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Summary

A biopsy is diagnostic procedure which permits a medical doctor known as a pathologist to look at cells from your body and determine whether they are cancerous (malignant) or not cancerous (benign). 4 out of 5 biopsies are not cancerous.

A biopsy starts with the removal of cells or tissues from the body,either during surgery or during an endoscopic exam such as a colonscopy for examination by a medical doctor known as a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. If the biopsy shows that cancer is pre.sent, the pathologist's findings become a primary basis for helping to determine the best treatment.

There are a variety of biopsy procedures. The method that will be recommended in any particular situation depends on the size and location of the tumor or area of interest.

The most common types of biopsies are:

  • A needle biopsy. 
    • With a needle biopsy, a needle is inserted through the skin. The insertion is usually guided by a CT scan.
    • A needle biopsy is not used with respect to colorectal tumors.
    • Sometimes a needle biopsy is done to confirm the spread (metasteses) of colorectal disease to the liver or lung.
  • An endocscope during a colonoscopy.
  • During surgery 

Before agreeing to a biopsy, it is important that you do the following:

  • Understand:
    • The type of biopsy the doctor recommends 
    • The risks and benefits
  • Ask your doctor about what happens during the procedure, what you have to do to prepare for the procedure, and what to expect afterward. 
  • Check your health insurance to see if it is covered. Biopsies are generally covered by health insurance.
    • If a biopsy is covered, how much should you expect to pay?
    • If a biopsy is not covered by insurance, ask about the cost. You may be able to find a less expensive place to perform a biopsy. Also keep in mind that all medical bills are negotiable. For more information, see Uninsured and How To Negotiate A Medical Bill.
  • To learn how to prepare for a biopsy, and about what happens to tissue after a biopsy, see the other sections of this document. To learn about the resulting pathology report, click here.

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More Information

Second Opinions 101 Uninsured

How To Prepare For A Colorectal Biopsy

Before having a biopsy, it is recommended that you consider the following:

  •  Whether you would like to seek  a second opinion from a radiologist or surgical oncologist who is not connected with the originating doctor or facility.  If you decide to get a second opinion:
    • Find out from the doctor who will provide the second opinion what documentation is needed. 
    • Verify through your health insurance whether the second opinion will be covered. If it will be covered, ask what portion you will be responsible for paying? If insurance will not cover it, find out how much the second opinion will cost. (The document in "To Learn More" helps figure out how to get uninsured treatments.)
    • To learn more about second opinions, including how to choose a doctor for a second opinion, and how to tell your doctor you want one, click here
  • Inform your doctor if you are taking any blood thinning medications. He/She will give you instructions on when to stop these medication prior to the biopsy. Blood thinning medications increase the risk of persistent bleeding following a biopsy.
  • Ask your doctor if you will be given an oral antibiotic prior to the biopsy and when you should begin taking the antibiotic.  Antibiotics are often given to protect against potential infection after a biopsy.
  • Thoroughly read the  consent form you will be asked to sign before the procedure in its entirety.  It should  describe what procedure will be done, the potential complications of the procedure and who will be performing the procedure. It is important that you not only read this consent form but also understand what you are signing. If there is content you don't agree with, change it. To learn more about medical consent forms, click here.
  • If you have health insurance, verify through the insurance company that the doctor who will perform the biopsy and the facility where it will be performed are covered by your insurance.

How Is Tissue Processed After A Biopsy Or Surgery?

The tissue removed during a biopsy or surgery must be cut into thin sections, placed on slides, and stained with dyes before it can be examined under a microscope. Two methods are used to make the tissue firm enough to cut into thin sections: frozen sections and paraffin-embedded (permanent) sections. All tissue samples are prepared as permanent sections, but sometimes frozen sections are also prepared.

Permanent sections are prepared by placing the tissue in fixative (usually formalin) to preserve the tissue, processing it through additional solutions, and then placing it in paraffin wax. After the wax has hardened, the tissue is cut into very thin slices, which are placed on slides and stained. The process normally takes several days. A permanent section provides the best quality for examination by the pathologist and produces more accurate results than a frozen section.

Frozen sections are prepared by freezing and slicing the tissue sample. They can be done in about 15 to 20 minutes while the patient is in the operating room. Frozen sections are done when an immediate answer is needed; for example, to determine whether the tissue is cancerous so as to guide the surgeon during the course of an operation.