Types of Biopsies: A Guide to the Different Procedures

Illustration representing different types of biopsy procedures used in medical diagnosis

Author: Shazia Abou Talib•Reading Time: 5-6 Minutes

When a doctor recommends a biopsy, you may be surprised to learn that there is no single procedure called “the biopsy.” There are several types of biopsies, the different diagnostic biopsy methods doctors use, and the one chosen depends on where the abnormal tissue is located, how much tissue is needed, and what information the healthcare team is trying to obtain.

Some biopsies collect cells or fluid. Others remove a small piece of tissue or, in certain circumstances, an entire abnormal area. Together, these make up the main cancer biopsy types used in diagnosis today, performed using a needle, an endoscope, or a surgical procedure.

Understanding the different types of biopsies can make medical conversations easier to follow and help you understand why a particular approach may be recommended.

If you are new to this topic, it may help to start with our guide on What Is a Biopsy? Understanding Why Your Doctor May Recommend One, which covers what a biopsy is, why it’s recommended, and what your results mean before diving into the different procedures below.

Why Are There Different Types of Biopsies?

Different tissues and organs require different approaches. A lump close to the skin, for example, may be accessible with a needle, while an abnormality inside the colon may need to be reached using an endoscope. A suspicious skin lesion may require removal of part or all of the affected area.

The choice of biopsy may depend on:

The location of the abnormality
Its size and depth
How easily it can be reached
The amount and type of tissue required
Whether imaging guidance is needed
The suspected condition
The individual’s overall health and medical circumstances

The aim is to obtain an appropriate sample that can provide reliable diagnostic information while considering the safety of the procedure.

1. Fine-Needle Aspiration (FNA)

Fine-needle aspiration, or FNA, is a needle biopsy procedure that uses a very thin, hollow needle attached to a syringe to collect cells and sometimes fluid from an abnormal area.

It may be used to investigate areas such as:

Thyroid nodules
Enlarged lymph nodes
Breast lumps
Other accessible masses

If the abnormality is deeper inside the body or cannot easily be felt, imaging such as ultrasound or CT may be used to guide the needle to the correct location.

What Makes FNA Different?

FNA collects a relatively small amount of material. This can be enough to answer certain diagnostic questions, but sometimes the sample does not provide enough tissue for all the laboratory tests that may be required.

In those situations, another type of biopsy, such as a core needle biopsy, may be recommended.

2. Core Needle Biopsy

A core needle biopsy also uses a hollow needle, but the needle is larger than the one used for FNA. Instead of collecting mainly individual cells or fluid, it removes small cylinders, sometimes called “cores,” of tissue giving the pathologist more tissue to examine.

Core needle biopsies may be used for abnormalities involving areas such as the:

Breast
Liver
Kidney
Prostate
Lymph nodes
Other soft tissues

Depending on the location, ultrasound, CT, mammography, or MRI may be used to guide the needle.

FNA vs Core Needle Biopsy

The following biopsy comparison highlights the main differences between the two approaches:

Fine-Needle Aspiration	Core Needle Biopsy
Uses a very thin needle	Uses a larger hollow needle
Collects cells and/or fluid	Collects small cores of tissue
Provides a smaller sample	Provides more tissue for examination
Useful in selected lumps, nodules and lymph nodes	Often selected when tissue architecture or additional testing is needed

Neither method is automatically “better.” The appropriate choice depends on the tissue being examined and the information required.

3. Surgical Biopsy

Sometimes a larger sample is needed or the abnormal area is better approached surgically. A surgical biopsy, sometimes called an open biopsy, removes part or all of an abnormal area for examination. There are two principal forms.

Incisional Biopsy

An incisional biopsy removes only a portion of an abnormal area. It may be considered when a lesion is large or when removing the entire area solely for diagnosis would not be appropriate.

Excisional Biopsy

An excisional biopsy removes the entire lump or suspicious area. Whether an incisional or excisional approach is appropriate depends on factors such as the location and size of the abnormality, the suspected condition, and the purpose of the procedure.

