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DEP Paper 1 > Surgical Procedures > Flashcards

Surgical Procedures Flashcards

1
Q

What is a cone specimen?

A

A cone shaped excision from the cervix, taken using a scalpel or a diathermic loop.

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2
Q

Where are cones, LLETZ or knife cones taken from?

A

Cervix

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3
Q

Where in the hospital are cones usually carried out?

A

Colposcopy department
Gynaecology threatres

Local anaesthetic for LLETZ
General anaesthetic for knife

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4
Q

What is the typical description for a cone?

A

A (shaped) piece of cervix measuring (3D). The os is (description and 2D measurements). Any other significant Macroscopic information.

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5
Q

How is a cone handled at dissection?

A

Serial slices, all processed in the same orientation giving an inner and an outer piece.
If 50yrs+ cruciate the inner and outer pieces

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6
Q

What is the benefit of a cone procedure?

A

Allows for treatment of deeper cervical pre-cancerous lesions
Can give a diagnosis or treatment (if shallow) of glandular lesions in the LUS
Allows for visualisation and treatment of pathology on the ecto and endocervical portions of the cetvix

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7
Q

What is the disadvantage of cones?

A

Can lead to issues with fertility
Pain
Bleeding
Discharge
Stenosis
Risk of late miscarriage
Risk of premature birth

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8
Q

What are the special considerations for cones?

A

Surface epithelium is fragile, handle with care
Orientation of slices is vital

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9
Q

How is a curettage taken?

A

The top surface of skin, or a Mucossal lining is removed via a ring shaped tool (curette). It can be combined with diatherm and/or suction

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10
Q

What type of samples are commonly taken via currettage?

A

Skin
Endometrium (D&C)
POC

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11
Q

Where are curettes specimens usually taken?

A

G. P.
Colposcopy clinic
Gynaecology threatres
Local anaesthetic

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12
Q

What is a typical description for a currettage?

A

Skin
Count pieces
Measure
Describe fragments

Endometrium
Describe appearance
Semi-quantitive estimate of volume

POC
Multiple pieces of membanous and haemorrhagic material together measuring, 3 dimensions. Comment of the presence or abscence of fetal tissue. Do not sample any fetal tissue but measure the length

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13
Q

How are currettage usually handled in the lab?

A

Everything processed for skin and Endometrium
If skin Inking deep margin can help embedding
Embed on edge
Bissect if >5mm

POC process a cassette of placenta tissue.
If molar pregnancy is suspected them more blocks are required, up to 5. Include vesicles

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14
Q

What are the advantages of a currettage?

A

Removes superficial lesions
Cheap
Little scarring
Relatively un-invasive

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15
Q

What are the disadvantages of currettage specimen?

A

Used for benign conditions, is problematic if lesion then turns out to be malignant.
Tissue can be burnt at the edge
Margins are not included

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16
Q

What is the aim of a currettage?

A

skin
Therapeutic and diagnostic
Benign - warts, fleshy moles
Premalignant - actinic keratoses and seborrheic keratoses)
Malignant - BCC, SCC, Bowen’s disease

Endometrium
Therapeutic - Endometra intraepithelial hyperplasia
Uterine polyps
Diagnostic - uterine cancers

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17
Q

What type of specimens are endoscopic biopsies?

A

Needle cores,
Cold/hot snare
Pinch biopsies
Brushings

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18
Q

Where are endoscopic biopsies taken?

A

Radiology depae
Endoscopy clinic, can be with anesthetic or not
Also specialist clinics such as colposcopy for hysteroscopy

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19
Q

What is a typical description for endoscopic biopsies?

A

Count number of biopsies
Measure size
Process all

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20
Q

How are endoscopic biopsies handled in the lab?

A

With care, delicate and can have crush artifact
Lie straight if linear
Wrap to prevent loss
3 Levels at sectioning
Possible for spares to be taken at sectioning too

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21
Q

What are the advantages of endoscopic biopsies?

A

Less invasive than open surgery
Can detect various pathologies
Allows for visualisation of internal organs
Accurate sampling
Quick

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22
Q

What are the disadvantages of endoscopic biopsies?

A

Can be invasive
Costly
Specialist training
Bleeding
Perforation
Allergic reactions to anaesthetic
Infections
Inflammation

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23
Q

What special considerations do endoscopic biopsies need?

A

Delicate - crush artefact
May need wrapping
Small so care at trimming and sectioning
Levels at cutting

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24
Q

What is the aim of endoscopic biopsies?

A

Diagnostic,
Therapeutic for polyps

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25
Q

What types of evacuation are there?

A

Dilation and evacuation (D&E) used after 14 weeks
Suction evacuation
ERPC

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26
Q

What specimen type is taken via evacuation?

A

POCs

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27
Q

Where are evacuations carried out?

A

Theatres general and Gynaecology

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28
Q

What is a typical description of an evacuation?

A

Multiple pieces of membranous and haemorrhagic tissue, together measuring… There are no fetal parts identified/fetus measures… This has not been sampled.

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29
Q

How are evacuations handled in the lab?

