J. Taylor Whaley, M.D. The Abramson Cancer Center of the University of Pennsylvania
What are incisional and excisional biopsies?
An incisional biopsy is a procedure in which a small area of tissue is taken to identify the composition (or make-up) of a lesion or abnormality. An excisional biopsy is a more involved procedure where the entire abnormality or area of interest is removed.
To further clarify this, there are four options for obtaining a tissue sample.
A fine needle aspiration is the simplest, least invasive test and uses the smallest needle to simply remove cells from the abnormality. This is not always adequate to obtain a diagnosis, depending on the area to be biopsied.
A core needle biopsy removes not only cells, but also a small amount of the surrounding tissue. This provides additional information to assist in the identification of the lesion.
An incisional biopsy takes out even more surrounding tissue. It takes out some of the abnormality, but not all. The doctor will slice into the lesion and remove only a portion of it. If the lesion is found to be cancerous, further surgery may be needed to remove the whole abnormality.
An excisional biopsy generally removes the entire area in question.
If the lesion of interest is large, an incisional biopsy may be performed to make sure the cosmetic outcome following the procedure is suitable. Alternatively, if the abnormality is small, an excisional biopsy may be performed. Ultimately, your doctor will decide what is most appropriate for you based on the location and size of the lesion and the suspected diagnosis.
While a core needle biopsy can be performed on most parts of the body, incisional and excisional biopsies are most often used for lesions involving the breast, skin, muscles, and lymph nodes.
How is this test performed?
Incisional or excisional biopsies are generally done to follow up on an abnormality detected on a scan or physical exam. These are typically performed as an outpatient procedure, using local anesthesia (a numbing medicine). Occasional, depending on the location of the biopsy, a medicine may also be given to relax you.
The procedure typically takes about an hour. If a sedating medicine is given, you will need to recover for an hour or two. You will also need transportation home as you will not be allowed to drive or leave without supervision.
The sample is then sent for review to the pathologist, a doctor who specializes in looking at tissues under the microscope. After the pathologist has established a diagnosis, a report will be generated for your doctor.
Similar to any biopsy, the most common risk associated with the procedure is bleeding. A hematoma, or a pocket of blood, can form and collect at the site of the biopsy. This can be uncomfortable but should resolve over the following week. If there is severe pain following the procedure, you should contact your doctor immediately.
How do I prepare for an incisional or excisional biopsy?
If sedation is going to be given, you will need to fast for 6-8 hours prior to the procedure. If only local anesthesia is used, there is no fasting needed.
If you are on blood thinners, your doctor will likely have you stop them several days in advance. This should be discussed when the biopsy is scheduled.
How do I interpret the results of a pathology report?
Following the biopsy, the tissue sample is processed by a pathologist. A preliminary report may be given to the doctor; however, the final report generally takes several days.
The report generally states the patient's name, date of birth, site of biopsy, and indication (reason for the test) at the top of the report. Pathology reports follow a standard outline, regardless where they are obtained. The findings are discussed in a very systematic approach. For this reason, it is very important to discuss the results with your doctor.
The first paragraph typically reports the final diagnosis. This is a summary of the findings, often generated to answer the question posed by the ordering physician. If the biopsy is obtained for oncologic purposes, it commonly will state if the findings are benign (not cancer), malignant (cancer), or unable to be determined.
The following paragraphs generally include the specific technical information involved in obtaining and processing of the sample. The details of the diagnosis can also be found here. Because reports are generated for other medical professionals, the terminology is often medically oriented and can be difficult to interpret.
You may want to ask for a copy of the report for your records, but you should ask your healthcare provider to review the results with you.