abdominal biopsy techniques
DESCRIPTION
Abdominal Biopsy Techniques. KAKUI Shigeru DVM Miyazaki JAPAN. Good Oncology Practice. Biopsy,Biopsy,Biopsy. Accuracy of Biopsy (Low to High). FNA Needle Punch Incisional biopsy Excisional biopsy. Patient Risk (Low to High). FNA Needle Punch Incisional biopsy Excisional biopsy. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/1.jpg)
Abdominal Biopsy Techniques
KAKUI Shigeru DVMMiyazaki JAPAN
![Page 2: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/2.jpg)
Good Oncology Practice Biopsy,Biopsy,Biopsy
![Page 3: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/3.jpg)
Accuracy of Biopsy(Low to High) FNA Needle Punch Incisional biopsy Excisional biopsy
![Page 4: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/4.jpg)
Patient Risk(Low to High) FNA Needle Punch Incisional biopsy Excisional biopsy
![Page 5: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/5.jpg)
Biopsy Always the surgeons responsibility!
![Page 6: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/6.jpg)
Value of Biopsy “If the histological diagnosis is
incorrect,every subsequent step in the management of the patient may also be incorrect”
![Page 7: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/7.jpg)
Positive Attitude “give the patient the benefit of
doubt” “do not doom the patient without
knowing what you are treating”
![Page 8: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/8.jpg)
Common Excuses for not Performing Biopsy “the owner refuse to pay for it” “the result will not matter anyway” I know the owners will not elect
adjunctive therapy anyway” “no matter what it is, the animal will
eventually die from it anyway” “pathologists are always wrong”
![Page 9: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/9.jpg)
Withrow “if a mass warrants surgical
removal, it warrant tissue analysis”
![Page 10: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/10.jpg)
Medical Oncologist “there is no body cavity which
cannot be reached by a strong arm and a 16 gauge needle”
![Page 11: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/11.jpg)
Multidisciplinaly Approach-Cancer Oncologist Nutritionist Surgeon Radiologist Pathologist
![Page 12: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/12.jpg)
Abdominal Exploration
Complete your exploration first unless:
Active hemorrhage Gross contamination Lesion obstructs vision
![Page 13: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/13.jpg)
Incisional vs. Excisional Biopsy
Decision Making:
1.Will full excision be potentially curative?
2.Will excision of entire lesion improve patient’s condition
![Page 14: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/14.jpg)
Incisional vs. Excisional BiopsyDecision Making:
3.Will excision cause significant problems?
Hemorrhage, ischemia, increase operative time 4.Is there hope for success with non surgi
cal treatments?
![Page 15: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/15.jpg)
Excisional Biopsy-Advantages
“If in doubt, cut it out”
1.Less seeding tumor cells 2.Diagnostic and therapeutic
![Page 16: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/16.jpg)
Incisiosional Biopsy Conciderations
Need diagnosis before excision?
Type or extent of treatment altered Client consent for treatment altered Reconstruction difficult Likelihood for morbidity or mortality
![Page 17: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/17.jpg)
When to Biopsy
Abnormal tissue Appearance
Supports reason for exploratory Tumor staging; metastatic involvement
![Page 18: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/18.jpg)
When to Biopsy
Normal tissue Appearance
Potential for involvement of “normal” appearing tissue
Diagnostics indicate disease in “normal” appearing tissue
![Page 19: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/19.jpg)
Where to Biopsy Sample lesion including “normal”
adjacent tissue Sample various areas in diffuse
conditions, Inflammatory or infected tissue
![Page 20: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/20.jpg)
Equipment and Materials Bakers biopsy punch Needle punch biopsy Gelfoam Suture material General surgery pack
![Page 21: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/21.jpg)
Principles of Biopsy Limit tumor seeding Control contamination Minimize manipulation Provide representative sample Do not limit Surgicul excision
![Page 22: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/22.jpg)
Biopsy Tips
Hemorrhage Control
Digital pressure Ligate local supplying vessesls Gelfoam Omental “tack”technique
![Page 23: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/23.jpg)
Biopsy Tips
Minimize Sample Artifact
Stay suture manipulation Use 4x4 sponges as “cutting board”
![Page 24: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/24.jpg)
Proper Biopsy Preparation Cut into sections after excision Specimens<1cm thick 1:10 ratio formalin: tissue volume
![Page 25: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/25.jpg)
Liver Biopsy
General indications
Liver size changes Abnormal laboratory tests Benign vs. Malignant processes Assess liver disease Evaluation treatment of liver disease
![Page 26: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/26.jpg)
Open Liver Biopsy Excisional biopsy; primary hepatic neoplas
ms, singular metastatic nodules Incisional biopsy; diffuse diseases, multipl
e nodules
![Page 27: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/27.jpg)
Liver Biopsy
Contraindication;
Coagulation abnormalities
No bleeding tendencies;Screen activated clotting time,platelet count
Suspect bleeder; coagulation profile treat first.