A

Representative sample of chorionic villus samples
If suspect molar pregnancy then more extensive sampling required, including the any vesicles identified. Measure the maximum diameter of the largest vesicles.

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30
Q

What special considerations are needed for evacuations?

A

Sensitive specimens
Require sensitive disposal and cremation form - consent
Kept seperately to normal specimens within the department
Sample any grape like areas are may have diagnostic significance
Never sample any fetal parts
The sample is generally to prove pregnancy

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31
Q

What is an excisional specimen?

A

Surgical procedure that involves removing tissue using a knife. In skins it indicates complete removal of the suspected lesion

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32
Q

Where can excisions be removed from?

A

Anywhere

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33
Q

What is an incisional specimen?

A

A surgical cut into soft tissues.
For skins - removal of part of a lesion, along with normal tissue for comparison

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34
Q

Where are incisional specimens taken?

A

Skin

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35
Q

What is a laparoscopy?

A

Examination of the abdominal cavity using a Laproscopy (type of endoscope) passed through a small incision in the abdominal wall.
Can be used with ultrasound.
Uses general anesthetic

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36
Q

What is an LLETZ specimen?

A

A large loop excision of the transformation zone of the cervix

A heated wire loop that cuts a cervical specimen away and cautorises the remaining tissue

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37
Q

What is a mammotome?

A

A small probe (mammotome vacuum assisted breast biopsy device) is asserted into the breast via a small incision. The vacuum gently draws in tissue into a hollow chamber where it is cutand collected

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38
Q

What are needle core specimens?

A

A core shaped piece of tissue taken through a wide gauge needle

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39
Q

What is open surgery?

A

Surgery carried out by making a wide incision allowing the entire organ or cavity to be visualised

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40
Q

What are the advantages of open surgery?

A

Direct access to organ
High accuracy
Good visualisation
Less expensive than laparoscopy

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41
Q

What is a pipelle specimen?

A

A specimen obtained by placing a small tube into the cervix and dying suction to remove a sample if Endometrium

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42
Q

What is an excisional specimen?

A

A specimen that includes the entire lesion along with a rim of healthy tissue.

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43
Q

What procedures can be used to take samples from the liver?

A

Percutaneous core biopsy - medical liver disease
Wedge excision - diagnostic/excision
Lobectomy - malignancy
Hepatectomy

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44
Q

What procedures can be used to take samples from the liver?

A

Percutaneous core biopsy - medical liver disease
Wedge excision - diagnostic/excision

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45
Q

What procedures can be used to take samples from the skin?

A

Incisional - inflammatory conditions
Punch biopsy - disgnostic and therapeutic, partial or complete excision if small and benign
Shave or curattage - therapeutic for cosmetic reasons or benign lesions
Excision - diagnostic or benign
Wide local excision - compliance with datasets following MM diagnosis
Wedge excision - excision of part of a flap of tissue

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46
Q

What procedures can be used to take samples from the prostate?

A

TRUS (transrectal ultrasound) guided core biopsy
TURPS (transurethral resection of prostate specimen)
Mitlens????
Prostectomy - malignancy

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47
Q

What procedures can be used to take samples from the cervix?

A

HPV sample - screening
LBC cervical specimen - screening
Punch - diagnostic
LLETZ - therapeutic for lesions low in the canal
Knife cone - therapeutic for higher in the canal/glandular
Trachelectomy -???
Polypectomy - removal of polyps
Hysterectomy - removal of uterus, cervix +/- tubes and ovaries

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48
Q

What procedures are used to investigate vagina bleeding? And what are the implications of their use?

A

Vaginal/abdominal ultra sound - imaging, show enlargement
Hysteroscopy - imaging of endometrial canal abnormal growths
MRI - imaging of organs, cysts, masses, changes in size
Blood tests - hormone concentration, infection/tumour markers
Urine - pregnancy test

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49
Q

What surgical procedures are used to investigate breast lump with inflamed nipple? What are it’s clinical indications?

A

Mammogram - identify masses, calcification, less invasive than needles but can indicate if necessary
FNA - can identity cystic, atypia, malignancy, benign.
Trucut biopsies - can be ultrasound guided or not, any mass
VAB - same as true cut but larger yield

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50
Q

6 different endoscopic surgical procedures? What part of their body do they investigate?

A

Bronchoscopy - bronchus, lung
Cystoscopy - urethra, bladder
Hysteroscopy - cervical and endometrial canal
Colonoscopy - liver and lower GI tract
Upper endoscopy - nasal/pharynx, Oesophagus
Laproscopy - abdominal cavity

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51
Q

Advantages to endoscopic procedures

A

Less recovery time
Little or no scarring
Less chance of infection
Less invasive

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52
Q

For a breast lesion, why would a VAB or mammatome be more useful?

