• Image-guided biopsy. Your doctor may use an image-guided biopsy approach when he or she cannot feel a tumor or when the area is deeper inside the body. During this procedure, your doctor guides a needle to the location with the help of an imaging technique. Your doctor can do an image-guided biopsy using a fine needle, core, or vacuum-assisted biopsy (see below). This depends on the amount of tissue needed, possible diagnoses, and other factors. Your doctor will use one of the following types of imaging based on the location and other factors:
• Fine needle aspiration biopsy. During this minimally invasive biopsy, the doctor uses a very thin, hollow needle attached to a syringe. He or she collects a small amount of tissue from the suspicious area to examine and test. Your doctor may use this biopsy for a mass that he or she can feel through the skin or with image-guided biopsy (see above).
• Core needle biopsy. This type of biopsy uses a larger needle to remove a larger tissue sample. It is similar to a fine needle biopsy and is also minimally invasive.
• Vacuum-assisted biopsy. This type of biopsy uses a suction device to collect a tissue sample through a specially designed needle. Your doctor can collect multiple or large samples from the same biopsy site with this method. A vacuum-assisted biopsy can sometimes be image guided.
• Excisional biopsy. During an excisional biopsy, your doctor removes the entire suspicious area. This is commonly used for suspicious changes on the skin. Doctors also sometimes use it for a small, easily removable lump under the skin. However, fine needle aspiration or core needle biopsy are more common for lumps that cannot be seen or felt through the skin.
• Shave biopsy. For this type of biopsy, the doctor uses a sharp tool to remove tissue from the skin surface.
• Punch biopsy. During a punch biopsy, the doctor inserts a sharp, circular tool into the skin. He or she then takes a sample from below the skin surface.
• Endoscopic biopsy. An endoscope is a thin, lighted, flexible tube with a camera. Doctors use this tool to view the inside of the body, including the bladder, abdomen, joints, or gastrointestinal (GI) tract. They insert endoscopes through the mouth or a tiny surgical incision. The attached camera helps the doctor see any abnormal areas. Doctors also use them to take tiny samples of the tissue using forceps. The forceps are also a part of the endoscope.
• Laparoscopic biopsy. This type of biopsy is used for the abdomen. Similar to an endoscopic biopsy, the doctor inserts a thin tube with a video camera called a laparoscope into the abdomen through a tiny incision. The camera helps the doctor see any abnormal areas. Then doctors can insert a small needle and take a tissue sample.
• Bone marrow aspiration and biopsy. These two procedures are similar. Doctors often do them at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy removes a small amount of solid tissue using a needle. Doctors use these procedures to find out if a person has a blood disorder or blood cancer. Blood cancers include leukemia, lymphoma, or multiple myeloma.

A common site for a bone marrow aspiration and biopsy is the pelvic bone. This bone is located in the lower back by the hip. The doctor usually numbs the skin in that area with medication beforehand. Other types of medication to block pain, or anesthesia, may be used. Learn more about  Liquid biopsy. This minimally invasive procedure can test a blood sample for cancer. During a liquid biopsy, a health care professional collects a routine sample of blood and analyzes it in a specific way. Compared to a tissue biopsy, a liquid biopsy has less risks to patients, and doctors can easily perform it multiple times. It may also allow doctors to check the progress of a tumor and see how well a treatment is working. This type of biopsy is still new, and more research is being done to learn about its uses. For now, this type of biopsy is not used for most people with cancer.

Who does a biopsy and who analyzes the sample?

The health care team member who performs your biopsy often depends on the type of biopsy you need and on the part of the body being examined. Your biopsy may be done by:

• A surgeon
• A radiologist, who specializes in taking and reading medical images
• An oncologist, who specializes in treating cancer
• A gastroenterologist, who specializes in the function and disorders of the GI tract. The GI tract includes the stomach, intestines, and associated organs.
• A pathologist, who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. He or she analyzes the tissue sample(s) removed during a biopsy.
• A cytologist, who specializes in the study of cells. He or she may perform a fine needle aspiration.
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  Richard Potvin
  Associate Managing Editor
  General Surgery: Open Access