Biopsy

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List of terms related to Biopsy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Synonyms and keywords: Bone biopsy, Soft tissue biopsy, Biopsy in musculoskeletal system, Biopsy of organs

Overview

Biopsy is the gold standard test for the diagnosis of tumors. The tumor is then staged into benign and malignant tumors.

Biopsy

• Biopsy is the gold standard test for the diagnosis of tumors.

Prerequisites for a Biopsy

• CBC, platelets and coagulation studies should be done.
• Cross-sectional imaging to evaluate local anatomy such CT scan and MRI.
• Treatment center carrying out biopsy must be capable of proper diagnosis and treatment.
• The surgeon who performs biopsy should preferably be the one who is later going to do the final excision.

Technique

• Open
• Closed

Open Technique

• The tumor is surgically exposed and biopsy of the tumor is taken.

Open Biopsy.Source: Case courtesy of Dake~commonswiki, via Wikimedia Commons

Incisional biopsy

• A small surgical incision carefully placed to access tumor without contamination of critical structures.

Excisional biopsy

• It is done for small, superficial soft tissue masses.

Incision

• Longitudinal incision in the extremities is taken.
• It should allow for extension of the incision for definitive management.

Approach

• Never expose neurovascular structures during the procedure.
• During the biopsy, all tissue exposed is considered contaminated with tumor.
• Meticulous hemostasis must be carried out.
• Post-surgery hematomas are considered contaminated with tumor.
• Always deflate the tourniquet prior to wound closure.

Biopsy

• Perform through the involved compartment of the tumor.
• For bone lesions with a soft tissue mass, perform the biopsy using the soft tissue mass.

Closure

• If drain is kept, remove the drain out of the skin in line with surgical incision.
• This helps in excising the drain site with definitive surgical extensive incision.

Fine Needle Aspiration (FNA)

• It provides cytologic specimen.
• It is the most commonly used for carcinoma.
• It is usually not preferred for sarcoma.

Needle Biopsy.Source: Case courtesy of Linda Bartlett (photographer) [Public domain, via Wikimedia Commons]

Core biopsy (Tru-cut Biopsy)

• It allows for tumor structural examination.
• It allows evaluation of both the cytologic and stromal elements of the tumor.
• It is frequently used for sarcomas.

Sequence of Diagnostic Studies

• The various investigations must be performed in the following order:

• • X-ray
  • MRI
• Biopsy