Needle biopsies
A needle biopsy is a medical procedure designed to collect tissue samples from suspected tumors or growths, helping diagnose various types of cancer, including those affecting the breast, lung, prostate, kidney, and more. There are two primary types of needle biopsies: fine needle biopsy, which uses a thin needle to extract small tissue samples, and core needle biopsy, which employs a wider needle to extract larger samples. Tools like the Mammotome and Advanced Breast Biopsy Instrumentation (ABBI) are specialized instruments used primarily for breast biopsies.
The procedure is generally less invasive than traditional surgical biopsies and can often be performed on an outpatient basis. Prior to the biopsy, patients may undergo specific preparations based on the tissue being sampled, which might include fasting and imaging guidance to accurately locate the tumor. The biopsy process involves local anesthesia and may use imaging techniques to guide the needle to the target area, ensuring multiple samples can be taken if necessary.
Post-procedure care typically involves monitoring for a short period and instructions for activity restrictions to promote healing. While needle biopsies are relatively safe, there are some risks, including bleeding and infection, particularly in highly vascular organs like the liver and kidneys. The samples collected are then analyzed to provide insights regarding the nature of the tumor, helping inform further treatment options if cancer is detected.
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Needle biopsies
ALSO KNOWN AS: Fine needle biopsy, core needle biopsy, stereotactic (exact) biopsy, Mammotome biopsy, Advanced Breast Biopsy Instrumentation (ABBI)
DEFINITION: A needle biopsy is a procedure in which a sample of body tissue is extracted by using a hollow needle or a similar instrument. There are two types of needle biopsies: fine needle biopsy and core needle biopsy.
In fine needle biopsy, a thin needle attached to a syringe is used to extract the tissue samples. In core needle biopsy, a wide-gauge needle or a special biopsy instrument, such as a Mammotome or Advanced Breast Biopsy Instrumentation (ABBI), is used. The Mammotome and ABBI are used only to perform a breast biopsy. The core needle ranges from 0.25 to 1 centimeter in diameter. It has a special cutting edge and a spring-loaded device that suctions out the tissue samples. The Mammotome suctions in breast tissue and then cuts it with a rotating blade. The ABBI extracts a cylinder of breast tissue about the size of the tumor.
Cancers diagnosed: Breast, lung, prostate, kidney, thyroid, musculoskeletal, liver, heart, and skin cancers
Why performed: Needle biopsies are performed to obtain samples of tissue from a tumor or growth that is suspected of being cancer. Needle biopsies are considered less invasive than surgical biopsies and often can be performed as an outpatient procedure.
Patient preparation: The patient preparation will depend on the tissue that is being sampled, the risk of the procedure, and the type of facility where the biopsy is to be performed. If a core needle biopsy is carried out in a physician’s office, then ultrasonic guidance is used to localize the tumor, unless it is palpable. If it is palpable, then no radiologic guidance is required.
Needle biopsies that require the use of fluoroscopy, computed tomography (CT), (MRI), or mammography to localize the tumor or that are considered high risk are performed in an outpatient surgical center. Patient preparation may include a preoperative physical examination, blood work, and possibly an electrocardiogram (EKG). The patient needs to fast for two to four hours before the procedure.
Occasionally, high-risk biopsy procedures require that the patient be admitted to the hospital for the biopsy and then stay overnight for monitoring. In this instance, patient preparation would require a preoperative physical examination, blood work, and an EKG. Also, the patient would need to fast after midnight on the day of the biopsy.
Steps of the procedure: The patient is positioned so that the area to be biopsied is exposed. This area is then scrubbed and disinfected. A local anesthetic is injected into the biopsy area. If the tumor is not palpable, then radiologic imaging is used to localize the tumor and to follow the progress of the needle into the tissue. This is called stereotactic localization.
For a fine needle biopsy, the surgeon inserts the needle into the tumor and aspirates small samples of tissue. The needle is repositioned several times so that multiple tissue samples can be taken.
Unless the tumor is superficial, for core needle biopsy, a small (0.25 inch in length) is made into the tissue. The core needle is then inserted into the tumor through the incision. Multiple tissue samples are taken.
For core needle, Mammotome, and ABBI biopsies of the breast, the patient is positioned on her stomach with a single breast hanging through a hole in a specially designed table. This procedure uses either mammography or ultrasound guidance to localize the breast tumor. For MRI guidance, the patient is positioned on her stomach and both breasts are hanging pendent. The biopsy is performed on the hanging breast.
In the twenty-first century, several advancements in needle biopsies have increased the procedure’s accuracy. Endoscopic Ultrasound-Guided Fine Needle Biopsy has made obtaining hard-to-reach tissue samples easier. Rapid On-Site Evaluation techniques have allowed doctors to evaluate biopsy samples in real time, ensuring needle biopsies accurately sample the correct tissues. Combining ultrasound, CT, and MRI has also increased the accuracy of diagnosis. Finally, the design of the biopsy needles was consistently updated for improved accuracy.
After the procedure: If an incision was made, then either a suture (stitch) or an adhesive paper (Steri-Strip) is applied to close the edges of the incision. A sterile dressing is applied over the biopsy site. For some biopsies, a pressure dressing is applied after the biopsy procedure. Usually, the patient is monitored for at least one hour after the biopsy.
The patient can remove the dressing in one to two days, and they should avoid vigorous physical exercise or heavy lifting for two weeks after a biopsy.
Once a needle biopsy has healed, including Mammotome and ABBI, the patient is unlikely to have a scar from the procedure.
Risks: The liver and the kidney are highly vascular (have many blood vessels) and thus are at high risk of bleeding following biopsies. Lung biopsies carry a risk of causing the collapse of a portion of the lung (pneumothorax). Other risks of needle biopsy are nerve damage and infection.
Results: The biopsied tissue is sent to a cytologist or a pathologist to be examined under a microscope. A cytologist examines the cells from a fine needle biopsy, in which the specimens consist of aspirated cells. A pathologist examines the samples from core needle biopsies, which consist of cores of tissue. This tissue must be sliced thinly and applied to a slide for examination.
The surgeon will receive a pathology report that describes the cells of the tumor. It will discuss the size, shape, and activity of the cells and their nuclei, comparing them with normal cells. The report states whether the tumor is cancer and, if so, the type of cancer cells present within the tumor.
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