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Value of Biopsy “If the histological diagnosis is
incorrect,every subsequent step in the management of the patient may also be incorrect”
Positive Attitude “give the patient the benefit of
doubt” “do not doom the patient without
knowing what you are treating”
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”
Medical Oncologist “there is no body cavity which
cannot be reached by a strong arm and a 16 gauge needle”
Abdominal Exploration
Complete your exploration first unless:
Active hemorrhage Gross contamination Lesion obstructs vision
Incisional vs. Excisional Biopsy
Decision Making:
1.Will full excision be potentially curative?
2.Will excision of entire lesion improve patient’s condition
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?
Excisional Biopsy-Advantages
“If in doubt, cut it out”
1.Less seeding tumor cells 2.Diagnostic and therapeutic
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
When to Biopsy
Abnormal tissue Appearance
Supports reason for exploratory Tumor staging; metastatic involvement
When to Biopsy
Normal tissue Appearance
Potential for involvement of “normal” appearing tissue
Diagnostics indicate disease in “normal” appearing tissue
Where to Biopsy Sample lesion including “normal”
adjacent tissue Sample various areas in diffuse
conditions, Inflammatory or infected tissue
Equipment and Materials Bakers biopsy punch Needle punch biopsy Gelfoam Suture material General surgery pack
Principles of Biopsy Limit tumor seeding Control contamination Minimize manipulation Provide representative sample Do not limit Surgicul excision
Biopsy Tips
Hemorrhage Control
Digital pressure Ligate local supplying vessesls Gelfoam Omental “tack”technique
Proper Biopsy Preparation Cut into sections after excision Specimens<1cm thick 1:10 ratio formalin: tissue volume
Liver Biopsy
General indications
Liver size changes Abnormal laboratory tests Benign vs. Malignant processes Assess liver disease Evaluation treatment of liver disease
Open Liver Biopsy Excisional biopsy; primary hepatic neoplas
ms, singular metastatic nodules Incisional biopsy; diffuse diseases, multipl
e nodules
Liver Biopsy
Contraindication;
Coagulation abnormalities
No bleeding tendencies;Screen activated clotting time,platelet count
Suspect bleeder; coagulation profile treat first.
Spleen Biopsy
Indications;
Excisional biopsy Large splenic masses
Incisional biopsy Difuse disease Regenerative vs. malignant processes
Spleen Biopsy Bakers Punch Technique Guillotine Technique Mattress Suture Technique TA stapler Technique
Hollow Organ Biopsy
Principles;
Gentle Tissue Handling Full thickness samples Protect against contamination Protect “otomy” site?
Intestinal Biopsy Indications
Single Biopsy Solitary, viable, and nonobstructive amend
able to resection
Multiple biopsies Diffuse processes
Intestinal Biopsy Technique Proper preparation 1-2cm length antimesenteric enterotomy Prevent excess mucosal eversion Do not remove >20% circumference
Intestinal Closure Remove everted muccosa Appositional, noncrushing pattern Transverse vs. longitudinal closure Omentum or serosal patch coverage
Pancreatic Biopsy
Principles;
Gentle handling Preserve blood supply Avoid duct areas No electrocoagulation
Pancreatic Biopsy Indications
Excisional Biopsy Solitary nodules
Incisional Biopsy Diffuse involvement Benign vs. malignant processes Lesions near duct areas
Pancreatic Biopsy Techniques Shave biopsy technique
Guillotine or suture fracture Peripheral tissue lesions Diffuse lesions
Pancreatic Biopsy Techniques Wedge incision technique
Needle punch technique Parencymal lesions in body Nonresectable masses
Lymph Node biopsy
Indications;
Lymphadenopathy Benign vs. malignant proccesses Clinical staging Paraneoplastic proccess
Lymph Node biopsy Liac and mesentric nodes most biopsied Excisional biopsies unless risk vascular co
mpromise Stay suture technique
Kidney Biopsy
Techniques
Needle Punch Biopsy Less hemorrhage, easier
Wedge Biopsy(Preferred) More consistent samples More hemorrhage
Prostatic Biopsy
Principles
Avoid central located urethral area Contain contamination, tumor cells Examine median iliac LN Minimal peripheral dissection
Incisional Prostatic Biopsy
Indications
Benign vs. malignant disease Obtain culture specimen,refractory prostat
itis
Prostatic BiopsyTechniques
Needle Punch Poorly exposed areas Difficult disease
Wedge incision Requires good exposure More hemorrhage