LO4 - Biopsy Technique

Question 1

What is/are the most common US guided biopsy for soft tissue?

Answer 1

FNA biopsy

Core biopsy

Question 2

FNA uses what gauge needle

Answer 2

20-25 gauge

Question 3

Technique rad uses to collect cells into cannula during FNA

Answer 3

Back and forth motion

Question 4

When is FNA indicated (3)

Answer 4

Nodules/masses
Enlarged LN
Inflamed tissue

Question 5

What are common sites for FNA (3)

Answer 5

Breast
Thyroid
LN in neck, groin, axilla

Question 6

What is cytopathology/cytology

Answer 6

Diagnoses malignant/premalignant cells and diseases on microscopic level

Question 7

Gauge level for core biopsy

Answer 7

14-19 gauge needle

Question 8

Between FNA and core biopsy, which collects a larger sample?

Answer 8

Core

Question 9

When is a core biopsy indicated

Answer 9

Abnormal imaging (CT, US, mammogram)
Abnormal biochemistry (proteinuria, elevated LFTs/enlarged liver) 

Obtains abnormal soft tissue sample / sample in organ

Question 10

what is the most common core biopsy needle mechanism

Answer 10

Re-usable (ProMag) - punch

Disposable (super core/Trucut) - controlled click

Question 11

What happens to samples after collected from core biopsy

Answer 11

Tissues are preserved in formaldehyde then sent to SURGICAL PATHOLOGY/HISTOLOGY

Question 12

Biopsy techniques (2)

Answer 12

Free hand

Needle guided

Question 13

At what angle is the needle inserted when sampling superficial structures versus deeper structures. Describe the orientation relative to the transducer

Answer 13

Superficial = shallow angle, needle hub away from the transducer 
Deep = steep angle, needle hub close to transducer

Question 14

Describe some pros to the free-hand technique

Answer 14

Easy skill to replicate once mastered
Costs less, does not need needle guide
Most institutions have needles & syringes Less administrative work to order right needle
Can easily avoid nearby structure/can reach hard to biopsy area because angle is not controlled by guide

Question 15

What are some cons to the free-hand technique

Answer 15

User-dependent
Potential tissue damage
Needle angle not controlled
Big learning curve

Question 16

What are some pros for needle guided technique?

Answer 16

Controlled needle insert angle, needle tracks closer to each other
Less tissue damage
Less learning curve
Decreased procedure time

Question 17

what are some cons to guided biopsy technique?

Answer 17

Expensive
Specific guides for specific machines/transducers - pt scheduling
Difficult to manipulate guide near rib spaces or lesions closer to diaphragm due to set angles

Question 18

Liver biopsy contraindications

Answer 18

Uncooperative pt
Extrahepatic biliary obstruction
Bacterial cholangitis
Abnormal coagulation indices
As cites
Cystic lesions
Amyloidosis
Pt body habitus/poor penetration of sound through soft tissue

Question 19

Coagulopathy suggested threshold INR liver biopsy

Answer 19

<1.4-1.5

Question 20

PTT suggested threshold liver biopsy

Answer 20

<45-50 s

Question 21

PLT suggested threshold liver biopsy

Answer 21

> 50 000 - 70 000

Question 22

What is used to correct clotting abnormalities (2)

Answer 22

Vitamin k or FFP (fresh frozen plasma)

Question 23

Pre liver biopsy (6)

Answer 23

Requisition: history & bloodwork
Visibility
Access
Ascites
Smaller intrahepatic vessels
Target: peripherally located lesions with normal parenchyma

Question 24

Liver biopsy patient position

Answer 24

Supine / left lateral deuce

Question 25

how many samples are obtained for liver biopsy

Answer 25

2-6

Question 26

In what time frame will most complications occur after liver biopsy

Answer 26

First 3 hrs

Question 27

Liver biopsy complications (8)

Answer 27

``` Abdo/shoulder pain Hematoma Hemobilia Hemo- or pneumothorax Vasovagal rx Puncture to adj organs Peritonitis Mortality ```

Question 28

Where is the selected choice for a renal biopsy

Answer 28

Renal parenchyma in lower pole left kidney

Question 29

Renal biopsy contraindications

Answer 29

``` Bleeding diathesis Severe hypertension Seeding RCC Hydronephrosis Infection Pt unable to lie prone Obesity ```

Question 30

renal biopsy complications

Answer 30

``` Pain Hematuria Bleeding/hematoma Tract seeding Infection Mortality ```

Question 31

When do most complications occur after a renal biopsy

Answer 31

80-100% <12 hours | 40-50% <4 hrs

Question 32

BP after renal biopsy should be taken when and what should the diastolic reading be under?

Answer 32

Within 24 hours | <90 mmHg

Question 33

For LN biopsy, where are FNA samples sent and where are core samples sent?

Answer 33

FNA=cytology | Core=histology

Question 34

what are symptoms enough to indicate a LN biopsy? (3)

Answer 34

Ongoing fever, night sweats weight loss

Question 35

LN biopsy diagnosis normal result (3)

Answer 35

Normal # LN Structure/appearance LN normal No signs of infection

Question 36

Abnormal LN biopsy result (4)

Answer 36

Sign of infection (mono/TB) Cancer cells present HIV Inflammatory disease (sarcoidosis)

Question 37

Contraindications to LN biopsy (3)

Answer 37

Uncooperative pt Allergies Blood thinners

Question 38

Complications LN biopsy (6)

Answer 38

``` Pain Bruising Bleeding Infection Allergic rx Lymphedema ```