Biopsy: Types, Procedures & What to Expect

What Is a Biopsy and Why Is It Done?

A biopsy is a diagnostic procedure that removes a small sample of tissue or cells from your body for microscopic examination by a pathologist. It is the most accurate way to determine if an abnormality is cancerous, benign, or caused by infection, inflammation, or other conditions.

The word "biopsy" comes from the Greek words "bios" (life) and "opsis" (sight), literally meaning "to see living tissue." A biopsy provides information that cannot be obtained through other diagnostic tests like blood tests, X-rays, or physical examinations alone. While imaging studies can identify suspicious areas, only a biopsy can provide a definitive diagnosis by showing exactly what the cells look like under a microscope.

When your doctor recommends a biopsy, it typically means that other tests have found an abnormality that needs further investigation. However, requiring a biopsy does not necessarily mean you have cancer. Many biopsies reveal benign (non-cancerous) conditions, infections, inflammatory diseases, or normal tissue. The purpose is to get accurate information so your doctor can recommend the most appropriate treatment.

Biopsies serve several important functions in medical care. They can confirm or rule out a suspected diagnosis, determine the specific type of disease present, establish the grade or severity of a condition, and help guide treatment decisions. For cancers, biopsies provide crucial information about the tumor type, how aggressive it is, and whether certain targeted therapies might be effective.

The Difference Between Biopsy and Cytology

There are two main approaches to examining tissue and cells: histological examination (biopsy) and cytological examination (cytology). Understanding the difference helps clarify why your doctor might recommend one approach over another.

A biopsy (histological examination) removes a small piece of tissue that preserves the architecture and relationship between cells. This allows pathologists to see how cells are organized, whether they are invading surrounding tissue, and detailed structural features. Biopsies provide the most comprehensive information and are generally required for definitive cancer diagnosis.

A cytology test examines individual cells rather than tissue structure. Examples include Pap smears (cervical cytology) and fine needle aspirations. Cytology is less invasive and excellent for screening purposes, but may not provide enough information for definitive diagnosis. Sometimes cytology is used initially, with biopsy following if the results are abnormal.

What Are the Different Types of Biopsy?

The main types of biopsy include needle biopsies (fine needle aspiration and core needle), surgical biopsies (incisional and excisional), endoscopic biopsies, and specialized procedures for specific organs like bone marrow, liver, kidney, and prostate biopsies. The type chosen depends on the location, size of sample needed, and accessibility of the tissue.

Doctors choose the biopsy type based on several factors: where in the body the suspicious area is located, how much tissue is needed for accurate diagnosis, whether the area is accessible without surgery, and the patient's overall health. Modern biopsy techniques have evolved to minimize invasiveness while maximizing diagnostic accuracy.

Needle Biopsies

Needle biopsies are the most common type and use a needle to extract tissue samples through the skin. They are less invasive than surgical biopsies and can often be performed in an outpatient setting with local anesthesia. There are two main types of needle biopsy.

Fine Needle Aspiration (FNA) uses a very thin needle (similar to those used for blood tests) to withdraw cells and small tissue fragments. FNA is commonly used for thyroid nodules, breast lumps, and lymph nodes. The procedure is quick, causes minimal discomfort, and rarely requires stitches. However, because only individual cells are obtained, it may not provide enough tissue architecture for definitive cancer diagnosis.

Core Needle Biopsy uses a slightly larger needle to remove a cylindrical "core" of tissue. This preserves tissue architecture and provides more material for analysis. Core biopsies are commonly used for breast, prostate, liver, and kidney biopsies. They provide more diagnostic information than FNA but are still minimally invasive compared to surgical biopsy.

Surgical Biopsies

Surgical biopsies involve making an incision to remove tissue. They are used when needle biopsy cannot access the area, when a larger sample is needed, or when the suspicious area should be completely removed.

Incisional Biopsy removes a portion of the abnormal area for diagnosis. This approach is used when the suspicious area is large and complete removal is not practical or necessary for diagnosis. The remaining tissue may be removed later based on biopsy results.

