What is a biopsy?
A biopsy is the removal of a sample of tissue from the body for
examination. The tissue will be examined under a microscope to
assist in diagnosis. Therefore, only very small samples are needed.
Sometimes, it's enough just to scrape over an area. This is the case
with smear examinations of the cervix (neck of the womb).
During examination of the large intestine, a biopsy can be taken
with forceps through a tube known as an endoscope.
In other cases, for instance, a liver or kidney biopsy, the biopsy
is taken using a large hypodermic needle.
A liver biopsy can be used to confirm diagnoses such as hepatitis,
cirrhosis of the liver or tumours.
The biopsy is usually performed with the patient lying on their left
side with their right shoulder extended and their right hand under
their head. It's important to remain in this position and to keep as
still as possible. A local anaesthetic will be given to numb the
A needle is then guided between two ribs towards the surface of the
liver, and the biopsy is taken quickly.
This biopsy is taken in order to examine the lining of the womb.
If a woman is suffering from irregular periods or abnormal vaginal
bleeding, it may reveal a hormone imbalance in the body, polyp
formation or, less commonly, the development of a tumour.
An endometrial biopsy can be performed in a number of different
Dilatation and curettage (D&C)
(D&C) is a common gynaecological procedure, but it's being replaced
by the more modern practice of hysteroscopy.
A D&C is performed under a short general anaesthetic. The cervix is
opened gradually by introducing a series of rounded sticks or
dilators. These are initially very small but increase in size until
the cervix is dilated sufficiently to accept a curette – a small
instrument shaped like a rectangular spoon. The curette is used to
obtain a sample from the lining of the womb.
A fibre-optic tube, with a bright light at the end, is inserted
through the cervix to obtain a direct view of the lining of the
Biopsy under direct vision can be made by passing forceps through
the inside of the tube into the womb. This is usually performed
under a local anaesthetic, but some women may be advised to have a
Other methods have been developed to allow a small sample of tissue
to be removed from the womb lining without anaesthetic in an
The most common is a flexible, straw-like device with a plunger.
This allows the gynaecologist to apply gentle suction to the lining
of the womb and obtain a sample or biopsy of tissue.
A prostate biopsy may be performed if abnormality is found by the
doctor or nurse, while performing a digital rectum examination (DRE).
A trans-rectal ultrasound scan (TRUSS) of the prostate gland may be
requested to assess any abnormality felt on DRE, or if a blood test
shows an elevated PSA (prostate specific antigen) blood test.
The procedure takes place in hospital and is performed without
The radiologist or urologist performing the procedure will have
requested any patients taking blood thinning agents, eg aspirin or
warfarin, to have discontinued them for up to one week beforehand
because of the risk of bleeding. Antibiotics will be given to the
patient beforehand to cover the risk of infection.
Throughout the biopsy, the patient lies on his side with his knees
bent and his legs pulled up to his chest.
If any abnormality is seen on the ultrasound scan, a biopsy is taken
there and then. The patient feels a number of short, sharp pains as
a number of small needles move in and out of the prostate.
As many as 16 small cylindrical samples can be taken, four from each
quadrant of the gland.
The procedure can also be done without ultrasound guidance. To do
this the doctor uses a finger to guide a single needle to the
abnormal area and takes a series of biopsies, one after the other.
After the procedure: the patient may experience some discomfort for
a short period of time and possibly notice some blood in their urine
intermittently for a few days.
When there are changes in the skin that require further examination,
a punch biopsy may be useful.
First, a local anaesthetic is injected or given in the form of a
cream that's applied to the area one hour before.
A small cylindrical piece of skin is removed by a special device
that punches a small hole through the layers of skin to obtain a
sample. Then the skin is sewn together again with a couple of
stitches. This leaves a very small, almost invisible, scar.
Depending upon the result of the biopsy, the patient may be asked to
return to have the whole skin lesion completely removed.
Bone marrow biopsy
A bone marrow biopsy may be necessary for many different diseases of
the bone marrow, the blood and the lymphatic system. The biopsy will
normally be taken from the upper part of the hip (a point called the
iliac crest), but it can also be taken from the breastbone
First, a local anaesthetic is given. Then a strong needle is led
through the skin and the outer part of the bone until it reaches the
softer, central part of the bone (bone marrow). A syringe is put on
the loose end of the needle and some bone marrow is sucked out. This
sample is examined under a microscope.
This kind of biopsy is used if a clinical examination, ultrasound
scan or a mammography reveals the possibility of a lump or tumour in
the breast. The biopsy determines whether the lump is benign or
One method called fine-needle aspiration or FNA, uses a hypodermic
needle to pierce the skin and suck out the sample. This may
sometimes be done under ultrasound or X-ray guidance.
Another option is a surgical biopsy, where the whole lump is
Small intestine biopsy
It's not always possible to examine the central part of the small
intestine (jejunum) with an endoscope. In such cases, a biopsy
capsule is used to take samples from the area.
The patient swallows the capsule, which is connected to a thin tube.
Then, an X-ray is taken to make sure that the capsule is in the
When the capsule is in the right place, a partial pressure is
created in the tube by pulling back a syringe connected to the other
end of the tube. In this way, a small piece of the mucous membrane
of the small intestine is sucked into the capsule. The membrane
sample is cut off in the capsule, and the capsule is pulled back so
that the biopsy can be examined.
This is most useful in the investigation of the bowel condition
called coeliac disease.
A kidney (renal) biopsy may be necessary to diagnose certain
conditions relating to a tumour or inflammation of the organ. It may
also be utilised to monitor a kidney following transplantation
Your kidneys are usually found on either side of the upper abdomen,
underneath the diaphragm and towards the back.
The biopsy is usually taken from behind (except in the place of a
transplanted kidney) with a hollow needle being pushed through the
anaesthetised skin and muscles into the kidney tissue to obtain a
small sample. The patient is asked to hold their breath for a short
time during the procedure to prevent the kidney from moving with the