Understanding Needle Biopsy

A needle biopsy diagnoses cancer and other diseases

Medically reviewed by Steffini Stalos, DO

A needle biopsy is a procedure to take a tissue sample. Often, this tissue is examined for signs of cancer or other diseases. A needle biopsy comes in many forms and can be taken from many body areas. The two types of needle biopsy are fine needle aspiration and core needle biopsy.

This article will cover needle biopsies, including how they differ from other biopsies. It will discuss what cancers and diseases a needle biopsy diagnoses, if needle biopsies are painful, and what you need to know about needle biopsy pathology findings.

Needle Biopsy Compared to Other Types of Biopsy

During a biopsy, tissue samples are collected to help diagnose a disease. A biopsy can be taken in several ways, depending on where the abnormal area is, what condition is suspected, and why the biopsy is being done.

Biopsy procedures differ in how the sample is collected, where it is collected, and if the provider uses any special equipment to image the area. Commonly used biopsy procedures include:

• Needle biopsy: This outpatient procedure uses a needle to take a tissue sample. The two common types of needle biopsy are fine needle aspiration (FNA) and core needle biopsy (CNB). A needle is also used during a bone marrow biopsy.

• Surgical (open) biopsy: If the area that needs to be biopsied is hard to reach or if you’re already scheduled for surgery to remove the lesion, your surgeon will take samples for testing at this time. Surgery is more invasive than a needle biopsy.

• Minimally invasive surgical biopsies: These use much smaller surgical cuts through which a camera and tools are inserted. This may be called a laparoscopic biopsy if it is used to look inside the belly, a thoracoscopic biopsy if it is used to look inside the chest, or a mediastinoscopic biopsy if it is used to look at the space between the lungs.

• Skin lesion biopsy: This test removes a small amount of skin to look for skin conditions or diseases. It may include removing the upper layers of skin (a shave biopsy) or removing deeper layers of the skin (a punch or excisional biopsy).

• Endoscopic biopsy: This is a tissue sample taken during an endoscopy, when a thin, flexible tube with a camera and tools is passed inside the body to look at a specific area.

Image-Guided Biopsy

A healthcare provider often uses imaging technologies during a needle biopsy to check that they’re sampling the right area. This makes it more likely that the tissue sample doesn’t miss the abnormal area, especially if it’s small or can’t be felt. Imaging for needle biopsies includes X-rays, ultrasound, a computed tomography (CT) scan, or magnetic resonance imaging (MRI).

The three types of needle biopsy you may encounter are:

• A fine needle aspiration uses a very thin needle to remove a sample of cells and fluid. There is no incision. In some cases, the results are available on the same day. But there isn’t always enough tissue and information in the sample to give a definitive diagnosis, so another biopsy may be needed.

• A core needle biopsy uses a larger needle. It leaves the structure of the tissue intact, enabling the pathologist (specialist in anatomic and laboratory analysis) to get a better idea of how invasive a growth may be. It is often used with image guidance. In some cases, the skin will be cut to access the biopsy location. Processing of this biopsy sample usually takes longer than a fine needle aspiration.

• A vacuum-assisted biopsy uses suction to collect a tissue sample through a special needle. It removes more tissue without needing surgery. An incision may be needed to access the biopsy location.

What Does a Needle Biopsy Diagnose?

One common use of a needle biopsy is to test an abnormal growth for cancer. Your healthcare provider may see an abnormal mass on a cancer screening test and order a biopsy. The biopsy will show whether the growth is benign (not cancer) or malignant (cancer) by examining the cells directly.

Other common conditions can also be detected by a biopsy. It depends on the tissue being tested and the diseases a needle biopsy may diagnose. Conditions like infections, inflammation, and autoimmune disorders can be diagnosed with a biopsy. It can also be a part of an organ transplant to verify a tissue match or look for signs of organ rejection.

