Biopsy is a medical procedure that involves taking a small sample of tissue from the body to examine under a microscope. This tissue sample is analyzed to help diagnose or identify certain diseases like cancer. Since biopsy involves an invasive procedure, many patients wonder if getting a biopsy means they will need to be hospitalized.
Types of Biopsies
There are several different types of biopsies that can be performed depending on the location of the abnormal tissue. Some common types of biopsies include:
- Skin biopsy – A sample of skin is removed to check for skin cancer or other skin conditions.
- Shave biopsy – A small shave-like sample of the top layer of skin is removed.
- Punch biopsy – A deeper, cylindrical core sample of skin is removed.
- Incisional biopsy – A portion of an abnormal lump or lesion is removed for examination.
- Excisional biopsy – The entire abnormal lump or lesion is surgically removed.
- Fine needle aspiration – A thin needle is used to withdraw fluid and cells from lumps or tumors.
- Core needle biopsy – A larger hollow needle is used to remove a cylindrical core of tissue.
- Endoscopic biopsy – Instruments are inserted through an endoscope to collect tissue samples from areas like the gastrointestinal tract.
- Bone marrow biopsy – A sample of bone marrow is taken from the hip bone.
Biopsy Procedures Requiring Hospitalization
Most simple biopsies like skin, shave, punch, fine needle aspiration, and core needle biopsies can be performed in an outpatient setting or doctor’s office. They are relatively quick procedures that do not require staying overnight in a hospital.
More involved surgical biopsies like excisional biopsies and endoscopic biopsies may require hospitalization for a short period, usually no longer than 24 hours. This allows for close monitoring after surgery to manage pain and watch for bleeding or other complications.
Types of biopsies that typically require hospitalization include:
- Excisional biopsy – Removing an entire lump or suspicious lesion requires surgery in an operating room and a brief hospital stay for recovery.
- Endoscopic biopsy procedures like a colonoscopy with biopsy or endoscopic ultrasound with fine needle biopsy – These involve inserting instruments into the body cavities or organs which requires sedation or anesthesia. Observation is needed after the procedure so hospitalization for less than 24 hours is usually required.
- Bone marrow biopsy – This procedure is done under anesthesia so a few hours of recovery in the hospital is necessary.
- Surgical lung biopsy – Taking a small sample of lung tissue requires general anesthesia and 1-2 days hospital stay.
- Laparoscopic biopsy – Using instruments inserted through small abdominal incisions requires anesthesia and hospital stay.
- Brain or spinal cord biopsy – Any neurosurgery requires careful post-operative monitoring in a hospital.
Reasons for Hospitalization for Biopsy
There are several reasons why a biopsy procedure may require a patient to be observed overnight or for a longer hospital stay. These include:
- General anesthesia is required – Procedures done under full general anesthesia require a hospital stay to recover from the effects of anesthesia.
- Risk of excessive bleeding – Surgical biopsies have a risk of bleeding which needs to be monitored.
- Pain management – Hospitalization allows pain from surgical biopsies to be managed with IV medication.
- Infection risk – Hospitalization allows antibiotics to be given if needed to reduce infection risk.
- Procedure location – Biopsies involving organs deep in the body like lungs, liver, or brain require hospitalization.
- Observation for complications – Hospital stay allows complications like bleeding, pain, dizziness to be quickly treated.
Outpatient Biopsy Procedures
There are many types of biopsies that can be done as an outpatient procedure without needing hospital admission. Common outpatient biopsies include:
- Skin biopsy
- Shave biopsy
- Punch biopsy
- Fine needle aspiration
- Core needle biopsy
- Endoscopic biopsy of GI tract, bladder, vulva
- Breast biopsy
- Prostate biopsy
- Thyroid biopsy
- Lymph node biopsy
These procedures can obtain tissue samples adequate for diagnosis while minimally invasive. They involve little risk of complication so hospitalization is not required.
Many outpatient biopsies can be performed right in the doctor’s office. Fine needle aspiration and core needle biopsies are commonly done in the radiology suite of medical clinics. Patients can go home soon after the procedure once any mild sedation wears off.
