Assessment for image-guided biopsy

Why imaging may not be enough

Imaging may suggest the nature of a lesion, but several diseases look alike. Analysis of the tissue can distinguish an inflammatory process from a tumor, define the type of tumor or provide information that guides treatment. A sample may also be requested for reasons unrelated to cancer.

Not every lesion needs a biopsy. Some have sufficiently characteristic features or are followed over time. In other situations an endoscopic or surgical route, or a sample from another site, is preferred. The key question is how the answer will change the medical decision.

Cells or a core of tissue

Fine-needle aspiration takes mainly cells for cytology. A core needle biopsy takes fragments of tissue that also preserve its organization and may be needed for histology and other analyses. The choice depends on the organ and the suspected diagnoses.

When molecular or microbiological tests are requested, this must be known before the procedure. The amount, preservation and processing of the material affect the information that can be obtained. A small sample is not always sufficient for every analysis, even when the needle was placed accurately.

What the specialist assesses before the procedure

The original images are reviewed, together with the location and the relationship to blood vessels and neighboring organs. The area expected to give useful information is chosen, along with the route that aims to limit damage. For some tumors the planning must be coordinated with the team that may carry out later treatment.

The general condition, the coagulation tests and the platelet count are assessed according to the procedure. Lung disease, infections, possible pregnancy and the ability to stay in position affect the plan. If no safe route exists, an alternative may be needed rather than an attempt at any cost.

Medicines and preparation

Bring the complete list of medicines, including anticoagulants and antiplatelet agents that affect clotting. Do not stop them yourself: the decision must weigh the risk of bleeding against the risk of thrombosis, especially in patients with a mechanical valve or a coronary stent.

Instructions on food, tests and accompaniment vary with the anesthesia and the organ. Some biopsies are done under local anesthesia, while others require sedation, that is, calming with medicines, or longer monitoring. Ask for written instructions from the service that will perform it and report previous reactions to medicines or contrast.

Benefits and risks

Image guidance helps with localization and with planning the trajectory. A percutaneous biopsy, that is, one through the skin, may avoid a surgical procedure solely to obtain a diagnosis. Risks nevertheless remain, such as pain, bleeding, infection or damage to nearby structures.

Risks depend on the site. In a lung biopsy, for example, pneumothorax may occur, that is, a collection of air between the lung and the chest wall, which sometimes needs drainage. The benefit and the risk must be explained for the specific procedure, together with the alternatives and the consequence of not doing it.

Frequently asked questions

Does an image-guided biopsy hurt? It is usually performed under local anesthesia at the puncture site, so the discomfort is mainly brief: pressure or mild pain at the moment the sample is taken. Some tenderness may remain for hours or days afterwards. Pain that increases quickly, swelling or bleeding calls for immediate contact with the team.

How long does the procedure take and can you go home the same day? Taking the sample itself usually lasts a few minutes, but preparation, positioning and monitoring afterwards extend the time spent. In many cases the patient goes home after a period of observation; this depends on the organ, the medicines and the general condition. The doctor tells you beforehand what to expect.

How long must you wait for the anatomopathological result? Preparing the sample in the laboratory takes several working days, while some additional tests, such as immunohistochemical or molecular ones, may extend the time. The doctor informs you of the expected time and of how you will receive the answer. The result is explained in a consultation, not only by handing over a written report.

What happens if the result is benign but the suspicion remains? The result must convincingly explain the targeted finding. If the image remains concerning or the symptoms continue, repeating the sample, another sampling method or close follow-up with imaging may be recommended. A benign answer should not be accepted as final when it does not match the clinical picture.

Can a tumor spread because of the biopsy? The risk that tumor cells spread along the needle track is very small and, for most tumors, does not change the outcome of treatment. Failing to obtain the correct diagnosis, on the other hand, may lead to inappropriate treatment. The specialist plans the entry route taking later treatment into account as well.

What should I do at home after the biopsy? Follow the instructions given: keep the area clean and dry as advised, avoid heavy exertion and lifting for the stated time, and take only the pain medicines you have been allowed. Do not restart anticoagulants on your own without instruction. Tell the team about fever, bleeding, swelling that increases or new pain.

How the result is interpreted

The pathologist’s report is linked to the imaging and the clinical data. A benign result must convincingly explain the targeted finding. When there is a mismatch or the material is insufficient, review, repetition or another method may be needed. A sample without tumor cells does not always exclude disease in every circumstance.

Ask who will receive the result and who will explain the next step. After the procedure follow the monitoring plan and the restrictions given.

Care at Tirana Polyclinic: We assess the indication and the imaging materials, and we perform image-guided biopsy and the collection of the sample for anatomopathological (histological or cytological) analysis. We clarify the diagnostic question first. When another guidance method or a different setting is needed, we direct you to the appropriate service.