Reasons to do a needle biopsy include:

• Test an abdominal lump for cancer

• Diagnose a bone infection or cancer

• Test for blood cancers (leukemia) in the bone marrow

• Check a lump or abnormality detected on a mammogram for breast cancer

• Test the endometrium (uterine lining) to determine the cause of abnormal uterine bleeding (for example, cancer or endometriosis)

• Look for kidney failure, inflammation, or benign or cancerous growth

• Test for liver diseases such as hepatitis C, cirrhosis, infections, and cancer

• Test a nodule for lung cancer

• Study an enlarged or abnormal lymph node

• Detect muscle infections or defects

• Identify diseases of the connective tissue and blood vessels

• Test for underlying causes of male infertility

• Test a thyroid nodule for cancer

Needle Biopsy Pain: What to Expect

Needle biopsies are outpatient procedures done while you’re awake. Pain medications may be injected into the area to decrease the discomfort. These shots may sting.

Typically, an FNA biopsy will cause only mild discomfort. A CNB may hurt slightly more and require more numbing. Imaging during a biopsy, like a mammogram during a stereotactic breast biopsy, can also be uncomfortable.

Generally, if the biopsy location is sensitive, it may be more uncomfortable. Tell your healthcare provider if you’re uncomfortable and if you need additional pain medicine during the procedure.

Coping With Anxiety and Anticipatory Pain

If you’re feeling anxious ahead of a biopsy, know that needle biopsies are typically quick, and the healthcare provider can use numbing creams and shots to make it painless. Practice some relaxation techniques before the procedure.

While needle biopsies are less invasive than other biopsy approaches, they may cause a lot of anxiety if you have trypanophobia. Trypanophobia is a fear of needles.

If you have a needle phobia, talk to your healthcare provider about modifications to the procedure or additional steps you can take to avoid spiking your fear and anxiety. Other treatments for trypanophobia include cognitive behavioral therapy (a form of talk therapy) and medications.

More generally, facing a biopsy can be hard. Anxiety about medical tests is common. It may be called scanxiety. Talk with your healthcare provider—they can advise you on coping with the feelings.

You may be worried that it will hurt or anxious about getting a cancer diagnosis. Finding a growth anywhere can be nerve-racking as you wait for results. If you are having a biopsy of a nodule in the lung, thyroid, or breast, know that most are not cancerous.

Day of Needle Biopsy

A specially trained radiologist typically does needle biopsies. They may be called an interventional radiologist or a neuroradiologist. You’ll likely have a needle biopsy in an outpatient setting, at a medical provider’s office, specialty clinic, or a hospital.

It should require minimal preparation. When you schedule your appointment, the care team will send you detailed instructions about getting ready for your biopsy.

Before

Before any medical test, you tell your healthcare provider about any prescriptions, supplements, vitamins, or over-the-counter (OTC) drugs you’re taking. You may need to stop taking medicines like blood thinners. Don’t stop or change your medication without talking to your provider.

Tell them about your allergies, especially if you’ve had a bad reaction to anesthesia. Ensure the healthcare provider doing the biopsy knows of your medical conditions.

Tell your provider if you may be pregnant—they’ll need to avoid imaging that uses radiation while doing the biopsy. A pregnancy test can check before the procedure.

Most needle biopsies will require little preparation, depending on the type of needle biopsy and the location. You should be able to eat and drink before most needle biopsies, but ask your care team.

When you get to your appointment, the medical team will have you remove clothing and jewelry and put on a hospital gown. They’ll explain the procedure and have you sign a consent form saying you understand the benefits and risks and agree to have the biopsy done.

During

During a needle biopsy, you'll be awake. They may give you an intravenous (IV) line to administer mild sedation or relaxing medicines during the biopsy. They may have you lie down or sit up during the biopsy. They may tell you to hold your breath or stay still while they take samples and images.

If imaging tests are used, they'll do images first to confirm the location they need to biopsy and determine the safest way to access it. They'll mark your skin where the needle will go in. The provider will clean and disinfect the area, cover it with a clean and sterile drape, and then numb the biopsy area with creams and injections.

For a core needle or vacuum-assisted biopsy, the provider will make a small cut in the skin to insert the needle. They'll move the needle into place and sometimes take follow-up images to confirm the location. They'll remove and reinsert the needle to take multiple samples of tissue.

A core needle biopsy may employ a device that automatically moves the needle to collect "cores" of tissue. A vacuum-assisted biopsy uses vacuum pressure to pull tissue from the needle into the sampling chamber. Without removing the needle, the device rotates and collects more samples.

