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When the doctor calls for a biopsy

A biopsy can help determine if one has cancer or another disease. Learn about the different types of biopsies and other tools in cancer diagnosis.

In most settings, a cancer diagnosis is made based on clinical, radiological and histopathological findings. For many cancers, the only way to make or confirm a diagnosis is to perform a tissue biopsy, which is an invasive procedure. A piece of tissue or a sample of cells extracted from a specific organ provides representative tissue of the actual tumour that can be assessed in a highly accurate manner, by identifying the cell types and providing predictive biomarkers of response to targeted treatments.

“Changi General Hospital’s (CGH) pathologists are crucial members of a patient’s diagnostic team and play a vital role in diagnosing and staging cancer,” says Dr Michael Tan, Senior Consultant, Department of Laboratory Medicine, CGH. “They provide diagnostic information to patients based on tissue sampled from biopsies. Pathologists, who are doctors with specialised laboratory skills, may also guide the course of treatment and make recommendations on the management of the disease, which may include additional biopsies or other relevant tests to confirm or exclude a disease.”

Common types of biopsies

Core Biopsy

Tissue samples are extracted using a larger needle and examined. This is often guided by an imaging technique, such as a Computed Tomography (CT) scan or ultrasound scan.

Fine Needle Aspiration Cytology

Cells are collected using a narrow needle, guided by ultrasound scans for target sampling of a lesion. While the narrower needle entails a reduced quantity of tumour cells sampled, it is a highly-effective tool for diagnosing and determining the stage of the cancer.

Incisional Biopsy

A part of the tumour or organ is surgically removed for examination in this procedure. This method of sampling tissue could potentially offer a greater amount of tissue for diagnosis than a core biopsy.

Excisional Biopsy

This surgical procedure is a wide incisional biopsy that removes the entire lesion or tumour for diagnostic purposes. Excisional biopsy is potentially a curative procedure if the entire lesion is removed.

Punch Biopsy

In this minimally-invasive procedure, a round piece of tissue is removed using a sharp and circular instrument for diagnostics. This is most frequently used for skin biopsies due to its effectiveness and safety in removing small lesions.

Research on liquid biopsies as a complementary diagnostic option

A recent study by CGH, the Agency for Science, Technology and Research’s (A*STAR) Institute of Bioengineering & Bioimaging, and Lucence showed that liquid biopsies can complement conventional tissue biopsies used for lung cancer diagnosis, and provide early detection of cancer recurrence.

Lung cancer cells from liquid biopsy under a microscope. Photo: A*STAR’s IBB


When the doctor calls for a biopsy