Biopsy

Biopsy
0 January 29, 2014

Biopsy is a key step in the diagnosis of bone and soft tissue tumors. An inadequately performed biopsy may fail to allow proper diagnosis, have a negative impact on survival, and ultimately necessitate an amputation to accomplish adequate margins of resection. Poorly performed biopsy remains a common finding in patients with musculoskeletal tumors. So the recommendations were made regarding the technical aspects of the biopsy, stating that whenever possible, a patient with a suspected primary musculoskeletal malignancy should be referred before biopsy to the institution or the specialist who will perform the definitive resection and reconstruction.

Biopsy should be done only after clinical, laboratory, and roentgenographic examinations are complete. As stated above, completion of the evaluation before biopsy will aid in planning the placement of the biopsy incision, will help provide more information leading to a more accurate pathological diagnosis.

Types of biopsy:

1- Closed biopsy (does not involve an incision): The specimen is obtained after skin puncture (FNA) by a needle or trephine. Fine-needle aspiration has been shown to be a reliable technique for the diagnosis of soft-tissue tumors that also provides sufficient material for additional studies. Diagnostic accuracy of FNA is highest when the cell type of the tumor is homogeneous, as in multiple myeloma or metastatic carcinomas.

Core needle biopsy (CNB), was shown to be more than 90% accurate in differentiating malignant from benign lesions. In most patients with suspected bone or soft tissue sarcomas it is the biopsy performed before initiation of treatment. Open biopsy is performed when the pathologic diagnosis either is inconclusive or does not correlate with the clinical presentation and radiological findings. Bone biopsies, using a CNB, should be performed under CT or fluoroscopy guidance, and multiple cores should be obtained. Biopsy of deep- seated or pelvic soft-tissue tumors is performed under CT guidance.

2- Open biopsy which may be:

Open excisional biopsy can be done if the tumor is benign and small, if the preoperative diagnosis is fairly certain and the tumor is located in excisable bone like the fibula, rib or the patella.

Or an open incisional biopsy is a reliable diagnostic method because it allows the pathologist to evaluate cellular morphologic features and tissue architecture from different sites of the lesion. Furthermore, it provides material for performing ancillary studies such as immunohistochemistry, cytogenetics, molecular genetics, flow cytometry, and electron microscopy. These studies may help in the diagnosis and subclassification of bone and soft-tissue tumors, and therefore guide the definitive treatment.


Biopsy is taken from a small incision directly to the
bone without opening any tissue planes

Biopsy site is determined according to the planned
surgery

Biopsy is taken from a small incision directly to the
bone without opening any tissue planes

Biopsy site is determined according to the planned
surgery

an open large resected tumor specimens is considered an open excisional biopsy from different anatomical locations

Posted in Diagnosis by emad