Excisional Biopsy removes the entire suspicious area, serving both diagnostic and potentially therapeutic purposes. This is often used for skin lesions and some breast lumps where complete removal is desirable. If the biopsy shows cancer, additional surgery may still be needed to ensure adequate margins.

Endoscopic Biopsies

Endoscopic biopsy uses a thin, flexible tube with a camera (endoscope) to reach internal organs through natural body openings. Small instruments pass through the endoscope to collect tissue samples. Common examples include colonoscopy biopsies (colon), bronchoscopy biopsies (lungs), and upper endoscopy biopsies (esophagus, stomach).

Specialized Organ Biopsies

Certain organs require specialized biopsy techniques due to their location or the specific diagnostic information needed. These procedures are typically performed by specialists in radiology, gastroenterology, urology, or hematology.

Bone marrow biopsy samples the soft tissue inside bones where blood cells are produced. It is essential for diagnosing blood cancers like leukemia, lymphoma, and multiple myeloma, as well as other blood disorders. The procedure typically takes marrow from the back of the hip bone using a special needle.

Liver biopsy helps diagnose liver diseases including hepatitis, cirrhosis, and liver cancer. A needle passes through the skin into the liver, often guided by ultrasound or CT imaging to ensure accurate placement.

Kidney biopsy diagnoses kidney diseases by sampling kidney tissue, usually through a needle inserted in the back. It helps determine the cause of kidney dysfunction and guides treatment decisions.

Prostate biopsy samples the prostate gland when prostate cancer is suspected, typically due to elevated PSA levels or abnormal findings on digital rectal exam. Multiple cores are usually taken using ultrasound or MRI guidance.

Skin biopsy is one of the most common biopsies performed. Techniques include shave biopsy (removing a thin layer), punch biopsy (removing a small cylindrical sample), and excisional biopsy (removing the entire lesion).

How Should You Prepare for a Biopsy?

Biopsy preparation varies depending on the type and location, but generally includes discussing your medications with your doctor (especially blood thinners), following any fasting instructions, arranging transportation if sedation is used, and asking questions about what to expect during and after the procedure.

Proper preparation helps ensure your biopsy goes smoothly and safely. Your healthcare provider will give you specific instructions based on the type of biopsy you are having, but there are several general principles that apply to most procedures.

One of the most important preparation steps involves your medications. Blood-thinning medications such as warfarin, aspirin, clopidogrel, and newer anticoagulants can increase bleeding during and after the biopsy. Your doctor will tell you whether and when to stop these medications before the procedure. Never stop any medication without your doctor's explicit instruction, as stopping anticoagulants can have serious consequences for some patients.

Supplements and over-the-counter medications can also affect bleeding. Fish oil, vitamin E, garlic supplements, ginkgo biloba, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may need to be stopped before the procedure. Make sure to tell your doctor about all medications and supplements you take.

Fasting Requirements

Some biopsies require fasting (not eating or drinking) beforehand, particularly those involving sedation or general anesthesia. A full stomach increases the risk of aspiration (breathing stomach contents into the lungs) during sedation. Typical fasting instructions include no solid food for 6-8 hours before the procedure and no clear liquids for 2-4 hours before.

However, not all biopsies require fasting. Simple skin biopsies or needle biopsies with local anesthesia only may not have any fasting requirements. Always follow the specific instructions from your healthcare provider.

Day of the Procedure

On the day of your biopsy, wear comfortable, loose-fitting clothing that allows easy access to the biopsy site. Avoid jewelry and valuables. If you will receive sedation, arrange for someone to drive you home, as you will not be able to drive yourself.

Arrive early to complete any necessary paperwork and allow time for pre-procedure preparations. You may have blood tests to check your clotting function, an IV placed for medications, and a final review of your medical history and the procedure plan.

What Happens During a Biopsy Procedure?

During a biopsy, you receive anesthesia to numb the area (or sedation for deeper procedures), the doctor uses appropriate instruments to collect tissue samples while potentially using imaging guidance, and the samples are sent to a pathology laboratory for microscopic examination. Most procedures take 15-60 minutes depending on the type and complexity.

Understanding what happens during your biopsy can help reduce anxiety and help you prepare mentally for the experience. While specific details vary by biopsy type, most procedures follow a similar general pattern.

