Transcript
Page 1: Abdominal Biopsy Techniques

Abdominal Biopsy Techniques

KAKUI Shigeru DVMMiyazaki JAPAN

Page 2: Abdominal Biopsy Techniques

Good Oncology Practice Biopsy,Biopsy,Biopsy

Page 3: Abdominal Biopsy Techniques

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

Page 4: Abdominal Biopsy Techniques

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

Page 5: Abdominal Biopsy Techniques

Biopsy Always the surgeons responsibility!

Page 6: Abdominal Biopsy Techniques

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

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

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

Withrow “if a mass warrants surgical

removal, it warrant tissue analysis”

Page 10: Abdominal Biopsy Techniques

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

Multidisciplinaly Approach-Cancer Oncologist Nutritionist Surgeon Radiologist Pathologist

Page 12: Abdominal Biopsy Techniques

Abdominal Exploration

Complete your exploration first unless:

Active hemorrhage Gross contamination Lesion obstructs vision

Page 13: Abdominal Biopsy Techniques

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

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

Excisional Biopsy-Advantages

“If in doubt, cut it out”

1.Less seeding tumor cells 2.Diagnostic and therapeutic

Page 16: Abdominal Biopsy Techniques

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

When to Biopsy

Abnormal tissue Appearance

Supports reason for exploratory Tumor staging; metastatic involvement

Page 18: Abdominal Biopsy Techniques

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

Where to Biopsy Sample lesion including “normal”

adjacent tissue Sample various areas in diffuse

conditions, Inflammatory or infected tissue

Page 20: Abdominal Biopsy Techniques

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

Page 21: Abdominal Biopsy Techniques

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

Page 22: Abdominal Biopsy Techniques

Biopsy Tips

Hemorrhage Control

Digital pressure Ligate local supplying vessesls Gelfoam Omental “tack”technique

Page 23: Abdominal Biopsy Techniques

Biopsy Tips

Minimize Sample Artifact

Stay suture manipulation Use 4x4 sponges as “cutting board”

Page 24: Abdominal Biopsy Techniques

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

Page 25: Abdominal Biopsy Techniques

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

Open Liver Biopsy Excisional biopsy; primary hepatic neoplas

ms, singular metastatic nodules Incisional biopsy; diffuse diseases, multipl

e nodules

Page 27: Abdominal Biopsy Techniques

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

Baker’s Biopsy Punch Technique Isolated liver lesion Deeply located lesion

Page 29: Abdominal Biopsy Techniques

Guillotine Method Difuse liver disease Isolated lesion at periphery

Page 30: Abdominal Biopsy Techniques

Spleen Biopsy

Indications;

Excisional biopsy Large splenic masses

Incisional biopsy Difuse disease Regenerative vs. malignant processes

Page 31: Abdominal Biopsy Techniques

Spleen Biopsy Bakers Punch Technique Guillotine Technique Mattress Suture Technique TA stapler Technique

Page 32: Abdominal Biopsy Techniques

Hollow Organ Biopsy

Principles;

Gentle Tissue Handling Full thickness samples Protect against contamination Protect “otomy” site?

Page 33: Abdominal Biopsy Techniques

Intestinal Biopsy Indications

Single Biopsy Solitary, viable, and nonobstructive amend

able to resection

Multiple biopsies Diffuse processes

Page 34: Abdominal Biopsy Techniques

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

Page 35: Abdominal Biopsy Techniques

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

Page 36: Abdominal Biopsy Techniques

Pancreatic Biopsy

Principles;

Gentle handling Preserve blood supply Avoid duct areas No electrocoagulation

Page 37: Abdominal Biopsy Techniques

Pancreatic Biopsy Indications

Excisional Biopsy Solitary nodules

Incisional Biopsy Diffuse involvement Benign vs. malignant processes Lesions near duct areas

Page 38: Abdominal Biopsy Techniques

Pancreatic Biopsy Techniques Shave biopsy technique

Guillotine or suture fracture Peripheral tissue lesions Diffuse lesions

Page 39: Abdominal Biopsy Techniques

Pancreatic Biopsy Techniques Wedge incision technique

Needle punch technique Parencymal lesions in body Nonresectable masses

Page 40: Abdominal Biopsy Techniques

Lymph Node biopsy

Indications;

Lymphadenopathy Benign vs. malignant proccesses Clinical staging Paraneoplastic proccess

Page 41: Abdominal Biopsy Techniques

Lymph Node biopsy Liac and mesentric nodes most biopsied Excisional biopsies unless risk vascular co

mpromise Stay suture technique

Page 42: Abdominal Biopsy Techniques

Kidney Biopsy

Principles

Adequate patient prep. Ensure normal coagulation function Avoid hilar area

Page 43: Abdominal Biopsy Techniques

Kidney Biopsy

Indications

Acute vs. chronic disease Glomerulonephropathies

Page 44: Abdominal Biopsy Techniques

Kidney Biopsy

Techniques

Needle Punch Biopsy Less hemorrhage, easier

Wedge Biopsy(Preferred) More consistent samples More hemorrhage

Page 45: Abdominal Biopsy Techniques

Prostatic Biopsy

Principles

Avoid central located urethral area Contain contamination, tumor cells Examine median iliac LN Minimal peripheral dissection

Page 46: Abdominal Biopsy Techniques

Incisional Prostatic Biopsy

Indications

Benign vs. malignant disease Obtain culture specimen,refractory prostat

itis

Page 47: Abdominal Biopsy Techniques

Prostatic BiopsyTechniques

Needle Punch Poorly exposed areas Difficult disease

Wedge incision Requires good exposure More hemorrhage

Page 48: Abdominal Biopsy Techniques

Conclusions

Full benefits of biopsy:

Surgeon’s ability to fully explore the abdomen and recognize abnormalities

Proper indications and technique


Recommended