Core Needle Biopsy (CNB) is a minimally invasive diagnostic technique guided by imaging, which involves puncturing the lesion tissue with a specially designed hollow needle to obtain cellular or tissue samples. Its primary purpose is to quickly acquire sufficient tissue for pathological analysis, assisting physicians in determining whether a tumor is benign or malignant, identifying infection types, or assessing inflammation severity. Due to its minimal trauma and high diagnostic accuracy, it is commonly used for evaluating abnormal lesions in organs such as the breast, liver, and lymph nodes.
Compared to traditional surgical excisional biopsy, core needle biopsy offers advantages such as shorter procedure time and faster recovery, and can be precisely guided under ultrasound, computed tomography, or magnetic resonance imaging. This technique is widely used in early cancer screening and the pathological diagnosis of unknown tumors, making it an essential tool in modern precision medicine.
Core needle biopsy can be divided into two main types: "Vacuum-Assisted Biopsy" and "Automatic Spring-Loaded Needle." Vacuum-assisted systems use negative pressure to secure tissue and are suitable for obtaining multiple samples; automatic spring-loaded needles puncture at high frequency to ensure tissue integrity. The mechanism involves directly obtaining cylindrical tissue samples approximately 0.3 to 1.5 centimeters in diameter through puncture needles, which are then fixed and stained for histological analysis by pathologists.
When combined with imaging guidance systems, accuracy can be improved. For example, breast biopsies often use real-time ultrasound monitoring of the needle tip. After obtaining tissue samples, pathologists observe cell morphology, arrangement, and special staining results to determine the nature of the lesion, such as grading malignant tumors or identifying infectious bacteria.
In addition, this technique is also suitable for:
The procedure generally involves four stages: 1. Imaging localization of the lesion; 2. Local anesthesia at the puncture site; 3. Obtaining 3-5 tissue segments with the core needle; 4. Applying pressure to the puncture site to achieve hemostasis. General anesthesia is usually limited to children or patients with severe anxiety.
"Dosage" here refers to the number of punctures and the amount of tissue obtained. Usually, 3-5 tissue segments are collected to ensure sufficient material for pathological analysis. For hard lesions (e.g., bone), special curved needles may be required, while soft tissue lesions often use 14-18G hollow needles. The procedure duration is approximately 15-60 minutes, depending on the depth and location of the lesion.
The advantages of core needle biopsy include:
The minimally invasive nature allows patients to complete the examination on an outpatient basis, which is especially safer for elderly or patients with compromised cardiopulmonary function. Additionally, the obtained tissue can be used for genetic testing, aiding in personalized treatment planning.
Possible immediate risks include:
Rare complications include:
Absolute contraindications:
Relative contraindications:
Patients should prepare in advance: discontinue anticoagulants (such as aspirin, warfarin) 3-5 days prior; fast for 4 hours on the day of the procedure (if sedation is required). Post-procedure, pressure should be applied to the puncture site for at least 30 minutes to prevent bleeding.
If patients are using antiplatelet drugs (e.g., corticosteroids for asthma), they should communicate with their physician to adjust dosages before the procedure. Patients undergoing radiotherapy or chemotherapy should confirm whether tissue hardening due to treatment might affect biopsy results.
Interactions with imaging examinations should also be considered: MRI guidance requires avoiding metal fixators and pacemakers; contrast-enhanced CT scans should evaluate renal function before use. Patients should avoid vigorous activity within two weeks after the procedure to prevent bleeding along the puncture tract.
For breast lesions, the diagnostic accuracy of core needle biopsy for malignant tumors reaches 98%, with misdiagnosis rates of only 1-2%. Liver lesion analysis shows an accuracy of up to 94%, superior to fine-needle aspiration (75%). Multiple large studies have confirmed that its sensitivity and specificity are better than imaging alone.
The 2018 New England Journal of Medicine comparative study indicated that core needle biopsy has a 97% accuracy in determining HER2 status in breast cancer, directly influencing targeted therapy choices. The sufficient tissue obtained also allows for genetic testing, aiding in personalized treatment strategies.
Alternatives include:
When choosing alternatives, considerations include:
What preparations are needed before treatment? Is fasting or discontinuing certain medications required?
Before core needle biopsy, your doctor may ask you to fast for 4 to 6 hours and confirm whether you are taking anticoagulants (such as aspirin or blood thinners). Some patients need to stop specific medications in advance to reduce bleeding risk. Follow your physician’s personalized instructions.
How can I alleviate common discomfort after treatment?
Post-procedure, you may experience local pain or swelling. It is recommended to avoid strenuous activity for 24 hours and use ice packs to relieve discomfort. If pain persists or worsens, contact your healthcare team. Your doctor may prescribe pain medication or further evaluate.
When can I resume normal work or bathing after the procedure?
Most patients can return to light work within 1-2 days. Avoid lifting heavy objects or exerting pressure on the puncture site for at least one week. When bathing, keep the puncture area dry, use waterproof dressings, and generally can bathe normally after 3 days, but avoid soaking in baths or hot water directly on the wound.
If the biopsy results are abnormal, what is the follow-up frequency?
If results indicate malignancy or suspicious lesions, your doctor will schedule follow-up imaging or surgical assessment based on the lesion’s characteristics, typically within 1-3 months. Benign results usually require regular check-ups every 6-12 months, with specific plans tailored to individual medical history.
What factors influence the accuracy of core needle biopsy?
Accuracy depends on lesion size, number of punctures, and tissue sample volume. Lesions smaller than 5 millimeters may require image-guided procedures to improve success rates. If initial results are inconclusive, repeat biopsy or additional diagnostic methods may be recommended to enhance reliability.
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