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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
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Biopsy, histology and molecular testing

Essential points for quick revision.

Synopsis

Select and sequence safe cancer tissue acquisition, preserve material for morphology and biomarkers, interpret an integrated pathology report, and manage inadequate or discordant results through multidisciplinary review.

  • Obtain tissue only when the result will change diagnosis or management and the route does not compromise later surgery, staging or safety.
  • The preferred biopsy is lesion- and pathway-specific: cytology, core biopsy, endoscopic sampling, marrow sampling or excision answer different questions.
  • Exclude procedure-specific hazards such as phaeochromocytoma, coagulopathy, vascular lesion and unsafe anatomical access before sampling.

Investigation priorities

01
Image-guided core biopsyFirst step

Obtain architecture and material for immunohistochemistry and molecular testing.

Management branches

PlanChoose the specimen and route

Imaging suggests malignancy and tissue confirmation will change care.

  1. Review differential, staging imaging, accessible lesions, coagulation, medicines and tumour-specific hazards with the responsible team.
  2. Select the least harmful route that provides enough tissue for morphology and mandatory biomarkers without compromising definitive surgery.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom