Surgical Biopsies and Needle Biopsies for Lymphomas

What is a Biopsy?

In a biopsy, doctors remove part or all of a suspected tumor tissue in order to get a better look at it under a microscope. The person examining the tissue is an experienced pathologist who can tell the difference between benign cancer cells and malignant cancer cells.

Biopsies, extremely important in making a cancer or lymphoma diagnosis, are known as cytological studies. A cytological study is one in which cells are removed from the body and examined by an expert under a microscope. Perhaps the most familiar cytological study is the Pap smear, in which cells are removed from the cervix and examined by an expert pathologist.

There are a number of types of biopsies to make a cancer diagnosis; your doctor will know which one is best for you and your condition. The first two are considered surgical biopsies, the latter two are considered needle biopsies.

Excisional biopsy

An excisional biopsy is a procedure that involves the complete removal of a tumor. Generally this kind of biopsy is reserved for extremely small tumors that are also easy to reach—they may be on the skin, for example, or in the mouth.

An excisional biopsy does not normally require anything beyond a local anesthetic, but you should ask your doctor whether you will receive a local or a general anesthetic. If you are nervous you may also inquire about a sedative.

Incisional biopsy

An incisional biopsy is in contrast to the excisional biopsy because in this procedure, the doctor cuts into the lesion or tumor and physically removes a part of it before closing up the incision made in the skin.

An incisional biopsy does not normally require anything beyond a local anesthetic, but you should ask your doctor whether you will receive a local or a general anesthetic. If you are nervous you may also inquire about a sedative.

Core needle biopsy

In a core needle biopsy, doctors insert a needle (with a diameter between 1/10 and 1/6 of an inch) into a mass that is suspected of being a cancerous tumor. Depending on the size and position of the mass, a CT, an MRI or even an Ultrasound may be required to help guide the needle into the mass. Using the needle, doctors collect a sample of the tissue to be examined under the microscope.

It is common for this procedure to involve a local anesthetic to make it as pain-free as possible. However, patients should expect to see some bruising and soreness develop following the procedure.

Fine needle aspiration biopsy

Not unlike core needle biopsies, fine needle aspiration (FNA) uses needles with diameter considerably smaller than those used in core needle biopsy to extract tissue samples from suspected masses in the body. FNA provides doctors with high rate of accuracy in diagnosing the type of cancer presented in the mass.

It is common for this procedure to involve a local anesthetic to make it as pain-free as possible. However, patients should expect to see some bruising and soreness develop following the procedure, although it shouldn't be as bad following FNA as it might be following a core needle biopsy.

The needle is inserted into the body for between 10-20 seconds, and is normally done twice. It is said to be no more painful than a typical blood draw.

Will I require only one biopsy?

Only your doctor will know whether one biopsy, or one type of biopsy, is required to make an accurate diagnosis. Sometimes one type of biopsy will be used to confirm the results of another type of biopsy. You should ask your doctor what he or she expects to learn from this first biopsy, and what chances there are that you will need another biopsy.

Resources:
--Everyone's Guide to Cancer Therapy, revised 5th edition. Ed. Andrew Ko M.D. et al. Andrews McMeel Publishing, Kansas City. 2008.
--Lymphomainfo.net: Biopsy definition
--National Cancer Institute: Biopsy definitions