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Why is Biopsy Performed?

Lesions needing biopsy are usually discovered either because they can be felt by a patient or physician or they are visible on a medical imaging examination such as X-ray, Ultrasound, CT scan, MR exam, etc. Screening tests such as Pap smear or PSA blood test (prostate specific antigen) can also detect otherwise unknown cancer and lead to biopsy of the appropriate site.

Lab biopsy sample showing cancer cells
This pathology image of a breast biopsy specimen shows Hyalinized Calcified Fibroadenoma

Once an abnormality is found, biopsy is often then used to determine the exact nature of the suspected abnormality. A physician may perform a biopsy as part of cancer diagnosis, in order to determine whether an area of concern is malignant (cancerous) or benign (not cancerous). For example, breast biopsy is the removal of a sample of breast tissue for laboratory (histologic) examination by a pathologist and is the definitive way to determine if an abnormality is cancerous or not. A clinical pathologist is a specially trained physician who performs laboratory analysis of the biopsy specimen (tissue sample) to determine its type.

Microscopic examination of tissue (histology) or cells (cytology) usually gives a correct and definitive diagnosis. In the case of a malignant tumor, biopsies of the surrounding tissue and the lymph nodes can be done to determine whether the cancer has spread (metastasized). In the case of cancer diagnosis, biopsy can also allow the physician to grade the cancer. Another important use of biopsy is to determine the cause of infections or inflammations that can not be explained with other testing.

Surgical biopsy (excisional biopsy) may involve removing the entire mass (tumor) for testing. Biopsy is often done using the guidance of imaging or endoscopy. If cancer is present, a pathologist can usually tell what type of cancer it is and may be able to judge whether the cells are likely to grow slowly or quickly. Click here to go to the section on types of biopsy.

Percutaneous biopsy is routinely done using the guidance of medical imaging (such as ultrasound, mammography or CT imaging). The primary physician, radiologist, surgeon or other physician will determine the most appropriate method of biopsy and guidance based on various factors including:

  • the tissue, organ or body part to be sampled
  • how suspicious the abnormality appears
  • the size, shape and other characteristics of the abnormality
  • the location of the abnormality
  • the number of abnormalities
  • other medical conditions a patient may have
  • the preference of the patient, and
  • the systems available at a given hospital or healthcare location

Biopsy is often performed to diagnose diseases and lesions of various organs including:

  • Bone biopsy is performed for people with bone pain and other indicators of bone cancer.
  • Bone marrow biopsy is performed in cases of abnormal blood counts, such as unexplained anemia, high white cell count, and low platelet count. In adults, the sample is usually taken from the pelvic bone.
  • Breast biopsy is performed to confirm if a lesion is benign or malignant
  • Cervical biopsy is often performed endoscopically to diagnose cervical cancer or other cervical diseases. Methods of cervical biopsy include the cervical punch and cone biopsy.
  • Joint biopsy is usually guided by arthroscopy. A tissue specimen is taken from the synovial membrane that lines the joint. Joint biopsy can diagnose gout, pseudogout, bacterial infections, lupus, rheumatoid arthritis or Reiter's disease.
  • Kidney biopsy can be performed to diagnose a long list of disorders. When renal function is diminished by an unknown cause or when imaging exams such as CT , Ultrasound, Nuclear, or MRI show abnormalities but cannot differentiate between some of the possible causes.
  • Liver biopsy may help identify liver disorders and diagnose abnormalities as benign or malignant.
  • Lymph node biopsy can be done to look for diseases such as chronic lymphatic leukemia, Hodgkin's disease, infectious mononucleosis, and rheumatoid arthritis. Lymph node biopsy can also diagnose if cancer has spread from the primary location into the lymphatic system. This can help the physician determine the stage of cancer.
  • Lung biopsy is performed to confirm diagnosis of widespread lung disease and to diagnose abnormalities. Lung biopsy is done to confirm cancer or other lung disease. Lung biopsy can also examine tissue from the trachea (wind pipe) and bronchi (major air passages of the lungs).
  • Pleural biopsy is sampling of the pleura, the sac that covers the lungs. Pleural biopsy is done to differentiate between malignant and non-malignant disease and to diagnose viral, fungal, or parasitic disease and collagen vascular disease of the pleura.
  • Prostate biopsy is done to confirm or rule our prostate cancer or to determine the cause of prostate enlargement or elevated serum prostate markers (PSA: prostate specific antigen).
  • Small Intestine biopsy is often performed to determine what may be causing diarrhea or poor absorption in the intestine.
  • Skin biopsy is often done to test for malignant cancer and to diagnose chronic bacterial or fungal skin infections.
  • Synovial biopsy is a type of endoscopic biopsy used to sample synovial tissue from the surface of a joint.
  • Thyroid and parathyroid biopsy is done to diagnose people with thyroid enlargement or nodules, breathing and swallowing difficulties, vocal chord paralysis and other problems such as unexplainable weight loss. Thyroid biopsy may be used to diagnose Hashimoto's disease, hyperthyroidism, and nontoxic nodular goiter.

Biopsy may also be performed to sample the following organs to test for cancer and other disease: adrenal gland, biliary tract, bladder, carpal tunnel, colon, endometrium, gingiva (gums), heart, muscle, nerve, salivary gland, small bowel, mouth, nasal mucosa, rectum, testicle, throat, and tongue.

Updated: December 30, 2008