A

Provide a larger specimen
Less chance of missing the lesion
Show the architecture of the tissue that may aid in the diagnosis

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53
Q

Compare and contrast the clinical indications for using a LLETZ and a knife cone

A

LLETZ shows the lower portion of the canal and the transformation zone, common site of metaplasia and dysplasia
Knife good for glandular lesions as can sample higher up the canal. Higher risk of complications following a knife cone

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54
Q

Compare and contrast breast VAB and core biopsy

A

Core - diagnostic, well defined lesions
VAB - larger sample size due to needle size and vacuum. Can be used on diffuse lesions as well as distinct. Can be therapeutic for proven benign conditions

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55
Q

Compare and contrast incisional and excisional

A

Inc - diagnostic, part of the lesion plus healthy tissue, used in inflammatory conditions or larger lesions, not MM
Exc - diagnostic and therapeutic, entire lesion and small margin of healthy tissue. Can be used on MM as well as other lesions

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56
Q

Compare and contrast Endometrium curettage and pipelle

A

Curettage - removes chips of tissue, longer recovery, may need to stay in, general anesthetic, dilate cervix, can be image guided
Pipelle - vacuum aided needle, removes cylindrical cores, cheaper, less invasive, less anaesthetic, blind procedure

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57
Q

Define incisional biopsies with an example of its use

A

Often an unorientated eclipse of sin/mucosa that contains part of a lesion with healthy tissue also included. Used for diagnosis. Used for inflammatory conditions

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58
Q

Define wide local excisions with an example of its use

A

Further rexcsision of an excised lesion site. Includes the scar and a minimum margin as mentioned in the dataset. Used for MM

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59
Q

Define curettage with an example of its use

A

Spoon like tool used to scrape a sample from the surface of the tissue (skin and Endometrium). Used for warty lesion on skin

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60
Q

Precautions and handling for incisional biopsies

A

May be small - wrap
Show healthy tissue and lesion - if possible bisect longitudinally
Margins are not necessary as incomplete removal but Inking can aid embedding

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61
Q

Precautions and handling for wide local excisional specimens

A

Margins - record accurately as needed for the dataset
- ink as identify if residual lesion is completely excised and to the correct margins
We process all

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62
Q

Precautions and handling for curettage

A

Small and friable - wrap and handle of care
Ink margins to help with embedding

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63
Q

Artefacts that can occur during surgical procedures

A

Crush
Opening
Disruption of capsules

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64
Q

How do you minimalism the impact if artefacts introduced during surgical procedures?

A

Describe the effect of the artefact
If possible sample around
If it requires sampling describe and include in the block ID so that it can be taken into account

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65
Q

How do you minimalism the impact if artefacts introduced during surgical procedures?

A

Describe the effect of the artefact
If possible sample around
If it requires sampling describe and include in the block ID so that it can be taken into account

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66
Q

How can you remove tissue from the prostate?

A

Millens procedure - rare morsalated removal
TURPS - benign hyperplasia
Needle core - transrectal or transperianal
Radical cystoproctectomy - bladder and prostate
Prostectomy - entire prostate

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67
Q

Benefits if MRI assisted removal for prostate cancer?

A

Accurate, more targeted
No need for mapping
Shorter procedure
Less invasive/destructive

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68
Q

16yo, D&V 4/7,pain right side of abdominal that comes and goes, 37.8 temperature, elevated WBC count. What are the probable diagnoses?
What tests can you use to confirm?

A

Acute appendicitis - most likely - blood count, ultrasound, plapation
Ectopic pregnancy - pregnancy test
UTI - culture urine
ovarian cyst rupture - ultrasound
Endometriosis - laparoscopy s

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69
Q

What are the benefits and disadvantages of laparoscopic and open surgery?

A

Laparoscopy - quick recovery
Less invasive
Restrictive actions
Requires specialist training
Small access point only remove small amounts of tissue

Open - easier to visualise
More likely to find incidental findings
Slow recovery
High risk of infection
If necessary can remove larger bits of tissue assuming consent given

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70
Q

Why might a laparoscopic procedure be converted to an open procedure immediately?

A

Incidental findings
Haemorrhage
Complications

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71
Q

In what circumstances might an open procedure be favoured?

A

Rapid procedure - trauma
Large resection
Previous surgery, adhesions
Patient choice

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72
Q

Give 2 examples of benign or premalignant diseases that can be investigated by bone marrow trephine sampling?

A

Multimyoloma metabolic bone disorder
Amylodosis thrombocytopenia
Autoimmune granuloma to us bone disease

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73
Q

How are bone marrow handles in the dissection room?

A

Count pieces, measure, describe tissue and any pathology seen, comment on attached blood clots. Decant formalin off and place into decal for 24hrs. Leave notes and reminders to remove this the next day. If immune is likely to be requested then any soft areas can be removed for processing before specimen is placed in decal, extended pricessing

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74
Q

What are the consequences of jot handling bone marrow specimens correctly?

A

Poor sections
Missed information
Missed diagnosis
Loss of tissue
If over decal led then loss of IHC
Carry over
Patient resampling

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75
Q

What are the consequences of not handling bone marrow specimens correctly?

A

Poor sections
Missed information
Missed diagnosis
Loss of tissue
If over decal led then loss of IHC
Carry over
Patient resampling

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76
Q

Which organs does oesophagogastroduodenoscopy involve?

A

Oesophagis
Stomach
Duodenum

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77
Q

Give a benign condition for the Oesophagus, stemach and Duodenum and the implications of leaving it untreated?