4. Endoscopic Biopsy

Some areas inside the body can be reached using an endoscope, a thin tube equipped with a light and camera. During an endoscopic biopsy, the doctor views the area and passes small instruments through the endoscope to collect tissue.

Gastroscopy

A gastroscopy allows examination of the oesophagus, stomach, and beginning of the small intestine. Tissue can be sampled from areas that require further investigation.

Colonoscopy

A colonoscopy examines the colon and rectum. Tissue samples may be taken from abnormal areas, and polyps may also be removed for examination.

Bronchoscopy

A bronchoscopy allows doctors to examine the airways and collect samples from suspicious areas within the respiratory system.

5. Skin Biopsy

A skin biopsy removes cells or tissue from an area of skin so it can be examined in a laboratory. Several techniques are available, and the method selected depends on the type, depth, size and location of the skin abnormality.

Shave Biopsy

A shave biopsy removes tissue from the upper layers of the skin using a blade or similar instrument.

Punch Biopsy

A punch biopsy uses a circular cutting instrument to remove a small section that includes deeper layers of skin.

Incisional and Excisional Skin Biopsy

An incisional skin biopsy removes only part of the abnormal area for examination, while an excisional skin biopsy removes the entire suspicious area, sometimes together with a border of surrounding skin depending on the clinical situation.

Skin biopsies can be used to investigate both cancerous and non-cancerous skin conditions.

6. Bone Marrow Aspiration and Biopsy

Bone marrow is the soft, spongy tissue inside certain bones where blood cells are produced. A bone marrow examination often involves two related procedures performed together: bone marrow aspiration, which collects a sample of the liquid portion, and bone marrow biopsy, which removes a small sample of bone and marrow tissue.

Samples are usually taken from the back of the pelvic or hip bone. These procedures can help doctors investigate conditions affecting the blood and bone marrow, including:

Leukaemia
Lymphoma
Multiple myeloma
Some forms of anaemia
Other disorders involving blood-cell production

A bone marrow biopsy may also be used to determine whether a cancer that started elsewhere in the body has reached the bone marrow.

7. Vacuum-Assisted Biopsy

A vacuum-assisted biopsy is a type of needle biopsy that uses a suction device to help collect tissue through a hollow needle. The technique can allow multiple or larger samples to be collected from the same biopsy site and is used in selected situations, including some breast biopsies.

How Imaging Can Guide a Biopsy

Sometimes an abnormal area is too small, too deep inside the body, or cannot be felt during a physical examination. In these situations, doctors may use imaging technology to guide a biopsy needle precisely to the area that needs to be sampled, commonly referred to as an image-guided biopsy.

Depending on the location of the abnormality, imaging guidance may include:

Ultrasound
CT (computed tomography)
MRI (magnetic resonance imaging)
Mammography or stereotactic imaging for certain breast abnormalities

Imaging guidance can be combined with needle biopsy techniques such as fine-needle aspiration (FNA) or core needle biopsy. The imaging itself does not remove the tissue, it helps the healthcare professional locate the target and guide the biopsy needle to the appropriate area.

8. What About Liquid Biopsy?

You may also hear the term liquid biopsy, particularly in discussions about newer approaches to cancer testing. Unlike a traditional tissue biopsy, a liquid biopsy examines blood or another body fluid for cancer-related material, which may include circulating tumor cells, circulating tumor DNA (ctDNA), cell-free DNA (cfDNA), or certain proteins.

Liquid biopsies may provide useful information in selected cancers and clinical situations. However, liquid biopsy and traditional tissue biopsy serve different purposes, and it cannot be used in every cancer or clinical situation.

How Do Doctors Choose the Right Type of Biopsy?

Location

An abnormality close to the skin may be accessible with a needle, while tissue inside an organ may require imaging guidance or endoscopy.

Size and Depth

The size and position of an abnormality influence whether cells, a small tissue core, part of the lesion, or the entire area should be sampled.

Amount of Tissue Needed

Some investigations require only a small cellular sample. Others require enough tissue to assess its architecture or perform additional laboratory testing.

Accessibility and the Clinical Question

Doctors consider which method can safely reach the area while obtaining an adequate sample, and select the procedure according to what the healthcare team needs to determine.

