Biopsy

Question 1

Pros of a Pre-Op biopsy? (Incisional) ?

Answer 1

• BETTER PLANNING ( rst
  chance at Sx is best
  chance!!!)
• Definitive Dx enables pre-op
  radiation (Feline Vaccine
  Associated Sarcoma)

Question 2

Cons of Pre-op Biopsy (Incisional?

Answer 2

• Two procedures
• Progression while waiting to do definitive sx
• Cost
• INC risk of local recurrence*

Question 3

When to do FNA ?

Answer 3

Cutaneous and SC masses select abdo and thoracic under US guidance

-> definitive diagnosis wih MCT, malignant melanoma, lymphoma

Question 4

Describe how Incisional biopsy is done? Use?

Answer 4

Wedge incision - small section of mass removed with scalpel or Baker punch

USE: to grade w tumor (biological activity)

INCREASED chance of local recurrence

Question 5

What can we use for bone biopsy? How to do it?

Answer 5

Jamshidi or Trephine
Biopsy in the CENTRE (periphery may only have reactive bone)

Question 6

Do we biopsy for limb spare?

Answer 6

No typical - cons outweight pros
-> Higher risk of local recurrence

Question 7

2 good reasons to try and FNA?

Answer 7

Egg-shell cortex on Xray
Or
Soft tissue extension

Question 8

Where should u aim on bone biopsy?

Answer 8

CENTRE of lesion
Reactive bone does nott equal benign disease

Question 9

What are soem risks of bone biopsy?

Answer 9

• Inc lameness
• Pathologic fracture
• Non-diagnostic
• Tumor seeding

Question 10

Closure for stomach incisional biopsy?

Answer 10

2 layer
- Simple cont
- Lembert oversew e

Question 11

When is excisional biopsy good?

Answer 11

For MCT
Curative vs diagnostic
=> usually unplanned excision may cause more difficult definitive surgery

Question 12

Describe mammary tumors

Answer 12

50% malignant in dogs and 50% of those metastasize
In CATS 90% malignant

Aspirate and make sure not MCT

Question 13

Splenic tumors?

Answer 13

DONT FNA may bleed

Question 14

Bladder tumor?

Answer 14

= Urotheliql tu;ors => poster child for translocation / Seeding if FNA

Question 15

Lung tumor?

Answer 15

Staging to rule out metastatic dx
Whole body CT ideal
RISK of seeding into body wall, pneumothorax, haemothorax

Question 16

Nasal tumors?

Answer 16

Needle samples difficult due to infection
Use outer stylet of spinal needle => Ram/jam technique

Question 17

Thyroid tumors

Answer 17

Mobile mid cervical ventral neck
FNA cytology guided by US because carotid is close!

Question 18

Should u FNA anal sac tumors

Answer 18

No usually carcinoma and occasionally melanoma
- bleeding & seeding

Instead if anal sac LNs are enlarged enough to safely aspirate take those -> helps owner in decision making

Question 19

Biopsy on intestinal tumors?

Answer 19

• Lymphoma in cats ,adenocarcinoma in dogs
• cause obstruction and blood loss - excisional biopsy typical
  = staging important

Question 20

How to biopsy intestine

Answer 20

Occlude lumen
Punch biopsy
Single layer appositional closure

Question 21

Stomach biopsy?

Answer 21

• incisional biopsy
• 2 layer closure

Question 22

Biopsy of Kidney?

Answer 22

• Tru-cut with 18G at an angle NOT perpendicular to not disturb the blood supply

Question 23

Biopsy of pancreas

Answer 23

• guillotine method
  -wedge