Image-Guided Biopsies

A biopsy is a procedure that takes tissue samples in order to but not limited to finding out the nature of a tumor or the type and severity of kidney or liver disease.

When a doctor needs to see the best and safest spot from which to take the tissue, an image-guided biopsy is used. The biopsy is done while your child is having a CT scan, an ultrasound, or an X-ray to see inside the body, depending on where the tumor is located. Using the images or pictures as a guide, the doctor will place a thin needle into the body at the spot where the biopsy is needed. The needle will take out a tiny piece of tissue that can be tested in the lab.

Because images are needed to guide the placement of the needle during a biopsy, this procedure is usually done in one of two areas:

• in the Interventional Radiology (IR) suite using ultrasound (sound waves) or fluoroscopy (X-rays); or
• in a CT room using a CT scanner.

You may want to bring along a “comfort” item — such as a favorite stuffed animal or “blankie” — for your child to hold during the procedure.

If your child is having sedation or anesthesia, there are important rules for eating and drinking that must be followed in the hours before the procedure.

• Your child may not have solid foods or milk products up to 8 hours before the scheduled procedure.
• Formula-fed babies may be given formula up to 6 hours before the scheduled procedure.
• Breastfed babies may nurse up to 4 hours before the scheduled procedure.
• Your child may have clear liquids (water, Pedialyte® and apple juice) up to 2 hours before the scheduled procedure. Your child cannot drink anything carbonated.

The image-guided biopsy is done by the Interventional Radiology staff in the Department of Pediatric Radiology at UPMC Children’s Hospital. Interventional Radiology performs minimally-invasive procedures with image guidance.

The procedure will be done in either the Interventional Radiology suite or a CT scan room. In the room will be a pediatric interventional radiology doctor, who will do the image-guided biopsy, as well as pediatric radiology technologists and nurses who will help the doctor. Other medical and imaging staff also may be present to help during the procedure. The doctor and other staff will be wearing hats (like shower caps), masks, gloves and lead aprons during the procedure. The lights will be dim inside the room.

If the biopsy is done in the Interventional Radiology suite, inside the room you will see an X-ray machine, an ultrasound machine, a long table and television screens. You might explain to your child that the X-ray machine is a large camera for taking pictures that will be seen on the TV screens.

If the biopsy is done in a CT scan room, inside the room you will see the CT machine with a long table that will slide into the tube-shaped or tunnel-like scanner where the camera is located.  If your child has any questions, the staff will be happy to answer them before the procedure.

• You may accompany your child to the Interventional Radiology suite or CT room and give support and comfort until the procedure begins or until sedation medication is given.
• Your child will be asked to lie down on the table and a “seat belt” will be placed around your child to help him or her keep still during the procedure.
• Once the procedure begins, you will be shown to the main waiting area. You may either stay there or ask the desk staff for a pager in case you would like to get something to eat or drink in the cafeteria, Pop Stop or gift shop.
• The area of your child’s body on which the biopsy is to be done will be examined either using CT, X-ray, or ultrasound images at this time. These images will determine the exact location on your child’s body where the biopsy will be done.
• A special soap will be used to clean the area on your child’s body where the biopsy will be done.
• Your child’s body will be covered with a sterile sheet everywhere but the spot where the biopsy will be done. The sheet will keep that area of your child’s body clean and germ-free.
• Your child will be given medication through a needle to numb the area around the spot where the biopsy will be done.
• The doctor will pass a special type of needle through the skin in the chosen area.
• When the doctor removes the needle, it will contain a small piece of tissue, called a sample.
• A pathologist (a doctor who studies samples in the lab) may come to examine the tissue to make sure an adequate sample has been taken. The pathologist will then take the biopsy tissue sample to the lab to be tested.
• Once the procedure is finished, the doctor may place a bandage over the area on your child’s body where the biopsy was done.
• Your child may need to have a period of recovery if sedation or anesthesia is used.

As a parent, you may have concerns about radiation exposure. Children’s Hospital takes every precaution to make sure your child is safe. Our goal is to do the procedure correctly and thoroughly, while exposing your child to the smallest amount of radiation necessary to take the X-rays.

• Advances in equipment and film have lowered the amount of radiation your child will receive.
• All of the equipment is inspected regularly.
• Parts of the body that are not being X-rayed will be protected with a lead cover or apron when possible.

• If sedation or anesthesia medication is used, it is likely that your child will not feel pain during the procedure or remember it afterward.
• A supervising pediatric interventional radiology doctor is always present during the procedure.
• If your child needs general anesthesia for the biopsy procedure, you will receive information on general anesthesia.

We welcome your help and support before and after the biopsy. The most important role of a parent and guardian is to help your child stay calm and relaxed before the procedure.

• The best way to help your child stay calm is for you to stay calm.
• We encourage you to talk to your child and hold his or her hand before the procedure.
• We welcome your questions, but please ask them either before or after the procedure.

When your child returns to his or her room, your child may need to lie on either his or her right side or back for 2 to 4 hours, depending on the type of biopsy and where on the body it was done. The pediatric interventional radiology doctor will give you specific instructions. Your child is asked to remain in bed for this period of time in order to reduce the chances of bleeding or other complications after the biopsy.

A report of your child’s biopsy results will be sent to the doctor who prescribed it. Your doctor will relay these results to you. Results usually are not available on the same day the biopsy was done.

If your child has any special needs or health issues you feel the doctor needs to know about, please call the Department of Pediatric Radiology at Children’s and ask to speak with a nurse before your child’s biopsy is done. It is important to notify us in advance about any special needs.

Before you come to the hospital, explain to your child what will happen in words that he or she can understand. Preparing your child beforehand, as well as comforting your child during the test, will help your child have a more positive experience. Sometimes it is difficult to know how to explain tests to children. If you have any questions about ways to prepare or support your child, please contact the c­­­­­­hild life specialist at the phone number listed below.