[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [The pathology laboratory](https://durgical.com/en/general-pathology/#a-lab) › Biopsy: excisional, incisional, core needle, punch and fine-needle aspiration

[General pathology](https://durgical.com/en/general-pathology/) · [The pathology laboratory](https://durgical.com/en/general-pathology/#a-lab)

# Biopsy: excisional, incisional, core needle, punch and fine-needle aspiration

- Technique

A biopsy takes a piece of tissue to look at under the microscope; the technique chosen decides what the pathologist can answer.

Updated 2026-11-01

## Key points

- Fine-needle aspiration = cells; core needle = tissue with architecture.
- FNA cannot separate follicular adenoma from follicular carcinoma of the thyroid: that requires seeing the capsule and vessels.
- Suspected melanoma: complete excisional biopsy to measure Breslow thickness.
- Suspected lymphoma: whole node, sent fresh.
- A negative biopsy of a highly suspicious lesion may be a sampling error: repeat or widen it.

## What it is

A biopsy is the removal of tissue from a living person for study. Some techniques remove the whole lesion, some only part of it, some a cylinder of tissue and some just loose cells. Choosing the right one avoids repeat biopsies: a sample without architecture cannot show invasion, and a lesion cut through cannot have its depth measured.

## Key facts

- Excisional biopsy: removes the whole lesion with a rim of normal tissue; it diagnoses and sometimes treats.
- Incisional biopsy: removes only part of a large lesion; it guides planning of the definitive operation.
- Core needle biopsy: takes cylinders of tissue that keep their architecture; the usual way to study a breast lump.
- Punch biopsy: a full-thickness cylinder of skin, useful for rashes and skin tumours.
- Fine-needle aspiration (FNA): obtains loose cells, not tissue; quick and minimally invasive, but cannot show invasion.
- Endoscopic biopsy: small mucosal fragments taken at endoscopy, colonoscopy or bronchoscopy.

## Step by step

- The clinician defines the question: what is the lesion, is it malignant, which markers does it carry?
- The technique is chosen by organ, size, access and whether tissue architecture is needed.
- If melanoma is suspected, the whole lesion is preferably removed so its thickness can be measured.
- If lymphoma is suspected, a whole node is sent fresh, for flow cytometry and molecular studies.
- The sample is labelled and fixed in formalin at once, unless fresh tissue is needed.
- It is sent with the clinical data: age, site, imaging and the suspected diagnosis.

## Which biopsy technique to choose

| Technique | What it obtains | Advantage | Limit |
| --- | --- | --- | --- |
| Excisional | The whole lesion | Complete diagnosis and margins | More invasive; not suited to large lesions |
| Incisional | Part of the lesion | Useful in large lesions before surgery | May miss the worst area |
| [Core needle](https://durgical.com/en/conditions/breast-cancer/) | Cylinders of tissue | Architecture, grade and markers with little invasion | Small sample: sampling error |
| Punch | Full-thickness skin cylinder | Quick, done in clinic | Small or superficial lesions only |
| [Fine-needle aspiration](https://durgical.com/en/conditions/thyroid-nodule/) | Loose cells | Minimally invasive and fast | Cannot tell in situ from invasive, or follicular adenoma from carcinoma |
| [Endoscopic](https://durgical.com/en/conditions/barrett-oesophagus/) | Mucosal fragments | Reaches hollow organs without surgery | Superficial; may miss deep invasion |

## Clinical notes

- Suspicious breast lump: image-guided core needle biopsy before any surgery; it gives type, grade and receptors.
- Suspicious pigmented lesion: excisional biopsy with a narrow margin; a superficial shave can transect the tumour and prevent measuring Breslow thickness.
- Enlarged node with suspected lymphoma: a whole node beats an aspirate, because the diagnosis depends on architecture.
- Sentinel node: the first node draining a tumour is removed and examined to stage without clearing the whole region.

## Memory aid

Fine needle meets the residents, core needle sees the house: FNA brings loose cells, the core brings the building with its architecture.

## Test yourself

Think of the answer, then tap the question to see it.

## Which type of biopsy keeps tissue architecture and is the usual choice for a breast lump?

Core needle biopsy, which takes tissue cylinders and allows type, grade and receptor testing.

## Why is fine-needle aspiration not enough to diagnose follicular thyroid carcinoma?

Because the diagnosis rests on capsular or vascular invasion, and FNA only obtains loose cells.

## Which biopsy is preferred for a pigmented lesion suspicious for melanoma?

A complete excisional biopsy with a narrow margin, so that Breslow thickness can be measured.

## How should a lymph node be sent when lymphoma is suspected?

Whole and fresh, so flow cytometry and molecular studies can be done as well as histology.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/biopsy-excisional-incisional-core-needle-punch-and-fine-needle-aspiration/)

## Related

- [Frozen section: the intraoperative consultation](https://durgical.com/en/general-pathology/frozen-section-the-intraoperative-consultation/)
- [Cytology: the Pap test, fine-needle aspiration and body fluids](https://durgical.com/en/general-pathology/cytology-the-pap-test-fine-needle-aspiration-and-body-fluids/)
- [From specimen to report: fixation, margins and the pathology report](https://durgical.com/en/general-pathology/from-specimen-to-report-fixation-margins-and-the-pathology-report/)
- [Immunohistochemistry: the principle and the markers to know](https://durgical.com/en/general-pathology/immunohistochemistry-the-principle-and-the-markers-to-know/)
- [Molecular pathology: PCR, FISH, sequencing and liquid biopsy](https://durgical.com/en/general-pathology/molecular-pathology-pcr-fish-sequencing-and-liquid-biopsy/)
- [Grading and staging: what TNM means](https://durgical.com/en/general-pathology/grading-and-staging-what-tnm-means/)

## Related conditions

- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Basal cell carcinoma](https://durgical.com/en/conditions/basal-cell-carcinoma/)
- [Cutaneous squamous cell carcinoma](https://durgical.com/en/conditions/cutaneous-squamous-cell-carcinoma/)
- [Thyroid nodule](https://durgical.com/en/conditions/thyroid-nodule/)
- [Solitary pulmonary nodule](https://durgical.com/en/conditions/solitary-pulmonary-nodule/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)
- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)
- [Colorectal polyps and hereditary polyposis syndromes (FAP, Lynch)](https://durgical.com/en/conditions/colorectal-polyps-and-hereditary-polyposis-syndromes/)
- [Barrett oesophagus](https://durgical.com/en/conditions/barrett-oesophagus/)
- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)
- [Soft tissue sarcomas (liposarcoma, leiomyosarcoma, rhabdomyosarcoma)](https://durgical.com/en/conditions/soft-tissue-sarcomas/)

## Elsewhere in DurgiPedia

- [From biopsy to slide: fixation, sectioning, frozen section](https://durgical.com/en/histology/from-biopsy-to-slide-fixation-sectioning-frozen-section/)
- [Microscopy and stains: H&E, PAS, trichrome, silver, immunohistochemistry](https://durgical.com/en/histology/microscopy-and-stains-h-y-e-pas-trichrome-silver-immunohistochemistry/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Biopsy: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003416.htm) (MedlinePlus, US National Library of Medicine, 2024); [How Cancer Is Diagnosed](https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis) (National Cancer Institute, 2023); [Pathology Reports](https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet) (National Cancer Institute, 2023).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/general-pathology/biopsy-excisional-incisional-core-needle-punch-and-fine-needle-aspiration/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/biopsy-excisional-incisional-core-needle-punch-and-fine-needle-aspiration/