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Diagnostic Evaluations

Biopsy

Some biopsies are performed endoscopically, while others are performed under image guidance, such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) in the radiology suite. In some cases, biopsies are performed in the operating suite, which allows a doctor to collect tissue from deep within the body.

Some sites that are commonly biopsied include the breast, skin, bone marrow, GI tract, lung, liver, bladder, colon and lymph nodes. A doctor determines the method of biopsy based on several factors, such as the size, shape, location and characteristics of the abnormality.

Some types of biopsy include those listed below.

Bone marrow aspiration and biopsy

Bone marrow biopsies are performed to diagnose and monitor a variety of hematologic cancers, such as leukemia, lymphoma and multiple myeloma. The procedure also may be used for cancers that have spread to the bone marrow from another area, such as the breast.

A bone marrow aspiration and biopsy procedure removes a small sample of bone marrow fluid and/or a small amount of bone (typically from the hip or breast bone) through a needle. The bone marrow is the soft, sponge-like tissue inside most bones that produces white blood cells, red blood cells and platelets. The sample is then examined under a microscope by a pathologist.

Doctors may recommend a bone marrow aspiration and biopsy if an abnormality is detected in a patient’s bloodwork. Examining the bone marrow gives more information about the blood cells to determine the stage or progression of the disease and to monitor treatment. This procedure also may be performed to collect a bone marrow sample for a stem cell transplant.

CT-guided biopsy

During a CT-guided biopsy, a doctor inserts a biopsy needle into the body under the guidance of images generated by a CT scanner. A computed tomography (CT) scan (also known as a computed axial tomography scan, or CAT scan) uses X-ray technology to produce detailed images of areas inside the body to assist doctors in accurately placing a needle into tissue to remove a sample for testing.

During the scan, patients lie down inside a CT machine, which takes images from many angles as the X-ray tube rotates around the patient’s body. After the biopsy is complete, a pathologist inspects the cells under a microscope, looking for cancerous abnormalities.

MRI-guided breast biopsy

MRI-guided breast biopsy is used to precisely locate and remove tissue from a suspicious area in the breast for diagnosis and treatment planning.

During this minimally invasive, image-guided procedure, the patient lies face-down on a padded exam table, and the affected breast is positioned into an opening in the table. The breast is then gently compressed between two plates marked with a grid structure, and scanned laterally and medially, allowing for imaging of all quadrants of the breast, the axilla and up into the chest wall.

Using targeting software, the radiologist measures and pinpoints the position of the breast tumor with respect to the grid. This helps calculate the position and depth of the needle placement for the biopsy.

In preparing for the biopsy, a local anesthetic is first injected into the breast to numb it. Next, the radiologist inserts a core needle and advances it to the location of the tumor. MRI is then used to verify the tumor’s position.

Once the tumor’s position has been confirmed, a vacuum-assisted needle uses vacuum pressure to pull tissue from the breast into the sampling chamber. The tissue samples are then taken to the laboratory for pathology testing.

Sentinel lymph node biopsy

Sentinel lymph node biopsy is used to diagnose and stage cancer by helping to determine whether cancer has spread. During a sentinel lymph node biopsy, a radioactive substance and/or a dye is injected near the tumor site. The first lymph nodes that absorb the dye are identified as sentinel lymph nodes, because they are the first lymph node drainage to which cancer is most likely to spread from a primary tumor. More than one lymph node may be considered a sentinel lymph node.

The surgeon removes the sentinel lymph nodes for examination by a pathologist, who tests the tissue for the presence of cancer cells. The biopsy procedure is sometimes referred to as sentinel lymph node dissection because it involves removing just a few lymph nodes for testing. If the sentinel nodes show no signs of cancer, the cancer is less likely to have spread, and the oncologist may recommend that no further lymph nodes be removed. This determination helps inform oncologists in recommending an appropriate treatment plan, while avoiding the unnecessary removal of healthy lymph nodes.

If cancer is found in the sentinel lymph nodes, additional surgery may be needed to remove more lymph nodes, depending on the metastasis or number of lymph nodes involved. In some circumstances, a sentinel lymph node biopsy may be performed at the same time, before or after the primary tumor is removed.

A sentinel lymph node biopsy is often recommended for breast cancer patients to determine whether cancer has spread to the axillary lymph nodes, located under the arm. Sparing healthy lymph nodes in the underarm area may help prevent a condition known as lymphedema, which leads to excess fluid buildup and swelling in the tissue, most often in the extremities, such as the arms and legs.

A sentinel lymph node biopsy may also be an option for melanoma patients whose cancer has a high risk of spreading to the lymph nodes. Sentinel lymph node biopsy is also recommended for some patients to determine whether their gynecologic cancer has spread to the pelvic lymph nodes, because this procedure may reduce the risk of complications common to surgeries to remove all the lymph nodes in the pelvic area.