Biopsy

Biopsies are most frequently performed to diagnose cancer but also to identify other conditions. Millions of biopsies are performed each year in the United States to examine tissue from the breast, prostate, skin, and many other parts of the body. The anesthesia and pain management considerations for a biopsy can depend on the method used to remove the tissue and where in the body it is taken from.

What is a biopsy?

A biopsy is a medical procedure in which small samples of cells or tissue are removed for examination in a laboratory. A doctor called a pathologist examines the cells or tissue under a microscope to check for damage or disease.

What parts of the body can be biopsied?

A biopsy can be performed on any part of the body, but these are some of the more commonly performed biopsies:

• Abdominal wall fat pad biopsy. Most often done to test for amyloidosis—a disorder in which abnormal proteins build up in tissues and organs, impairing their function.
• Bone biopsy. Used to identify the cause of pain or infection, to determine whether a tumor is cancerous, or to diagnose other abnormalities.
• Bone marrow biopsy. Used to diagnose and monitor blood cell disorders, bone marrow disorders, certain types of cancers, and infections.
• Breast biopsy. Used to confirm or rule out breast cancer.
• Cervix, vagina, or vulva biopsy. Used to determine the existence of abnormal or precancerous cells.
• Endometrial biopsy. Used to identify the cause of heavy or irregular bleeding. Tissue is removed from the lining of the uterus (the endometrium).
• Kidney biopsy. Used to identify parts of the kidney that are damaged, to determine the best treatment for a kidney problem, or to check for signs of infection, inflammation, scarring, or unusual deposits of a protein called immunoglobulin.
• Liver biopsy. Used to diagnose and determine the severity of liver damage and diseases such as cancer, to determine the best course of treatment, and to assess treatment effectiveness.
• Lung biopsy. Used to determine whether a lesion or nodule (a small, solid lump) is cancerous or to look for evidence of tuberculosis or a fungal, viral, or parasitic disease.
• Lymph node biopsy (of the neck, underarms, chest, abdomen, or groin). Used to check for a primary cancer such as lymphoma or to determine whether cancer from a nearby primary tumor has spread to the lymph nodes.
• Prostate biopsy. Used to confirm a cancer diagnosis and to distinguish between cancer and an enlarged prostate.
• Skin biopsy. Used to check for skin cancer, skin infections, and skin disorders such as psoriasis.
• Testicular biopsy. Usually performed to help determine the cause of male infertility.
• Thyroid biopsy. Used to determine whether a nodule (a small, solid lump) is cancerous.
• Upper small intestine biopsy. Used to make a definitive diagnosis of celiac disease.

Other parts of the body where biopsies may be done include the adrenal glands, bladder, brain, colon, esophagus, mouth, nose, stomach, throat, and vocal cords.

What are the types of biopsy procedures?

The National Library of Medicine and National Cancer Institute describe the following types of biopsy procedures:

• Fine needle aspiration biopsy. The doctor uses a small needle attached to a syringe to remove very small amounts of tissue.
• Core biopsy. The doctor uses a wider, hollow needle attached to a spring-loaded device to remove slivers of tissue.
• Open biopsy. A surgeon makes a cut into the affected area to access and remove tissue. In an incisional biopsy, the surgeon removes a sample of abnormal tissue or part of a lump or suspicious area. In an excisional biopsy, the surgeon removes the entire lump or suspicious area.
• Laparoscopic biopsy. This type of biopsy allows for much smaller surgical cuts than an open biopsy. These cuts provide sufficient space to insert a laparoscope—a camera-like instrument that guides the surgeon to the right spot—and the tools needed to remove the tissue.
• Shave biopsy. The doctor uses a small blade or razor to remove or scrape the outermost layers of skin to get a tissue sample, usually to examine for skin cancer or to diagnose a rash.
• Punch biopsy. The doctor uses a cookie-cutter-like skin-punch tool to remove deeper layers of skin—a sample that is about the size and shape of a pencil eraser. This is typically done to diagnose rashes.

What anesthesia should I receive for a biopsy?

The type of anesthesia used will depend in part on the level of invasiveness of the specific procedure. Your anesthesiologist will also consider risk factors related to your health (e.g., heart conditions, obesity, sleep apnea) and any previous reactions to anesthesia. Other considerations will include the level of patient awareness required—for example, whether the doctor will need you to follow instructions or answer questions—and whether the safety and success of the procedure depend on your remaining completely relaxed or still.

The general rule is to use only as much anesthesia as needed, because the chance of side effects increases with higher doses. Heavy sedation can be a particular concern for patients with risk factors such as breathing problems, morbid obesity, or sleep apnea.

These are the options for anesthesia:

• Local anesthesia. Minimally invasive biopsies, including many bone marrow, breast, and skin biopsies, can be done solely with the injection of a numbing medicine, such as lidocaine. The medicine minimizes or eliminates pain in the area being worked on.
• Local anesthesia with sedation. Sedation helps patients relax and is likely to be used when the biopsy is somewhat more invasive. The sedative is usually administered through an IV placed in the arm. The level of sedation can range from minimal (you’ll feel drowsy but able to talk) to deep (you probably won’t remember the procedure) and will depend on the situation. For example, light sedation may be used if you need to be aware enough to follow instructions, as when asked to take a breath and hold it during a liver biopsy.
• General anesthesia. This type of anesthetic renders the patient completely unconscious. It is most often used for the most invasive biopsies, such as those in which tissue is drawn from inside the chest or abdomen, and for biopsies in which it is critical for the patient to remain relaxed or still. General anesthesia impairs breathing, so a ventilator is used with either a breathing tube or a supraglottic airway device. Supraglottic devices keep the upper airways clear for ventilation but do not require intubation (placement of a tube through the airway into the lower windpipe).

If your procedure may require sedation or general anesthesia, discuss your options with the anesthesiologist in advance. Anesthesiologists are medical doctors with expertise in determining the safest and most effective anesthesia for a particular patient.

The anesthesiologist should ask you about your prior experience with anesthesia and about any anesthesia reactions among your family members, going back multiple generations if possible. You should also talk about your current health and health history, including any chronic pain that could make it difficult for you to remain comfortable under sedation instead of general anesthesia.

Provide information about any medicines, supplements, or narcotics you are using, including marijuana or CBD products, which can impact the type and amount of anesthesia you can safely receive.

How can I manage pain after a biopsy?

The amount and type of pain management required will depend in large part on the invasiveness of the biopsy procedure and the body part where the biopsy was done. Be aware that certain types of pain may signal a complication from the procedure, so always inform your doctor if you experience any unanticipated pain or pain that lasts longer than you were told to expect.

Fine needle and core biopsies usually do not result in much pain during recovery, and the numbing medication used for the procedure lasts several hours. More pain is to be expected following an open or laparoscopic biopsy because the procedures are more invasive.

The preferred options for pain relief during recovery are nonnarcotic pain medicines. Because anesthesiologists are trained to help patients manage pain, it is best to consult with the anesthesiologist and the physician performing the procedure before your biopsy to discuss options for postoperative pain management.

Anesthesiologists work with your surgical team to evaluate, monitor, and supervise your care before, during, and after surgery—delivering anesthesia, leading the Anesthesia Care Team, and ensuring your optimal safety.