A

Oesophagus - barret’s metaplasia - cancer
Stomach - ulcers - perforation
Duodenum - celiac - malnutrition

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78
Q

What is an ERPC?

A

Evacuation of retained products of conception

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79
Q

What are the potential risks of an ERPC and how are they addressed?

A

Blood loss - cautery, transfusion, complete removal
Future fertility issues - IVF
Anesthetic reactions - monitoring
Perforation - surgery
Infections - antibiotics

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80
Q

What are the clinical reasons/indications for performing a cervical biopsy?

A

Abnormal smears
Repeat positive HPV results
Diagnosis is f a larger lesion
Confirmation of CIN

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81
Q

What are the clinical reasons/indications for performing a LLETZ?

A

Abnormal smears
Repeated HPV
CiN 2 or 3 diagnosis
Persistent CIN 1 results
Patient choice

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82
Q

What are the clinical reasons/indications for performing myomectomy?

A

Removal of possible fibroid
Preservation of uterus when removing fibroids
Patient choice

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83
Q

What are the clinical reasons/indications for performing hysteroscopic biopsies?

A

Abnormal bleeding
Suspected polyps
Abdominal pain

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84
Q

What is an EBUS and what are the clinical implications for it?

A

Endobronchial ultrasound guided biopsy
Taken to advise treatment and patient pathway and possibly prolong their life

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85
Q

What is a VATS wedge resection and what are the clinical implications for it?

A

Video assisted thoracic surgery wedge removal of lung
Less invasive than open resection surgery
Can be used in the treatment of bulla

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86
Q

What is a Lobectomy and what are the clinical implications for it?

A

Removal of one lobe of the lung
Treat and excise lesions
Retain more lung capacity than removing the entire lung

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87
Q

What is a pneumonectomy and what are the clinical implications for it?

A

Removal of one lung
Completely remove a lesion that has spread throughout the lobe but has not spread to the other lung or any surrounding tissues

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88
Q

What surgical procedures are used to diagnose and treat Melanoma of the skin?

A

Skin excision used to remove and diagnose in one procedure. Usually clinical assessment of ABCDE is sufficient for a confident appraisal of the lesion
Don’t use punch unless lesion is small enough to completely remove
Incisions aren’t used as can lead to seeding
Wide local excision and sentinel lymph node biopsy are then used for further treatment to assess the extent of spread
I extremely advanced cases limb removal is an option but this is more about prolonging life span, than treating

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89
Q

What procedures can be used to take specimens from the GI tract and what clinical factors can influence their use?

A

Endoscopy - small samples
Laproscopy - easy removal
Open surgery - good visibility

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90
Q

What procedures can be used to take specimens from the breast and what clinical factors can influence their use?

A

Needle - small incision diagnostic
Vacuum assisted needle - larger sample therapeutic for confirmed benign or diagnostic
Lumpectomy - diagnostic or therapeutic less damage and removal of breast tissue
Mastectomy - removal of the entire breast, therapeutic, prophylactic

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91
Q

8 sites where endoscopes can obtain specimens?

A

Nasopharynx
Trachea/bronchi
Pleural cavity
Uterus
Urinary tract
Joint spaces
Upper GI (Oesophagus, stomach, beginning of the duodenum)
Lower GI (terminal ileum, caecum, ascending, transverse, descending and sigmoid colons, rectum and anal canal)

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92
Q

4 endoscopic procedures and where they are used in the body?

A

Hot/cold snare biopsies - colonic polyps
Brush biopsies - biliary duct
Pinch biopsies - oesophageal and stomach biopsies
Needle - bronchial masses

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93
Q

What is the aim of a cervical cone?

A

Therapeutic, for cervical cell changes, suspected cervical cancer and rmearly stafe cancer (1A1)

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94
Q

What special considerations are needed for curettings?

A

Skin
Most effective when the lesion is softer than the surrounding skin

POC
Requires consent and sensitive disposal

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95
Q

What is a fiber optic endoscope and how is it used in a clinical setting?

A

A long thin tube, flexible or fixed, with a close focusing camera and light source on the end.
It can be passed through natural orifice or small Incisions to visualise inside organs or cavities
Biopsies can be taken by passing tools through the endoscope
Can be used along with ultrasound to help

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96
Q

What is an ERCP?

A

Endoscopic retrograde cholangio pancreatography

97
Q

What does a ERCP do?

A

Visualisesthe pancreas, bile ducts and gallbladder
Allows brushing and biopsies

98
Q

What is a capsule/deep endoscopy?

A

Capsule
Used to visualise the small bowel
Capsule with a camera attached that is swallowed.

Deep
Uses balloons to inflate the bowel and allow visualisation

99
Q

What is a capsule/deep endoscopy?

A

Capsule
Used to visualise the small bowel
Capsule with a camera attached that is swallowed.

Deep
Uses balloons to inflate the bowel and allow visualisation

100
Q

What is the aim of evacuations?

A

Removal of products of conception, whether planned or following miscarriage
Prevent infection
Reduce risk of bleeding

101
Q

What organ are evacuations carried out on?

A

Uterus

102
Q

I hat is a D&E?