![Page 28: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/28.jpg)
Baker’s Biopsy Punch Technique Isolated liver lesion Deeply located lesion
![Page 29: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/29.jpg)
Guillotine Method Difuse liver disease Isolated lesion at periphery
![Page 30: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/30.jpg)
Spleen Biopsy
Indications;
Excisional biopsy Large splenic masses
Incisional biopsy Difuse disease Regenerative vs. malignant processes
![Page 31: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/31.jpg)
Spleen Biopsy Bakers Punch Technique Guillotine Technique Mattress Suture Technique TA stapler Technique
![Page 32: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/32.jpg)
Hollow Organ Biopsy
Principles;
Gentle Tissue Handling Full thickness samples Protect against contamination Protect “otomy” site?
![Page 33: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/33.jpg)
Intestinal Biopsy Indications
Single Biopsy Solitary, viable, and nonobstructive amend
able to resection
Multiple biopsies Diffuse processes
![Page 34: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/34.jpg)
Intestinal Biopsy Technique Proper preparation 1-2cm length antimesenteric enterotomy Prevent excess mucosal eversion Do not remove >20% circumference
![Page 35: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/35.jpg)
Intestinal Closure Remove everted muccosa Appositional, noncrushing pattern Transverse vs. longitudinal closure Omentum or serosal patch coverage
![Page 36: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/36.jpg)
Pancreatic Biopsy
Principles;
Gentle handling Preserve blood supply Avoid duct areas No electrocoagulation
![Page 37: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/37.jpg)
Pancreatic Biopsy Indications
Excisional Biopsy Solitary nodules
Incisional Biopsy Diffuse involvement Benign vs. malignant processes Lesions near duct areas
![Page 38: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/38.jpg)
Pancreatic Biopsy Techniques Shave biopsy technique
Guillotine or suture fracture Peripheral tissue lesions Diffuse lesions
![Page 39: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/39.jpg)
Pancreatic Biopsy Techniques Wedge incision technique
Needle punch technique Parencymal lesions in body Nonresectable masses
![Page 40: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/40.jpg)
Lymph Node biopsy
Indications;
Lymphadenopathy Benign vs. malignant proccesses Clinical staging Paraneoplastic proccess
![Page 41: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/41.jpg)
Lymph Node biopsy Liac and mesentric nodes most biopsied Excisional biopsies unless risk vascular co
mpromise Stay suture technique
![Page 42: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/42.jpg)
Kidney Biopsy
Principles
Adequate patient prep. Ensure normal coagulation function Avoid hilar area
![Page 43: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/43.jpg)
Kidney Biopsy
Indications
Acute vs. chronic disease Glomerulonephropathies
![Page 44: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/44.jpg)
Kidney Biopsy
Techniques
Needle Punch Biopsy Less hemorrhage, easier
Wedge Biopsy(Preferred) More consistent samples More hemorrhage
![Page 45: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/45.jpg)
Prostatic Biopsy
Principles
Avoid central located urethral area Contain contamination, tumor cells Examine median iliac LN Minimal peripheral dissection
![Page 46: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/46.jpg)
Incisional Prostatic Biopsy
Indications
Benign vs. malignant disease Obtain culture specimen,refractory prostat
itis
![Page 47: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/47.jpg)
Prostatic BiopsyTechniques
Needle Punch Poorly exposed areas Difficult disease
Wedge incision Requires good exposure More hemorrhage
![Page 48: Abdominal Biopsy Techniques](https://reader035.vdocuments.site/reader035/viewer/2022062805/56814cd4550346895db9d833/html5/thumbnails/48.jpg)
Conclusions
Full benefits of biopsy:
Surgeon’s ability to fully explore the abdomen and recognize abnormalities
Proper indications and technique