ABSITE REVIEW: BIOPSY TECHNIQ FOREARM LESION
BIOPSY TECHNIQ FOREARM LESION [J]
THE ABSITE REVIEW, P.86
Technique for biopsy of an extremity soft tissue mass suspected of being a sarcoma
– The incision should be oriented along the long axis of the extremity, at the point where the lesion is closest to the surface, and situated so that it can be readily excised along with the tumor if a diagnosis of sarcoma is made.
– There should be no raising of flaps or disturbance of tissue planes superficial to the tumor.
– The mass should not be enucleated within the pseudocapsule; rather, incisional biopsy leaving the bulk of the lesion undisturbed should be carried out.
– Before wound closure, hemostasis should be achieved to avoid a hematoma, which could disseminate tumor cells through normal tissue planes.
– Drains are not used routinely.
absite review, p.86
SURGICAL REVIEW, P.222
– When a suspicious mass is discovered, especially if it is greater than 5cm in diameter, a tissue sample must be obtained for diagnosis.
– Core needle biopsy is generally the diagnostic procedure of choice and allows for the determination of the histologic type and grade of a sarcoma.
– Alternatively, an open biopsy can be performed and is specifically indicated when a core needle biopsy is nondiagnostic.
– Lesions smaller than 3cm can be completely excised.
– Biopsy incisions should be chosen to allow for subsequent incorporation into the definitive resection.
– Incisional biopsies on the extremities are therefore performed utilizing longitudinal skin incisions.
– In addition, care must be taken to avoid raising tissue flaps, disturbing tissue planes, and creating hematomas to minimize dissemination of malignant cells.
– Fine needle aspiration biopsy is generally not used as the initial diagnostic procedure because of the small amount of material obtained and the ow diagnostic accuracy.
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