Updated: 12/27/2018

Biopsy Principles

Topic
Review Topic
0
0
Questions
6
0
0
Evidence
7
0
0
Videos
1
Cases
1
Techniques
1
https://upload.orthobullets.com/topic/8082/images/biopsy thigh.jpg
https://upload.orthobullets.com/topic/8082/images/tru-cut.jpg
https://upload.orthobullets.com/topic/8082/images/principle_of_trucut_biopsy.jpg
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 sarcoma 
  • 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
 

Please rate topic.

Average 4.1 of 25 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Technique Guides (1)
Questions (6)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ12.35) A 53-year old female presents to your community hospital with right shoulder pain of 2 weeks duration, night sweats, and loss of appetite. Her past medical history is significant for hypertension only. A radiograph is performed and is shown in Figure A. What is the most appropriate next step in management. Review Topic

QID: 4395
FIGURES:
1

Observation

2%

(70/4457)

2

Blood cultures

8%

(337/4457)

3

CT guided biopsy

20%

(892/4457)

4

Hemiarthroplasty

0%

(14/4457)

5

Referral to an orthopaedic oncologist

70%

(3124/4457)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (10)
POSTS (1)
VIDEOS (1)
CASES (1)
Topic COMMENTS (9)
Private Note