A

Dilation and evacuation
Used after 14 weeks gestation
Cervical canal is dilated
Forcepts passed through to remove the pregnancy

103
Q

What is a suction evacuation?

A

Gentle stretching of the cervix to allow instruments to enter the uterus and allow the pregnancy to be removed via vaccum

104
Q

What is a ERPC?

A

Gentle stretching of the cervix. Suction and curettage is then passed into the endometrial canal do the products of canception can be scrapped away and removed

105
Q

What are the advantages of n evacuation?

A

Planned procedure
Patient unaware of the procedure due to anaesthetic

106
Q

What are the disadvantages of an evacuation?

A

Anaesthetic risks
Infection
Endometriosis seeding.
Rare perforatiy
Retained products causing further complications

107
Q

Where are excisions taken?

A

GP clinics
Outpatients
Threatre

Local and general anesthetic depending on the specimen

108
Q

How do you habdle a skin excision within the department?

A

Generally an ellipse
Can be orientated or not
Ink margins
Process all of lesion +/- margins as necessary

109
Q

How do you handle a skin excision within the department?

A

Generally an ellipse
Can be orientated or not
Ink margins
Process all of lesion +/- margins as necessary

110
Q

What are the advantages of a skin excision?

A

Precise removal
Minimal damage to surrounding tissue
Versatile
Allows for examination of lesion and margins

111
Q

What are the disadvantages of skin excisions?

A

Time
Can lead to scarring
More invasive than biopsies if it is a benign condition

112
Q

What are the special considerations for skin excisions?

A

May require wrapping
Difficult to sample lesion and tips if very small
Cannot be replaced if lost

113
Q

What is the aim of a skin excision?

A

Therapeutic
Diagnostic
Often used for suspected cancers to combine the two aims

114
Q

What is a hysteroscope?

A

A form of endoscope that allows for visualisation and sampling of the endometrial canal

115
Q

Where are hysteroscopy carried out?

A

Colposcopy clinic
Gynaecology theatres

Don’t require anaesthetic bit local can help if needed

116
Q

How are hysteroscopy samples dealt with in lab?

A

Count pieces
Measure
Process all

117
Q

What are the advantages of hysteroscopy?

A

Considered minimally invasive
Safe
Cheap
Useually less painful than open suegery

118
Q

What are the disadvantages of hysteroscopy?

A

Can be painful
Not suitable if cervical Stenosis is present
Not always tissue to test

119
Q

Are there any special considerations for hysteroscopic biopsies?

A

May require wrapping as small

120
Q

What are the aims of hysteroscopy?

A

Therapeutic
Removal of fibroids, polyps. IUDs and adhesions

121
Q

Where are incisional skin/mucosa specimens taken?

A

GP clinics
Oitpatients

122
Q

What are the advantages of Incisions biopsies?

A

Samples lesion
Can easily be made cosmetically pleasing
High accuracy compared to punches

123
Q

What are the disadvantages of incisional biopsies?

A

If malignant will require further surgery
Can be expensive when compared to other biopsies
Time

124
Q

What are the special considerations for incisional biopsies?

A

Orientation (eg alopecia)
Can be small

125
Q

What is the aim of incisional biopsies?

A

Diagnostic
Visualisation of the lesion healthy tissue junction
Can demonstrate vascular issues

126
Q

What clinical implications may result in an incisional biopsy?

A

Inflammatory conditions
Should not be used for Melanoma - seeding

127
Q

What organs can be visualised using laparoscopy?

A

Liver
Pancreas
Gallbladder
Uterus
Fallopian tubes
Ovaries
Kidneys

128
Q

Where is laparoscopy carried out?

A

In theatre under general anaesthetic

129
Q

What are the advantages of laparoscopy?

A

Less pain
Small incision point
Less scarring
Quicker recovery

130
Q

What are the disadvantages of laparoscopy?

A

Technically challenging
Difficult to control bleeding
Limited tactile feedback
Organ damage
Hernias

131
Q

What are the aims of laparoscopy?

A

Therapeutic
Diagnostic
Visualisation

132
Q

Where are mammotome procedures carried out and on which organ?

A

Breast

Within breast clinic outpatients
Local anaesthetic
Ultrasounday also be used to guide the mammotome

133
Q

What are the advantages of a mammotome?

A

Allows for accurate diagnosis without the need for surgery
Minimal scarring, pain and recovery

134
Q

What are the advantages of a mammotome?

A

Allows for accurate diagnosis without the need for surgery
Minimal scarring, pain and recovery

135
Q

What are the disadvantages of a mammotome?

A

Not suitable for lesions >2cm
Can have a high false negative rate
Can have high inadequate rate
Higher costa
Can lead to hematoma
Residual tumour may exist

136
Q

Which organs can be sampled with a needle core biopsy?

A

Breast
Lymph nodes
Kidneys
Liver
Prostate
Pancreas
Spleen
Thyroid
Lungs
Tonsils
Adenoids

137
Q

Where are needle core biopsies carried out?

A

Outpatients
Radiology

Local anaesthetic

138
Q

How are needle biopsies treated in the lab?

