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Pathology & second opinions

Additional Tests — on Your Existing Biopsy Sample

If your oncologist or a second-opinion pathologist needs more information from your biopsy, they can usually request it from tissue already stored at the laboratory. A new procedure is often not needed.

Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026

  • No repeat biopsy needed in most cases — Additional tests are usually run on sections cut from the block already stored at the lab.
  • The doctor makes the request, not you — Laboratories act on written requests from doctors, who specify the correct test for your case.
  • Tissue availability is checked first — Before any sections are cut, the lab assesses whether enough tissue remains in the block.
  • This can save time and money — Avoiding a repeat procedure means less discomfort, lower cost, and no additional wait for a new sample.
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In most cases, yes — extra tests can be added to an existing biopsy without a repeat procedure. Your oncologist or a second-opinion pathologist requests them in writing to the laboratory that holds the block. Whether enough tissue remains is checked before any cutting begins.

Can extra tests be added to an existing biopsy without another procedure?

When your biopsy was taken, the tissue was processed and sealed in a small wax block called a paraffin block. This block is stored at the pathology laboratory, usually for several years.

New, thin sections can be cut from the same block and sent for additional testing. A new biopsy is not required unless the stored tissue has been used up or the original sample was very small.

Tests commonly added later include immunohistochemistry, which identifies proteins on cancer cells, and molecular or biomarker tests such as PD-L1, HER2, EGFR, KRAS, MSI, or TMB. Which ones apply depends on your cancer type, and your oncologist will specify them.

What do you need before requesting additional tests?

  • The name and full address of the laboratory holding your biopsy block
  • A copy of your biopsy report, which carries the accession number the laboratory uses to find your block
  • The name of the specific test your oncologist or second-opinion pathologist wants added
  • A formal written request on the doctor's letterhead — laboratories do not act on patient requests alone
  • Your written consent if the laboratory requires it before releasing or re-cutting tissue

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How requesting additional testing works, step by step

  1. Your doctor writes to the laboratory

    Your oncologist or the pathologist reviewing your case writes directly to the laboratory holding your paraffin block. The request names the specific test and your accession number.

  2. The laboratory checks how much tissue remains

    Before cutting any new sections, the laboratory assesses whether the block has enough tissue left. If it does not, they inform the requesting doctor, who advises whether a repeat biopsy is needed.

  3. New sections are cut and prepared

    If enough tissue is available, thin sections are cut from the block, placed on glass slides, and prepared for the test — either processed in that laboratory or forwarded to a specialist lab if the test is not performed locally.

  4. Results go back to the requesting doctor

    The report is sent to the doctor who made the request. They review it and discuss what it means for your treatment at your next appointment, or sooner if the result is urgent.

Did you know?

A single biopsy block can yield dozens of thin sections for different tests — far more than most diagnoses ever require.

This means tissue collected on the day of your biopsy can answer questions that were not asked at the time.

Source: College of American Pathologists; Royal College of Pathologists — tissue fixation and processing standards

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Common questions

Frequently asked questions

How do I know if there is enough tissue left in my biopsy block?

The laboratory checks this before cutting any new sections, so there is no way to know in advance. What determines it is how large the original biopsy sample was, how many sections have already been cut, and how well the block was stored. If the tissue is exhausted, the requesting doctor will tell you and advise whether a new biopsy is the right next step. Core needle biopsies typically yield more tissue than fine needle samples, so the chance of having enough is generally higher if that method was used.

Can I request the extra tests myself, or does it have to come from a doctor?

It has to come from a doctor. Pathology laboratories do not act on requests from patients directly, because the doctor needs to specify the correct test for your cancer type and interpret the result in the context of your full case. What you can do is go to your appointment knowing which tests you want to ask about, and ask your oncologist whether they are appropriate for your diagnosis. That conversation is worth having, and your oncologist should be able to explain the reasoning either way.

Can my biopsy block be sent to a different laboratory for a second opinion?

Yes. Paraffin blocks and the slides cut from them can be transferred between laboratories. The receiving institution — usually the one conducting the second opinion — makes a formal request to the holding laboratory. There is usually a consent process and sometimes a handling fee for the transfer. The original block is generally returned after the second opinion is complete. CION can coordinate this as part of a second-opinion review at any of its centres.

How long will additional testing take?

It depends on the test. Routine immunohistochemistry staining generally takes a few working days once the block is available and the request has been confirmed. Molecular tests such as next-generation sequencing take considerably longer and may need to be sent to a specialist laboratory. Your oncologist or the laboratory coordinator can give you a realistic expectation once the request is placed. Turnaround times vary by test and laboratory and cannot be stated in advance.

Will extra test results change my diagnosis or treatment plan?

They may. Additional testing is usually requested precisely because the existing results do not give enough information to make a confident treatment decision. A biomarker result can clarify which drug is most appropriate, establish whether targeted therapy is an option, or determine whether immunotherapy is likely to help. Your oncologist will explain what they hope to learn from the extra test and how the result will shape the next decision. The answer the test gives is not always what either of you expects.

Full index

Browse all 701 biopsy topics

Every page in this section, grouped by the part of the journey it belongs to. Pick a group to see what is in it.

What Is a Biopsy?

What Is a Biopsy? Everything You Need to Know →

Types of Biopsy Compared

Which Biopsy Will You Have? Techniques Compared →

Preparing for a Biopsy

What to Expect on the Day of Your Biopsy →

Recovery and Aftercare

After a Biopsy: Recovery, Aftercare and Warning Signs →

Biopsy by Body Part

Biopsy by Body Part: What to Expect at Each Site →

Understanding Your Report

How to Read a Biopsy Report: Terms Explained →

IHC and Molecular Markers

IHC and Molecular Markers on a Biopsy: What They Mean →

Grading and Scoring Systems

Cytology & Prostate Scoring Systems Explained →

How Accurate Is a Biopsy?

How Accurate Is a Biopsy? Errors and Second Opinions →

If Your Result Is Benign

Your Biopsy Is Benign: What It Means and What Comes Next →

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