This document discusses biopsy procedures. It defines biopsy as the surgical removal of tissue for examination and diagnosis. Various types of biopsies are described including incisional, excisional, core needle and image-guided biopsies. The importance of proper patient evaluation prior to biopsy and careful biopsy technique are emphasized to minimize complications and obtain diagnostic tissue.
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. Oral biopsy; why, when, and how? Biopsy is the removal of the tissue from the living organism for the purpose of microscopic examination and diagnosis. Looking for a definitive diagnosis is the aim of biopsy. Types of Biopsy include incisional, excisional, drill, fine needle and frozen section biopsy.
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2. Definition / Introduction
Historic Perspective
Aim
Indications
Contra-indications
Classification/Types
Principles and Techniques
Complications
Situation in our Sub-region
Conclusion
3. Biopsy is derived from a Greek word (By-op-see) = Bio –
meaning LIFE and Opsy – TO LOOK
This is the surgical removal of a tissue specimen in a
living body for the purpose of examination and
diagnoses.
It could also be therapeutic
Invaluable in the mgt of certain surgical lesions
4. Any organ in the body can be biopsied using a variety
of techniques.
Proper patient evaluation is paramount.
The need for biopsy in surgery can not be over-
emphasize
5. 1870, Ruge and Joham Vert in Berlin introduced surgical
biopsy as an essential tool for diagnosis.
1889, Emarch put forward an argument that
confirmations should be made before surgeries for
malignancies.
Williams halsted 1st introduced this principle in United
States.
1941, study of exfoliated cells from female genital tract by
Papanicolaou.
6. This was adapted to study cells from other body
systems
Along with this were innovations in various kinds of
tissue preparations and staining techniques
9. Any lesion that persists for more than 2 weeks
with no apparent etiologic basis
Any inflammatory lesion that does not respond
to local treatment after 10 to 14 days.
Persistent hyperkeratotic changes in surface
tissues.
Any persistent tumescence, either visible or
palpable beneath relatively normal tissue.
Evaluation and monitoring of tissue rejection
after transplantion –kidney and liver
10. Inflammatory changes of unknown cause that persist
for long periods
Lesion that interfere with local function
Bone lesions not specifically identified by clinical and
radiographic findings
Any lesion that has the characteristics of malignancy
14. OPEN DIRECT BIOPSY
- Incisional
- Excisional
* marginal
* wide local
* radical
15. Aspiration biopsy is the use of a needle and syringe to
penetrate a lesion for aspiration if its contents.
Indications:
To determine the presents of fluid within a lesion
To ascertain the type of fluid within a lesion
When exploration of an intraosseous lesion is
indicated
16. Outpatient procedure
Infiltrate the site with LA
22G needle attached to a 10ml syringe(syringe holder)
Place the needle in the mass
Apply suction while the needle is move back and
forth within the mass
Release the suction and withdraw needle once cellular
aspirate is seen
17. The cellular material is then expressed unto the
microscope slide
Air-dry or fixed with 95% ethanol
18.
19.
20. Skin cleansing + LA
Small skin incision
Lesion approach at an angle 450
Stabilize the lesion and introduce the needle via the
skin until it abuts against the lesion
Fully mechanical biopsy gun is then fired
Tissue fixed in formalin
Bleeding usually not a problem,apply pressure
22. An incisional biopsy is the surgical sampling of a
lesion(representative part).
If a lesion is large or has different characteristics in
various locations more than one area may need to be
sampled
23. Indications:
Size limitations and ulcerated lesion
Hazardous location of the lesion
Great suspicion of malignancy
principle:
Representative areas are biopsied in a wedge fashion.
Margins should extend into normal tissue on the deep
surface.
Necrotic tissue should be avoided.
A narrow deep specimen is better than a broad shallow one.
24. An excisional biposy implies the complete removal of the
lesion.
Indications:
lesions Less than 1cm
The lesion on clinical exam appears benign.
When complete excision with a margin of normal tissue
is possible without mutilation.
25. Technique:
Skin incision shld be curvilinear and follow the langers lines
The entire lesion with 2 to 3mm of normal
appearing tissue surrounding the lesion is excised if
benign
2 – 3cm if malignant.
Lesions within 5cm of areolar margin ---- circumareolar
Tissue forceps shld only be applied when the lesion has
been clearly defined
26. The lesion can be shelled out in cases of suspected
fibro adenomas
Secure hemostasis
Drains shld not be used
Wound closed in two layers
29. Done whenever report is needed at the earliest
time. Here an unfixed fresh tissue is frozen (using
CO2) in a metal and sections are made and stained.
