1 / 48

Abdominal Biopsy Techniques

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.

cera
Download Presentation

Abdominal Biopsy Techniques

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Abdominal Biopsy Techniques KAKUI Shigeru DVM Miyazaki JAPAN

  2. Good Oncology Practice • Biopsy,Biopsy,Biopsy

  3. Accuracy of Biopsy(Low to High) • FNA • Needle Punch • Incisional biopsy • Excisional biopsy

  4. Patient Risk(Low to High) • FNA • Needle Punch • Incisional biopsy • Excisional biopsy

  5. Biopsy • Always the surgeons responsibility!

  6. Value of Biopsy • “If the histological diagnosis is incorrect,every subsequent step in the management of the patient may also be incorrect”

  7. Positive Attitude • “give the patient the benefit of doubt” • “do not doom the patient without knowing what you are treating”

  8. 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”

  9. Withrow • “if a mass warrants surgical removal, it warrant tissue analysis”

  10. Medical Oncologist • “there is no body cavity which cannot be reached by a strong arm and a 16 gauge needle”

  11. Multidisciplinaly Approach-Cancer • Oncologist • Nutritionist • Surgeon • Radiologist • Pathologist

  12. Abdominal Exploration Complete your exploration first unless: • Active hemorrhage • Gross contamination • Lesion obstructs vision

  13. Incisional vs. Excisional Biopsy Decision Making: • 1.Will full excision be potentially curative? • 2.Will excision of entire lesion improve patient’s condition

  14. Incisional vs. Excisional Biopsy Decision Making: • 3.Will excision cause significant problems? Hemorrhage, ischemia, increase operative time • 4.Is there hope for success with non surgical treatments?

  15. Excisional Biopsy-Advantages “If in doubt, cut it out” • 1.Less seeding tumor cells • 2.Diagnostic and therapeutic

  16. 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

  17. When to Biopsy Abnormal tissue Appearance • Supports reason for exploratory • Tumor staging; metastatic involvement

  18. When to Biopsy Normal tissue Appearance • Potential for involvement of “normal” appearing tissue • Diagnostics indicate disease in “normal” appearing tissue

  19. Where to Biopsy • Sample lesion including “normal” adjacent tissue • Sample various areas in diffuse conditions, Inflammatory or infected tissue

  20. Equipment and Materials • Bakers biopsy punch • Needle punch biopsy • Gelfoam • Suture material • General surgery pack

  21. Principles of Biopsy • Limit tumor seeding • Control contamination • Minimize manipulation • Provide representative sample • Do not limit Surgicul excision

  22. Biopsy Tips Hemorrhage Control • Digital pressure • Ligate local supplying vessesls • Gelfoam • Omental “tack”technique

  23. Biopsy Tips Minimize Sample Artifact • Stay suture manipulation • Use 4x4 sponges as “cutting board”

  24. Proper Biopsy Preparation • Cut into sections after excision • Specimens<1cm thick • 1:10 ratio formalin: tissue volume

  25. Liver Biopsy General indications • Liver size changes • Abnormal laboratory tests • Benign vs. Malignant processes • Assess liver disease • Evaluation treatment of liver disease

  26. Open Liver Biopsy • Excisional biopsy; primary hepatic neoplasms, singular metastatic nodules • Incisional biopsy; diffuse diseases, multiple nodules

  27. Liver Biopsy Contraindication; • Coagulation abnormalities • No bleeding tendencies;Screen activated clotting time,platelet count • Suspect bleeder; coagulation profile treat first.

  28. Baker’s Biopsy Punch Technique • Isolated liver lesion • Deeply located lesion

  29. Guillotine Method • Difuse liver disease • Isolated lesion at periphery

  30. Spleen Biopsy Indications; • Excisional biopsy Large splenic masses • Incisional biopsy Difuse disease Regenerative vs. malignant processes

  31. Spleen Biopsy • Bakers Punch Technique • Guillotine Technique • Mattress Suture Technique • TA stapler Technique

  32. Hollow Organ Biopsy Principles; • Gentle Tissue Handling • Full thickness samples • Protect against contamination • Protect “otomy” site?

  33. Intestinal Biopsy Indications Single Biopsy • Solitary, viable, and nonobstructive amendable to resection Multiple biopsies • Diffuse processes

  34. Intestinal Biopsy Technique • Proper preparation • 1-2cm length antimesenteric enterotomy • Prevent excess mucosal eversion • Do not remove >20% circumference

  35. Intestinal Closure • Remove everted muccosa • Appositional, noncrushing pattern • Transverse vs. longitudinal closure • Omentum or serosal patch coverage

  36. Pancreatic Biopsy Principles; • Gentle handling • Preserve blood supply • Avoid duct areas • No electrocoagulation

  37. Pancreatic Biopsy Indications Excisional Biopsy • Solitary nodules Incisional Biopsy • Diffuse involvement • Benign vs. malignant processes • Lesions near duct areas

  38. Pancreatic Biopsy Techniques • Shave biopsy technique • Guillotine or suture fracture Peripheral tissue lesions Diffuse lesions

  39. Pancreatic Biopsy Techniques • Wedge incision technique • Needle punch technique Parencymal lesions in body Nonresectable masses

  40. Lymph Node biopsy Indications; Lymphadenopathy • Benign vs. malignant proccesses • Clinical staging • Paraneoplastic proccess

  41. Lymph Node biopsy • Liac and mesentric nodes most biopsied • Excisional biopsies unless risk vascular compromise • Stay suture technique

  42. Kidney Biopsy Principles • Adequate patient prep. • Ensure normal coagulation function • Avoid hilar area

  43. Kidney Biopsy Indications • Acute vs. chronic disease • Glomerulonephropathies

  44. Kidney Biopsy Techniques • Needle Punch Biopsy Less hemorrhage, easier • Wedge Biopsy(Preferred) More consistent samples More hemorrhage

  45. Prostatic Biopsy Principles • Avoid central located urethral area • Contain contamination, tumor cells • Examine median iliac LN • Minimal peripheral dissection

  46. Incisional Prostatic Biopsy Indications • Benign vs. malignant disease • Obtain culture specimen,refractory prostatitis

  47. Prostatic Biopsy Techniques • Needle Punch Poorly exposed areas Difficult disease • Wedge incision Requires good exposure More hemorrhage

  48. Conclusions Full benefits of biopsy: • Surgeon’s ability to fully explore the abdomen and recognize abnormalities • Proper indications and technique

More Related