Download - Abdominal Biopsy Techniques
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Abdominal Biopsy Techniques
KAKUI Shigeru DVMMiyazaki JAPAN
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Good Oncology Practice Biopsy,Biopsy,Biopsy
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Accuracy of Biopsy(Low to High) FNA Needle Punch Incisional biopsy Excisional biopsy
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Patient Risk(Low to High) FNA Needle Punch Incisional biopsy Excisional biopsy
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Biopsy Always the surgeons responsibility!
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Value of Biopsy “If the histological diagnosis is
incorrect,every subsequent step in the management of the patient may also be incorrect”
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Positive Attitude “give the patient the benefit of
doubt” “do not doom the patient without
knowing what you are treating”
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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”
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Withrow “if a mass warrants surgical
removal, it warrant tissue analysis”
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Medical Oncologist “there is no body cavity which
cannot be reached by a strong arm and a 16 gauge needle”
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Multidisciplinaly Approach-Cancer Oncologist Nutritionist Surgeon Radiologist Pathologist
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Abdominal Exploration
Complete your exploration first unless:
Active hemorrhage Gross contamination Lesion obstructs vision
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Incisional vs. Excisional Biopsy
Decision Making:
1.Will full excision be potentially curative?
2.Will excision of entire lesion improve patient’s condition
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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?
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Excisional Biopsy-Advantages
“If in doubt, cut it out”
1.Less seeding tumor cells 2.Diagnostic and therapeutic
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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
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When to Biopsy
Abnormal tissue Appearance
Supports reason for exploratory Tumor staging; metastatic involvement
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When to Biopsy
Normal tissue Appearance
Potential for involvement of “normal” appearing tissue
Diagnostics indicate disease in “normal” appearing tissue
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Where to Biopsy Sample lesion including “normal”
adjacent tissue Sample various areas in diffuse
conditions, Inflammatory or infected tissue
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Equipment and Materials Bakers biopsy punch Needle punch biopsy Gelfoam Suture material General surgery pack
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Principles of Biopsy Limit tumor seeding Control contamination Minimize manipulation Provide representative sample Do not limit Surgicul excision
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Biopsy Tips
Hemorrhage Control
Digital pressure Ligate local supplying vessesls Gelfoam Omental “tack”technique
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Biopsy Tips
Minimize Sample Artifact
Stay suture manipulation Use 4x4 sponges as “cutting board”
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Proper Biopsy Preparation Cut into sections after excision Specimens<1cm thick 1:10 ratio formalin: tissue volume
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Liver Biopsy
General indications
Liver size changes Abnormal laboratory tests Benign vs. Malignant processes Assess liver disease Evaluation treatment of liver disease
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Open Liver Biopsy Excisional biopsy; primary hepatic neoplas
ms, singular metastatic nodules Incisional biopsy; diffuse diseases, multipl
e nodules
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Liver Biopsy
Contraindication;
Coagulation abnormalities
No bleeding tendencies;Screen activated clotting time,platelet count
Suspect bleeder; coagulation profile treat first.
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Baker’s Biopsy Punch Technique Isolated liver lesion Deeply located lesion
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Guillotine Method Difuse liver disease Isolated lesion at periphery
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Spleen Biopsy
Indications;
Excisional biopsy Large splenic masses
Incisional biopsy Difuse disease Regenerative vs. malignant processes
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Spleen Biopsy Bakers Punch Technique Guillotine Technique Mattress Suture Technique TA stapler Technique
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Hollow Organ Biopsy
Principles;
Gentle Tissue Handling Full thickness samples Protect against contamination Protect “otomy” site?
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Intestinal Biopsy Indications
Single Biopsy Solitary, viable, and nonobstructive amend
able to resection
Multiple biopsies Diffuse processes
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Intestinal Biopsy Technique Proper preparation 1-2cm length antimesenteric enterotomy Prevent excess mucosal eversion Do not remove >20% circumference
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Intestinal Closure Remove everted muccosa Appositional, noncrushing pattern Transverse vs. longitudinal closure Omentum or serosal patch coverage
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Pancreatic Biopsy
Principles;
Gentle handling Preserve blood supply Avoid duct areas No electrocoagulation
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Pancreatic Biopsy Indications
Excisional Biopsy Solitary nodules
Incisional Biopsy Diffuse involvement Benign vs. malignant processes Lesions near duct areas
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Pancreatic Biopsy Techniques Shave biopsy technique
Guillotine or suture fracture Peripheral tissue lesions Diffuse lesions
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Pancreatic Biopsy Techniques Wedge incision technique
Needle punch technique Parencymal lesions in body Nonresectable masses
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Lymph Node biopsy
Indications;
Lymphadenopathy Benign vs. malignant proccesses Clinical staging Paraneoplastic proccess
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Lymph Node biopsy Liac and mesentric nodes most biopsied Excisional biopsies unless risk vascular co
mpromise Stay suture technique
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Kidney Biopsy
Principles
Adequate patient prep. Ensure normal coagulation function Avoid hilar area
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Kidney Biopsy
Indications
Acute vs. chronic disease Glomerulonephropathies
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Kidney Biopsy
Techniques
Needle Punch Biopsy Less hemorrhage, easier
Wedge Biopsy(Preferred) More consistent samples More hemorrhage
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Prostatic Biopsy
Principles
Avoid central located urethral area Contain contamination, tumor cells Examine median iliac LN Minimal peripheral dissection
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Incisional Prostatic Biopsy
Indications
Benign vs. malignant disease Obtain culture specimen,refractory prostat
itis
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Prostatic BiopsyTechniques
Needle Punch Poorly exposed areas Difficult disease
Wedge incision Requires good exposure More hemorrhage
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Conclusions
Full benefits of biopsy:
Surgeon’s ability to fully explore the abdomen and recognize abnormalities
Proper indications and technique