The clinical picture (the 4 dimensions of the diagnosis before the biopsy) (HAVING A SURE DIAGNOSIS) may be so convincing that we are tempted to go ahead without taking a biopsy. In particular conditions, this may be the most suitable choice. Indeed, as we have seen, biopsy is not a trivial procedure; it causes pain and anxiety and costs time.
Skipping the biopsy when “the clinical picture speaks for itself” (i.e., when all the other clinical features are so clear as to leave little doubt as to the diagnosis of cancer) becomes even more logical if two other conditions are also present:
- the need to act immediately (i.e., to begin treatment, otherwise the patient may be lost);
- the new biological therapies have proved to have scant efficacy in that specific type of tumor. Indeed, before these new therapies can be prescribed, special tests have to be carried out on tumor samples, which can only be obtained by means of biopsy. In lung tumors for example, these special tests can enable treatment to be undertaken with biological drugs that are much more effective than chemotherapy (so skipping the biopsy would mean doing without this opportunity). For cancer of the pancreas, by contrast, no effective new drugs are yet available, so skipping the biopsy would not mean missing out on any such opportunity.
In short, in particular circumstances, the decision to begin therapy only on the basis of the patient’s symptoms, the physical examination and the results of laboratory and imaging tests, and without performing a biopsy, may be justified.