Tumour/mass Biopsy - XL

Biopsy

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No Fasting Required

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Multiplex tumor marker test.

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Tumour/Mass Biopsy - XL: Comprehensive Medical Test Guide

Why is it done?
- Definitive diagnosis of suspicious masses or tumours identified on imaging studies (CT, MRI, ultrasound, or X-ray)
- Determination of whether a lesion is benign or malignant through histopathological examination
- Classification and grading of malignant tumours to guide treatment planning and prognosis
- Identification of specific tumour type, stage, and molecular markers for targeted therapy selection
- Assessment of metastatic disease or involvement of surrounding tissues
- XL designation indicates a larger tissue sample procurement for comprehensive analysis, allowing for multiple staining techniques and genetic testing
- Performed when standard biopsy samples are insufficient or when complex diagnostic workup is anticipated
Normal Range
- Benign Result: Tissue shows normal, non-cancerous cellular architecture with no evidence of malignancy, dysplasia, or atypia
- Negative Result: No malignant cells identified; benign pathology such as cyst, fibroadenoma, inflammatory lesion, or lipoma
- Non-Diagnostic/Insufficient: Sample inadequate for definitive interpretation; repeat biopsy may be required
- Atypia of Undetermined Significance (AUS): Borderline findings with uncertain clinical significance; follow-up testing recommended
- Suspicious for Malignancy: High likelihood of cancer present; urgent clinical correlation and treatment planning required
- Positive/Malignant: Definitive evidence of malignancy with specific tumour type, grade, and stage documented
Interpretation
- Benign Pathology: Confirms mass is non-cancerous; conservative management or standard treatment for benign condition (e.g., cyst aspiration, hormone therapy for fibroadenoma, surgical excision if necessary)
- Malignant Result: Cancer confirmed; pathology report includes histological type (adenocarcinoma, squamous cell, etc.), grade (differentiation level), stage (TNM classification), and prognostic factors; dictates treatment approach (surgery, chemotherapy, radiation, immunotherapy)
- Grading System (Gleason, Nottingham, etc.): Lower scores (Grade 1-2): Well-differentiated, slower growth, better prognosis Grade 3: Moderately differentiated, intermediate prognosis Higher scores (Grade 4-5): Poorly differentiated, aggressive, worse prognosis
- Molecular Markers: XL biopsy enables testing for HER2 status, estrogen/progesterone receptors (breast cancer), EGFR/ALK mutations (lung cancer), BRAF/KIT mutations (melanoma), MMR/MSI status (colorectal cancer), and PD-L1 expression; findings guide targeted therapy and immunotherapy eligibility
- Inconclusive/AUS Results: Warrants repeat biopsy, additional imaging, or clinical correlation; may require rebiopsy at 3-6 months or multidisciplinary team discussion
- Factors Affecting Interpretation: Prior treatment (chemotherapy, radiation) may alter cellular appearance Infection or inflammation can mimic malignancy Crush artifact from improper handling may compromise diagnosis Small sample size may miss tumour heterogeneity
- Staining Techniques: Haematoxylin & Eosin (H&E) for morphology Immunohistochemistry (IHC) for cell markers In situ hybridization (ISH/FISH) for genetic abnormalities Special stains (Gram, PAS, Trichrome) for organism/material identification
Associated Organs
- Primary Organs/Systems: Breast tissue (ductal/lobular carcinoma, phyllodes tumours) Lung parenchyma (non-small cell carcinoma, small cell carcinoma, adenocarcinoma) Liver tissue (hepatocellular carcinoma, cholangiocarcinoma, metastatic disease) Prostate gland (adenocarcinoma) Thyroid (papillary, follicular, medullary carcinoma) Colorectal tissue (adenocarcinoma, mucinous carcinoma) Skin (melanoma, basal cell, squamous cell carcinoma) Bone/bone marrow (osteosarcoma, Ewing sarcoma) Lymph nodes (lymphoma, metastatic carcinoma) Soft tissue (sarcoma, lipoma, fibromatosis)
- Diseases Diagnosed: Solid organ malignancies Haematologic malignancies (lymphoma, leukaemia) Metastatic tumours Sarcomas Neuroendocrine tumours Germ cell tumours Benign neoplasms and tumour-like lesions
- Complications from Abnormal Results: Metastatic spread to distant organs (brain, liver, bone, lung) Lymph node involvement Organ dysfunction from tumour mass effect Paraneoplastic syndromes Tumour-related infections Bleeding and vascular invasion
- Biopsy-Related Risks: Infection at biopsy site Bleeding/haemorrhage (especially with anticoagulation) Pneumothorax (lung biopsy) Biliary peritonitis (liver biopsy) Nerve injury Tumour seeding (rare) Pain/bruising at biopsy site
Follow-up Tests
- Imaging Studies: CT chest/abdomen/pelvis for staging and metastatic workup MRI for better soft tissue characterization PET-CT for metabolic activity and distant disease Bone scan for skeletal metastases Brain MRI for neurological symptoms
- Laboratory Tests: Tumour markers (PSA, CEA, AFP, CA 19-9, etc.) Complete blood count for anaemia or cytopaenia Liver function tests Renal function assessment Coagulation studies before surgery
- Genetic/Molecular Testing: Cytogenetics (chromosome abnormalities) Flow cytometry (lymphoma, leukaemia) Fluorescence in situ hybridization (FISH) for specific translocations Next-generation sequencing (NGS) for comprehensive mutation analysis BRCA 1/2 testing (hereditary breast/ovarian cancer)
- Repeat Biopsy: If initial result inconclusive, non-diagnostic, or clinical suspicion remains high Typically performed 3-6 months after initial biopsy
- Multidisciplinary Tumour Board Discussion: Review by pathology, oncology, surgery, and radiology for treatment planning Correlation of biopsy findings with imaging and clinical presentation
- Monitoring During/After Treatment: Serial imaging (typically 3-6 monthly intervals) Tumour marker surveillance Rebiopsy if recurrence suspected
- Complementary Tests: Surgical staging procedures (sentinel node biopsy, thoracotomy) Bronchoscopy for airway involvement Endoscopy for gastrointestinal lesions Colonoscopy for colorectal pathology
Fasting Required?
- Fasting: YES, fasting is typically required (varies by biopsy type and anaesthesia)
- Duration: 6-8 hours from midnight if general or conscious sedation planned Local anaesthesia only: May not require fasting
- Fluid Intake: Clear liquids (water, apple juice, black coffee) typically allowed until 2-4 hours before procedure
- Medications to Avoid/Modify: Anticoagulants (warfarin, dabigatran): Hold 3-5 days before procedure or per cardiologist Antiplatelet agents (aspirin, clopidogrel): Hold 5-7 days, or per prescriber Antidiabetic drugs: May hold on day of procedure depending on type NSAIDs: Hold 3-5 days prior Arrange bridging anticoagulation if necessary with prescriber
- Pre-Procedure Preparation: Complete baseline laboratory studies (CBC, PT/INR, aPTT) 1 week prior Verify coagulation parameters are within acceptable range Confirm allergy status and adverse reactions to anaesthetics Review imaging (CT, ultrasound, MRI) to confirm lesion location and accessibility Obtain informed consent documenting risks and benefits Arrange for designated driver if sedation used Wear comfortable, loose-fitting clothing
- Post-Procedure Instructions: Resume normal diet once cleared Monitor biopsy site for bleeding, infection, or swelling Keep site clean and dry Report severe pain, fever, or persistent bleeding immediately Follow-up appointment in 1-2 weeks to discuss pathology results Avoid strenuous activity for 3-5 days depending on biopsy location

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