The term ‘biopsy’ comes from the Greek words bios meaning ‘life’ and opsis meaning ‘sight’ or ‘vision.’ Essentially, biopsies are a way for doctors to ‘see inside your body by extracting a small tissue sample for examination’.  In most cases, a biopsy is the only definitive method to diagnose cancer or other serious diseases. The tissue sample is analysed under a microscope to identify any abnormalities at the cellular level by a pathologist.

Radiology’s role in biopsies

Radiology-guided biopsies are often less invasive than surgical procedures, leading to less discomfort, quicker recovery times and fewer complications for the patient.

How do biopsies work?

Dr Nardus van Rooyen, a radiologist at SCP Radiology in Cape Town, explains: ‘Depending on the procedure, this form of interventional radiology uses ultrasound and CT imaging to guide the biopsy needle to the exact location of the tissue that needs to be sampled. This precise targeting increases the likelihood of obtaining an accurate tissue sample and minimises the risk of complications.

‘We utilise real-time imaging to monitor the needle’s progress, allowing us to avoid critical structures like blood vessels and nerves. Before the biopsy, we thoroughly review the patient’s imaging studies to plan the safest and most effective approach. After the biopsy, additional imaging may be performed to ensure there are no immediate complications and that a sufficient tissue sample has been collected.’

Why is a biopsy necessary?

A biopsy is often recommended when initial tests reveal abnormal tissue, which could be indicative of disease. While physical exams, CT scans or MRIs can detect masses or irregularities, they cannot distinguish between cancerous and non-cancerous cells. To provide a more accurate diagnosis, doctors often perform a biopsy, referring to the abnormal tissue as a tumour, lesion or mass.

Common reasons for a biopsy

• Breast lumps: Typically done using ultrasound guided core needle biopsy, vacuum-assisted biopsy or stereotactic (mammogram-guided) techniques
• Suspicious skin lesions: To diagnose potential skin cancers or other skin disorders
• Soft tissue masses: Often guided by CT or ultrasound to determine if a lump is benign or malignant
• Liver abnormalities: To check for liver damage, monitor the effectiveness of treatment or investigate unexplained liver disease
• Lung biopsies: To diagnose lung cancer or other pulmonary conditions
• Bone marrow disorders: Such as leukaemia and lymphoma
• Thyroid and salivary glands: To diagnose potential cancers or other abnormalities

Other reasons for a biopsy 

• Diagnosing infections: Especially those deep within the body that cannot be identified through less invasive tests
• Inflammatory or autoimmune disorders: For a definitive diagnosis
• Metabolic disorders: Such as liver or kidney issues, where tissue changes need to be examined
• Persistent, unexplained symptoms: Chronic pain, ulcers or other symptoms that remain unresolved 
• Stage assessment in cancer: A biopsy can help determine how far cancer has spread, which is crucial for staging and treatment planning
• Monitoring disease progression: In chronic conditions, periodic biopsies may be performed to track the disease’s progression or response to treatment

.

.

What to expect during a biopsy

1. Anaesthesia: Depending on the biopsy type, local or general anaesthesia may be administered.
2. Preparation: The area is thoroughly cleaned and sterilised.
3. Sample collection: The tissue is carefully collected using the most appropriate method.
4. Lab analysis: The sample is sent to a pathology lab for detailed examination.

What to remember about biopsies

If you are at high risk of bleeding, careful preparation and post-procedure monitoring are essential. If you are on anticoagulant medication (blood thinners) you need to inform the radiology practice ahead of the time as additional preparation may be needed.

Whether the biopsy is done in a hospital or outpatient setting, it’s important to report any pain, bleeding or other symptoms such as shortness of breath to your healthcare provider immediately.

Understanding your results

The radiologist collaborates closely with the pathologist to make a diagnosis. Biopsy results, particularly those concerning suspected cancer, may take a few days to process. Your doctor will either call you or schedule an appointment to discuss the findings. The biopsy report will indicate one of the following:

• Normal/Benign: No signs of disease
• Abnormal/Positive: Presence of disease (e.g., cancer, infection)
• Inconclusive: Results are unclear, which may necessitate a repeat biopsy or additional tests

Final thoughts

‘Biopsies are a cornerstone of modern medicine’, says Dr van Rooyen, ‘providing crucial information that guides treatment decisions. While the procedure can be anxiety-inducing, it remains one of the most reliable methods for diagnosing a wide range of medical conditions. Radiology plays a pivotal role in ensuring that tissue samples are collected accurately, ultimately leading to more effective patient care.’

• This article is intended to create awareness and none of the information it contains should replace the need for seeking personal advice from a qualified medical practitioner.

• Apart from selected screening examinations, all radiology procedures are performed upon referral from a qualified medical professional.