Can a biopsy show benign?

A biopsy is a medical procedure that involves taking a small sample of tissue from the body to examine under a microscope. Biopsies are performed to help doctors diagnose diseases and determine if cancer or other abnormal cells are present. The results of a biopsy can indicate whether tissue is benign (non-cancerous) or malignant (cancerous).

Table of Contents

What is a biopsy?

A biopsy involves removing a small piece of tissue or a sample of cells from the body so it can be analyzed in a laboratory. There are a few different types of biopsies:

Fine needle aspiration: A thin needle is used to withdraw fluid and cells from lumps or areas of swelling.
Core needle biopsy: A larger, hollow needle is used to extract a cylindrical piece of tissue.
Excisional biopsy: An entire lump or suspicious area is removed surgically.

Incisional biopsy: Only a portion of the abnormal area is removed for examination.
Endoscopic biopsy: Instruments are inserted through an endoscope to collect tissue samples from areas like the stomach or colon.

The tissue or cells collected from the biopsy are then sent to a laboratory and examined under a microscope by a pathologist. The pathologist analyzes the sample for any abnormalities or signs of cancer. From this analysis, the doctor can determine whether the cells are benign or malignant.

How does a biopsy show benign tissue?

When examining a biopsy sample, a pathologist looks at the structure and morphology of the cells. Benign cells appear normal and are well-differentiated, meaning they look very similar to the normal cells in that area of the body. The nuclei are uniform in size and shape. The cells are arranged in an orderly pattern and grow slowly. There are minimal signs of abnormal mitosis or cell division.

Some common features and characteristics of benign tissue samples include:

Architecture is normal and cells are well-differentiated

Nuclei are uniform in size and shape
Atypical nuclei are infrequent
No evidence of invasive growth patterns

Little to no mitotic activity (cell division)
No necrosis (cell death) present
Surrounding tissue appears normal

The pathologist analyzes the biopsy sample at both the cellular and tissue level to determine if the architecture and morphology of the cells and tissue indicate the mass is benign or malignant.

What tests are performed on a biopsy?

There are a variety of tests that can be performed on biopsy tissue to help determine if abnormal cells are present:

Hematoxylin and eosin (H&E) staining: This involves staining the biopsy sample with hemotoxylin and eosin to highlight the nuclei and cytoplasm. This allows a pathologist to examine the sample under a microscope.

Immunohistochemistry: This test uses antibodies to identify specific proteins within cells that can indicate the presence of cancer.
DNA analysis: DNA can be extracted from cells in a biopsy sample and tested for specific genetic mutations associated with certain cancers and diseases.
Flow cytometry: This analyzes the size, shape, and chemical properties of cells from a biopsy.

Cytogenetics: Chromosomes within cells are examined for abnormalities.
Microarrays: Gene expression profiles of cells can be measured to characterize disease processes.

These types of tests help pathologists classify abnormal cells, identify specific cancers, and distinguish between benign and malignant tissue changes.

What are some examples of benign biopsy results?

Here are some examples of conditions that may produce benign results when a biopsy is performed:

Lipoma: A benign fatty lump that forms under the skin, usually on the shoulders, neck, or trunk.
Fibroadenoma: A benign breast lump composed of glandular and fibrous tissue.

Leiomyoma: Benign smooth muscle tumors that can occur in the uterus called fibroids.
Rhabdomyoma: A typically benign tumor of skeletal muscle.
Hemangioma: A benign vascular tumor comprised of blood vessels.

Granular cell tumor: An uncommon benign growth involving Schwann cells often found on the tongue.
Lymph nodes: Can be biopsied to rule out lymphoma or metastatic cancer.
Moles: Biopsy can determine if skin lesions are benign nevi or melanomas.

Polyps: Pre-malignant growths in the colon, stomach, or uterus that are initially benign.
Bone tumors: Biopsy differentiates between malignant and benign bone tumors.

These are just some examples of benign conditions that may be diagnosed through biopsy. The pathologist examines the architecture and cytology of the cells to distinguish benign tissues from precancerous or malignant ones.

How accurate are biopsies in diagnosing cancer?

Biopsies are considered the gold standard for diagnosing most cancers. However, there is a small possibility that a biopsy could miss cancerous cells or come back as a false negative result. Some key points about the accuracy of biopsies include:

For most major cancers, biopsies are >90% accurate in detecting cancer.
False negative rate is estimated to be 1-5% for breast biopsies.

Lung biopsy false negative rate is 5-10% due to difficulty accessing lesions.
False negatives more likely with small lesions or inadequate samples.
An initial negative biopsy may require follow-up biopsy later.

Accuracy depends on the body site, lesion size, and biopsy method.

If a biopsy comes back negative but clinical suspicion for cancer remains high, the doctor may recommend repeating the biopsy or obtaining a sample from a different area of the suspicious mass or lesion.

What are the risks and side effects of a biopsy?

Biopsies are considered relatively safe, minor medical procedures. However, as with any invasive procedure, there are some risks and side effects to be aware of:

Pain or discomfort at the biopsy site
Bleeding, bruising, or infection of the biopsy site
Numbness due to nerve damage if organs like the brain or liver are biopsied

Collapse of the lung if fluid or air leak into chest cavity during lung biopsy
Pancreatitis after pancreas biopsy
Kidney damage from kidney biopsy

Miscarriage risk from chorionic villus sampling or amniocentesis in pregnancy

Serious risks from biopsy are not common, but can happen. Your doctor should discuss the specific potential complications of your planned biopsy procedure with you.

