Information for patients undergoing a percutaneous biopsy under CT-guidance

Introduction

This leaflet has been designed to answer some of the common questions you may have regarding your percutaneous biopsy. This is the starting point for discussion about your treatment with the doctors looking after you, who wish to make sure you have received enough information about the procedure before you sign the consent form.

A percutaneous biopsy is a way of taking a small piece of tissue out of your body, using a needle through a tiny skin incision, so that it can be examined under a microscope by a pathologist (an expert in making diagnoses from tissue samples). The procedure is called “percutaneous” as it is done through the skin. The radiologist undertaking the biopsy will use a CT Scanner to guide the needle into the correct place.

How long will I be in the department?

The procedure itself will take approximately 30 minutes. However, you will have a period of bed rest of up to 6 hours afterwards. This will be confirmed when your appointment is booked.

What to do when you arrive

• Report to the Radiology Day Unit if you are attending as an Outpatient.
• If you are attending as an Inpatient, you will be allocated an appointment and the X-ray porter will collect you in your bed to transfer you to the CT Department.

Staff you are likely to meet

• Radiologist
• Radiographer
• Radiology Nurse
• Clinical Support Worker
• Administration staff

Preparation for procedure/examination

Please contact the CT Department Reception on 01223 217426 if you:

• Have additional requirements that may require a longer appointment.
• Require a specific appointment time due to taking time-sensitive medication (e.g. insulin, medicines for Parkinson’s disease)
• Are claustrophobic.
• Are pregnant.
• Require hospital transport.
• Are unable to lie flat.
• Have mobility issues.
• Are taking any blood thinning medications, like Warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban, Clopidogrel or Ticagrelor you should inform your referring doctor before the procedure
• Have any allergies.
• Weigh 150 kg or more.

Benefits

A percutaneous biopsy is a way of taking a tiny piece of tissue for the pathologist to examine because other tests you have had, have shown an abnormal area of tissue. Determining the abnormality will help guide further treatment or surgical intervention. From these tests, however, it is not always possible to say what has caused the abnormality.

Risks

A percutaneous biopsy is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise. There is a risk of bleeding, although this is generally very slight.

If the bleeding were to continue, then it is possible that you might need a blood transfusion. Very rarely, an operation or another radiological procedure is required to stop the bleeding.

If you are having a lung biopsy performed, it is possible that air can get into the space around the lung (pneumothorax). This generally does not cause any real problems, but if it causes the lung to collapse, the air will need to be drained, either with a needle, or with a small plastic tube, inserted through the skin.

Unfortunately, some biopsies fail to give an answer. This may be because, despite taking every possible care, the piece of tissue which has been obtained is normal tissue rather than abnormal. Alternatively, although abnormal tissue has been obtained, it may not be enough for the pathologist to make a definite diagnosis. The Radiologist doing your biopsy may be able to give you some idea as to the chance of obtaining a satisfactory answer by reviewing the quality of sample taken.

Despite these possible complications, percutaneous biopsy is normally very safe and is designed to potentially save you from having a bigger procedure.

What will happen on the day of my procedure/examination?

You may have some blood tests prior to the biopsy to check you do not have an increased risk of bleeding.

On arrival in the CT Department from the ward or Radiology Day Unit you will be asked to change into a hospital gown.

You will then be asked to lie on the CT Scanner table in the position that the radiologist has decided is most suitable. Your skin will be cleaned with antiseptic, and you may have some of your body covered with a sterile sheet. The radiologist will use the CT Scanner to decide on the most suitable point for inserting the biopsy needle. Your skin will be then anaesthetised, and the biopsy needle inserted into the abnormal tissue.

Most biopsies do not hurt. The local anaesthetic used to anesthetise the skin will sting to start with, but this will soon pass as the skin and deeper tissues become numb. You may be aware of a pressure sensation as the needle passes into the deeper tissues, but this is usually well tolerated.

This will depend on the situation and type of biopsy. The procedure may take over 30 minutes, although you will be in the department for a longer period to ensure there have been no complications.

We recommend you do not undertake strenuous activity and that you rest for the remainder of the day.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival, email CUH accessibility or call 01223 256998.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Can I bring someone with me?

Those accompanying you may be required to stay out of the examination room during the procedure and remain in the waiting area.

Childcare whilst in department

Staff are unable to look after or supervise children whilst your procedure/examination is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure / examination. If you attend an appointment with children with no one to look after them whilst you have your examination/procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Personal belongings

These would preferably be left on the ward or in the Radiology Day Unit but can be brought down to the department if necessary – they will be kept in the room during the procedure.

What happens after my procedure/examination?

Depending on the type of biopsy, you may be asked to stay in bed for up to 6 hours until you have recovered. A nurse will carry out routine observations, such as taking your pulse and blood pressure. If you have any pain following the procedure, we may give you some pain-relief medication. Depending on the type of biopsy, you may have to stay in hospital overnight, this can be discussed with the Radiologist who performed your biopsy.

Possible side effects and additional aftercare

We recommend that you do not drive for twenty-four hours, and that you ask a friend or relative to drive you home following your procedure.

How, when and by whom will my results be communicated?

• You will have a follow-up appointment with your referring doctor to discuss the results of your biopsy.
• Your referring team or clinician will be responsible for communicating reports back to you.
• Test results are made available via MyChart but there is 3-week delay from when an examination has been reported to when it is available on MyChart. This delay, allows time for your clinical team to be able to see and action the results prior to them being released to an individual patient.

Are there any alternative tests?

If you are unable to have the biopsy under CT guidance it may be performed under Ultrasound if deemed suitable by a Radiologist.

Contacts/further information

Please contact the CT Department: 01223 217426.

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Question, concern or complaint?

Firstly, speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, via email at cuh.pals@nhs.net, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart