biopsy techniques Flashcards
most common Sonography guided biopsy for soft tissue? (2)
- fine needle aspiration (FNA) biopsy
- core biopsy
FNA uses what gauge of needle?
20-25 gauge
FNA of soft tissue biopsy steps?
- thin needle inserted into area of abnormal appering tissue
- needle is inserted using back and forth motion
- cells are collected with a cannula
- syringe attached to create negative pressure and aspirate the cells
- camples collected help make diagnosis
FNA is reccomended for? (3)
- nodules or masses
- enlarged lymph nodes
- inflammed tissue
common sites for FNA? (3)
- breast
- thyroid gland
- lymph nodes in neck, groin, axilla
FNA for solid lesions?
- cells are pushed out of cannula onto microscope slides
- usually a cytology technologist collecting samples
- syringe and needle are rines out with a fluid and that fluid will also be sent to lab for testing
what is cytopathology/cytology?
- dagnoses malignant and premalignant cells and diseases on the mircroscopic level
a core biopsy uses what gauge of needle?
14-19 gauge
what is the most common core biopsy needle mechanism?
Reusable spring loaded needle biopsy gun (ProMag) – Punch
Disposable spring loaded biopsy needle (Supercore/Trucut needle) – Controlled click
core biopsy samples are usually kept in what?
kept in a formaldehyde solution for preserving tissue samples (clear fluid)
example of a preservative used for a core biopsy is?
formalin
what is formalin?
- A solution of gas formaldehyde in water
- Widely used for preserving tissue samples
- It links protein molecules together, increasing the rigidity of the sample and making it easier to prepare thin slices for microscopic examination
- It also prevents decay
where are core biopsy samples sent?
to Surgical Pathology aka histology where they examine the tissue in different methods and create a report for the requesting physician
2 biopsy techniques?
- free hand
- needle guided
pros of hand free technique?
- once mastered its easy to replicate
- cost less, does not need needle guide
- most institutes have needles and syringes so less administered work
- can easily avoid near by structure and can reach hard to biopsy areas
cons of free hand technique?
- user dependent
- correcting needle angles within the organ could increase tissue damage
- needle angle is not controlled
- learning curve
pros of needle guide technique?
- controlled needle insert angle- less tissue damage
- less learning curve
- decreased procedure time
- less manipulation within organ
cons of needle guided technique?
- expensive
- specific guides for specific machines or trandsucers
- doctors tend to prefer free hand
- difficult to manipulate guide near rib spaces of lesions closer to diaphragm
Liver biopsy indications?
Evaluation of abnormal hepatic laboratory test results
Confirmation of diagnosis and prognostication
Suspected hepatic neoplasm
Diagnosis ofcholestatic liver disease
Evaluation of infiltrative or granulomatous disease
Following a case ofliver transplantationto evaluate and manage rejection
To evaluate unexplainedjaundiceor suspected drug reactions
Liver - Random biopsy possible diagnosis?
Acute hepatitis Autoimmune hepatitis (AIH) Steatosis (fatty liver, nonalcoholic steatohepatitis ) Primary sclerosis cholangitis (PSC) Primary biliary cirrhosis (PBV) Wilson’s disease Hemachromatosis Infections and pyrexia of unknown origin (tuberculosis) HCV/ HBV viral infection Liver transplant rejection Liver transplant ischemia
Liver - Targeted/Lesion biopsy possible diagnosis?
Hepatic metastasis Atypical hemangiomas Hepatocellular carcinoma (HCC; hepatoma) Adenoma Focal nodular hyperplasia Regenerative nodule
liver biopsy contraindications? (8)
- Uncooperative patient (sedation required)
- Extrahepatic biliary obstruction (risk of biliary peritonitis, septicaemic shock and death)
- Bacterial cholangitis
- Abnormal coagulation indices
- Ascites
- Cystic lesions (especially echinococcal cyst)
- Amyloidosis
- Patient body habitus or poor penetration of sound through soft tissue
Liver biopsy Coagulopathathy suggested threshold?
- preferably within 24 hours
Liver biopsy INR?
<1.4-1.5
liver biopsy PTT?
<45-40sec
liver biopsy PLT?
