What is biopsy? Who should do the biopsy? And biopsy treatment in India

What is biopsy?

Biopsy is a medical test in which part of the abnormal tissue is taken out and is sent for analysis under microscope by a specialist (Pathologist)

How is biopsy done?

Biopsy can be either an open biopsy or a needle biopsy. In open biopsy, small incision is given over the abnormal area to obtain the material. However, in needle biopsy, the same material can be obtained by a needle without any need for an incision or suturing.

Since, a needle biopsy doesn’t need any incision or suturing, the pain, surgical morbidity and hence the complications are much lesser with a needle biopsy.

Biopsy Treatment in India

I’ve been told that needle biopsy may not yield a result, so shall I go for open biopsy?
If done correctly, needle biopsy is able to give results in almost all the patients. Moreover, the tissue so obtained should be sent to specialist doctors (Pathologists) who are experienced to analyse the small amount of tissue obtained in needle biopsy and give a conclusive report.

Open biopsy unnecessarily increase the pain and trauma when we can have the same results just with a needle. Not only that, the scar of biopsy needs to be removed at the time of final surgery, and hence, open biopsy means more removal of the skin at the time of final surgery which can very well be avoided with a needle biopsy

Is FNAC same as needle biopsy?

NO. FNAC is entirely a different procedure than a needle biopsy though both are done with a needle.

FNAC stands for Fine Needle Aspiration Cytology and in FNAC only cells are aspirated from the abnormal tissue whereas in needle biopsy the abnormal tissue  is taken out for analysis.

FNAC should not be done in bone and soft tissue tumours because the diagnosis of any bone and soft tissue tumour is based on the tissue material itself and not just the cells. Moreover, many a times FNAC may not be able to extract the cells and may give a false negative reports. Not only that many a times we need special tests called as IHCs (ImmunoHistochemistry) which can not be performed on FNAC specimen.

In a nutshell , FNAC has NO role in the diagnosis of bone and soft tissue tumours and should not be done.

Is biopsy painful?

A needle biopsy of soft tissue can be done as an opd procedure under local anesthesia without causing any pain to the patient. However, a bone biopsy can be painful sometimes if done under local anesthesia and hence, patient may be given general anesthesia for the same

Who should do the biopsy?

Biopsy should always be done by a surgeon who should be doing the final surgery. A poorly done biopsy may not only yield false negative or inconclusive results but also wrongly placed biopsy scars can be detrimental for future limb salvage (which might unnecessarily cause increase in extent of surgery and hence the complications). To summarise, biopsy should always be done by Orthopaedic Oncologist or one of his team members since the location and technical aspects of biopsy can affect the biopsy treatment in India options and final outcome of the patient.

Dr Rajat Gupta
Orthopaedic Oncologist
Bone Cancer Clinic
# 5, Sector 19 A,
Chandigarh

Location: India

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