A

Straighten core
Wrap
Handle with care
Levels +/- spares at cutting

139
Q

What are the advantages of needle core biopsies?

A

More material than FNAs
Less invasive than surgical bopsies
Maintain architecture

140
Q

What are the disadvantages of needle core biopsies?

A

Expensive
Can be inconclusive
Slower than FNAs
Require specialist training

141
Q

What is the aim of needle core biopsies?

A

Diagnostic

142
Q

What special considerations do needle core biopsies require?

A

Friable
Easily damaged
Need straightening before processing

143
Q

What are the disadvantages of open surgery?

A

Long recovery
Anaesthetic risks
Scarring
Normal complications of surgery

144
Q

What is the aim of open surgery?

A

Generally therapeutic
Can be used diagnostic ally but usually all other options are exhausted first

145
Q

What are the special considerations of specimens received die to open surgery?

A

All considerations are specific to the specimen type
May be a frozen section to confirm, correct tissue is samples or that margins are clear before the surgery is complete

146
Q

Where are pipelle specimens taken?

A

Colposcopy

+/- local anesthetic

147
Q

How are pipelle specimens described?

A

Scanty/miderate/bulky curettings of Endometrium measuring (Semi-quantitive estimate of volume)

148
Q

How are pipelle specimens handled in the lab?

A

Process all
May require wrapping
May be scanty
Note for enbedding

149
Q

What are the advantages of a pipelle biopsy?

A

Less expensive
Less discomfort
Highlysensitive for abnormal changes
High accuracy for endometrial cancer

150
Q

What are the disadvantages of a pipelle?

A

Limited capacity for polyps and focal lesions
Not advised if patient has infections, clotting disorders, PID or is pregnant

151
Q

What is the aim of a pipelle?

A

Diagnostic

152
Q

What special considerations are needed with pipelle specimens?

A

Can be very small
Wrap
Easily crushed

153
Q

What is a punch biopsy?

A

Removal of skin or mucosa using a cylindrical sharpened tool (punch). The punch is rotated back and forth to cut to the required depth, the lifted. The base is cut with a knife, scissors or scalpel

154
Q

Where are unchexcisions carried out?

A

GP surgery
Outpatients

155
Q

Typical punch description?

A

A punch of skin/mucosa measuring 2/3 dimensions. Description of surface and any appropriate margins.

156
Q

How are punches handles in the lab?

A

Bisect if >5mm.
Process all
Embed longitudinally
Levels at sectioning

157
Q

What are the advantages to punch biopsies?

A

Easy to perform
Uniformly shaped tissue
Low risks to patient
Shows fill thickness of akin/mucosa

158
Q

What are the disadvantages of Pinch biopsies?

A

Can produce inadequate samples
Doesn’t show deep tissue
Limited size

159
Q

What are the special considerations of punch biopsies?

A

Not used for Melanoma
Orientation us very important, especially in alopecia cases

160
Q

What is the aim of a punch biopsy?

A

Diagnostic
Therapeutic if small lesion

161
Q

What is a resection specimen?

A

A surgical procedure that removes part or all of an organ, tissue or structure. Some have specific names

162
Q

Where are resection specimens taken?

A

Theatre
Under general anesthetic

163
Q

What are the advantages and disadvantages of resection specimens?

A

Depend on the specimen type and pathology being removed. All surgeries are weighted against the risk of the pathology being untreated

164
Q

What is the aim of a resection specimen?

A

Therapeutic
Some involve complete removal and hope to prevent reoccurance others reduce symptoms only

165
Q

What is a shave excision in the skin?

A

A razor-like tool is used to remove any lesions that are limited to only the superficial layers of the skin

166
Q

Where are skin shaves carried out?

A

GP surgeries
Outpatients

Without anesthetic

167
Q

What is a typical description of a skin shave specimen?

A

Shape of skin
Size, 3 dimensions
Appearance and any margins I’d applicable

168
Q

How are skin shave specimens dealt with in the lab?

A

All processed
Bisect if >5mm
Embed on edge if possible
Ink base

169
Q

What are the advantages of a ad kin shave?

A

Cheap
Little skill to perform

170
Q

What are the advantages of a skin shave?

A

Cheap
Little skill to perform

171
Q

What are the disadvantages of a skin shave?

A

Can cause scarring
Further surgery required if the deep margin is involved

172
Q

What is the aim of a skin shave?

A

Therapeutic for benign conditions

173
Q

What is a breast shave excision?

A

Re-excision of a previous surgery revolving around a specific margin. Some are done at the first surgery if the Clinician feels more of a margin is required whilst other occur weeks later when the report states margins are still involved

174
Q

Where are breast shaves performed?

A

Theatres

General anaesthetic

175
Q

What is a typical description for a breast shave?

A

A piece of FFT measuring… And weighing… There is a suture indicating the new cut surface, this is inked… The opposite is inked… On slicing there is a cavity/lesion measuring and description if applicable. This lies and margin measurements

176
Q

How is a breast shave handled with the lab?

A

At least 2 colour inks
Serially sliced
All ptocessed

177
Q

What considerations are there when dealing with breast shaves?

