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.
- Histological morphology and immunohistochemistry establish lineage; molecular tests refine classification, prognosis or treatment selection rather than replacing tissue context.
- Plan fixation, transport and allocation before the procedure because decalcification, scant cells or exhausted blocks can prevent essential biomarkers.
- A negative biopsy can mean no cancer, sampling error, necrosis or an unsuitable assay; radiology-pathology discordance requires review.
- Do not request broad molecular panels without a defined decision, validated platform and plan for uncertain or possible germline findings.
- Communicate the final integrated diagnosis, uncertainty, specimen adequacy and pending addenda to the treating multidisciplinary team.
Investigation priorities
Obtain architecture and material for immunohistochemistry and molecular testing.
Management branches
Imaging suggests malignancy and tissue confirmation will change care.
- Review differential, staging imaging, accessible lesions, coagulation, medicines and tumour-specific hazards with the responsible team.
- Select the least harmful route that provides enough tissue for morphology and mandatory biomarkers without compromising definitive surgery.
- Pre-alert pathology about suspected diagnosis, fresh-tissue or molecular requirements, infection risk and specimen transport.