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CLINICAL APPROACH TO A PATIENT (Biopsy Methods (Incisional (Disadvantages,…
CLINICAL APPROACH TO A PATIENT
Evaluation
Histology
nature and grade
Extent of disease
locally
distant sites
Paraneoplastic syndromes
Concurrent disease
prognosis
ability to tolerate treatment
Terminologies
Stage
diagnostic procedure
extent of disease
TNM
Tumour
Physical examination
Size
Mobility
Degree of fixation
Relationship
anatomical structures
+/- erythema
+/- ulceration
Diagnostic Imaging
For
Deep tumours
Vital structures involved
Complex anatomical compartments
Bone involved
Adjacent to bone
invasive oral tumour
Other techniques
Endoscopy
GI
Urogenital
Airway
Biopsy
Node
Physical Examination
Size
Relationship
+/- ulceration
Mobility
Degree of fixation
TEXTURE AND CONSISTENCY
Diagnostic Imaging
Biopsy
Metastasis
Diagnostic Imaging
Radiography
pulmonary metastasis
Views
L Lateral
Dorsoventral
R Lateral
Lungs, liver, bones
Physcial Examination/ History
Biopsy
NOT suitable for lymphoproliferative disorders
staged according to various organ systems involved
Grade
pathological description of tumout
how malignant
mitotic rate
tissue architecture
pleomorphism
When
Post-surgical biopsy
Essential
Assess surgical margins
Adequate?
Follow-up therapy
Required?
Grade of tumour
Prognosis
pre-surgical biopsy
not required/ avoided
treatment regime unlikely to be modified
mastectomy
severe haemorrhage possible
splenic haemangiosarcoma
Advantages
Detect neoplastic disease
Tumour type
Adequacy of surgical margins
Tumour grade
Considerations
Tissue type
Fluid
Bone
Soft tissue
Position to recover tissue
Central
Margin
Location
Amount of tissue
Biopsy Methods
Fine Needle Aspirate
Cytology
Purpose
Identify presence of neoplastic disease
Disadvantages
Lost of tissue architecture
Requires experienced clinical pathologist
distinguish inflammation from neoplasia
Advantages
Easily recovered
Minimum requirements
instrumentation
hypodermic needles
Little disruption
tumour and surrounding tissues
Multiple samples
single biopsy procedure
Samples readily mounted and stained
Inflammation vs. Neoplasia vs. Hyperplasia
Inflammation
Acute
Chronic
Neoplasia
Benign
Low nuclear: cytoplasmic ratio
Well-differentiated
Similar appearance to normal tissue
Malignant
Pleomorphic
Asicocytosis
Anisokaryosis
Anaplasia
High nuclear: cytoplasmic ratio
Multinucleated
Examination of individual or groups of cells
Needle Biopsy
Histology
Remove small core of tissue
"Tru-Cut"
Advantages
recover more tissue
Retained architecture
suitable for routine processing techniques
inaccessible sites can be biopsied
Multiple samples
Disadvantages
Greater incidence of post biopsy complications
Skin Punch
skin and superficial tumours
Advantages
more tissue
Multiple sample
Retained architecture
Incisional
Surgical removal of a solid piece of tissue
substantial amount of tissue
enable histopathological typing and grading
Advantages
exposure of biopsy site
allow accurate selection of sampling site
reduce risk of complications
adequate amount of tissue recovered
variety of processing techniques can be performed
Disadvantages
requires GA
Time consuming
Non-representative
Complicate future surgery
Seeding tract
Bladder tumours
Not curative
Haemorrhagic or viscous rupture possible
Use when lesion too large or difficult to excise
Principles to keep in mind
Incision
As small as possible
Multiple samples
No electrocautery
distort architecture
Uninvolved anatomic planes and compartments should not be breached
Fresh instrumentation for each site
Excisional
complete removal of tumour
samples removed from tumour
Bone Marrow
Rosenthal needle
aspirate biopsy
Jamshidi needle
core biopsy
For
lymphoid and myeloid tumours
Indications
Non-regenerative anaemia
secondary immune mediated haemolytic anaemia
haematopoietic tumours
Procedure
femur, humerus
lateral recumbancy
iliac crest
sternal recumbancy