Abdominal Biopsy
Techniques
KAKUI Shigeru DVM
Miyazaki JAPAN
Good Oncology Practice

Biopsy,Biopsy,Biopsy
Accuracy of Biopsy
(Low to High)
FNA
 Needle Punch
 Incisional biopsy
 Excisional biopsy

Patient Risk
(Low to High)
FNA
 Needle Punch
 Incisional biopsy
 Excisional biopsy

Biopsy

Always the surgeons responsibility!
Value of Biopsy

“If the histological diagnosis is
incorrect,every subsequent step in
the management of the patient may
also be incorrect”
Positive Attitude
“give the patient the benefit of
doubt”
 “do not doom the patient without
knowing what you are treating”

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”

Withrow

“if a mass warrants surgical removal,
it warrant tissue analysis”
Medical Oncologist

“there is no body cavity which
cannot be reached by a strong arm
and a 16 gauge needle”
Multidisciplinaly ApproachCancer
Oncologist
 Nutritionist
 Surgeon
 Radiologist
 Pathologist

Abdominal Exploration
Complete your exploration first
unless:
Active hemorrhage
 Gross contamination
 Lesion obstructs vision

Incisional vs. Excisional
Biopsy
Decision Making:
1.Will full excision be potentially
curative?
 2.Will excision of entire lesion
improve patient’s condition

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?

Excisional BiopsyAdvantages
“If in doubt, cut it out”
1.Less seeding tumor cells
 2.Diagnostic and therapeutic

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

When to Biopsy
Abnormal tissue Appearance
Supports reason for exploratory
 Tumor staging; metastatic
involvement

When to Biopsy
Normal tissue Appearance
Potential for involvement of “normal”
appearing tissue
 Diagnostics indicate disease in
“normal” appearing tissue

Where to Biopsy
Sample lesion including “normal”
adjacent tissue
 Sample various areas in diffuse
conditions, Inflammatory or infected
tissue

Equipment and Materials
Bakers biopsy punch
 Needle punch biopsy
 Gelfoam
 Suture material
 General surgery pack

Principles of Biopsy
Limit tumor seeding
 Control contamination
 Minimize manipulation
 Provide representative sample
 Do not limit Surgicul excision

Biopsy Tips
Hemorrhage Control
Digital pressure
 Ligate local supplying vessesls
 Gelfoam
 Omental “tack”technique

Biopsy Tips
Minimize Sample Artifact
Stay suture manipulation
 Use 4x4 sponges as “cutting board”

Proper Biopsy Preparation
Cut into sections after excision
 Specimens<1cm thick
 1:10 ratio formalin: tissue volume

Liver Biopsy
General indications
Liver size changes
 Abnormal laboratory tests
 Benign vs. Malignant processes
 Assess liver disease
 Evaluation treatment of liver disease

Open Liver Biopsy
Excisional biopsy; primary hepatic
neoplasms, singular metastatic
nodules
 Incisional biopsy; diffuse diseases,
multiple nodules

Liver Biopsy
Contraindication;

Coagulation abnormalities
No bleeding tendencies;Screen
activated clotting time,platelet count
 Suspect bleeder; coagulation profile
treat first.

Baker’s Biopsy Punch
Technique
Isolated liver lesion
 Deeply located lesion

Guillotine Method
Difuse liver disease
 Isolated lesion at periphery

Spleen Biopsy
Indications;

Excisional biopsy
Large splenic masses

Incisional biopsy
Difuse disease
Regenerative vs. malignant processes
Spleen Biopsy
Bakers Punch Technique
 Guillotine Technique
 Mattress Suture Technique
 TA stapler Technique

Hollow Organ Biopsy
Principles;
Gentle Tissue Handling
 Full thickness samples
 Protect against contamination
 Protect “otomy” site?

Intestinal Biopsy Indications
Single Biopsy
 Solitary, viable, and nonobstructive
amendable to resection
Multiple biopsies
 Diffuse processes
Intestinal Biopsy Technique
Proper preparation
 1-2cm length antimesenteric
enterotomy
 Prevent excess mucosal eversion
 Do not remove >20% circumference

Intestinal Closure
Remove everted muccosa
 Appositional, noncrushing pattern
 Transverse vs. longitudinal closure
 Omentum or serosal patch coverage

Pancreatic Biopsy
Principles;
Gentle handling
 Preserve blood supply
 Avoid duct areas
 No electrocoagulation

Pancreatic Biopsy
Indications
Excisional Biopsy
 Solitary nodules
Incisional Biopsy
 Diffuse involvement
 Benign vs. malignant processes
 Lesions near duct areas
Pancreatic Biopsy
Techniques

Shave biopsy technique

Guillotine or suture fracture
Peripheral tissue lesions
Diffuse lesions
Pancreatic Biopsy
Techniques

Wedge incision technique

Needle punch technique
Parencymal lesions in body
Nonresectable masses
Lymph Node biopsy
Indications;
Lymphadenopathy
 Benign vs. malignant proccesses
 Clinical staging
 Paraneoplastic proccess
Lymph Node biopsy
Liac and mesentric nodes most
biopsied
 Excisional biopsies unless risk
vascular compromise
 Stay suture technique

Kidney Biopsy
Principles
Adequate patient prep.
 Ensure normal coagulation function
 Avoid hilar area

Kidney Biopsy
Indications
Acute vs. chronic disease
 Glomerulonephropathies

Kidney Biopsy
Techniques

Needle Punch Biopsy
Less hemorrhage, easier

Wedge Biopsy(Preferred)
More consistent samples
More hemorrhage
Prostatic Biopsy
Principles
Avoid central located urethral area
 Contain contamination, tumor cells
 Examine median iliac LN
 Minimal peripheral dissection

Incisional Prostatic Biopsy
Indications
Benign vs. malignant disease
 Obtain culture specimen,refractory
prostatitis

Prostatic Biopsy
Techniques

Needle Punch
Poorly exposed areas
Difficult disease

Wedge incision
Requires good exposure
More hemorrhage
Conclusions
Full benefits of biopsy:
Surgeon’s ability to fully explore the
abdomen and recognize
abnormalities
 Proper indications and technique
