A biopsy is a medical procedure that takes a sample of tissue from your body to be examined in a laboratory. The tissue sample itself may also be called a ‘biopsy’ or a ‘biopsy sample’.
The laboratory may use special stains (dyes) or do tests on the tissue. A histopathologist looks at the slides to check for abnormal cells to see if lymphoma is present.
To diagnose lymphoma, a biopsy sample is often taken from a lymph node. Lymph nodes are part of the immune system. Lymph nodes are small, oval swellings arranged in groups at various points along the lymphatic drainage system, for example, in the neck, armpit, groin, chest and abdomen. They help fight infections and drain waste fluids from the body’s tissues.
A biopsy is usually the only way to confirm lymphoma. Your doctor might also ask you to have a biopsy to:
- tell which type the lymphoma is
- monitor whether your lymphoma is growing and when to begin treatment
- check how well your lymphoma has responded to the treatment.
There are several types of biopsy, including:
- excision biopsy, where a lymph node (gland) is completely removed
- incisional biopsy, where part of a lymph node is removed
- core needle biopsy, where a small sample of the lymph node is taken (also known as a ‘core biopsy’ or a ‘needle biopsy’)
- laparoscopic (keyhole) biopsy, where all or part of a lymph node is removed.
All of these procedures are safe and well-established.
Excision biopsy is the most common type of biopsy used to diagnose lymphoma. This procedure removes a whole lymph node, giving doctors a large enough sample to tell whether or not lymphoma is present. Additional tests can be done on the tissue sample, should they be needed.
Excision biopsy is a minor operation. You go to hospital as an outpatient and the visit takes a few hours.
The procedure is performed under local or general anaesthetic. If the lymph node is near the surface of your skin, you usually have a local anaesthetic. If it is deeper inside your body, you might have a general anaesthetic.
Imaging scans (such as a CT, ultrasound, X-ray or MRI) are sometimes done before an excision biopsy. These images help to guide your surgeon to the exact place to take the biopsy sample from. After the scan, the area is cleaned and numbed it. The surgeon removes the lymph node and sends the tissue to a laboratory where it is examined by a pathologist.
After an excision biopsy, your wound is stitched and dressed. You should be given information about how to care for the biopsied area. If you are not offered this advice, ask for it.
You are allowed to go home as soon as you can pass urine and walk. It is not safe for you to drive yourself home if you had a general anaesthetic. You may be able to drive if you had local anaesthetic but it is usually advised to have someone collect you from the hospital.
Stitches are normally removed a week later, either at your GP surgery or at the hospital.
Incisional biopsy is commonly used in cases where lymph nodes are large. The procedure is similar to that of an excisional biopsy, but only part (as opposed to all) of a lymph node is removed.
Core needle biopsy takes a small sample of the lymph node. Your doctor might do a core needle biopsy if there is a possibility that the node is swollen because of an infection or because of cancer that has spread from elsewhere in your body. Core needle biopsy might also be recommended when it is too difficult to remove the whole gland. Your doctor may still ask you to have an excision biopsy at a later date, particularly, if the core needle biopsy sample is not large enough to rule out lymphoma.
Core needle biopsy is a minor procedure. Usually, it takes around 15–30 minutes. It is usually performed under local anaesthetic. A surgeon or radiologist uses a hollow needle to remove some of the tissue from the lymph node before sending it to a laboratory for examination.
If the lymph node to be biopsied is near to the surface of your skin, the surgeon can feel for it. If it is deeper within your body, they might ask you to have an ultrasound or CT scan, performed by a radiologist. The scan images help guide the doctor to the exact place to take the biopsy sample from.
After a core biopsy, your wound is dressed. You should be given information about how to care for the biopsied area. If you are not offered this advice, ask for it. You can go home soon after your biopsy; occasionally, you may be asked to stay in the day ward for a few hours of observation afterwards. It is generally safe for you to drive yourself home.
Laparoscopic (keyhole) biopsy
Laparoscopic (keyhole) biopsy involves a surgeon making a small incision (cut) through your skin. A very narrow instrument is then passed through the incision and all or part of a lymph node is removed.
You might have a laparoscopic biopsy if the lymph nodes affected are deep within your body, for example, in your abdomen (tummy).
Laparoscopic biopsy is performed under general anaesthetic. You might need to stay in hospital overnight, but you should be allowed to go home the next day. It may be safe for you to drive but it is advisable to have someone collect you.