Positioning and Preparation

You will be positioned to give the doctor the best access to the biopsy site. For many biopsies, you lie on an examination table or bed. The position depends on the location being biopsied—lying on your back for breast or thyroid biopsies, on your side for kidney biopsies, or in various positions for other sites.

The area around the biopsy site is cleaned with antiseptic solution to prevent infection. Sterile drapes may be placed around the area. If imaging guidance (ultrasound, CT, or MRI) will be used, the imaging equipment is positioned.

Anesthesia

Most biopsies use local anesthesia—an injection that numbs only the area being biopsied. You remain awake but should not feel pain during the procedure. You may feel pressure or pushing sensations, but these should not be painful. The initial injection of local anesthetic may sting or burn briefly.

For some biopsies, sedation is added to help you relax. Sedation can range from mild relaxation (where you are awake but calm) to moderate sedation (where you may doze and have little memory of the procedure). Sedation is commonly used for endoscopic biopsies and bone marrow biopsies.

General anesthesia (being completely asleep) is used for some surgical biopsies, particularly those requiring incisions in difficult-to-reach areas or when larger tissue samples are needed.

The Sampling Process

For needle biopsies, the doctor inserts the needle through your skin to the target area, often using ultrasound or CT guidance to ensure accurate placement. For fine needle aspiration, gentle suction withdraws cells. For core needle biopsy, the needle mechanism cuts and captures a tissue cylinder. Multiple samples may be taken from different areas to ensure adequate tissue for diagnosis.

For surgical biopsies, the doctor makes an incision through the skin to access the suspicious area. Tissue is removed using surgical instruments, and the incision is closed with stitches, staples, or adhesive strips.

For endoscopic biopsies, the endoscope is inserted through a natural opening (mouth, rectum, or urethra). When the suspicious area is visualized on the camera, small instruments pass through the endoscope to collect tissue samples.

After Sample Collection

Once adequate samples are obtained, the doctor removes any instruments and applies pressure to the site to minimize bleeding. Depending on the biopsy type, you may receive a bandage, stitches, or a pressure dressing. The tissue samples are placed in preservative solution and sent to the pathology laboratory.

If you received sedation, you will be monitored until you are awake and stable. You will receive post-procedure instructions about wound care, activity restrictions, and signs of complications to watch for.

What Should You Expect After a Biopsy?

After a biopsy, you may experience mild soreness, swelling, or bruising at the biopsy site that typically resolves within a few days. Most people can return to normal activities within 24-48 hours, though some biopsies require longer recovery periods. Contact your doctor if you develop fever, severe pain, heavy bleeding, or signs of infection.

Recovery from a biopsy is typically straightforward, but varies depending on the type of biopsy and individual factors. Understanding what to expect helps you prepare and know when something might need medical attention.

Immediate Post-Procedure Period

Immediately after the biopsy, you may spend time in a recovery area while any sedation wears off. Staff will monitor your vital signs and check the biopsy site for excessive bleeding. Once you are stable, you will receive written post-procedure instructions and can usually go home.

Common symptoms in the first 24-48 hours include mild pain or discomfort at the biopsy site, some swelling or bruising, and light bleeding or drainage that stains the bandage. These are normal and typically improve rapidly.

Pain Management

Most biopsy site discomfort can be managed with over-the-counter pain relievers like acetaminophen (paracetamol). Your doctor may recommend avoiding NSAIDs like ibuprofen for the first 24-48 hours if there is concern about bleeding. Applying ice packs (wrapped in cloth) can help reduce swelling and discomfort.

Pain that is severe, worsening, or not relieved by over-the-counter medication may indicate a complication and should be reported to your doctor.

Wound Care

Keep the biopsy site clean and dry. Follow your doctor's instructions about when you can shower or bathe. Do not submerge the site in water (no swimming, baths, or hot tubs) until your doctor says it is safe—usually until any stitches are removed or the wound has healed.

Change bandages as instructed. Some oozing is normal for the first day or two, but the bandage should not be soaked through with blood. Watch for signs of infection: increasing redness spreading from the site, warmth, swelling, pus or foul-smelling drainage, or fever.

