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Interventional > LO4 - Biopsy Technique > Flashcards

LO4 - Biopsy Technique Flashcards

1
Q

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

A

FNA biopsy

Core biopsy

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2
Q

FNA uses what gauge needle

A

20-25 gauge

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3
Q

Technique rad uses to collect cells into cannula during FNA

A

Back and forth motion

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4
Q

When is FNA indicated (3)

A

Nodules/masses
Enlarged LN
Inflamed tissue

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5
Q

What are common sites for FNA (3)

A

Breast
Thyroid
LN in neck, groin, axilla

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6
Q

What is cytopathology/cytology

A

Diagnoses malignant/premalignant cells and diseases on microscopic level

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7
Q

Gauge level for core biopsy

A

14-19 gauge needle

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8
Q

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

A

Core

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9
Q

When is a core biopsy indicated

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

Obtains abnormal soft tissue sample / sample in organ

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10
Q

what is the most common core biopsy needle mechanism

A

Re-usable (ProMag) - punch

Disposable (super core/Trucut) - controlled click

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11
Q

What happens to samples after collected from core biopsy

A

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

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12
Q

Biopsy techniques (2)

A

Free hand

Needle guided

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13
Q

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

A 
Superficial = shallow angle, needle hub away from the transducer 
Deep = steep angle, needle hub close to transducer
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14
Q

Describe some pros to the free-hand technique

A

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

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15
Q

What are some cons to the free-hand technique

A

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

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16
Q

What are some pros for needle guided technique?

A

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

17
Q

what are some cons to guided biopsy technique?

A

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

18
Q

Liver biopsy contraindications

A 
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
19
Q

Coagulopathy suggested threshold INR liver biopsy

A

<1.4-1.5

20
Q

PTT suggested threshold liver biopsy

A

<45-50 s

21
Q

PLT suggested threshold liver biopsy

A

> 50 000 - 70 000

22
Q

What is used to correct clotting abnormalities (2)

A

Vitamin k or FFP (fresh frozen plasma)

23
Q

Pre liver biopsy (6)

A 
Requisition: history &amp; bloodwork
Visibility
Access
Ascites
Smaller intrahepatic vessels
Target: peripherally located lesions with normal parenchyma
24
Q

Liver biopsy patient position

A

Supine / left lateral deuce

25
Q

how many samples are obtained for liver biopsy

A

2-6

26
Q

In what time frame will most complications occur after liver biopsy

A

First 3 hrs

27
Q

Liver biopsy complications (8)

A 
Abdo/shoulder pain
Hematoma
Hemobilia
Hemo- or pneumothorax
Vasovagal rx
Puncture to adj organs
Peritonitis
Mortality
28
Q

Where is the selected choice for a renal biopsy

A

Renal parenchyma in lower pole left kidney

29
Q

Renal biopsy contraindications

A 
Bleeding diathesis
Severe hypertension
Seeding RCC
Hydronephrosis
Infection 
Pt unable to lie prone
Obesity
30
Q

renal biopsy complications

A 
Pain
Hematuria
Bleeding/hematoma
Tract seeding
Infection
Mortality
31
Q

When do most complications occur after a renal biopsy

A

80-100% <12 hours

40-50% <4 hrs

32
Q

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

A

Within 24 hours

<90 mmHg

33
Q

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

A

FNA=cytology

Core=histology

34
Q

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

A

Ongoing fever, night sweats weight loss

35
Q

LN biopsy diagnosis normal result (3)

A

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

36
Q

Abnormal LN biopsy result (4)

A

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

37
Q

Contraindications to LN biopsy (3)

A

Uncooperative pt
Allergies
Blood thinners

38
Q

Complications LN biopsy (6)

A 
Pain
Bruising
Bleeding
Infection
Allergic rx
Lymphedema

Interventional (7 decks)

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