excisional biopsy
Meaning of excisional biopsy: The whole lump comes out, so the pathologist can judge not only what the cells are but where they stop.
Definition of excisional biopsy
An excisional biopsy is a procedure in which an entire lump or abnormal area is cut out and sent for examination, rather than a piece being sampled. Because the whole lesion is removed, its size, its internal architecture and whether abnormal cells reach the cut edges can all be assessed. The same operation sometimes turns out to be the treatment as well.
How is it different from other biopsies?
| Method | What is taken | Common setting |
|---|---|---|
| Excisional | The whole lesion | Small lumps, lymph nodes, moles |
| Incisional | A wedge from a larger mass | Lesions too big to remove |
| Punch | A small cylinder of skin | Rashes and skin lesions |
| Shave | A slice from the surface | Raised surface lesions |
| Core needle | A thin thread of tissue | Breast, liver, prostate |
A punch biopsy and a shave biopsy both sample rather than remove, and each answers a narrower question.
Why remove the whole thing?
Some questions cannot be answered from a fragment. Whether abnormal cells have broken out of their original layer depends on seeing the boundary intact. Whether the growth was fully removed depends on inking the outside surface and checking how close cells come to it, which is only possible when there is an outside surface to ink. Lymph node disorders are the clearest case: telling one lymphoma from another depends on the arrangement of cells throughout the whole node, and a needle sample destroys that arrangement.
What does the procedure involve?
Most are done with local anesthetic, with the area numbed and the skin closed with stitches afterward. Deeper or larger lesions, and nodes inside the chest or abdomen, need general anesthetic. The surgeon usually marks the specimen with stitches or clips so the laboratory knows which edge faced which direction, which matters if further surgery is needed at one particular margin.
What does the report describe?
Beyond the diagnosis, the biopsy specimen report gives measurements, describes how far the abnormality extends, and states the distance from each cut edge. A margin described as involved means abnormal cells reach the ink, and a clear margin means a rim of normal tissue surrounds the lesion.
Used in a sentence
An excisional biopsy of the enlarged cervical node was performed under general anesthesia.
Good to know
Removing the lesion whole preserves the margins and the internal architecture, which sampling methods cannot show, and this is why lymph node diagnosis usually requires it.
Word origin
Where “excisional biopsy” comes from
Excision comes from the Latin excidere, to cut out; biopsy joins the Greek bios, meaning life, to opsis, meaning sight.