Tissue Biopsy: What to Expect

A biopsy is the removal of cells or tissue for analysis. The purpose of a biopsy is to characterize the morphologic and histologic features of the sample, and, in some cases, to test for the presence of certain molecular biomarkers. In oncology, a biopsy is critical to determine if cancer is present and to assess other features that may help guide disease management decisions.

Educating patients about what to expect during and after a biopsy procedure is important to reduce prebiopsy anxiety.¹ Patients typically worry about pain or discomfort during biopsy, and, in one study, investigators found that the anticipation of pain during biopsy was associated with actual pain during the procedure.^1,2 Preparing patients for the biopsy before the procedure is associated with lower levels of anxiety.³

Prior to the Biopsy

There are several different types of biopsy; these differ in regard to the amount of tissue that is removed and the way in which the tissue is excised.⁴ Clinicians should explain to patients that the selection of biopsy type depends on the overall goal of the biopsy and  part of the body in which the procedure is expected to occur. For cancer diagnosis, a larger amount of tissue may be needed to ensure there is sufficient material for a definitive diagnosis and for the analysis of any biomarkers, where applicable.

Patients or caregivers may ask if a biopsy will result in the seeding of tumor cells, which could initiate metastasis. Studies suggest that this is a potential, but very rare, risk for most cancers; however, most reports are case studies or small retrospective studies and the data that are available are not definitive.^5,6 Some authors suggest that seeding is underreported.⁶

In a systematic review of 7 studies of head and neck cancer, seeding was estimated to occur in 0.00012% of cases with fine-needle aspiration (FNA) and 0.0011% of cases using core needle biopsy (CNB).⁷ A meta-analysis of 8 studies of hepatocellular cancer reported an overall risk of seeding of 2.7%.⁸ In prostate cancer, a systematic review reported the risk of seeding to be less than 1%, but noted that the quality of data were very poor.⁵

Seeding appears to occur more frequently in breast cancer. A systematic review found that approximately one-third of patients who underwent CNB had seeding.⁹ Many tumor cells, however, did not survive after seeding. This study also found that vacuum-assisted CNB was associated with a lower risk of seeding compared with conventional automated devices.

During the Procedure

Most biopsy procedures are done on an outpatient basis and use local anesthesia.¹⁰ Biopsies that are more complicated, such as those involving a deep internal organ, may require more extensive anesthesia. Patients must understand instructions for the day of the procedure, such as whether a driver is required, which medications can or cannot be taken leading up to or on the day of the procedure, and whether eating or drinking is allowed prior to surgery.  

Most patients do not experience pain during biopsy. In a study of 136 women undergoing stereotactically or ultrasound-guided breast biopsy, 40% and 49% reported no pain or mild pain, respectively, and only 12% reported moderate to severe pain during biopsy.² Patients who anticipated pain during a biopsy were more likely to experience pain, highlighting the importance of educating patients about what to expect before the procedure.