PIT FALLS
-Technically difficult
-Difficult to get accurate result
30. ADVANTAGES:
-Its quick and surgeons can decide the further steps to
follow
31. USES:
-CA breast
-Follicular CA of thyroid when FNAC fails
-for accessing on-table clearance margin and depth.
-study of lymph nodes and their positivity for
malignancy.
32. This uses image intensifier to enhance the
accuracy of the site of the biopsy.
Radiological images of the site of the lesion, the
location the size and the shape the dept and other
characteristics are employed in order to increase
the accuracy of the procedure this involves
ultrasound CT-scan MRI and mammography.
33.
34.
35. Exfoliative cytology is the histopathologic
examination of cells that have been obtained by
their physical removal, followed by their placement
on a glass slide, and then appropriately stained. The
term "Pap smear" is commonly used for exfoliative
cytology, but it only refers to the method of staining
and is in honor of the man who is credited with
developing the staining technique, Dr.
Papanicolaou.
36. It is important to develop a systematic approach in
evaluating a patient with a lesion in the body.
Pre-operative
Intra-operative
Post-operative
37. A detailed health history
A history of the specific lesion
A clinical examination
A radiographic examination
Laboratory investigations
Patient selection
Proper patient counseling
Obtain informed consent
Optimize patient e.g. stop anticoagulants
38. Proper pre-op localization of lesion especially of
impalpable lesions
Surgeon should be competent and preferably be the
one to perform the definitive surgery
40. Erythroplasia- lesion is totally red or has a speckled red
appearance.
Ulceration- lesion is ulcerated or presents as an ulcer.
Duration- lesion has persisted for more than two weeks.
Growth rate- lesion exhibits rapid growth
Bleeding- lesion bleeds on gentle manipulation
Induration- lesion and surrounding tissue is firm to the
touch
Fixation- lesion feels attached to adjacent structures
41. The anatomic location of the lesion/mass
The physical character of the lesion/mass
The size and shape of the lesion/mass
Single vs. multiple lesions
The surface of the lesion
The color of the lesion
The sharpness of the boundaries of the lesion
The consistency of the lesion to palpation
Presence of pulsation
Lymph node examination
42. Anesthesia
- General, regional, or local
- block anesthesia is preferred to infiltration
- when block anesthesia is not possible, distant
infiltration may be used
- Do not inject directly into the lesion
44. Incisions should be made with a scalpel.
They should be converging
Should extend beyond the suspected depth of the lesion
They should parallel important structures
Margins should include 2 to 3mm of normal appearing
tissue if the lesion is thought to be benign.
5mm or more may be necessary with lesions that appear
malignant, vascular, pigmented, or have diffuse borders.
Longitudinal in the extremities
45. . Ulcers;
- avoid central necrotic areas
- include adjoining normal tissue
. In deeply situated tissue take whole thickness and
normal tissue
. Handle tissues gently to preserve architecture
46. Avoid electrocautery for cutting if possible
Haemostasis
Artery forceps, ligation, diathermy etc
Suction devices should be avoided
Drain when indicated, must be within the incision
Aim at primary closure of wound
47. Primary closure of the surgical site is necessary
In oral cavity mucosal undermining may be necessary
Elliptical incision on the hard palate or attached
gingiva may be left to heal by secondary intention.
49. Direct handling of the lesion will expose it to crush injury
resulting in alteration the cellular architecture.
Specimen should be immediately placed in 10% formalin
solution and should be completely immersed
Boin’s solution for testicular biopsy and peripheral nerves
Chromate solution for chromafinomas
Gluteraldehyde for tissues for electron microscope
50. A biopsy data sheet should be completed and the
specimen immediately labeled. All pertinent history
and descriptions of the lesion must be conveyed.
Biodata
Unit and consultant in charge
Nature of specimen and provisional diagnosis
Date of specimen collection
Previous histology results if any
Clinical features and operative findings
51. This could be generalized or organ specific
Generalized :Infection;Hemorrhage;Pain; Tumor
upgrading; Ulceration; keloids; Hypertrophic
scar; Deformity
Specific organ compl.-PROSTATE:-
prostatitis,urinary retention,blood in
semen,bleeding rectum.LUNGS:-pneumothorax,
heamothorax,empyoma thorases,atelectases.
53. They don’t corroborate your clinical impression
Repeat the biopsy!!!
Determine if the tissue was looked at by a Pathologist
The results show malignancy
55. As we are in the era of evidence-based medicine the
use of biopsy in surgery can never be over-emphasize.
A careful surgical harvest of a sample of tissue with
pertinent information so as to assist the pathologist in
making the correct diagnosis is paramount.