Biopsy Types at a Glance

Type	Sample Nature	Examples of Where It May Be Used
Fine-Needle Aspiration	Cells and/or fluid	Thyroid, lymph nodes, breast lumps
Core Needle Biopsy	Small cores of tissue	Breast and other organs or tissues
Incisional Biopsy	Part of an abnormal area	Larger or selected lesions
Excisional Biopsy	Entire abnormal area	Selected accessible lumps or lesions
Endoscopic Biopsy	Tissue reached through an endoscope	Digestive tract, lungs and other internal areas
Skin Biopsy	Skin cells/tissue	Moles, lesions and other skin abnormalities
Bone Marrow Biopsy	Bone and marrow tissue	Blood and bone-marrow disorders
Vacuum-Assisted Biopsy	Multiple or larger samples through a needle	Selected abnormalities, including some breast lesions
Imaging-Guided Needle Biopsy	Cells or tissue, depending on needle technique	Small, deep or difficult-to-locate abnormalities
Liquid Biopsy	Cancer-related material in blood or other body fluid	Selected cancer testing

Key Takeaways

There are many types of biopsies, and each serves a different diagnostic purpose.
Fine-needle aspiration collects cells or fluid, while core needle biopsy collects small pieces of tissue.
Incisional biopsy removes part of an abnormal area; excisional biopsy removes the entire area.
Endoscopic biopsies allow doctors to obtain tissue from certain areas inside the body.
Skin and bone marrow biopsies use techniques designed for those particular tissues.
Imaging can help guide a needle biopsy when an abnormality is small, deep or difficult to locate.
Vacuum-assisted biopsy allows multiple or larger samples to be collected through a needle in selected situations.
Liquid biopsy is different from conventional tissue biopsy and has specific uses in cancer care.
The appropriate biopsy depends on the individual clinical situation.

Frequently Asked Questions

1. Which type of biopsy is the least invasive?

FNA is among the less invasive tissue-sampling techniques because it uses a very thin needle. However, the least invasive option is not necessarily the most appropriate one, the goal is to obtain the sample needed to answer the clinical question.

2. Is a core biopsy better than an FNA?

Not universally. A core biopsy provides more tissue, while FNA may be sufficient in some situations. Your healthcare team chooses the technique according to the tissue being examined and the information required.

3. Is an excisional biopsy the same as surgery?

An excisional biopsy is a surgical procedure in which the entire abnormal area is removed. The extent of the procedure depends on the location and size of the tissue being removed.

4. Are all biopsies performed with needles?

No. Biopsies can be performed using needles, surgical techniques, endoscopes or specialised instruments depending on the part of the body being examined.

5. Is a liquid biopsy the same as a tissue biopsy?

No. A liquid biopsy examines blood or another body fluid for cancer-related material, while a traditional tissue biopsy removes cells or tissue from an area of the body for examination.

6. Are biopsies only used when cancer is suspected?

No. Biopsies can also help diagnose non-cancerous diseases and conditions. The reason for performing a biopsy depends on the individual medical situation.

References

National Cancer Institute (NCI). Biopsy. NCI Dictionary of Cancer Terms. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/biopsy
American Cancer Society. How Is a Biopsy Done? Last Revised: March 24, 2026. Retrieved from https://www.cancer.org/cancer/diagnosis-staging/tests/biopsy-and-cytology-tests/biopsy-types.html
Mayo Clinic. Biopsy: Types of Biopsy Procedures Used to Diagnose Cancer. Updated December 24, 2025. Retrieved from https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/biopsy/art-20043922
National Cancer Institute (NCI). Bone Marrow Aspiration and Biopsy. NCI Dictionary of Cancer Terms. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/bone-marrow-aspiration-and-biopsy
American Cancer Society. Bone Marrow Biopsy and Aspiration. Accessed August 2026. Retrieved from https://www.cancer.org/cancer/diagnosis-staging/tests/biopsy-and-cytology-tests/bone-marrow-biopsy-and-aspiration.html
NHS. Biopsy. National Health Service. Retrieved from https://www.nhs.uk/tests-and-treatments/biopsy/