Ultrasound Department - Information for patients undergoing a percutaneous biopsy under Ultrasound guidance

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 signing 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 an ultrasound machine 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 check in desk.

Staff you are likely to meet

• Radiologists
• Sonographers
• Radiology Nurses
• Healthcare Support Workers
• Administrative Staff

Preparation for procedure/examination

Please contact us in advance of your procedure/examination on 01223 216455 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
• Weigh 150 kg or more
• If you are taking any blood thinning medications, like warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban, Clopidogrel or Ticagrelor you should inform your doctor before the procedure
• Have any allergies you must inform your doctor

Benefits

Other tests you have had have shown an abnormal area of tissue. From these tests, it is not always possible to say what has caused the abnormality. A percutaneous biopsy is a way of taking a tiny piece of tissue for the pathologist to examine and to understand what the abnormality is.

Risks

A percutaneous biopsy is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise.

If you are having a liver, kidney or spleen biopsy, then 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 else 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 sample.

Despite these possible complications, percutaneous biopsy is normally very safe and is designed to 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 Ultrasound 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 ultrasound examination 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 ultrasound machine decide on the most suitable point for inserting the biopsy needle. Your skin will then be 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 may be in the department for 4-6 hours to ensure there have been no complications.

We recommend you do not undertake strenuous activity and 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 or contact the accessbility team by email or telephone: 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 in the designated storage area but can be brought down to the department if necessary – they will either be left on your bed (if kept in the room) or placed on the side.

What happens after my procedure/examination?

Depending on the type of biopsy, you may be asked to stay in bed for a few hours until you have recovered. A nurse will carry out routine observations, such as taking your pulse and blood pressure, to make sure there are no problems. If you have any pain following the procedure, we may give you some pain-relief medication. Depending on the biopsy you may have to stay in hospital overnight.

This can be discussed with the doctors looking after you.

Possible side effects and additional aftercare

We recommend that you do not drive for twenty-four hours and 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 doctor to discuss the results of your biopsy. Sometimes the biopsy is not successful in obtaining the required tissue, or there was not enough normal tissue for the pathologist to make the diagnosis. In this case you may be recalled to have another biopsy.

Your referring team or clinician will be responsible for communicating reports back to you.

Test result 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, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Are there any alternative tests?

If you are unable to have the biopsy under ultrasound guidance it may be performed under CT.

Contacts/further information

Please contact the US department on 01223 216455.

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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