Introduction Purpose of the biopsy is to confirm a suspected diagnosis The biopsy is not a substitute for a thorough history, physical exam, and laboratory investigation prerequisites for a biopsy CBC, platelets, coagulation studies cross-sectional imaging to evaluate local anatomy treatment center performing biopsy must be capable of proper diagnosis and treatment Indications for Biopsy Indications aggressive bone or soft tissue lesions soft tissue lesions larger than 5cm, deep to fascia, or overlying bone/neurovascular structures unclear diagnosis in a symptomatic patient solitary bone lesions in a patient with history of carcinoma When a biopsy is not indicated asymptomatic latent bone lesions or a symptomatic active bone lesions which appear entirely benign on imaging don't necessarily need a biopsy soft tissue lesion which are completely benign on MRI don't necessarily need a biopsy (e.g. lipoma, hemangioma) Types of Biopsy Fine Needle Aspiration (FNA) provides cytologic (cellular) specimen frequently used for carcinoma not typically used for sarcoma Core biopsy (Tru-cut) allow for tumor structural examination can evaluate both the cytologic and stromal elements of the tumor frequently used for soft tissue sarcoma 85-95% accuracy in diagnosis Incisional biopsy small surgical incision carefully placed to access tumor without contamination of critical structures Excisional biopsy select indications: small, superficial soft tissue masses Principles of the Open Incisional Biopsy Incision use longitudinal incision in the extremities allows for extension of the incision for definitive management Approach do not expose neurovascular structures all tissue exposed during the biopsy is considered contaminated with tumor maintain meticulous hemostasis post-operative hematomas are considered contaminated with tumor release tourniquet prior to wound closure Biopsy perform through the involved compartment of the tumor for bone lesions with a soft tissue mass, it is ok to perform the biopsy using the soft tissue mass Closure if using a drain, bring drain out of the skin in line with surgical incision allows drain site to be removed with definitive surgical extensile incision
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Guided Needle Biopsy of Malignant Lesion Orthobullets Team Pathology - Biopsy Principles
QUESTIONS 1 of 13 1 2 3 4 5 6 7 8 9 10 11 12 13 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.160) A 45-year-old woman presents with concerns of a painful knee that has rapidly progressed in the last 9 months. Axial T1 and T2 MRI images are depicted in Figures A and B. The treating surgeon elects to proceed with a biopsy. How should the biopsy be performed? QID: 213056 FIGURES: A B Type & Select Correct Answer 1 Fine needle biopsy through posterior approach 2% (34/1736) 2 Transverse incisional biopsy through anterior approach 2% (31/1736) 3 Transverse incisional biopsy through posterior approach 1% (20/1736) 4 Longitudinal incisional biopsy through medial approach 92% (1595/1736) 5 Longitudinal incisional biopsy through lateral approach 3% (52/1736) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ16.90) A 65-year-old woman has had a dull pain at night on the posterior aspect of her left thigh. Subsequent workup revealed a mass developing on the left thigh as seen in Figures A through C. She undergoes an incisional biopsy, and a postoperative drain is to be placed. In which of the locations indicated in Figure D should the drain be placed? QID: 8852 FIGURES: A B C D Type & Select Correct Answer 1 1 1% (18/1849) 2 2 2% (43/1849) 3 3 7% (131/1849) 4 4 80% (1474/1849) 5 5 9% (170/1849) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2017 When and How to Biopsy Bone and Soft Tissue Tumors Nathan Hammel, M.D. (COA 2017, 3.2) Pathology - Biopsy Principles A 4/12/2018 831 views 5.0 (4) Pathology | Biopsy Principles Pathology - Biopsy Principles Listen Now 14:46 min 10/18/2019 503 plays 5.0 (5)