Activity Restrictions

Activity restrictions depend on the biopsy type. Simple skin biopsies may have minimal restrictions—just avoiding strenuous activity that stretches the area for a few days. More invasive biopsies may require longer rest periods.

For internal organ biopsies (liver, kidney), you may be advised to avoid heavy lifting and strenuous activity for a week or more. Follow your doctor's specific instructions, as pushing too hard too soon can increase bleeding risk.

How Long Does It Take to Get Biopsy Results?

Biopsy results typically take 1-2 weeks, though some may be available within a few days and complex cases may take longer. A pathologist examines the tissue under a microscope, performs any necessary special tests, and prepares a detailed report that your doctor will review with you.

Waiting for biopsy results can be an anxious time, but understanding the process helps explain why it takes time. Your tissue sample goes through several steps before results are available.

What Happens in the Laboratory

After collection, your tissue sample is placed in a preservative solution (usually formalin) and transported to the pathology laboratory. There, it undergoes processing—a series of steps that replace water in the tissue with paraffin wax, allowing very thin slices to be cut.

The processed tissue is embedded in a paraffin block and cut into extremely thin slices (4-5 micrometers thick—about 1/20th the thickness of a human hair). These slices are mounted on glass slides and stained with dyes that make different cell structures visible under the microscope.

A pathologist—a doctor specialized in diagnosing diseases by examining tissue—examines the slides under the microscope. They assess the cells' appearance, how they are arranged, whether they show signs of cancer or other diseases, and many other features.

Additional Testing

Sometimes the initial examination leads the pathologist to order additional tests, which adds to the turnaround time. Immunohistochemistry uses antibodies to identify specific proteins in cells, helping determine cancer type and treatment options. Molecular testing may be performed to look for genetic changes that affect prognosis or treatment response.

These additional tests can add several days to a week to the process but provide important information for treatment planning.

Understanding Your Results

The pathology report describes what the pathologist found in your tissue. For cancer biopsies, the report typically includes the diagnosis (type of cancer), grade (how abnormal the cells look, which relates to aggressiveness), margins (whether cancer reaches the edge of the removed tissue), and sometimes staging information.

Your doctor will review the results with you and explain what they mean for your health and treatment options. Do not hesitate to ask questions—this is complex information, and understanding your diagnosis is important.

What Are the Risks and Complications of Biopsy?

Biopsy is generally very safe, with serious complications being rare. Common minor side effects include pain, bruising, and bleeding at the biopsy site. More serious but uncommon complications can include infection, significant bleeding, and damage to nearby structures. The diagnostic benefits of biopsy almost always outweigh the risks.

While biopsies carry some risks, they are among the safest medical procedures performed. Understanding potential complications helps you make an informed decision and recognize problems if they occur.

Common Minor Side Effects

Virtually all biopsies cause some temporary effects at the biopsy site. Pain and tenderness are normal for several days after the procedure and are typically mild and manageable with over-the-counter pain relievers. Bruising is common, especially with needle biopsies, and resolves over 1-2 weeks. Minor bleeding or oozing at the site is normal for the first day or two.

Infection

Infection at the biopsy site is uncommon when proper sterile technique is used. Signs of infection include increasing redness spreading from the site, warmth, swelling, pus drainage, and fever. Infections are treated with antibiotics and rarely lead to serious problems when caught early.

Bleeding

Significant bleeding is uncommon but can occur, especially in people taking blood-thinning medications or those with bleeding disorders. Internal biopsies (liver, kidney) have higher bleeding risk than skin biopsies. This is why medication adjustments and careful technique are so important.

Organ-Specific Risks

Some biopsies have specific risks related to the organ being sampled. Lung biopsies can cause pneumothorax (air leaking from the lung into the chest cavity), which may require treatment. Liver and kidney biopsies have a small risk of internal bleeding. Your doctor will discuss specific risks relevant to your procedure.

The Myth of Cancer Spread

A common concern is whether biopsy can spread cancer. Multiple large research studies have conclusively shown that biopsy does not spread cancer. While cancer cells can theoretically be dislodged during the procedure, they rarely survive or establish new tumors. The diagnostic benefit of biopsy far outweighs this theoretical risk, and biopsy remains essential for cancer diagnosis and treatment planning.

