which is called an anesthesia.
This type of medication will help you relax before, during, and sometimes after the operation.
Some anesthetic medications will also help you go to sleep-in other words you will undergo sedation. When you wake up, the biopsy would have been over.
However, there are a few things that you can do to help make sure that things go well.
Here are a few Question and Answer's that might help you through:
What type of and how much anesthetics will be administered?
It will all depend on the type of surgery that you will have. Before a biopsy, you will have one or several appointments with your doctor where he will assess your health condition.
Your doctor will take into account several important factors. Examples of which include your overall status of your health, gender, weight, and age.
Most likely, your doctor is also going to call in a specialist called an anesthesiologist – a doctor that specializes in anesthetics. The anesthesiologist will take in to the information that your doctor has gathered and then make sure that you will get the right type and amount of anesthetics.
Do I have to go fasting?
When there is an operation involved with your biopsy, your doctor will likely inform you not to eat or drink anything after midnight (i.e. the night before the biopsy).
Why will your doctor do that? You see, the anesthetic that will be administered (some through IV, some are topical, and some are injected), will make your body's muscles relax.
Some of the organs, muscles, and tissues that will be affected may include your throat, your stomach, etc. When that happens food can back up and sometimes the food and drink you had can get into your lungs. Fasting will help to prevent that from happening.
Do I need to stop taking my meds?
As stated earlier, some biopsies, especially the invasive ones, will require you to stop taking certain meds. Your doctor will ask you to stop taking them several days before the actual operation.
Note that there are medications that will interact with anesthetic medicines. The way these drugs interact will have different effects and some may even be detrimental. Remember that some drugs don't mix well with anesthetics.
Some will make you bleed more during the actual operation. Examples of such medications include NSAIDs like ibuprofen and aspirin and other blood thinners like warfarin (Coumadin) as well as clopidogrel (Plavix).
Some blood pressure medication is okay and there are reflux medicines that can still be taken as well. However, you should ask your doctor about it before taking them before the actual operation.
Can I still take my herbal supplements?
With regard to herbal supplements, you should first consult with your doctor whether you should continue to take them or stop taking them for a while. Your doctor may recommend that you should stop taking them a few days before and maybe after your biopsy.
Some herbal supplements can react with the anesthetic medication that will be administered to you. Some can affect your blood pressure especially during surgery while others may cause bleeding.
Here are some supplements that you may have to stop taking for several days or as prescribed by your doctor:
- St. John's wort
- Black cohosh
Remember to tell everything about any supplements that you may be taking before a biopsy or tissue test is scheduled. Your doctor needs to know that info in order to prescribe the right course of treatment and how to go about with the procedure.
What are the other things that I need to tell my doctor?
There are other things that you should tell your doctor before the actual biopsy. A lot of the things that you will be asked will be about your medical history.
Other than the medications that you are on, here are some of the other details that will help your doctor make a more accurate assessment of your overall health condition:
- You are pregnant
- How you reacted to anesthetics the last time you were administered one
- If you have any kind of bleeding problems
- Feel any sort of numbness especially in your legs and also your arms
- If you are taking any steroids
- Did you take any form of NSAIDs?
- Are you taking any type of street drugs
- Drink alcohol
- Do you smoke?
- Tell your doctor if you have any kind of breathing problems like COPD or maybe asthma
- Health conditions such as but not limited to thyroid disease, sleep apnea, kidney disease, liver disease, diabetes, heart problems, high blood pressure, etc.
- Any allergies to certain types of medication, rubber, latex, etc.
Make sure to tell these and other details to your doctor. Your doctor will want a comprehensive outlook on your health condition, which is why these questions need to be answered as honestly and as accurately as possible.
Will I need someone to drive me home after the biopsy?
It will all depend on the type of procedure that was performed and the type of medication that was administered. If there was little to no anesthesia used then you most certainly can drive yourself home after the procedure.
However, if the tissue test was invasive and it involved open surgery plus the administration of sedatives and anesthetics then you will need someone to drive you home after the procedure.
If your doctor talks about using general anesthesia then most likely you will be sleeping throughout the entire operation. Consider it an equivalent of getting a sedative.
You should arrange for someone, a friend or a family member, to drive you home after the biopsy. You will also need someone to look after you at home until you recover.
Other Reminders before the Biopsy
- If you're not fasting eat only a light meal
- If you're undergoing a breast biopsy bring/wear a comfortable bra
- Wear loose fitting clothing
- Ask your doctor about safe pain relievers (usually acetaminophen like Tylenol).
- Don't wear any necklaces, earrings, etc.
- Use only bath oil, talcum powder, and deodorant on the day of your tissue test.
- You may setup an appointment with a therapist to help you deal with your emotions before and after the operation
- Talk with your family and friends. Get all the support you can get. You will also need their support while waiting for the results.
What to Expect After a Tissue Test
Expect a waiting period after your biopsy or tissue test. Sometimes a pathologist will need to take some time to test and analyze the results. In the meantime here are some of the things that you can do while you wait and recover:
- If there was an incision made, such as in the case of a cardiac biopsy where a cut will be made to the right side of your neck, you will be asked to keep your head in an upright position for a certain amount of time. This prevents bleeding and reduces the amount of pressure on the wound.
- If the wound or incision was made elsewhere (e.g. accessing the femoral vein) then that part of your body will be raised until the wound gets healed.
- If you feel any pain, shortness of breath, or any other symptoms after your biopsy, then call your doctor immediately.
- Avoid any form of strenuous activity such as sports, weightlifting, jogging, tennis, swimming, skiing, base jumping etc. You are also not supposed to do any house chores until your wound heals. Ask a friend or family member to cover for you with the house chores.
- Expect that the area where the incision was made to have some kind of bruising. Take note that it will take 5 to 7 days to completely heal.
- Call your doctor immediately if there is any redness, drainage, bleeding, swelling, or even heat in the area that was operated on.
Tissue testing is something that you can prepare for. It's a part of the overall treatment that your doctor can provide for you. The results will help determine the next course of action so your doctors can give you the best possible care.
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