After

The biopsy procedure will take about an hour. The actual sample removal will take just a few minutes. When done, they’ll apply pressure to stop any bleeding. If they’re using imaging, they may take another picture to ensure they got the right spot.

They’ll cover the biopsy site with a dressing. Needle biopsies don’t usually require stitches. You'll be observed for several hours or you might be sent home soon after the procedure.

How long it takes to recover from a needle biopsy depends on the type of biopsy and where the tissue came from. You might feel fine right afterward, or you may need to go home and rest. If you were given a sedative, you’ll feel sleepy, and someone must drive you home.

Self-Care After Needle Biopsy

To care for your biopsy wound at home, you can usually ice the area and take over-the-counter painkillers if uncomfortable. Talk to your healthcare provider for their specific recovery advice. 

You may see bruising around the biopsy insertion site, and it may feel painful for a week or so. If you’re having any of the following symptoms, make sure to call your healthcare provider immediately:

• The biopsy location is red or swollen.

• You’re feeling severe pain.

• You have a high fever.

• Your wound is bleeding.

Related: Bruise on Breast: Causes and Treatments

Needle Biopsy Results

The tissue samples taken during a needle biopsy are sent to the lab, where a pathologist examines them. They will do many different tests, depending on what they're looking for and where the tissue came from.

Fine needle aspiration results may be available as soon as the biopsy day, but a core needle biopsy pathology report can take a few days to more than a week.

A healthcare provider will review your biopsy results with you. Often, the first question answered is if the biopsy shows signs of cancer or is noncancerous. If the biopsy tissue is benign, the results might indicate another condition is causing the type of growth or the abnormality.

If the results show cancer, they may note the stage and grade of cancer. Another test on the sample can show molecular or genetic features. These include specific gene changes to the cancer that help classify it.

Molecular tests for tumor markers in the biopsied tissue can help your oncologist (cancer specialist) determine the best course of treatment. They may recommend targeted therapy or hormone treatments that work well against your cancer.

Other information that may appear on your biopsy results include:

• Atypical samples are not cancerous but may become cancer or indicate a raised cancer risk.

• Samples that contain carcinoma are cancer from the cells that line organs.

• Sarcoma samples have cancer cells that started in connective tissue or muscle.

• Samples that show lymphoma have cancer cells that started in the lymphatic system.

• Leukemia samples have cancer cells that started in the bone marrow.

• Samples that show hyperplasia have a high level of specific cells in a tissue or organ. This may increase the risk of cancer or be a part of the body's normal disease response.

• A sample showing dysplasia has an increased number of abnormal or atypical cells. It may signify a viral infection or precancerous state.

• A sample marked as a neoplasia shows signs of abnormal, controlled cell growth. Neoplasia can be benign or cancerous.

Summary

A needle biopsy is a medical procedure. It takes a tissue sample to check for cancer or other diseases.

Needle biopsies collect tissue samples from various parts of the body. Fine needle aspiration (FNA) and core needle biopsy (CNB) are standard. A vacuum-assisted biopsy is another method that uses suction to collect tissue samples.

Needle biopsies detect cancer, including breast, lung, and thyroid cancer. They can also diagnose bone infections, blood cancers, and other conditions. They are often used to investigate abnormal lumps and lymph nodes. They can diagnose connective tissue disorders.

Needle biopsies may cause discomfort and some pain. Most of the time, a local numbing medicine is used. Sometimes, sedatives are used. Pain medications may reduce discomfort. Radiologists in outpatient settings perform most needle biopsies. Mention any medications you take, allergies you have, and medical conditions you have or have had to the healthcare provider.

The provider may use imaging like X-rays or MRI during a needle biopsy. These ensure they're testing the right area. They'll mark the biopsy site, clean it, numb it, and collect samples. It takes about an hour.

Recovery time varies. Bruising and discomfort may last for a week or more. Tissue samples are sent to a lab and examined by a pathologist. Results can take a week or more.

The most relevant results will indicate if an abnormality is cancer (malignant) or not cancer (benign). Additional tests can reveal cancer stage, grade, and genetic features. Molecular tests help guide treatment decisions.

Read the original article on Verywell Health.