Biopsy

There are different types of biopsy – your specialist will explain which is best for you. The type of biopsy you have will depend on where in your body the abnormal area is and the type of cancer that is suspected.  

The main types of biopsy are:

• fine needle aspiration (FNA) 
• core biopsy 
• open biopsy

Sometimes a small piece of tissue is removed (incisional) or an entire lump or suspicious area (excisional).   The tissue is then examined under a microscope.

CT Guided Lung Biopsy

Bone marrow is a spongy material found inside your bones. Blood cells are made in your bone marrow.  A bone marrow biopsy is often needed if your doctor is concerned that you may have a problem with your blood cells are made, if you have a blood disorder sometimes bone marrow biopsies are also taking to check how well your treatment has worked.

What to expect
A bone marrow biopsy takes a small sample of the bone marrow from within your hip bone.
You will be asked to attend the hospital to have a bone marrow biopsy, these are often done in the Phoenix Unit but also in the Out-patients department or on a ward if you are already admitted to hospital.
The doctor of nurse will help you to get comfortable lying on your side. They will inject some local anaesthetic to numb the area.
A needle is put through your skin and into the hip bone and a small sample of liquid bone marrow is taken out. This is called a bone marrow aspitate
You may also need a small sample of the core of bone marrow this is called a trephine biopsy, this is taken in the same way but with a slightly larger needle.
It may feel a little uncomfortable for a few seconds when the liquid is taken from the bone marrow.

After a Bone marrow Biopsy
The doctor or nurse will put a small dressing over the biopsy area, this can be removed after 24 hours.
Most patients are ready to go home straight after their test
Most patients do not need sedation to have a bone marrow biopsy, if you do need sedation 
•    You will need someone to collect you from the hospital.
•    You should have someone with you for 24 hours.
•    You should not drive for 24 hours afterwards.

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A sentinel lymph node is the first lymph node to which cancer cells are most likely to spread from a primary cancer. Sometimes, there can be more than one sentinel lymph node. 

A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed, and looked at to see whether cancer cells are present. It is used in people who have already been diagnosed with cancer.

A negative SLNB result shows that cancer has not yet spread to nearby lymph nodes or other organs.
A positive SLNB result shows that cancer may have spread to other nearby lymph nodes. This information can help a doctor determine the stage of the cancer (extent of the disease within the body) and develop an treatment plan.

What happens during an SLNB?

First, the sentinel lymph node (or nodes) must be found. To do this, a doctor injects a radioactive substance, a blue dye, or both near to the cancer. The surgeon then uses a device to detect the lymph node that contains the radioactive substance or that is stained with the blue dye. Once the sentinel lymph node is found, the doctor makes a small cut in the skin and removes the node.
The sentinel node is then checked for cancer cells by a pathologist. If cancer is found, the doctor may remove more lymph nodes, either during the same operation or at a different time. SLNB may be done on an outpatient basis or may require a short stay in the hospital.
SLNB is usually done at the same time the cancer is removed but in some cases is done before that operation.

What are the benefits of SLNB?

SNLB helps doctors stage cancers and estimate the risk that tumor cells have developed the ability to spread to other parts of the body. If the sentinel node is negative for cancer, a patient may be able to avoid more extensive lymph node surgery, reducing the potential complications associated with having many lymph nodes removed.

What are the possible harms of SLNB?

All surgery to remove lymph nodes, including SLNB, can have harmful side effects, although removal of fewer lymph nodes is usually associated with fewer side effects, particularly serious ones such as lymphedema. The potential side effects include:

• Lymphedema, or tissue swelling. During lymph node surgery, lymph vessels leading to and from the sentinel node or group of nodes are cut. This disrupts the normal flow of lymph through the affected area, which may lead to an abnormal build up of lymph fluid that can cause swelling. Lymphedema may cause pain or discomfort in the affected area, and the overlying skin may become thickened or hard.
• The risk of lymphedema increases with the number of lymph nodes removed. 
• Seroma, or a mass or lump caused by the build up of lymph fluid at the site of the surgery
• Numbness, tingling, swelling, bruising, or pain at the site of the surgery, and an increased risk of infection
• Difficulty moving the affected body part
• Skin or allergic reactions to the blue dye used in SNLB
• Rarely a false-negative biopsy result—this may give the patient and the doctor a false sense of security about the extent of cancer in the patient’s body.

 
Is SLNB used to help stage all types of cancer?

No. SLNB is most commonly used to help stage breast cancer and melanoma. It is sometimes used to stage penile cancer and endometrial cancer.  It is being studied with other cancer types.

Sentinel Node Biopsy for Cancer of the Penis