> 50 000- 70 000
what may be used to correct clotting abnormalities? (2)
- vitamin K
- fresh frozen plasma
Liver- pre biopsy?
- Check for requisition and previous medical history, along with recent blood work for INR, PTT, PLT.
- Determine easiest visibility of lesion
- Determine access (intercostal, subcostal, subxyphoid)
- Look for ascites
Random: determine a region without larger intrahepatic vessels
Target: look for peripherally located lesions with normal parenchyma
Liver biopsy pre-scan images? (4)
- random biopsy (area of interest 2D and colour)
- targeted biopsy (chosen lesion with measurements and color images
- GB
- RLQ/LLQ
Liver BiopsyPatient position and procedure set up?
- Patient is usually lying supine or left lateral decubitus on bed
- Some time patient will have to hold their breath when obtaining the sample
- This will be a core biopsy, requiring either a biopsy gun or a disposable biopsy needle mechanism.
- Radiologist will obtain anywhere from 2 to 6 samples depending on sample quality and indication of the procedure.
Liver biopsy how many samples?
2-6 samples
Liver Biopsy Steps (10)?
- Radiologist will obtain consent from patient
- Radiologist will scan with ultrasound to determine best approach for needle insertion
- Radiologist will mark the skin with marker or a straw
- Time out documentation / pause performed
- After cleaning of the skin, local anesthetic will be used to numb the area
Using ultrasound radiologist will use scalpel to cut into point of insertion - 14-18 gauge needle is used to obtain sample
- After the biopsy, alcohol will be used to clean the skin
- Band aide will be applied to cover the cut
- Patient will be asked to lie on the right side to apply pressure and decrease the
- chance of bleeding if the insertion is on the right side
Liver Post-Biopsy Images?
- To check if there is bleeding from needle track
- Hematoma
- 2D and color/power doppler images
- Damage to area near biopsy site (recheck gallbladder and for free fluid)
liver biopsy- post patient care?
- No clear set standard for post biopsy care
- Usually monitored by a nurse in surgical day care unit or other designated nursing unit
- Patient can use Tylenol if there is pain after procedure
almost all complications of liver biopsy will appear within how many hours?
first 3 hours
liver biopsy- end points?
Obtain a tissue sample that is representative of the liver lesion or of the hepatic parenchyma and that is adequate enough to obtain a pathologic diagnosis.
Tissue sample will be placed in Formalin bottles, and sent to histology for further analysis.
liver biopsy complications?
Abdominal or shoulder pain Hematoma Hemobilia Hemo- or pneumothorax Vasovagal reaction Puncture to adjacent organs Peritonitis Mortality
renal random biopsy indications
Proteinuria (nephrotic syndrome)
Microscopic hematuria
Urologically unexplained macroscopic hematuria
Renal manifestation of systemic disease
Unexplained renal failure
Renal transplant rejection
Renal transplant ischemia/drug-induced toxicity
Renal transplant chronic allograft nephropathy
for a renal random biopsy what is typically the selected location?
- lower pole of left kidney
renal biopsy- targeted indications?
Renal cell carcinoma (RCC) Oncocytoma Papillary adenoma Renal lymphoma Renal leiomyoma (capsuloma) angiomyolipoma
renal biopsy contraindications?
Bleeding diathesis Severe hypertension Seeding of RCC Hydronephrosis Infection Patient unable to lie prone obesity
renal biopsy complicaitons?
Pain Puncture to adjacent structures Hematuria Bleeding/hematoma Tract seeding (when tumor cells are left behind in needle tract) Infection mortality
renal biopsy INR?
<1.4-1.5
renal biopsy PTT?
<45-50sec
renal biopsy PLT?
> 50 000- 70 000
renal biopsy BP?
<90 mmHg diastolic
renal biopsy BP?
<90 mmHg diastolic
lymph node biopsy?
FNA Biopsy or Core Biopsy may be performed
FNA samples sent to cytology
Core samples sent to histology
lymph node biopsy indications?
Cause of enlarged node
Cause of symptoms, such as an ongoing fever, night sweats or weight loss
Staging (plan cancer treatment)
lymph node biopsy contraindications?
Uncooperative patient
Allergies
Blood thinners
