Biopsy

What is a Biopsy Test?

A biopsy is a procedure in which a small sample of tissue or cells is taken from your body and examined under a microscope. It is one of the most reliable ways to find out what is causing a lump, growth or abnormal result, and it is the standard way to confirm or rule out most cancers.

It involves obtaining a sample of tissue or cells for laboratory analysis. A doctor who specialises in examining tissue, called a pathologist, studies the sample to find out whether the cells are normal or abnormal and, if abnormal, what is causing the change.

A biopsy is often done after an imaging test, such as an X-ray, ultrasound, CT scan or MRI, has found something that needs a closer look. Imaging can show that something is there, but only a biopsy can tell you exactly what it is.

Why Might You Need a Biopsy?

Your doctor may recommend a biopsy if:

• A scan or X-ray has shown a lump, shadow or growth that needs to be identified
• You or your doctor have felt a lump, for example in the breast, neck or armpit, or you have enlarged lymph nodes
• A blood test, such as a blood count or a tumour marker, is abnormal and needs further investigation
• You have a skin spot or mole that has changed in size, shape or colour, or a skin problem that does not heal
• An endoscopy, such as a gastroscopy or colonoscopy, has shown an ulcer, polyp or area of abnormal lining
• Your doctor needs to find out the cause of inflammation, infection, or liver or kidney disease

A biopsy can tell your doctor whether a condition is cancerous or non-cancerous, what type it is, and, when cancer is found, how aggressive it appears to be. This helps your doctor decide on the best treatment for you.

Why this matters in Singapore

Cancer is a significant health concern in Singapore. Between 2017 and 2021, an average of 46 people were diagnosed with cancer every day, and about 1 in 4 people may develop cancer in their lifetime, according to the Singapore Cancer Registry.

The most common cancers in men are prostate, colorectal and lung cancer. In women, they are breast, colorectal and lung cancer. Stomach and skin cancers are also among the more common cancers here. For many of these cancers, a biopsy is the step that confirms the diagnosis.

The encouraging news is that many cancers can be treated successfully when they are found early. If you have a persistent lump, a skin change that is not going away, bleeding, unexplained weight loss or other symptoms that worry you, please see a doctor early. If a biopsy is recommended, it is important to have it done promptly so that you can get answers and, if needed, start treatment without delay.

Types of Biopsy

A biopsy is performed using a needle, a probe, a scope or a surgical instrument, depending on where in the body the sample is taken from. Your doctor will explain which type is suitable for you.

Bone marrow biopsy

• Done when a blood test shows an abnormality. Blood cells are made in the bone marrow, the soft tissue inside certain bones.
• Can help diagnose blood disorders such as leukaemia, lymphoma and multiple myeloma.
• A long needle is used to draw a sample of bone marrow, usually from the hipbone, although other bones may be used.
• You will be given local anaesthesia to numb the area and minimise discomfort.

Endoscopic biopsy

• Done to collect samples from internal organs, such as the stomach, oesophagus, colon, lung and bladder.
• A flexible, thin tube called an endoscope, with a light and camera, is passed into the body through a natural opening such as the mouth, rectum or urethra. Small instruments passed through the endoscope are used to collect samples.
• The doctor can see the area on a screen, so the sample can be taken precisely from the abnormal area.

Needle biopsy

• Done to collect cells or tissue from lumps under the skin or from deeper organs, such as suspicious breast lumps, enlarged lymph nodes, the thyroid, liver, lung or prostate.
• A fine needle may be used to draw out cells or fluid, while a slightly larger needle may be used to take a thin core of tissue.
• For deeper areas, an imaging technique such as ultrasound or CT scan is often used to guide the needle to the right spot.
• Local anaesthesia is used to numb the area.

Skin biopsy

• Done when there is a skin disorder, or a mole or spot that looks suspicious.
• The skin is numbed with local anaesthesia, and a small area of skin is removed with a blade or scalpel, or with a small circular tool.
• The sample is checked for infection, inflammation or skin cancer.

