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What Is an Excision Biopsy?

By Geisha A. Legazpi
Updated Mar 03, 2024
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In general, a biopsy is tissue removal for the purpose of microscopically examining the tissue by a doctor who specializes in the field of pathology. An excision biopsy is a procedure done to remove a mass of tissue that is possibly malignant or cancerous. It is essential for diagnosing and treating small or non-metastatic cancers such as melanomas and localized cancers such as breast cancer. This procedure can also be used to detect deeper or metastatic cancers, upon which surgical or medical procedures considered as definitive treatments can be performed.

Sometimes called surgical biopsy, an excision biopsy involves either tissue or organ removal. It can be done to remove suspicious lumps of the skin, breast, thyroid, and other parts of the body. There may be times when the mass is not visible and is located deep within the body. For instance, the para-aortic lymph nodes near the aorta and the heart may be enlarged due to metastatic lung cancer. In this case, an excision biopsy is performed to remove the lymph nodes and examine them.

When a breast lump is detected and cancer is suspected, an excision biopsy may be the preferred method for removing the lump. Wire-guided biopsy of the breast is a special type of surgical biopsy wherein a radiologist assists the surgeon in the removal of the lump. A mammography machine is used to visualize the lump and to insert a needle connected to a wire. The surgeon follows the wire and cuts out the breast mass, which is then sent to a pathologist for definitive diagnosis. Wire-guided biopsy is best used for breast lumps that are seen on mammography but are not palpable or visible.

In an excision biopsy, the removed specimen is histologically or microscopically examined. The pathologist evaluates the surgical margin of the removed tissue. If the pathologist reports that there are clear or negative margins, it means no cancerous cells have been found at the edges of the specimen. When the pathology report states positive margins it means cancerous cells have been found at the margins, and a wider excision is needed for treatment of the disease.

An important advantage of doing an excision or surgical biopsy is obtaining a large specimen, thereby decreasing the probability of diagnostic error. This procedure requires stitches, leaves a scar, and may cause significant bleeding or infection. The decision to do excision biopsy instead of other biopsy techniques usually depends on the type of malignancy suspected, how large the mass is, and how accurate the diagnosis will be.

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Discussion Comments

By Rotergirl — On Dec 09, 2014

When I had the nodule on my thyroid removed, I guess you could call that an excision biopsy, since they didn't take my entire thyroid.

I'd had a fine needle aspiration biopsy about six weeks before, and since the results didn't show a malignancy, I just needed to schedule surgery. That needle biopsy was just too much fun. They deadened my neck, then they did six passes with six needles. I couldn't really feel anything, but I was thrilled when it was over, let me tell you.

The actual surgery was outpatient. I had it on a Friday and was back at work the following Wednesday. For once, I didn't have to feel guilty for taking seven naps in one day.

By Pippinwhite — On Dec 08, 2014

When my mom had breast cancer, she had an excision biopsy of the tumor. It was done as day surgery, and she was home by that afternoon.

The pathology report showed it was cancer, but was not a very big tumor -- only about the size of a quarter. The next week, she had a mastectomy, after consultation with her surgeon and oncologist. She had three positive lymph nodes, but had chemotherapy, and is now a 25-year survivor! We are thankful such excellent treatment was available for her when she needed it. She found the lump herself, so she's a living example of how effective self examinations are.

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