Biopsy procedure in Kenya: A crucial diagnostic aid in cancer

What is a Biopsy Test

A biopsy test is a medical procedure performed to collect tissue or cell samples from a diseased organ or  part of the body. The tissue is thereafter submitted to the clinical laboratory for analysis. A biopsy is a critical diagnostic modality for a range of diseases including cancer, infections, inflammatory diseases, degenerative disorders as well as autoimmune disorders. For some conditions especially malignancies, a biopsy  is often critical to arrive at a conclusive diagnosis.

Here are 7 most important facts you should know about tissue biopsy.

Fact #1: Importance of Biopsies

Biopsies are essential as they provide doctors with crucial information for accurate diagnosis, prognosis, and treatment planning. They help identify the presence of abnormal cells, determine the stage and grade of cancers, evaluate treatment effectiveness, and guide personalized therapies. 

Fact #2: Commonly biopsied organs

Pretty much any part or organ of the body, from hair to toe, can be biopsied. Some of the more commonly biopsied are presented below.

1. Skin Biopsy
   The skin is the largest organ in the body and is prone to various diseases and conditions. These range from infective conditions like fungi to cancers like melanomas. Biopsy test for skin has the advantage of being straightforward and easy. Methods used include scrapings, punch biopsies, wedge and excision biopsies.
2. Lymph nodes. Lymph nodes are part of the body’s immune system, the defence mechanism against infections as well as cancers. As such, lymph nodes tend to be affected by pathology occurring in the organs they drain. Both superficial and deep(internal) lymph nodes are amenable to biopsy.
3. Thyroid Gland. The thyroid gland sits in front of the neck and secretes crucial thyroid hormones. It’s prone to inflammation, benign and malignant tumours as well as degenerative disorders. Biopsy of the thyroid supplements other diagnostic modalities like imaging and blood tests, helping doctors make the right diagnosis.
4. Breasts. Breasts are prone to many conditions, most benign and some malignant. A biopsy test is critical in making the right diagnosis, especially for suspicious lesions such as lumps. Thankfully, breast biopsies are relatively easy to perform with menial complications
5. Stomach, oesophagus and colon. The gastrointestinal tract is frequently subjected to biopsy, with endoscopy being the modality of choice. This allows visualisation of the surface of these organs and allows the taking of biopsies of only the diseased parts.
6. Liver and Kidneys and lungs. In combination with modern imaging techniques, a biopsy of these internal organs has become more precise. 
7. Bone Marrow. Bone marrow aspiration and biopsy enable accurate diagnosis of diseases affecting blood such as anaemia and cancers such as leukaemia. In addition, a wide range of diseases are diagnosed by examining the bone marrow.

The Brain: Why we don’t routinely biopsy the brain!
The brain is probably the most unique and complicated human organ. Due to the complexity and risk involved, most of the time biopsy is not done before treatment. Other diagnostic modalities play are employed. If surgery is done, the material removed is then submitted to the lab to confirm the preoperative diagnosis.

Fact #3: Types of Biopsy Tests in Kenya

a) Needle Biopsy

Needle biopsies are minimally invasive procedures that involve using a thin needle to extract tissue or fluid samples from the affected area. This type of biopsy includes:

• Fine Needle Aspiration (FNA) Biopsy: Used for extracting cells from palpable lumps or masses.
• Core Needle Biopsy: Involves removing a small cylinder of tissue using a larger needle.
• Vacuum-Assisted Biopsy: Utilizes suction to collect multiple tissue samples through a single needle insertion.

b) Surgical Biopsy

Surgical biopsies are more invasive procedures that involve the removal of an entire lump, suspicious area, or lymph node. Common surgical biopsy techniques include:

• Incisional Biopsy: Removes a small portion of the tumour or lesion for examination.
• Excisional Biopsy: Involves removing the entire tumour or lesion.