A

Dissect in oder to show a plane that passes through the new cut surface and the old one.
The shave may be completely negative. Any residual tumour left after the initial surgery may have been removed with diathermy

178
Q

What is the aim of a breast shave?

A

Therapeutic
Prevent reoccurances

179
Q

What is a suction biopsy?

A

Biopsy taken with the aid of suction inorder to obtain a larger specimen size
Can be VAB - breast, muscle or nerve - rectum

180
Q

Where are suction biopsies taken?

A

Outpatients
Specialist GP surgeries

Local anaesthetic, rectal do not need anesthetic

181
Q

Typical suction biopsy description?

A

Count
Measure +/- weight

182
Q

How are suction biopsies dealt with in the lab?

A

Process all
May need wrqpping
Levels +/- spares depending on protocol

183
Q

What are the advantages of suction biopsies?

A

Little or no scarring
Accurate
Safe
Can be used with imaging
Larger yield

184
Q

What are the disadvantages of suction biopsies?

A

Bruising
Tenderness
Can miss the lesion if no imaging
No margins so more surgery if malignant

185
Q

What is the aim of a suction biopsy?

A

Diagnostic
Therapeutic ally if proven benign lesion

186
Q

What is a trephine?

A

A specialist needle that is used for taking a core of bone marrow for disorders and haemotological malignancies

187
Q

Where are trephine biopsies performed?

A

Outpatients

Local anaesthetic

188
Q

What is a typical trephine biopsy description?

A

Count
Measure

189
Q

How are trephine biopsies handled in the lab?

A

Decalcification for 24hrs only
All processed
Wrap
Levels and spares at disection

190
Q

What are the advantages of trephine biopsies?

A

Can confirm bone marrow involvement
Able to confirm several diagnoses

191
Q

What are the disadvantages of trephine biopsies?

A

Invasive
Sampling errors
Requires decalcification = delayed result

192
Q

What considerations are there with trephine biopsies?

A

Impact on IHC of decalcification
Would HODS be a better test?

193
Q

What is the aim of trephine biopsies?

A

Diagnostic

194
Q

What is a wedge resection?

A

Removal of a wedge shaped bit of tissue. It usually removes the lesion and a small margin, usually lesions <5cm

195
Q

What organs can have a wedge excision taken from them?

A

Skin - ear, lip and eyelid
Lung
Liver

Rarer
Ovary
GI tract

196
Q

Where are wedge excisions performed?

A

Outpatients for skin with local anaesthetic

Theatres for internal organs with general anaesthetic

197
Q

What are the advantages of a wedge resection?

A

Less invasive than full resection
Preserves more organ functiin

198
Q

What are the disadvantages of a wedge resection?

A

Can have high reoccurance rates
Lower survival rate for certain cancers - eg lung

199
Q

What are the special considerations for wedge resection?

A

Sampling is usually different from that of a normal resection
Margins need careful consideration as may not be obvious

200
Q

What is the aim of a wedge resection?

A

Usually therapeutic
Can be diagnostic

201
Q

What is a TURP?

A

Transurethral resection of prostate

Sampling of the prostate using a resectoscope (endoscope with diathermic loop attached). Passed through the urethra into the prostate. Tissue is cut away by the loop into the bladder which is then flushed to collect the sample.

202
Q

Where are TURPs carried out?

A

Theatres

General anaesthetic

203
Q

What is a typical description for a TURP?

A

Multiple prostate chips weighing…

204
Q

How are TURP specimens dealt with in the lab?

A

If small everything is processed
If large the first 12g are processed then an additional 2g for every extra 5g of weight

205
Q

What are advantages of TURP specimens?

A

Can be useful when TRUS is not possible
Not usually used for malignancy but if patient is too ill it can help prolong life/lessen symptoms

206
Q

What are the disadvantages of TURP specimens?

A

Can lead to urinary incontinence
Erectile disfunction
Urethral strictures
Infertility

207
Q

What is the aim of TURP specimens?

A

Therapeutic, mainly for prostatic hyperplasia

208
Q

What can bronchoscopy diagnose?

A

Infections - bacterial, viral, fungal, parasites
Lung damage
Autoimmune disorders
Cancer

209
Q

What are the advantages of bronchoscopy?

A

Quick
Little preparation
Quick recovery
Low risk of complications

210
Q

What are the disadvantages of bronchoscopy?

A

Can lead to bleeding
Irritation
Voice box spasms
Seisures
Cardiac arrhythmias
Heart attack

211
Q

What are the advantages of cystoscopy?

A

Early detection
Video recording

212
Q

What are the disadvantages of cystoscopy?

A

Infections
Bladder spasms
Urinary retention
Biopsies only

213
Q

What is a TRUS?

A

Transrectal ultrasound

Ultrasound that is used to guide a needle through the rectal wall and into the prostate gland

214
Q

What are the advantages of a TRUS biopsy?

A

Lower risk or urinary retentiin
Low cost

215
Q

What are the disadvantages of a TRUS biopsy?

A

Limitations in targeting
Risk of infection

216
Q

What special considerations are needed for TRUS biopsies?