Preparing for a Biopsy
Whether a biopsy is outpatient or requires hospitalization, there are some steps patients can take to prepare for the procedure. These include:
- Avoid blood thinners like aspirin, ibuprofen, warfarin prior to biopsy if advised by the doctor.
- Arrange a ride home from the hospital or clinic.
- Follow any special instructions for diet, medication or cleansing before the biopsy.
- Discuss pain management options with your doctor if you are concerned about discomfort.
- Consider recommended pre-biopsy blood tests.
- Make plans for post-biopsy care like help with dressing changes or someone to assist you.
- Understand the details of your particular biopsy procedure beforehand so you know what to expect.
Recovery after Biopsy
Recovery time after a biopsy depends on the type of biopsy done. Simpler outpatient biopsies like fine needle aspiration or skin biopsy have little recovery time needed. You can return to normal activity right after the biopsy in most cases.
More extensive surgical biopsies will require wound care, pain control and limited activity for about 1 week after hospital discharge. Your doctor will provide detailed discharge instructions for recovery after your biopsy.
Typical instructions after biopsy include:
- Keep the biopsy site dry and covered for 24-48 hours.
- Avoid strenuous activity for 1-2 days.
- Take over-the-counter pain medication as needed for soreness.
- Call your doctor if you have signs of infection like redness, swelling, pus.
- Get the biopsy results from your doctor in 1-2 weeks.
- See your doctor right away if you have bleeding that won’t stop.
- Return for a follow up appointment to discuss biopsy results when directed.
Risks and Complications of Biopsy
While biopsy is generally a very safe procedure, there are some possible risks and complications to be aware of. These include:
- Bleeding – Bleeding can occur from the biopsy site especially if a blood vessel is damaged. It is usually minimal.
- Infection – Infection is possible any time the skin is broken so keep the site clean.
- Pneumothorax – Lung biopsies carry a small risk of lung collapse called pneumothorax.
- Organ damage – Biopsies of organs like kidney, liver, spleen have a very small risk of damage.
- Nerve damage – Nerves can potentially be irritated or damaged during tissue sampling.
- Hematoma – Bleeding into surrounding tissue can cause a hematoma or bruise at the biopsy site.
Talk to your doctor right away if you have any concerning symptoms after your biopsy. Most complications are minor and very uncommon. Your doctor will discuss the specific risks of your planned biopsy procedure with you.
When to Get a Second Opinion Before Biopsy
Most of the time, biopsy is clearly needed to reach a definitive diagnosis. But in some cases, getting a second opinion from another specialist may be wise before undergoing a biopsy. Circumstances when a second opinion may be recommended include:
- The need for biopsy is uncertain based on imaging or other test findings.
- Your doctor is not a specialist in the type of biopsy suggested.
- The risks of the biopsy seem to outweigh the benefits in your particular case.
- You are not convinced a biopsy is the next best step.
- Your health condition is complex involving multiple potential affected sites.
- Findings could have more than one explanation and cause.
Do not hesitate to consult another qualified physician to discuss if biopsy is truly indicated or if alternative testing may be preferable before undergoing the procedure.
Questions to Ask Your Doctor Before Biopsy
Before having any recommended biopsy procedure, be sure to ask your doctor the following key questions:
- What type of biopsy do you recommend and why?
- What are the risks and complications of this specific biopsy?
- Will it require hospitalization or be outpatient?
- What kind of sedation or anesthesia will be used?
- How long will the procedure take?
- What is the recovery time and restrictions after biopsy?
- How soon until I get the biopsy results?
- Could an alternative test give the same diagnostic information?
- Is there a possibility the biopsy could make my condition worse?
Understanding the details about your biopsy will help you prepare, know what to expect, and have the best outcome.
Conclusion
While biopsy is an invasive test, the majority of biopsy procedures do not require patients to be hospitalized. Simple biopsies like fine needle aspiration and skin biopsy can be performed in an outpatient setting with minimal recovery time needed. More complex surgical biopsies that involve general anesthesia, risk of complication or biopsy of internal organs often warrant a short hospital stay for proper monitoring.
The decision of whether hospitalization is needed for a biopsy depends upon several factors the doctor considers based on the patient’s unique health condition. Don’t hesitate to speak to your physician to gain a full understanding of whether your recommended biopsy will involve hospital admission or strictly outpatient management.
