Information for patients undergoing a percutaneous biopsy

This leaflet has been designed to answer some of the common questions you may have regarding your percutaneous biopsy. This is the starting point for discussion about your treatment with the doctors looking after you, who wish to make sure you have received enough information about the procedure before signing the consent form.

What is a percutaneous biopsy?

A percutaneous biopsy is a way of taking a small piece of tissue out of your body, using a needle through a tiny skin incision, so that it can be examined under a microscope by a pathologist (an expert in making diagnoses from tissue samples). The procedure is called “percutaneous” as it is done through the skin. The radiologist undertaking the biopsy will use either an ultrasound machine or a CT scanner to guide the needle into the correct place.

Why do I need a percutaneous biopsy?

Other tests you have had have shown an abnormal area of tissue. From these tests, it is not always possible to say what has caused the abnormality. A percutaneous biopsy is a way of taking a tiny piece of tissue for the pathologist to examine and to understand what the abnormality is.

Who will be doing the percutaneous biopsy?

The doctors in charge of your case will have discussed the situation with the radiology department and have agreed that a percutaneous biopsy will be the best thing to do. A radiologist will perform the procedure. A radiologist has special expertise in using scanning equipment (CT and ultrasound) and in interpreting the images produced. They will look at these images whilst performing the biopsy.

Preparation for a biopsy

The biopsy will either take place in the CT or ultrasound department (part of the radiology department). Your biopsy can either be undertaken as an inpatient or outpatient. You may have some blood tests prior to the biopsy to check you do not have an increased risk of bleeding. If you are taking any blood thinning medications, like warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban or Clopidogrel , Ticagrelor you should inform your doctor before the procedure. If you have any allergies you must inform your doctor. If you have previously reacted to contrast medium (the dye used for CT imaging) you must tell your doctor about this.

What happens during a biopsy?

On arrival at the x-ray department, you will be asked to change into a hospital gown.

You will then be asked to lie on the CT scanner table or ultrasound examination table in the position that the radiologist has decided is most suitable. The radiologist will keep everything as sterile as possible. Your skin will be cleaned with antiseptic and you may have some of your body covered with a sterile sheet. The radiologist will use the ultrasound machine or the CT scanner to decide on the most suitable point for inserting the biopsy needle. Your skin will be then anaesthetised and the biopsy needle inserted into the abnormal tissue.

Most biopsies do not hurt. The local anaesthetic used to anesthetise the skin will sting to start with, but this will soon pass as the skin and deeper tissues become numb. You may be aware of a pressure sensation as the needle passes into the deeper tissues but this is usually well tolerated.

How long does a biopsy take?

This will depend on the situation and type of biopsy. The procedure may take over 30 minutes, although you will be in the department for a longer period to ensure no there have been no complications.

What happens after a biopsy?

Depending on the type of biopsy you may be asked to stay in bed for a few hours until you have recovered. A nurse will carry out routine observations, such as taking your pulse and blood pressure, to make sure there are no problems. If you have any pain following the procedure, we may give you some pain-relief medication. Depending on the biopsy you may have to stay in hospital overnight. This can be discussed with the doctors looking after you.

Do not expect to get the result of the biopsy before you leave, as it will always take a few days for the pathologist to do all the necessary tests on the biopsy specimen. We recommend you do not undertake strenuous activity and rest for the remainder of the day.

Can I drive home afterwards?

We recommend that you do not drive for twenty-four hours and you ask a friend or relative to drive you home following your procedure.

Are there any risks?

A percutaneous biopsy is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise.

If you are having a liver, kidney or spleen biopsy, then there is a risk of bleeding, although this is generally very slight.

If the bleeding were to continue, then it is possible that you might need a blood transfusion. Very rarely, an operation or another radiological procedure is required to stop the bleeding.

If you are having a lung biopsy performed, it is possible that air can get into the space around the lung (pneumothorax). This generally does not cause any real problems, but if it causes the lung to collapse, the air will need to be drained, either with a needle, or else with a small plastic tube, inserted through the skin.

Unfortunately, some biopsies fail to give an answer. This may be because, despite taking every possible care, the piece of tissue which has been obtained is normal tissue rather than abnormal. Alternatively, although abnormal tissue has been obtained, it may not be enough for the pathologist to make a definite diagnosis. The radiologist doing your biopsy may be able to give you some idea as to the chance of obtaining a satisfactory sample.

Despite these possible complications, percutaneous biopsy is normally very safe and is designed to save you from having a bigger procedure.

What do I do if I feel unwell after I have gone home?

If you feel unwell after your procedure, you should seek medical advice from your GP/ hospital doctor or through the emergency department and inform them that you have had a biopsy.

Follow-up

You will have a follow-up appointment with your doctor to discuss the results of your biopsy. Sometimes the biopsy is not successful in obtaining the required tissue, or there was not enough normal tissue for the pathologist to make the diagnosis. In this case you may be recalled to have another biopsy.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas, where the use of high-tech equipment and/or specialist one to one care is required.

Further information or comments

If you have any comments or feedback regarding the procedure or this information leaflet then please do not hesitate to contact the x-ray department.