Percutaneous Biopsy

A biopsy is a way of taking a small piece of tissue out of your body.  This is done using only a tiny cut, so that it can be examined under a microscope by a pathologist.   A pathologist is an expert in making diagnoses from tissue samples. Many parts of the body can be biopsied this way. Your doctor will inform you of which kind of biopsy you need to have. These include - lung, liver, bone, lymph nodes, kidney, breast tissue & the thyroid gland biopsies.

Because this biopsy is done through the skin, it is called a percutaneous biopsy. 

Other tests, such as an ultrasound scan or a CT scan, will have shown an area of abnormal tissue inside your body.   From the scan, it is not always possible to say exactly what this is due to.  The simplest way of finding out is by taking a tiny piece of it away for a pathologist to examine.

Your consultant and the radiologist will have discussed the situation.  They will have agreed that this is the best thing to do.   Your opinion will also be taken into account.  If, after discussion with your doctors, you do not want to have this done, you can decide against it.

A specially trained doctor called a radiologist. Radiologists have special expertise in using imaging equipment, and interpreting the images produced.  They need to look at these images while carrying out the biopsy. 

Usually in the x-ray department. Either in the CT scanning room, or else a special procedures room, with and ultrasound machine.

• you may need to be an in patient in the hospital although many biopsies can be performed as an out patient
• you will probably have had some blood tests, to check that you do not have an increased risk of bleeding
• you will probably be asked not to eat or drink for up to for four hours before the procedure
• you will be asked to put on a hospital gown

You must let your doctor know if

• you have any allergies or take any medication to thin your blood such as Aspirin, Warfarin, Heparin, Apixaban or Clopidogrel
• you have ever had a reaction to intravenous contrast medium.  This is the dye used for kidney x-rays and CT scans

The radiologist will keep everything as sterile as possible.  

• you will lie on the ultrasound or scanning table, in the position that the radiologist has decided is most suitable
• you may need to have a needle put into a vein in your arm.  This is to allow the radiologist to give you painkillers if needed
• your skin will be cleaned with antiseptic.  You may have some of your body covered with a theatre towel
• The radiologist will use the ultrasound machine or the CT scanner to decide on the most suitable point for the biopsy needle 
• your skin will be anaesthetised with local anaesthetic 
• the biopsy needle will be put into the abnormal tissue

The first part of the procedure may seem to take a while.  Doing the biopsy does not take very long at all.  The needle may be in and out so quickly that you barely notice it.

Most biopsies do not hurt at all after the local anaesthetic has been injected.

When the local anaesthetic is injected, it will sting to start with.  This soon wears off.  The skin and deeper tissues should then feel numb. 

Later, you may feel the needle passing into your body. This is more likely to be a dull pushing sensation rather than painful but just tell the doctor & more anaesthetic can be used if you find it very sore.

A nurse, or another member of clinical staff, will stand next to you to look after you.  If you do feel pain, he or she will be able to arrange for more anaesthetic.  

Every patient is different.  It is not always easy to predict how complex or how straight forward it will be.   It may be over in 30 minutes, although you may be in the x-ray department for about an hour.

You will be taken back to your ward on a trolley if you need to be an inpatient for your procedure. This will make sure that there are no bleeding problems. You will stay in bed for a few hours until you have recovered. 

If the biopsy being performed & you are an outpatient then it is likely that the staff will observe you for 20 minutes - 1 hour then allow you to go home.

If you have had a lung biopsy, then you will be an inpatient & are likely to have a chest x-ray at some stage.

All being well, you will be allowed home either on the same day, or perhaps the next.  Do not expect to get the result of the biopsy before you leave.  It always takes a few days for the pathologist to do all the tests on the biopsy specimen at an external laboratory in Edinburgh.

This is normally safe.  It will save you from having a bigger procedure.   There are a few risks or complications, as with any medical treatment.

If you are having a liver biopsy, then there is a risk of bleeding from the liver.  However, this is generally very slight.  If the bleeding were to continue, it is possible that you might need a blood transfusion.   Very rarely, an operation or another radiological procedure is needed to stop the bleeding.

If you are having a lung biopsy, it is possible that air can get into the space around the lung.  This usually does not cause any real problem.  However, if it causes the lung to collapse, the air will need to be drained.  This will be done either with a needle or a small tube, put in through the skin & you will remain in hospital until this is removed.
 
Unfortunately, not all biopsies are successful.  This may be because there may not be enough abnormal tissue for the pathologist to make a definite diagnosis. If this is the case they you may be recalled for a repeat of this biopsy procedure or else your doctor may decide to tray and gain the tissues sample using a different method. You will be told about this by your doctor.

This leaflet should have answered some of your questions.  Remember that this is only a starting point for discussion.   

Make sure you are satisfied that you have had enough information before you sign the consent form.

Further information

If you have any questions about the biopsy, you will be able to discuss these with the radiologist before the procedure.  Any other medical questions should be discussed with your doctor.

If you have specific concerns which you feel you must discuss before your appointment, please phone the Radiology office (01896 826417).  Ask to arrange to speak to a radiology nurse. This may involve planning a time when both of you are free to speak.