What Are the Different Organ-Specific Biopsy Procedures?

Different organs require specialized biopsy techniques. Common procedures include bone marrow biopsy for blood disorders, liver biopsy for hepatitis and cirrhosis, kidney biopsy for kidney disease, prostate biopsy for suspected prostate cancer, and skin biopsy for dermatological conditions. Each has specific preparation, procedure, and recovery considerations.

Bone Marrow Biopsy

Bone marrow biopsy samples the soft tissue inside bones where blood cells are produced. It is essential for diagnosing leukemia, lymphoma, multiple myeloma, aplastic anemia, and other blood disorders. The procedure usually samples marrow from the posterior iliac crest (back of the hip bone), which is safely accessed and rich in marrow.

The procedure involves two components: aspiration (withdrawing liquid marrow through a needle) and core biopsy (removing a small cylinder of bone and marrow). Local anesthesia is used, often with mild sedation. You may feel brief pressure and discomfort when the needle enters the bone and when marrow is aspirated. The entire procedure typically takes 15-30 minutes.

After bone marrow biopsy, you may have soreness at the biopsy site for several days. You can usually resume normal activities within 24-48 hours but should avoid strenuous activity for a few days.

Liver Biopsy

Liver biopsy diagnoses various liver conditions including hepatitis, cirrhosis, fatty liver disease, and liver tumors. It can also help stage liver disease and assess response to treatment. The most common approach is percutaneous liver biopsy, where a needle passes through the skin into the liver, guided by ultrasound or CT imaging.

Preparation often includes blood tests to check clotting function and sometimes stopping blood-thinning medications. During the procedure, you lie on your back with your right arm above your head. After local anesthesia, you hold your breath briefly while the needle is inserted—this keeps the liver still and reduces risk.

After liver biopsy, you typically rest for several hours while staff monitor for complications, particularly bleeding. You should avoid heavy lifting and strenuous activity for about a week. Right shoulder pain (referred pain from the liver) is common and usually mild.

Kidney Biopsy

Kidney biopsy helps diagnose the cause of kidney problems such as protein or blood in the urine, unexplained kidney function decline, or kidney transplant issues. It provides information that guides treatment and helps predict prognosis.

You typically lie on your stomach with a pillow under your abdomen to bring the kidneys closer to the surface. Using ultrasound guidance, the doctor inserts a needle through your back into the kidney and takes several tissue cores. You may feel pressure and hear clicking sounds from the biopsy needle.

Kidney biopsy has a higher bleeding risk than some other biopsies, so you usually stay for observation for several hours after the procedure. You may be advised to avoid strenuous activity and heavy lifting for 1-2 weeks. Blood in urine is common for the first 24 hours but should resolve.

Prostate Biopsy

Prostate biopsy is performed when prostate cancer is suspected, typically due to elevated PSA (prostate-specific antigen) levels or abnormal digital rectal examination findings. Modern approaches often use MRI-fusion technology to target suspicious areas identified on MRI imaging.

The biopsy can be performed through the rectum (transrectal) or through the perineum (transperineal). Multiple tissue cores (typically 10-12) are taken from different areas of the prostate to ensure adequate sampling. Local anesthesia is used, and antibiotics are given to prevent infection.

After prostate biopsy, blood in urine, semen, or stool is common for several weeks and is not cause for alarm. Fever, severe pain, or inability to urinate should be reported immediately as these may indicate infection.

Skin Biopsy

Skin biopsy is one of the most frequently performed biopsies, used to diagnose skin cancers, rashes, infections, and other dermatological conditions. Several techniques exist depending on the size and depth of tissue needed.

Shave biopsy removes a thin surface layer and is used for superficial lesions. Punch biopsy uses a circular blade to remove a small cylindrical sample, useful when deeper tissue is needed. Excisional biopsy removes the entire lesion and surrounding margin of normal skin, used when complete removal is therapeutic and diagnostic.

Skin biopsies heal with minimal scarring when properly cared for. Keep the area clean and dry, and follow wound care instructions. Stitches, if used, are typically removed in 7-14 days depending on the location.