About percutaneous needle biopsies

A needle biopsy is a way of taking a small sample of tissue from inside your body, using a thin needle inserted percutaneously (through your skin).

We send the sample to the laboratory where it is examined under a microscope by a pathologist.  A pathologist is a doctor who has expertise in analysing such samples and working out an underlying diagnosis.

Why you need a biopsy

It is likely that you have had a previous ultrasound, CT or MRI scan showing an abnormal area of tissue inside your body.

From the scan, it is not always possible to pinpoint the cause of the underlying problem. The simplest and most accurate way of finding the cause is by taking a tiny sample and sending it to the pathologist for analysis.

The information obtained from a biopsy usually enables us to give you a confident diagnosis and recommend the most appropriate treatment for you.

The doctor in charge of your case and your radiologist both feel a biopsy is the best investigation option for you.  They will discuss their recommendation with you and they will take your opinion into account. You will have the chance to ask questions.  If, after discussion with your doctors, you do not want us to carry out the procedure, you can decide against it.

We will not perform the biopsy without your written consent.

Who performs the procedure and where it takes place

A doctor called a radiologist will perform the biopsy.  A radiologist is a doctor with expertise in using X ray and scanning equipment and interpreting the images produced.  They use these images on screen, to guide the biopsy procedure.

It will take place in the Kingston Hospital Radiology Department, either in a room with ultrasound facilities or within the CT scanner if this is more appropriate technically.

Preparing for your procedure

You may need to be an inpatient in the hospital, although most biopsies can be performed as an outpatient. Patients usually require some blood tests beforehand, to check that they do not have an increased risk of bleeding. A member of the Interventional Radiology Unit team will discuss this with you.  [Amanda: does this discussion take place when they arrive, and does the hospital send them for the blood tests?]

To prepare as an outpatient, do the following.

  • You can take sips of water up to 2 hours before the procedure.
  • You can take your normal medicines up until the procedure.
  • When you receive your appointment letter, tell the Interventional Radiology Unit if you have previously had allergies to foods, medicines or intravenous contrast medium (the dye used for kidney X rays and CT scans).
  • When you receive your appointment letter, tell the Interventional Radiology Unit if you have been on blood thinning tablets such as warfarin, aspirin or clopidogrel.

If you are an inpatient, the following applies.

  • You can take sips of water up to 2 hours before the procedure.
  • You can take your normal medicines up until the procedure.

If you are an outpatient

You must have a responsible adult go home with you.
You must also have a responsible adult to stay with you for 24 hours (including overnight).

During the procedure you can expect the following.

  • We will ask you to change into a hospital gown and lie on the scanning table in the most suitable position to allow access to the organ or area of your body under investigation.
  • We will wrap a cuff around your arm to monitor your blood pressure, and place a clip on your finger to measure your pulse and breathing.
  • The radiologist performing the procedure will choose the most appropriate point on your skin, clean this area with antiseptic and anaesthetise it with an injection.
  • They will guide the biopsy needle through this numb area, into the tissue to be biopsied, using the pictures from the scanner on screen.
  • Usually the needle makes a little clicking sound as we take the sample.
  • We withdraw the needle and put a sticking plaster place over the needle entry site.
  • Sometimes we take two or more samples, to increase the chances of obtaining a suitable specimen.

Pain

When we anaesthetise your skin and deeper tissues with local anaesthetic, this will sting for a few seconds. After this the area will go numb and the procedure is likely to be almost pain free.

If the procedure does become uncomfortable for you, a nurse or another member of clinical staff can arrange for you to have painkillers through a needle in your arm, directly into the blood stream.

How long it takes

Every patient’s situation is different, but you can expect to be in the room for 20 to 30 minutes.

After the procedure

After the procedure, we will transfer you back to your ward [Amanda: or the Radiology Day Ward?].

It is important that you remain comfortable and lie quietly in bed for a few hours until you have recovered. Your nurse will monitor your pulse, blood pressure and breathing, to ensure you are recovering as expected.

If you have had a lung biopsy, we will probably give you a chest X ray to check that your lung is still inflated.

Your results

It will take a few days for the pathologist to do the necessary tests on your biopsy specimen.  Your referring doctor will contact you [Amanda: by phone/post?] to discuss your results.

Risks

Percutaneous biopsy is a safe procedure, but some risks or complications can arise. Your radiologist will discuss these potential risks in more detail.  They include the following:

  • Bleeding from the biopsy site.  This is usually minimal, but more serious bleeding can occur (although this is rare). This is why we will ask you whether you take blood thinning tablets and may ask you to take a blood test before your biopsy.  If bleeding continues, you may need a blood transfusion. In rare cases, we recommend an operation or another radiological procedure to stop the bleeding.
  • The needle can damage adjacent bodily structures while we insert it.  This is why a radiologist performs the procedure using imaging equipment.
  • If you are having a lung biopsy performed, it is possible for air to leak from the needle insertion hole and collect on the outside of the lung.  This is called a pneumothorax. This generally does not cause any real problem, but if the lung collapses, we will need to drain the air, either with a needle or a small tube inserted through your skin.
  • Not all biopsies are successful. Sometimes we are not able to guide the needle into the correct place. Sometimes we can guide the needle into the target area, but the sample we obtain is not sufficient for the pathologist to carry out a full assessment and give a confident diagnosis.

If you have concerns or questions about this procedure, you can discuss these with your medical team and your interventional radiologist at any time.

Contact information

Interventional Radiology Unit
 

Interventional Radiology Unit Charge Nurse​​​​​​​

Telephone:

Interventional Radiology Unit: 020 8934 6206

Interventional Radiology Unit Charge Nurse: 020 8934 2758