Fact # 4 : Preparing for a Tissue Biopsy Procedure 

Before a decision to do a biopsy is taken, your doctor will explain and review your clinical notes, examination findings as well as imaging and laboratory studies. With this, They will form a provisional diagnosis, of which biopsy may be needed to confirm, guide therapy and help in prognosis. The doctor will discuss all this information. Once its clear the need for biopsy, the next step is to discuss what the procedure will entail (see above), the benefits, and any associated risks. Here you will get an opportunity to ask any questions and have any concerns you may have addressed.

They may also give specific instructions regarding fasting, medication usage, or necessary laboratory tests.

Fact #4: The Actual Tissue Biopsy Procedure

During the biopsy, you will be positioned appropriately, and the area to be biopsied will be sterilized. The specific procedure will depend on the type of biopsy being performed. For needle biopsies, local anaesthesia is typically used, whereas surgical biopsies may require general or regional anaesthesia.

After the Biopsy: Post-Biopsy Care

After the procedure, you will receive instructions on caring for the biopsy site, managing any discomfort, and potential signs of complications. It’s important to keep the biopsy site dry for at least 24 hours. It’s important to follow these guidelines and promptly report any concerning symptoms to your healthcare provider.

Fact #5: How Tissue Biopsy is Processed and Analyzed

The collected tissue samples are sent to a laboratory for analysis. The type of analysis will depend on the likely disease, availability of the test and expertise. The processing and analysis is carried out by the anatomic pathology department or section.

Results and Follow-Up

The results are typically available within a few days to a couple of weeks. The turn around time is dependent on the type of processing required, some taking weeks, for example bony specimens. At times the biopsy may be sent to a more specialized center or even outside the country, usually to South Africa, India or even the UK.  Your healthcare provider will discuss the findings with you and develop an appropriate treatment plan or recommend further diagnostic tests if necessary.

Note: Biopsy does not always equate to cancer!

Fact #6: Complications of Tissue Biopsy Procedure

Tissue Biopsies are generally very safe procedures, however as with any invasive procedure, there some inherent risks. These are minimal and great care is taken to reduce them. Some of the recognised complications include:-

1. pain – during or after the procedure. Alert your healthcare provider as this can easily be managed by appropriate painkillers or anaesthesia
2. Infection – With meticulous infection prevention protocol, the risk of infection after biopsy is miniscule
3. Non-conclusive results – Sometimes the results are not conclusive to make the diagnosis. Repeat biopsy may be warranted, and this may be inconveniencing and/or expensive to the patient.

Fact #7: The costs of a Biopsy in Kenya

As we have seen, there are many different types of biopsies, ranging from simple to complex and everything in between. This variation is accounts for the variation in the cost. For simple fine needle aspiration, these may cost as low as KES 1800 at Kenyatta National Hospital to more than Kes 10,000 in the leading private hospitals. Biopsy for internal organs requiring anaesthesia may range from KES 50,000 to 100,000. Most health insurers in Kenya, including NHIF shy away from covering the cost of biopsies, yet it’s a critical diagnostic procedure. However, with pre-authorization, it may be possible, so ask your provider or agent.

Another cost implication is the laboratory analysis of the specimen. The cost will depend on what tests are carried out, with routine biopsy tests being cheaper. Immunohistochemistry and molecular tests can quickly escalate the cost

Bonus: Where can I get Tissue Biopsy test in Kenya?

Some biopsies can be performed in primary care setting like doctors’ clinics and medical center, for example FNAs and skin biopsies. More complex biopsies are typically performed in mid to upper level facilities (Level 4 -6). This encompasses county and national hospitals as well as mission and private hospital. Depending on complexity, some may be available only in specialist facilities. 

A wrap-up on Tissue Biopsy Procedure.

A biopsy is an extremely important diagnostic procedure. By extracting a piece of tissue or fluid from the body, doctors are able to accurately diagnose a variety of complex conditions such as cancers. 

With adequate evaluation and preparation, biopsies are safe and effective diagnostic modalities. 

Hope this article helps you understand the basics of biopsy tests. In case of any questions don’t hesitate to contact us or comment below.

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Till next time, happy and healthy living!

Medically Reviewed by: Dr Mwaura J