Surgical biopsy

• Done when the area cannot be reached by other methods, or when the results of other biopsies are unclear.
• The surgeon removes either part of the abnormal area or the whole area, such as a lump in the breast or abdomen.
• This is carried out in an operating theatre, usually under local or general anaesthesia, depending on the area.

Preparing for Your Biopsy

Preparation depends on the type of biopsy. Your doctor and our team will give you specific instructions. In general:

• Your medication: Tell your doctor about everything you take, especially blood thinners such as warfarin, aspirin and newer anticoagulants, as well as anti-inflammatory painkillers, supplements, and traditional or herbal medicines, because some of these can increase the risk of bleeding. Do not stop any medicine unless your doctor tells you to.
• Allergies: Let us know if you are allergic to any medicines, local anaesthetic, latex, plasters or skin disinfectants.
• Fasting: Some biopsies, such as endoscopic and surgical biopsies, require you to stop eating and drinking for several hours beforehand. You will be told if this applies to you.
• Pregnancy: Tell our team if you are pregnant or think you may be, especially if imaging such as a CT scan will be used.
• Health conditions: Let your doctor know if you have a bleeding disorder, heart or lung problems, or other medical conditions.
• What to bring: Your doctor’s referral letter, your NRIC (or passport if you are an international patient), previous scan reports or images, and a list of your medications.
• Support: Consider bringing a family member or friend, especially if you will be given sedation or anaesthesia. It also helps to have someone with you to take in what the doctor says.
• Consent: Your doctor will explain the procedure, what it involves and what to expect, and you will be asked to sign a consent form. This is a good time to ask any questions you have.

What Happens During a Biopsy?

The exact steps depend on the type of biopsy. In general:

• You will be asked to change into a hospital gown and be positioned so that the doctor can reach the area comfortably.
• The area is cleaned, and local anaesthesia is given to numb it. For some procedures, sedation or general anaesthesia may be used instead or as well.
• The doctor collects the sample using a needle, scope or surgical instrument. You may feel pressure or a brief pinch.
• If imaging is used, you will be asked to stay still while the doctor guides the instrument to the exact spot.
• Once the sample has been collected, pressure or a dressing is applied to the area. Stitches may be needed for skin and surgical biopsies.
• The sample is labelled carefully and sent to the laboratory.

What Happens After a Biopsy?

• You will rest until you feel well enough to leave. If you were given sedation or general anaesthesia, you will need someone to take you home and you should not drive.
• You may feel some soreness, bruising or tenderness around the biopsy site for a few days. Your doctor can advise you on pain relief.
• Keep the dressing clean and dry, and follow the instructions on wound care and when you can shower.
• Avoid heavy lifting or strenuous activity for the period advised by your doctor, particularly after bone marrow, needle or surgical biopsies.
• After an endoscopic biopsy, you may have a sore throat or mild bloating. Light bleeding in your stool or urine is possible depending on where the biopsy was taken.
• You will be given a follow-up appointment to review your results with your doctor.

Should you feel unwell, contact your doctor immediately or call our 24-Hour Medical Urgency Clinic.

Waiting for and Understanding Your Results

The sample is sent to the laboratory, where a pathologist examines it. Results are usually not available straight away, as the tissue has to be carefully prepared and studied. Your doctor will tell you roughly how long to expect to wait.

Waiting for results can be a stressful time, and it is natural to feel anxious. Try to keep to your usual routine, and ask your doctor if you have questions while you wait.

Your doctor will explain your results at your follow-up appointment. The results may show:

• Normal or non-cancerous (benign) findings: The cells are normal or the abnormality is not cancer. Your doctor may recommend treatment for another condition, or simply regular monitoring.
• Cancer cells: If cancer is found, further tests are done to find out the grade (how quickly the cancer cells are likely to grow) and the stage (how far the cancer has spread). This information helps your doctor and you decide on the treatment options.
• Inconclusive results: Sometimes the sample is too small or unclear to give a clear answer. Your doctor may recommend repeating the biopsy or doing another test.

If a diagnosis of cancer is made, you will not need to face it alone. Your doctor will explain the next steps and refer you to the appropriate specialists. Bringing a family member or friend to your results appointment can help you absorb the information and decide on the next steps.