MODUL STASE BEDAH ONKOLOGI

INCISIONAL BIOPSY

Gede Wara Samsarga

1771181002
PPDS Bedah Plastik FK UNUD/RSUP Sanglah
DEFINITION

• Biopsy is derived from a Greek word (By-op-see) = Bio – meaning LIFE and
Opsy – TO LOOK
• This is the surgical removal of a tissue specimen in a living body for the
purpose of examination and diagnoses.
 HISTORY

• 1870, Ruge and Joham Vert in Berlin introduced surgical biopsy as an essential
tool for diagnosis.
• 1889, Emarch put forward an argument that confirmations should be made
before surgeries for malignancies.
AIM

 To establish tissue diagnosis

 Grade tumors
 To detect receptors
 For screening purposes
 Monitoring, treatment, recurrence and prognosis
 Research purposes
 Microbiology
INDICATIONS FOR BIOPSY IN SURGERY

 Any lesion that persists for more than 2 weeks with no apparent etiologic basis
 Any inflammatory lesion that does not respond to local treatment after 10 to 14 days.
 Any persistent tumescence, either visible or palpable beneath relatively normal tissue.
 Inflammatory changes of unknown cause that persist for long periods
 Any lesion that has the characteristics of malignancy
CONTRA-INDICATIONS

• Uncontrolled bleeding diasthesis

• Anticoagulant therapy
• Over-whelming sepsis
• Severe impaired lung function
• Uncooperative patient
• Local infection near the site
TYPE OF BIOPSY

 OPEN DIRECT BIOPSY

- Incisional
- Excisional
INCISIONAL BIOPSY

• An incisional biopsy is the surgical sampling of a lesion.

• If a lesion is large or has different characteristics in various locations more than one area
may need to be sampled
INCISIONAL BIOPSY
 Indications:
 Size limitations and ulcerated lesion
 Hazardous location of the lesion
 Great suspicion of malignancy
 Principle:
 Necrotic tissue should be avoided.
 A narrow deep specimen is better than a broad shallow
one.
PRE-OPERATIVE

• A detailed health history

• A history of the specific lesion
• A clinical examination
• A radiographic examination
• Laboratory investigations
• Patient selection
• Proper patient counseling
• Obtain informed consent
• Optimize patient e.g. stop anticoagulants
MEDICAL CONDITIONS THAT WARRANT SPECIAL CARE INCLUDE:

 Congenital heart defects

 Coagulopathies
 Hypertension
 Poorly controlled diabetics
 Immunocompromised patients
 Renal compromise
CHARACTERISTICS OF LESIONS THAT RAISE THE SUSPICION OF
MALIGNANCY.

• Ulceration- lesion is ulcerated or presents as an ulcer.

• Duration- lesion has persisted for more than two weeks.
• Growth rate- lesion exhibits rapid growth
• Bleeding- lesion bleeds on gentle manipulation
• Induration- lesion and surrounding tissue is firm to the touch
• Fixation- lesion feels attached to adjacent structures
CLINICAL EVALUATION

• The anatomic location of the lesion/mass

• The physical character of the lesion/mass
• The size and shape of the lesion/mass
• Single vs. multiple lesions
• The surface of the lesion
• The color of the lesion
• The sharpness of the boundaries of the lesion
• The consistency of the lesion to palpation
• Presence of pulsation
• Lymph node examination
INTRA-OPERATIVE

 Anesthesia
- General, regional, or local
- Do not inject directly into the lesion
• POSITIONING
• ANTIBIOTICS
• ROUTINE CLEANING AND DRAPPING
INCISION

 Incisions should be made with a scalpel.

 Should extend beyond the suspected depth of the lesion
 They should parallel important structures
 Margins should include 2 to 3mm of normal appearing
tissue if the lesion is thought to be benign.
 5mm or more may be necessary with lesions that appear
malignant, vascular, pigmented, or have diffuse borders.
 Longitudinal in the extremities
INTRA-OPERATIVE CONSIDERATION

• Ulcers
- Avoid central necrotic areas
• In deeply situated tissue take whole thickness and normal tissue
• Handle tissues gently to preserve architecture
• Avoid electrocautery for cutting if possible
• Haemostasis
• Drain when indicated, must be within the incision
• Aim at primary closure of wound
HANDLING OF THE TISSUE SPECIMEN

• Direct handling of the lesion will expose it to crush injury resulting in alteration the cellular architecture.
• Specimen should be immediately placed in buffer formalin 10% solution and should be completely immersed
BIOPSY DATA SHEET

• A biopsy data sheet should be completed and the specimen immediately labeled. All pertinent history and
descriptions of the lesion must be conveyed.
• Biodata
• Unit and consultant in charge
• Nature of specimen and provisional diagnosis
• Date of specimen collection
• Previous histology results if any
• Clinical features and operative findings
COMPLICATIONS OF BIOPSY IN SURGERY

• This could be generalized or organ specific

• Generalized :Infection, Hemorrhage, Pain, Tumor upgrading, Ulceration, keloids, Hypertrophic scar, Deformity

• Organ specific :
• Prostate (prostatitis, urinary retention, blood in semen, bleeding rectum)
• Lungs (pneumothorax, hemothorax, empyoma, thoraxes, atelectases)
THANK YOU FOR YOUR ATTENTION