Definition

Image-guided biopsy is the removal of a sample of tissue or cells from the body by a radiologist using an imaging method such as CT, ultrasound or fluoroscopy to locate the biopsy site.  A pathologist usually does the examination of the tissue or cells.  The tissue or cells are generally examined under a microscope to determine the presence of any abnormality.

Parts of the Body Involved

A biopsy may be obtained from any part of the body.  The part of the body involved in a biopsy depends upon the location of inflammation or tumor.  Common biopsy sites includ

• Bone marrow
• Breast
• Brain
• Gastrointestinal tract
• Kidney
• Liver
• Lung
• Lymph nodes
• Neck
• Skin
• Thyroid
•  Prostate
•  Colon

Reasons for Procedure

A biopsy is usually performed to determine if the cells from a sample of body tissue are abnormal.  A major reason to obtain a biopsy is to rule out cancer.  Sometimes biopsies are obtained to determine the cause of an unexplained infection, inflammation, swelling or growth.

Risk Factors for Complications During the Procedure

The doctor performing the biopsy will discuss the possible risks of any specific biopsy before the procedure.  With CT guided biopsies, a radiologist will do the procedure.  Depending on where the biopsy is to be performed, the risks and complications vary.

What to Expect

Prior to the Procedure

The radiology scheduling nurse will tell you by phone what to do in preparation for the biopsy.  You may be asked to stop certain medicines or to not eat or drink after midnight before your appointment.  It is important that you understand and follow your instructions.  Please ask the nurse if you have any questions about your procedure.

During the Procedure

Your doctor will give you specific instructions.

Anesthesia

The doctor will numb the area with a local anesthetic before taking the biopsy.  Sedation and pain medication may be given with an IV for your comfort if needed.

Description of the Procedure

The radiologist performing the biopsy needs to locate the tissue to be sampled.  This may be done in three ways:

• Ultrasound.  Ultrasound uses sound waves to allow the radiologist to see the tissue and guide the needle for the biopsy.
• Fluoroscopy.  Fluoroscopy is like a regular x-ray, but the radiologist views the tissue on a special screen.
• Computed Tomography (CT).  A specialized x-ray scan that uses a computer to show cross-sectional images of the tissue.

Use of the CT scanner is the most common way with bone and neck biopsies.  This demonstrates small tissue areas clearly and allows multiple pictures to guide the needle.  You will be completely informed on what to do and what to expect by the CT technologist, CT nurse and the Radiologist.

Biopsy Equipment

Biopsy needle.  Most biopsy needles are very thin, about the size of the tip of a ballpoint pen.  These needles take very small samples of cells from your body.

Biopsy Gun.  The biopsy gun is a special needle device.  It is also very thin, like the needle, and has a special opening to take larger tissue samples than just a regular needle.  The tissue sample is taken very quickly for minimal discomfort.

After the Procedure

If you have a simple biopsy performed, you may go home.  If sedation is used, you may stay at the hospital for observation for 2 hours.  **If you have sedation, you must have someone take you home, as you will not be able to drive.**

How long will it take?

A biopsy using a CT scan for needle placement may take from 15 minutes to 1 hour depending on the difficulty of the biopsy site.  If the biopsy is done using ultrasound or fluoroscopy, the time is shorter. 

Will it hurt? 

Numbing the skin may sting for a couple of seconds, but after this, most of the sensation is pressure.  Medications to relieve pain and produce drowsiness may be administered during the biopsy.  The Radiologist performing the biopsy will tell you what to expect.  After the biopsy, there might be some pain where the tissue was removed.  Your doctor may prescribe medication to relieve the pain.

Possible Complications

• Bleeding
• Pain
• Infection
• Biopsy results that are not conclusive or difficult to interpret
• Negative or normal result

Average Hospital Stay

None.  Most people are free to go home within 1 to 2 hours.

Postoperative Care

Your doctor will provide care instructions according to the type of biopsy you have.

Outcome

A Pathologist, or a number of pathologists will interpret your biopsy.  Sometimes, the biopsy tissue has to be sent to specialized centers out of state.  Your doctor will inform you of the results.

Common interpretations of biopsies include:

• Normal tissue, no abnormalities
• Not normal, but no cancer (often an inflammation)
• Not normal, but difficult to interpret
• Not normal, not cancerous, but a precancerous condition
• Cancer
• Inconclusive 

Call Your Doctor If Any of the Following Occurs

• Bleeding
• Infection
• Fever
• Redness around the biopsy site
• Drainage from the biopsy site
• Enlargement of the biopsy site
• Worsening of your symptoms
•  New symptoms develop and persist