1. Abdominal Biopsy Techniques
KAKUI Shigeru DVM
Miyazaki JAPAN

2. Good Oncology Practice
Biopsy,Biopsy,Biopsy

3. Accuracy of Biopsy (Low to High)
FNA
Needle Punch
Incisional biopsy
Excisional biopsy

4. Patient Risk (Low to High)
FNA
Needle Punch
Incisional biopsy
Excisional biopsy

5. Biopsy
Always the surgeons responsibility!

6. Value of Biopsy
“If the histological diagnosis is incorrect,every subsequent step in the management of the patient may also be incorrect”

7. Positive Attitude “give the patient the benefit of doubt”
“do not doom the patient without knowing what you are treating”

8. Common Excuses for not Performing Biopsy
“the owner refuse to pay for it”
“the result will not matter anyway”
I know the owners will not elect adjunctive therapy anyway”
“no matter what it is, the animal will eventually die from it anyway”
“pathologists are always wrong”

9. Withrow
“if a mass warrants surgical removal, it warrant tissue analysis”

10. Medical Oncologist
“there is no body cavity which cannot be reached by a strong arm and a 16 gauge needle”

11. Multidisciplinaly Approach-Cancer
Oncologist
Nutritionist
Surgeon
Radiologist
Pathologist

12. Abdominal Exploration
Complete your exploration first
unless:
Active hemorrhage
Gross contamination
Lesion obstructs vision

13. Incisional vs. Excisional Biopsy
Decision Making:
1.Will full excision be potentially curative?
2.Will excision of entire lesion improve patient’s condition

14. Incisional vs. Excisional Biopsy
Decision Making:
3.Will excision cause significant problems?
Hemorrhage, ischemia,
increase operative time
4.Is there hope for success with non surgical treatments?

15. Excisional Biopsy-Advantages
“If in doubt, cut it out”
1.Less seeding tumor cells
2.Diagnostic and therapeutic

16. Incisiosional Biopsy Conciderations
Need diagnosis before excision?
Type or extent of treatment altered
Client consent for treatment altered
Reconstruction difficult
Likelihood for morbidity or mortality

17. When to Biopsy Abnormal tissue Appearance
Supports reason for exploratory
Tumor staging; metastatic involvement

18. When to Biopsy Normal tissue Appearance
Potential for involvement of “normal” appearing tissue
Diagnostics indicate disease in “normal” appearing tissue

19. Where to Biopsy Sample lesion including “normal” adjacent tissue
Sample various areas in diffuse conditions, Inflammatory or infected tissue

20. Equipment and Materials
Bakers biopsy punch
Needle punch biopsy
Gelfoam
Suture material
General surgery pack

21. Principles of Biopsy Limit tumor seeding Control contamination
Minimize manipulation
Provide representative sample
Do not limit Surgicul excision

22. Biopsy Tips Hemorrhage Control Digital pressure
Ligate local supplying vessesls
Gelfoam
Omental “tack”technique

23. Biopsy Tips Minimize Sample Artifact Stay suture manipulation
Use 4x4 sponges as “cutting board”

24. Proper Biopsy Preparation
Cut into sections after excision
Specimens<1cm thick
1:10 ratio formalin: tissue volume

25. Liver Biopsy General indications Liver size changes
Abnormal laboratory tests
Benign vs. Malignant processes
Assess liver disease
Evaluation treatment of liver disease

26. Open Liver Biopsy
Excisional biopsy; primary hepatic neoplasms, singular metastatic nodules
Incisional biopsy; diffuse diseases, multiple nodules

27. Liver Biopsy Contraindication; Coagulation abnormalities
No bleeding tendencies;Screen activated clotting time,platelet count
Suspect bleeder; coagulation profile treat first.

28. Baker’s Biopsy Punch Technique
Isolated liver lesion
Deeply located lesion

29. Guillotine Method
Difuse liver disease
Isolated lesion at periphery

30. Spleen Biopsy Indications; Excisional biopsy Large splenic masses
Incisional biopsy
Difuse disease
Regenerative vs. malignant processes

31. Spleen Biopsy Bakers Punch Technique Guillotine Technique
Mattress Suture Technique
TA stapler Technique

32. Hollow Organ Biopsy Principles; Gentle Tissue Handling
Full thickness samples
Protect against contamination
Protect “otomy” site?

33. Intestinal Biopsy Indications
Single Biopsy
Solitary, viable, and nonobstructive amendable to resection
Multiple biopsies
Diffuse processes

34. Intestinal Biopsy Technique
Proper preparation
1-2cm length antimesenteric enterotomy
Prevent excess mucosal eversion
Do not remove >20% circumference

35. Intestinal Closure Remove everted muccosa
Appositional, noncrushing pattern
Transverse vs. longitudinal closure
Omentum or serosal patch coverage

36. Pancreatic Biopsy Principles; Gentle handling Preserve blood supply
Avoid duct areas
No electrocoagulation

37. Pancreatic Biopsy Indications
Excisional Biopsy
Solitary nodules
Incisional Biopsy
Diffuse involvement
Benign vs. malignant processes
Lesions near duct areas

38. Pancreatic Biopsy Techniques
Shave biopsy technique
Guillotine or suture fracture
Peripheral tissue lesions
Diffuse lesions

39. Pancreatic Biopsy Techniques
Wedge incision technique
Needle punch technique
Parencymal lesions in body
Nonresectable masses

40. Lymph Node biopsy Indications; Lymphadenopathy
Benign vs. malignant proccesses
Clinical staging
Paraneoplastic proccess

41. Lymph Node biopsy Liac and mesentric nodes most biopsied
Excisional biopsies unless risk vascular compromise
Stay suture technique

42. Kidney Biopsy Principles Adequate patient prep.
Ensure normal coagulation function
Avoid hilar area

43. Kidney Biopsy Indications Acute vs. chronic disease
Glomerulonephropathies

44. Kidney Biopsy Techniques Needle Punch Biopsy Less hemorrhage, easier
Wedge Biopsy(Preferred)
More consistent samples
More hemorrhage

45. Prostatic Biopsy Principles Avoid central located urethral area
Contain contamination, tumor cells
Examine median iliac LN
Minimal peripheral dissection

46. Incisional Prostatic Biopsy
Indications
Benign vs. malignant disease
Obtain culture specimen,refractory prostatitis

47. Prostatic Biopsy Techniques Needle Punch Poorly exposed areas
Difficult disease
Wedge incision
Requires good exposure
More hemorrhage

48. Conclusions Full benefits of biopsy:
Surgeon’s ability to fully explore the abdomen and recognize abnormalities
Proper indications and technique