A

Very fragile - crush artefact
Lie straight before proceaaing

217
Q

What is a SLNB?

A

Sentinel lymph node biopsy

Sampling of the first lymph node or group of nodes that drain the site of a malignancy

218
Q

What parts of the body are sampled?

A

Any sites can be sampled.
Common are lymph nodes following malignant Melanoma diagnosis and anxillary clearance following breast cancer

219
Q

What is a typical description for a SLNB?

A

A lymph node measuring…
Describe unusual features on external and internal surfaces

220
Q

What are the advantages of a SLNB?

A

Less invasive than full removal
If lymph node is normal, preserves functuon
Determines metastases, staging
May help determine patient pathway

221
Q

What are the disadvantages of a SLNB?

A

Can lead to infection
Bleeding
Nerve damage
Lymphedema
Can lead to repeat surgery if positive for spread
Hugh false positive rate

222
Q

Where can needle cores be taken from?

A

Breast
Axilla
Lymph nodes
Abdominal
Kidney
Spleen
Liver
Thyroid
Parathyroid
Thymus
Tonsil
Adenoid

223
Q

Where can punch biopsies be taken from?

A

Cervix
Vulva
Vagina
Vaginal vault
Skin
Lip
Buccal mucosa
Scalp

224
Q

What can be sampled during laparoscopy?

A

Adrenal gland
Kidney
Spleen
Liver
Peritoneum
Ovary
Fallopian tube
Pouch of douglas
Parametrium
Adrenal
Ligation or salphingoectomy

225
Q

What can be sampled during bronchoscopy?

A

Lung
Bronchial biopsies
Voice box
Larynx
Pharnyx

226
Q

Skin specimen types?

A

Shave
C&C
Punch
Incisional
Excisional
Mohs micrographic surgery
Wide local excision
Cysts

227
Q

Breast specimen type?

A

Fine needle aspirations
Needle core
Vacuum assisted biopsy
Punch biopsy
Vacuum assisted excision
Breast reduction
Excisional biopsy
Benign lumpectomy
Wide local excision
Mastectomy
Sentinel lymph nodes
Ductectomy/dochectomy
Axillary clearance
Shave
Scar revision

228
Q

What specimens can be taken from the gastrointestinal tract?

A

Mucossal biopsies
Polypectomy
Appendectomy
Intestinal resections
Cholecystectomy
Pancreatectomy
Laparoscopic biopsies
Wedge of liver

229
Q

What specimens can be received from the endocrine system?

A

Adrenal gland resection
Parathyroid
Thyroid resection
Hemithyroidectomy
Needle core biopsies
FNAs

230
Q

What specimens can be taken from the genitourinary tract?

A

Mucossal biopsies
Bladder tumour curettings
Transperianal biopsies (needle core)
TRUS biopsy
TURPS
Cystectomy
Resection (bladder, prostate, testis, penile, foreskin, kidney, ureter, urethra)
Penile skin incisions/excisions
Needle biopsies - other sites

231
Q

What specimens can be taken fro head and neck?

A

Mucossal biopsies
Mucossal excisions
Cysts
Lipomas
Salivary glands
Nasal polyps
Tonsils
Fine needle aspirations
Needle biopsies
Cancer resections

232
Q

What specimens can be taken from the gynaecological tract?

A

Fine needle aspirw
Peritoneal washings
Ascites
Pipelle biopsy
D&C
D&E
Hysteroscopic biopsies
Laparoscopic biopsies
Endocervical biopsy
HPV testing
Pap smear
Colposcopy biopsy
LLETZ or knife cone
Amputation of the cervix
Polypectomy
Oophorectomy
Salphingectomy
Myomectomy
Hysterectomy
Placentas
POCs/STOPs
Ectopic pregnancies
Cysts

233
Q

What specimens can be received from endoscopy?

A

Gastric
Ampulla of vater
Antral
Common bile duct
Adrenal
Pancreatic
Oesophageal
Pharyngeal
Laryngeal
Vocal cord
Epiglotal
Nasopharynx
Orophaynx
Tracheal
Fundal
Pharynx
Pyloric
Bladder
Tonsil
Adwnoid
Duodenal
Jejunal
Caecal
Ascending, transverse, descending, sigmois colon
Rectum
Anal canal
Ileum
Splenic flexure
Hepatic flexure

234
Q

What specimens are received from autopsy?

A

Brain
Heart
Lungs
Liver
Kidney
Stomach
Spleen for toxicology
Any other areas of concern

235
Q

What kind of specimens can be classed as lumpectomies?

A

Wide local excisions
Magseed guided excisions
Major duct excisions
Sentinel lymph nodes
Axillary clearance
Cavity shaves
Nipple
Areola

236
Q

What kind of specimens can be classed as lumpectomies?

A

Wide local excisions
Magseed guided excisions
Major duct excisions
Sentinel lymph nodes
Axillary clearance
Cavity shaves
Nipple
Areola

237
Q

What is a TUS?

A

Transabdominal ultrasound

238
Q

What is a TUS?

A

Transabdominal ultrasound

239
Q

What is PET?

A

Position emission tomography

DEP Paper 1 (5 decks)

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