After a laparoscopic biopsy, your wound is dressed. You should be given information about how to care for the biopsied area. If you are not offered this advice, ask for it.
After your biopsy, a medical professional checks that it is safe for you to go home. They put a protective dressing on the area where the biopsy was taken from. Most dressings are waterproof, though they may not withstand a power shower (which gives a high pressure water spray). Your medical team should give you clear guidance on how to care for the biopsied area.
Below is some general guidance about how to care for the biopsied area. Always follow the specific advice given to you by your doctor or nurse.
- Leave the dressing on for a few days.
- Avoid swimming pools, saunas, hot tubs and Jacuzzis until the wound is healed (which usually takes around 7–10 days).
Note: Seek medical advice straightaway if you notice signs of infection, including bleeding, swelling of or discharge from the biopsied area, fever (a temperature above 38°C), chills and sweating.
It can take up to a couple of weeks for any swelling, soreness and bruising to go down after a biopsy. During this time, follow the advice given to you by the hospital about how to care for the biopsied area. While the area is healing, you may need to avoid strenuous exercise and heavy lifting.
The length of time it takes for your results to come back depends on the practice at your hospital and on your circumstances. Ask your doctor what to expect. Sometimes results come through within a few days; other times they take around a week. Your biopsy sample may need to be sent away for further laboratory tests, in which case the result may take longer.
Lymphoma is a complex disease. Special stains are often needed to look at the biopsy slides. It is also not uncommon for pathologists to consult with a colleague. Your medical team will talk to you about specific treatment as soon as they are satisfied that they have a firm diagnosis. In the meantime, it is possible to get ahead with staging tests and other assessments. Your team can also talk to you in general terms about treatment types.
It is natural to feel anxious while you are waiting for your results. Contact your GP if you are concerned about the length of time you have been waiting. If you would like to talk to someone about how you are feeling, or about any aspect of lymphoma, please call our Freephone helpline on 0808 808 5555.
Further biopsies might be taken from other areas that could be affected, such as the bone marrow. You may have more tests and scans to give doctors information about the exact type and stage of the lymphoma you have. All of these investigations help your medical team decide how best to treat you and when to begin treatment.
What other tests might I have?
Fine needle aspiration cytology
Occasionally, a fine needle aspiration cytology (FNAC or FNA) is done if lymphoma is suspected. Small amounts of tissue are collected from a lymph node using a very fine needle.
FNA involves a thin needle being put into a lymph node for 30–40 seconds. A small amount of material is then extracted and sent to a histopathologist. For lymph nodes under the skin, the procedure is done without an anaesthetic. For deeper lymph nodes, or where FNA is done with ultrasound or CT guidance, it is done under a local anaesthetic.
FNA may tell doctors whether there is a possibility that lymphoma is present. However, it is not enough on its own; further tests (such as excision biopsy) are needed to confirm the diagnosis.
FNA is a very safe procedure. In most cases, you can go home immediately afterwards.
Endobronchial ultrasound-guided fine needle aspiration
You may have endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) if the affected lymph nodes are deep within your chest and are difficult to biopsy.
The procedure involves passing a flexible tube down your windpipe. The tube contains a needle and an instrument called an ‘ultrasound probe’. Ultrasound guides the needle to the lymph nodes within the chest. Tissue is collected using the needle.
EBUS-FNA is done while you are under local anaesthetic, with sedation and pain relief. It takes about 30 minutes and you can go home about 2–3 hours after the procedure.
Here are the answers to some frequently asked questions and concerns about biopsies.
A biopsy is done under anaesthetic so it painless. Once the anaesthetic wears off, you might feel some discomfort, such as soreness or aching in the biopsied area. Usually, you are advised to take paracetamol or ibuprofen to relieve any pain. Your doctor or nurse might give you some other painkillers. Any pain should go away completely after a few days.
Lymph nodes are an important part of your immune system. The human body has a network of several hundred lymph nodes; removing a small number does not affect your immunity.
A lymph node biopsy tells whether or not lymphoma is present and what type of lymphoma it is. However, the procedure does not remove the lymphoma completely, even if the lymphoma is mostly in one area. Even for lymphomas that appear to be in one area only, surgery usually leaves some cells behind. For this reason, treatments such as chemotherapy and radiotherapy are much more effective.