How are biopsy results communicated?

The results of a biopsy are typically communicated to patients in one of the following ways:

Verbal: The ordering doctor may call the patient on the phone to provide the results.
In-person appointment: Patients often follow up with their doctor after the biopsy to review the findings.
Patient portal: Results can be posted on a secure online patient portal.

Written letter: A letter may be mailed detailing the biopsy findings.

Most doctors will schedule an in-person appointment to go over biopsy results with the patient, particularly if cancer or another serious diagnosis is found. This allows the doctor to explain the findings, discuss next steps, and answer any patient questions.

What happens if a biopsy shows cancer?

If cancer cells are detected in a biopsy sample, the patient will be diagnosed with cancer. The next steps include:

Determining the type of cancer based on the cells involved.
Staging the cancer to see if/how far it may have spread.
Ordering imaging tests like CT, MRI, PET to look for tumors.

Developing a treatment plan which may include surgery, chemotherapy, radiation, etc.
Providing counseling and education about the cancer diagnosis.
Scheduling follow-up care to monitor response to treatment.

Treatment and prognosis depend heavily on the particular type and stage of cancer. But most cancers found early while still localized can have good outcomes with modern treatments.

Can a benign biopsy turn malignant later?

In most cases, a truly benign biopsy means the tissue or mass does not have potential to become cancerous later on. However, there are some exceptions:

Some growths like polyps or warts can transform into cancers over time.

Precancerous conditions like actinic keratoses may eventually progress to squamous cell carcinoma.
Areas of dysplasia or atypia may be indicators of premalignant changes.
Atypical nevi or moles can rarely turn into melanoma.

For this reason, doctors may recommend regular surveillance and repeat biopsies for some types of initially benign growths that have malignant potential. Precancerous lesions may also be removed as a precaution against them becoming cancerous in the future.

What does “clinically benign” mean on a biopsy report?

The term “clinically benign” on a pathology report means that although the biopsy does not show definitive cancer or precancerous cells, the clinical signs and symptoms warrant close follow-up as if cancer is still suspected. Some reasons a biopsy may be reported as clinically benign include:

Borderline or indeterminate results not definitive for cancer.

Atypical cells present, but no clear malignancy.
Lesion appears suspicious, but limited sample in biopsy.
Discordance between imaging and biopsy pathology findings.

In these situations, the doctor will often recommend continued monitoring with physical exams and repeat imaging, as well as potentially repeat biopsy in the future to ensure no cancer develops.

Does a benign biopsy result mean no cancer?

In most cases, a pathologist giving a benign diagnosis from a biopsy means no cancer was detected in the sample analyzed. However, it does not completely exclude malignancy. Reasons a benign biopsy may not mean no cancer include:

Sampling error if the biopsy misses the tumor area.

Inadequate tissue obtained for proper diagnosis.
Incorrect analysis or interpretation by the pathologist.
Radiologist targets wrong location for image-guided biopsy.

According to studies, the false negative rate for biopsies ranges from 1-11%, depending on the type of cancer suspected. So even with an initially benign result, it is important to remain vigilant for any suspicious symptoms and follow your doctor’s recommendations for further testing or biopsy if needed.

How long does it take to get biopsy results?

The time it takes to receive your biopsy results can vary based on the following factors:

Type of biopsy – Fine needle aspiration is fastest; surgical biopsy slowest.

Site of biopsy – GI or lung biopsies take longer to culture cells.
Amount of tissue obtained – More tissue allows for more testing.
Additional testing – Immunohistochemistry, genetic tests take longer.

Lab processing time – Ranges from hours for frozen section to days for H&E stain.

Typical biopsy result timeframes:

Fine needle aspiration: 1-3 days

Core needle biopsy: 2-5 days
Surgical biopsy: 5-7 days

Rush testing can sometimes provide results within 24-48 hours. Discuss expected timing with your doctor so you know when to anticipate your results.

Should I be worried if a lump is benign after biopsy?

In general, a benign diagnosis from a biopsy means the lump or mass does not appear suspicious for cancer. Some reasons you may not need to worry about a benign lump include:

No concerning clinical symptoms present besides the lump itself.
Imaging like mammogram or ultrasound shows benign appearance.

Biopsy report is definitively benign like a lipoma or cyst.
Lump is unchanged in size or texture over subsequent exams.

However, it is appropriate to remain cautiously vigilant and alert your doctor about any lump with the following features:

Rapid growth or changes in the lump.
Pain, itching, or inflammation associated with it.
Highly vascular or bloody appearance.

Firm, irregular borders.
Persists longer than one menstrual cycle if breast related.

Any suspicious changes could warrant repeat imaging and potentially another biopsy of the area to re-evaluate.

Conclusion

In summary, a biopsy can reliably diagnose benign tissue in many cases. Specific benign results are confirmed when a pathologist finds normal cellular architecture and differentiation. However, limitations like sampling error mean even a benign finding will require continued follow-up and monitoring if any clinical concerns remain. Repeat biopsy may sometimes be needed for full reassurance. While anxieties are understandable after any abnormal finding, a benign biopsy result generally indicates the likelihood of cancer is low.