Ultrasound guided neck lump biopsy

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1 Ultrasound guided neck lump biopsy Information for patients Diagnostic Imaging Department X-Ray and Scanning Specialist Support If you require this leaflet in another language, large print or another format, please contact the Health Information Centre Tel: (023) , who will advise you.

2 What is a neck biopsy? A biopsy is a way of taking a very small sample of tissue from the lump in your neck using a special needle. Ultrasound is used to guide the needle into the correct position. The pathologist will look at the specimen under the microscope and interpret the appearances to make a diagnosis. Ultrasound is an imaging technique that uses high frequency sound waves to map out your internal organs. It does not hurt and is safe. Why do I need it? The commonest reason for performing a biopsy is that the fine needle test already performed has not provided a diagnosis to decide on the best treatment. What if I cannot attend for my appointment? If your appointment is not convenient please contact the Radiology Day Case Unit on ext: 6821 (Mon-Fri, ) as soon as possible so that a more appropriate time can be arranged. This telephone number may also be used for queries about the test. Do I need to do anything to prepare for the procedure? It is important we know about existing bleeding problems and any medications you may be taking that thin the blood. Drugs include aspirin, clopidogrel, warfarin, heparin, rivaroxaban and low molecular weight heparins such as clexane and enoxaparin, but there are others. Depending on exactly where the biopsy is to be taken from and whether the bleeding problem is correctable, the procedure may need to be delayed while appropriate arrangements are made to make it as safe as possible.

3 You will not need to have any routine blood tests in advance, unless you are on warfarin or have a clotting or liver problem. We will organise any that might be needed. No other preparation is required. Can I bring a relative or friend? Yes, but they may prefer not to be with you while the biopsy is performed. Where should I come for the biopsy? Please come to: Radiology Day Case Unit, Level C, Queen Alexandra Hospital. On arrival in the department please report to Reception and you will be directed to the appropriate waiting area. How long will it take? Please allow to be in the department for up to 3 hours. Although the biopsy itself only takes minutes, talking to you beforehand and resting afterwards can add up to 2 hours, and occasionally longer. Who will I meet? The biopsy will be performed by a radiologist, a doctor specialising in diagnostic imaging. You will also be cared for by a radiographic department assistant and by the Radiology nursing staff after the procedure. Who will explain the procedure to me? Will I have an opportunity to ask questions? Before the procedure starts the radiologist will explain to you what is going to happen and will answer any questions you may have. He or she will also tell you about the risks of the procedure.

4 How is a biopsy performed? You will usually be asked to lie on your back on the ultrasound bed, if possible with a pillow under your shoulders and your head tilted back a little. Don t worry if you find this difficult - we will work round whatever position you are able to manage. To start with, the radiologist will carry out an ultrasound scan to check the appearances in the neck and decide which way to do the biopsy. When the biopsy site has been identified, the skin is cleaned and a large sterile paper towel placed over your chest and neck. The site for the biopsy will be made numb with a small injection of local anaesthetic. A tiny nick is made in the skin and the special biopsy needle inserted. The ultrasound machine is used again to make sure the needle is placed in the correct position. The needle makes a click as the sample is taken. The radiologist will demonstrate this beforehand. Usually 2, and sometimes 3, samples are taken. Will it hurt? The local anaesthetic injection into the skin may sting but quickly goes numb. As the biopsy needle is inserted it is common to feel a pushing sensation. If the procedure is uncomfortable then please let the doctor know as he/she may be able to use more local anaesthetic.

5 What happens after the procedure? After the procedure you will have a small dressing placed over the puncture in the skin and will be taken to the nursing area. You will be asked to stay and rest in an easy chair for about an hour to make sure you feel well and that there has been no bleeding. If you have been taking medications to thin the blood but have stopped them for the procedure then it is important you do not leave the hospital until you have received instructions as to how and when to restart your medication. What should I do when I am at home? You should take it easy for the rest of the day, and possibly for the next day, avoiding sports and other strenuous activities. The area from which the biopsy has been taken may feel bruised. If this is the case you can take mild over the counter painkiller tablets e.g. paracetamol which should ease the pain. However, you must not take aspirin for 24 hours following your procedure as it increases the chance of bleeding. Do not remove or make the dressing wet for the first 24 hours. If the dressing is soiled you may use an Elastoplast/Bandaid instead. Bleeding from the puncture site is rare, but if there is any please press on the wound site for minutes and it should stop. If you are at all worried about the biopsy site or feel generally unwell please contact your GP or nearest Emergency department. You must not travel by air for 48 hours after your biopsy.

6 When will I receive the results? The results will not be available on the day of the test as it usually takes 7-10 days for the specimen to be prepared for the pathologist. Your consultant will make arrangements to discuss the results with you. Are there any risks from having this procedure? Complications as a result of biopsy are rare. The procedure will be fully explained by the radiologist on the day, including any potential complications, and there will be a chance for questions. The main risk is bleeding which is why it is important you follow our guidance regarding medicines which thin your blood. A major complication as a result of bleeding is exceptionally rare. Unfortunately not all biopsies produce sufficient material to provide a diagnosis. If this is the case then there will be a discussion between you and your doctor about the next best step. Sometimes it is possible to repeat the procedure.

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8 Consent What does this mean? Before any doctor, nurse or therapist examines you they must have your consent or permission. Consent ranges from allowing a doctor to take your blood pressure, (rolling up your sleeve and presenting your arm is implied consent), to signing a form to say you agree to the treatment or operation. It is important before giving permission that you understand what you are agreeing to. If you do not understand please ask. More detailed information is available on request. Information we hold about you and your rights under the Data Protection Act Please refer to the booklet Your Healthcare Information Your Rights! Our Responsibilities! for further guidance. How to comment on your treatment We aim to provide the best possible service and staff will be happy to answer your questions. However, if you have any concerns you can also contact the Patient Experience Service on or PALS@porthosp.nhs.uk Queen Alexandra Hospital is a teaching hospital and your images (x ray and scan pictures) may be used anonymously for teaching and research purposes. If you do not wish for this to happen please inform the radiographer performing your examination. Author: Diagnostic Imaging Produced: July 2012 Review: July 2015 Ref: Diag/ Medical Illustration ref: 12/3851 Portsmouth Hospitals NHS Trust