CT-Guided Biopsy & FNAC in Dadar West, Mumbai

What is a CT-guided biopsy or CT-guided FNAC?

A biopsy takes a small piece of tissue, or a few cells, from an abnormal area for examination under a microscope. In a CT-guided biopsy the radiologist passes a thin needle through the skin, and CT pictures show where the needle tip is at each step [1]. Biopsy is बायोप्सी in both Hindi and Marathi.

• CT-guided FNAC (fine needle aspiration cytology): a very fine needle draws out fluid or clusters of cells.
• CT-guided core biopsy: a slightly larger, spring-loaded needle takes thin cores of tissue, on which the laboratory can run extra tests. In lung cancer, for example, these include marker (biomarker) tests that help choose treatment [1] [9].

A needle biopsy is less invasive than an operation, needs no stitches, and its results are considered as accurate as a surgical sample [1], although sometimes, especially when lymphoma is suspected, more tissue is needed [1].

CT or ultrasound guidance: which one is used?

At AV Scan most needle tests are guided by ultrasound, which shows the needle moving live with no radiation (see ultrasound-guided biopsy and FNAC). Ultrasound cannot see through air or bone, and its picture fades with depth [4], so a small number of deeper targets that ultrasound cannot show clearly are sampled under CT guidance instead:

The radiologist makes the final choice after looking at your scans.

Why doctors ask for a CT-guided biopsy

A scan shows where an abnormal area is; often only a sample can say what it is: harmless, an infection, inflammation or cancer [1]. Common reasons:

• A lung nodule or mass on a chest X-ray or HRCT chest, especially one that a bronchoscopy cannot reach [2]
• A bone lesion, for example in the spine or pelvis, to tell an infection from a tumour [3]
• Enlarged lymph nodes deep in the chest or abdomen, or a deep abdominal mass [1]
• Suspected tuberculosis (TB), a common non-cancer finding in an Indian study of CT-guided FNAC [8]; in India lung cancer is sometimes mistaken for TB, which delays treatment [9]

Whether your target can be sampled at AV Scan depends on where it is and what your scans show; the radiologist reviews them, and our team tells you when you book. Still need the scan itself? See CT scans at AV Scan.

How to prepare for a CT-guided biopsy

• Send a photo of your doctor's prescription and recent scan reports on WhatsApp (opens WhatsApp); our team confirms the procedure, the preparation and the day.
• Tell us about any medicine that thins the blood or prevents clots, and do not stop it yourself. The doctor who prescribed it weighs the bleeding risk against your risk of a clot and decides whether and when to pause it; deep biopsies generally carry more bleeding risk than surface ones [6].
• Our team may ask for a recent clotting test (PT/INR) and a platelet count; the blood sample can be given at the centre (see blood tests).
• Tell us about a bleeding problem or liver disease, an allergy to local anaesthetic, antiseptic or latex, severe lung disease such as emphysema, or a possible pregnancy [2].
• If contrast is needed, a recent kidney function (creatinine) report may be requested; tell us about any allergy and about any diabetes medicines, such as metformin.
• Bring earlier scans (CD, DVD or cloud link), their reports and any earlier FNAC or biopsy reports. If your CT was done here, the radiologist already has your images to plan the needle route.
• Our team tells you whether you need to avoid food for a few hours beforehand.
• Plan for an adult to take you home, and do not drive yourself [7]; our team tells you whether an escort is essential.

What happens during a CT-guided biopsy

1. Consent

   The radiologist goes through your scans with you, explains the procedure, its risks and the other options, and answers your questions before you sign a consent form.

2. Positioning and a planning scan

   You lie on the CT table on your back, front or side. A short scan confirms the target and a needle route that avoids blood vessels, airways and bowel, and the entry point is marked on the skin [2] [7].

3. Numbing the skin

   The skin is cleaned and numbed with a local anaesthetic injection, which stings briefly. A tiny nick lets the needle in; no stitches are needed [1].

4. Guiding the needle and taking samples

   The needle moves forward in small steps, with a quick CT check after each. For a chest biopsy, breathe gently, do not cough, and hold your breath the same way each time you are asked. Usually two or three samples are taken, sometimes more [7] [2]; you feel pressure, and a core needle makes a click as each sample is taken.

5. Rest and checks

   A small dressing goes on and you rest while the team checks your breathing and pulse. After a lung biopsy a check scan or chest X-ray is often done before you go home [2] [7]; our team tells you how long to plan for. If there is an urgent finding, the radiologist contacts your doctor directly.

The procedure usually takes under an hour [2]. Say straight away if you feel faint, breathless or in pain.

Risks of a CT-guided biopsy, in plain numbers

Any CT-guided biopsy

• Soreness and a small bruise for a day or two: common.
• Bleeding: usually small. At the skin it stops with pressure, and a little bleeding inside the body usually settles on its own; this is why clotting is checked beforehand [1] [7].
• Infection needing antibiotics: less than 1 in 1,000 [1].
• Injury to a nearby structure, such as the bowel, a nerve or a blood vessel: rare [1] [3].
• Spread of a tumour along the needle track: rare [10].

Extra risks of a CT-guided lung biopsy

The needle crosses the thin lining around the lung, so the main risk is an air leak (pneumothorax, a partly collapsed lung). A review of many studies [5] and an NHS patient leaflet [7] give these figures:

Air leak (pneumothorax)

About 1 in 4 people after a core biopsy and 1 in 5 after an FNAC [5]; most are small and settle on their own [7].

Air leak that needs treatment

About 1 in 20 people [5] [7]. Treatment may be a small chest tube that lets the air out; it is generally removed the next day [2].

Coughing up a little blood

About 1 in 25 after a core biopsy and fewer than 1 in 50 after an FNAC [5]; it fades over 12 to 48 hours [2].

Bleeding inside the chest that needs an operation

Very rare: about 1 in 1,000 [7].

Air entering a blood vessel (air embolism)

Very rare: about 1 in 3,000 lung biopsies. It can cause chest pain, a heart attack or a stroke [7].

Death

Extremely uncommon: about 1 in 5,000 [7].

A core biopsy has more complications than an FNAC, mostly minor, but gives more tissue for tests; the radiologist weighs this for you [5]. A lung biopsy may not suit people with severe emphysema, lung cysts, a clotting disorder, low blood oxygen, high blood pressure in the lungs (pulmonary hypertension) or some kinds of heart failure [2].

Radiation and pregnancy

CT uses X-rays, but only the area around the target is scanned, with the dose kept as low as reasonably achievable on our Fujifilm Supria CT; the small risk is weighed against the benefit of a diagnosis [2]. Tell us if you are or might be pregnant: CT-guided procedures are generally avoided in pregnancy [1].

After your biopsy: aftercare and warning signs

• Keep the dressing dry until the next day [2].
• Rest for the remainder of the day. Avoid heavy lifting and strenuous exercise that night and for one full day after; most people return to normal activities on the second day after the biopsy [2].
• After a lung biopsy, have an adult stay with you overnight [7].
• After a lung biopsy, ask the radiologist before you book a flight; some hospitals advise not flying for up to six weeks [7] [2].
• Restart a blood thinner only when the doctor who prescribed it says so [6].

Contact your doctor or call us for bleeding that does not stop with firm pressure, pain, swelling or redness that keeps increasing, pus at the site, or a fever [3].

Your biopsy result and who explains it

Questions about cost?