Definition & Overview
An open incisional biopsy is a medical procedure used to take a sample of tissue from a suspicious growth, such as a lump or tumour, from different parts of the body. The procedure helps doctors determine whether a tumour is benign or malignant. It is considered as a surgical procedure because the doctor makes an incision to access the said growth.
There are two types of an open biopsy, namely incisional and excisional. An incisional biopsy takes only a part of the tumour for sampling, while an excisional biopsy removes the entire tumour. An open incisional biopsy is performed when doctors need more information about a tumour that cannot be entirely removed, perhaps due to its size. It is also used when doctors cannot access the tumour using non-surgical biopsy techniques such as a fine needle aspiration and core needle biopsy.
Who Should Undergo and Expected Results
An open incisional biopsy is performed on patients who have abnormal growths, such as lumps, tumours, or lesions. It often becomes necessary after a doctor detects a suspicious growth through magnetic resonance imaging (MRI) or other imaging tests.
Also known as a surgical biopsy, it is performed by making an incision on the skin to reach the tumour. Thus, it is considered as one of the more invasive types of biopsy. Despite this, it is considered as a safe and accurate method of diagnosing large or deep tumours that other types of biopsy cannot reach.
An open biopsy comes in two types:
Incisional – This is when the doctor removes only a small part of the tumour. Since less tissue is removed, the procedure is relatively safer and less invasive than an excisional biopsy.
Excisional – This is when the doctor removes the entire tumour as well as a margin of healthy tissue around it. As such, an excisional biopsy is more invasive, takes longer to recover from, and places the patient at a higher risk of bruising and infection.
Most doctors prefer to use excisional biopsy especially if the tumour is small enough to be taken out in a single procedure. This way, the patient no longer has to undergo another surgery in case the tumour turns out to be malignant. However, if the tumour is too big to be taken out during a biopsy procedure, doctors perform an incisional biopsy. As a general rule, doctors take out as much tissue as they need to identify the tumour’s composition. They do not take out any healthy tissue.
After an open incisional biopsy, the doctor will send the obtained tissue sample to a laboratory. A pathologist then prepares a report about the biopsy results.
The result of the procedure can be either:
Positive – This means that the obtained tissue sample contains cancer cells and that the patient will need to undergo cancer treatment.
Negative – The tissue does not contain cancer cells. This means that the tumour is benign. The patient can then discuss with his doctor what to do next. The ideal treatment for benign tumours is to have them surgically removed, especially if they are growing larger, are pressing on nearby nerves and blood vessels, and are causing symptoms such as headaches and seizures. The set of symptoms patients may experience due to a tumour tend to differ depending on where the tumour is located. For example, benign brain tumours can cause memory problems as the tumour takes up space in the brain. Fortunately, these tumours can usually be removed through surgery without any complications and with a very small risk of recurrence.
How is the Procedure Performed?
An open incisional biopsy can be performed as an outpatient procedure. After administering the local anaesthesia, the surgeon will clean the biopsy site and make a cut through the skin. The incision is usually 1.5 to 2 inches in diameter. Special surgical instruments are then inserted until the surgeon reaches the tumour. At this point, a piece of tissue from the suspicious growth is taken. The surgeon then closes the incision with sutures, and the sample tissue is sent to a pathologist’s laboratory for closer examination.
Patients can go home on the same day. However, due to the anaesthesia used, they are advised not to drive or operate machinery for up to 24 hours.
The doctor will also schedule a follow-up visit, during which the patient’s sutures may be removed.
Possible Risks and Complications
Patients who undergo an open incisional biopsy are at risk of:
- Bleeding – To reduce the risk of bleeding, patients are advised not to take blood-thinning medications several days before undergoing the procedure.
It is normal for patients to feel some soreness and tenderness at the biopsy site. These symptoms may last for a few days up to a week.
Whaley JT. “Incisional and excisional biopsy.” The Abramson Cancer Center of the University of Pennsylvania. 2014 Dec 29. https://www.oncolink.org/cancer-treatment/procedures-diagnostic-tests/biopsy-procedures/incisional-excisional-biopsy
Clayer M. “Open incisional biopsy is a safe and accurate technique for soft tissue tumours.” Anz J Surg. 2010 Nov; 80(11):786-8. http://www.ncbi.nlm.nih.gov/pubmed/20969684