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Abdominal Biopsy Techniques KAKUI Shigeru DVM Miyazaki JAPAN

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  • Abdominal Biopsy TechniquesKAKUI Shigeru DVMMiyazaki JAPAN

  • Good Oncology PracticeBiopsy,Biopsy,Biopsy

  • Accuracy of Biopsy(Low to High)FNANeedle PunchIncisional biopsyExcisional biopsy

  • Patient Risk(Low to High)FNANeedle PunchIncisional biopsyExcisional biopsy

  • BiopsyAlways the surgeons responsibility!

  • Value of BiopsyIf the histological diagnosis is incorrect,every subsequent step in the management of the patient may also be incorrect

  • Positive Attitudegive the patient the benefit of doubtdo not doom the patient without knowing what you are treating

  • Common Excuses for not Performing Biopsythe owner refuse to pay for itthe result will not matter anywayI know the owners will not elect adjunctive therapy anywayno matter what it is, the animal will eventually die from it anywaypathologists are always wrong

  • Withrowif a mass warrants surgical removal, it warrant tissue analysis

  • Medical Oncologistthere is no body cavity which cannot be reached by a strong arm and a 16 gauge needle

  • Multidisciplinaly Approach-CancerOncologistNutritionistSurgeonRadiologistPathologist

  • Abdominal ExplorationComplete your exploration first unless:

    Active hemorrhageGross contaminationLesion obstructs vision

  • Incisional vs. Excisional BiopsyDecision Making:

    1.Will full excision be potentially curative?2.Will excision of entire lesion improve patients condition

  • Incisional vs. Excisional BiopsyDecision Making:

    3.Will excision cause significant problems? Hemorrhage, ischemia, increase operative time4.Is there hope for success with non surgical treatments?

  • Excisional Biopsy-AdvantagesIf in doubt, cut it out

    1.Less seeding tumor cells2.Diagnostic and therapeutic

  • Incisiosional Biopsy ConciderationsNeed diagnosis before excision?

    Type or extent of treatment alteredClient consent for treatment alteredReconstruction difficult Likelihood for morbidity or mortality

  • When to BiopsyAbnormal tissue Appearance

    Supports reason for exploratoryTumor staging; metastatic involvement

  • When to BiopsyNormal tissue Appearance

    Potential for involvement of normal appearing tissueDiagnostics indicate disease in normal appearing tissue

  • Where to BiopsySample lesion including normal adjacent tissue Sample various areas in diffuse conditions, Inflammatory or infected tissue

  • Equipment and MaterialsBakers biopsy punchNeedle punch biopsyGelfoamSuture materialGeneral surgery pack

  • Principles of BiopsyLimit tumor seedingControl contaminationMinimize manipulationProvide representative sampleDo not limit Surgicul excision

  • Biopsy TipsHemorrhage Control

    Digital pressureLigate local supplying vesseslsGelfoamOmental tacktechnique

  • Biopsy TipsMinimize Sample Artifact

    Stay suture manipulationUse 4x4 sponges as cutting board

  • Proper Biopsy PreparationCut into sections after excisionSpecimens
  • Liver BiopsyGeneral indications

    Liver size changesAbnormal laboratory testsBenign vs. Malignant processes Assess liver diseaseEvaluation treatment of liver disease

  • Open Liver BiopsyExcisional biopsy; primary hepatic neoplasms, singular metastatic nodulesIncisional biopsy; diffuse diseases, multiple nodules

  • Liver BiopsyContraindication;

    Coagulation abnormalities

    No bleeding tendencies;Screen activated clotting time,platelet count Suspect bleeder; coagulation profile treat first.

  • Bakers Biopsy Punch TechniqueIsolated liver lesionDeeply located lesion

  • Guillotine MethodDifuse liver diseaseIsolated lesion at periphery

  • Spleen BiopsyIndications;

    Excisional biopsy Large splenic masses

    Incisional biopsy Difuse disease Regenerative vs. malignant processes

  • Spleen BiopsyBakers Punch TechniqueGuillotine TechniqueMattress Suture TechniqueTA stapler Technique

  • Hollow Organ BiopsyPrinciples;

    Gentle Tissue HandlingFull thickness samplesProtect against contaminationProtect otomy site?

  • Intestinal Biopsy IndicationsSingle BiopsySolitary, viable, and nonobstructive amendable to resection

    Multiple biopsiesDiffuse processes

  • Intestinal Biopsy TechniqueProper preparation1-2cm length antimesenteric enterotomyPrevent excess mucosal eversionDo not remove >20% circumference

  • Intestinal ClosureRemove everted muccosaAppositional, noncrushing patternTransverse vs. longitudinal closureOmentum or serosal patch coverage

  • Pancreatic BiopsyPrinciples;

    Gentle handlingPreserve blood supplyAvoid duct areasNo electrocoagulation

  • Pancreatic Biopsy IndicationsExcisional BiopsySolitary nodules

    Incisional BiopsyDiffuse involvement Benign vs. malignant processesLesions near duct areas

  • Pancreatic Biopsy TechniquesShave biopsy technique

    Guillotine or suture fracture Peripheral tissue lesions Diffuse lesions

  • Pancreatic Biopsy TechniquesWedge incision technique

    Needle punch technique Parencymal lesions in body Nonresectable masses

  • Lymph Node biopsy Indications;

    LymphadenopathyBenign vs. malignant proccessesClinical stagingParaneoplastic proccess

  • Lymph Node biopsyLiac and mesentric nodes most biopsiedExcisional biopsies unless risk vascular compromiseStay suture technique

  • Kidney BiopsyPrinciples

    Adequate patient prep.Ensure normal coagulation functionAvoid hilar area

  • Kidney BiopsyIndications

    Acute vs. chronic diseaseGlomerulonephropathies

  • Kidney BiopsyTechniques

    Needle Punch Biopsy Less hemorrhage, easier

    Wedge Biopsy(Preferred) More consistent samples More hemorrhage

  • Prostatic BiopsyPrinciples

    Avoid central located urethral areaContain contamination, tumor cellsExamine median iliac LNMinimal peripheral dissection

  • Incisional Prostatic BiopsyIndications

    Benign vs. malignant diseaseObtain culture specimen,refractory prostatitis

  • Prostatic BiopsyTechniques

    Needle Punch Poorly exposed areas Difficult disease

    Wedge incision Requires good exposure More hemorrhage

  • ConclusionsFull benefits of biopsy:

    Surgeons ability to fully explore the abdomen and recognize abnormalitiesProper indications and technique

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