The A to Z of Biopsies & Why it Should No More Scare You Away!

There’s no denying that biopsies can be scary. They’re done to confirm the presence of cancer or other serious diseases. That’s why it very important that one knows as much as you can about biopsies.

Dr. S. Veda Padma Priya mentions the 6 common myths about biopsies—and the facts you need to know…

MYTH #1: Biopsies cause cancer to spread. Most people worry that disturbing a tumor with a needle or surgery to perform a biopsy will allow cancer to spread.

Recent research: Studies have dispelled this common belief. In one recent study of pancreatic cancer patients, those who received a biopsy had better outcomes and lived longer than those who did not have a biopsy.

Possible exceptions: A testicular biopsy can potentially cause “local spread” through blood and lymph vessels and upstage the disease. So, testicular tumors that appear to be malignant on imaging are usually tested by removing the entire testicle.

Ovarian cysts that appear likely to be malignant on imaging are also not biopsied because leakage of the fluid can cause the malignant cells to spread.

MYTH #2: Biopsies are used only for cancer diagnosis. 

There are many types of biopsies. They include:

1. Fine-needle aspiration (a needle is used to withdraw material—often fluid—from a mass)…

2. Core biopsy (a hollow needle is used to remove narrow cylinders of suspicious tissue)…

3. Incisional biopsy (part of the tumor is removed surgically).

The biopsy is the most robust method that will give an answer to the question—do I have cancer? 

A clinical examination, laboratory tests, and imaging X-ray /computed tomography (CT) or MRI scan help as corroborative evidence.

But diagnosing cancer is not the only reason that a person might have a biopsy. Biopsy also confirms as to:

1. What type of cancer are we suffering from? Like carcinoma or lymphoma. Treatment may vary based on the diagnosis.

2. What treatment is most effective based on markers on biopsy material?

3. Nowadays we have genetic testing that can be done on tumor tissue to determine if it responds to a particular therapy or not.

MYTH #3: Bigger is better. 

It makes sense to think that bigger biopsy (removing a lot of tissue or entire tumor—is more accurate than one that removes just a bit of tissue). Nowadays core biopsy has replaced most of the other biopsies and they usually cause fewer complications, thereby speeding up the patients’ recovery.

In an Image-guided biopsy, the doctors aim needles with pinpoint accuracy using ultrasound or other imaging procedure. Core biopsies are most useful in breast and prostate cancers, and most lung and colon cancers are diagnosed by endoscopic procedures.

MYTH #4: One tissue sample is enough.

Suppose that a man with a small prostate cancer is given one core biopsy. If the sample doesn’t contain cancer cells, the man would be declared cancer-free (a “false-negative”). So it is routine to have multiple cores of tissue from all across the gland. Previously the urologist would take six core samples from the prostate gland. Now it’s mandatory to take twice the number of cores (12) so that cancer cells will not be missed.

MYTH #5: Biopsies are definitive. 

In the majority of cases, most pathologists while examining the same tissue samples will come to the same conclusion—but it’s not 100%. In certain situations of rare variants or metastases of unknown origin, the pathologists may have varied interpretations. Pathology is still the best way to diagnose and classify cancer, but it isn’t quite as exact as most people imagine. In the borderline scenario, the difference between benign and malignant cells isn’t always clear-cut.

MYTH #6: Cancer cannot be detected without a tissue sample. 

Some cancers can be diagnosed by cytology—samples of cells in urine or sputum or nipple discharge or pap smear. Some cancers are diagnosed based on imaging findings so a biopsy is not needed. For example, Hepatocellular carcinoma can be diagnosed from an imaging test.

On the horizon: “Liquid biopsies,” in which doctors look for circulating tumor cells, DNA or other substances in blood samples. This approach may soon be used to monitor how well patients respond to chemotherapy or other treatments. In the future, it might replace some biopsies for diagnosing cancer—but the technology isn’t there yet.

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