Biopsy in bone tumours

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					          Musculo-
Biopsy in Musculo-Skeletal
         Tumors.
         Tumors

 Freih Odeh Abu Hassan,
F R C S (Eng ) F.R.C.S. (Tr & Orth.)
F.R.C.S.(Eng.), F R C S (Tr.& Orth )
      Professor of Orthopedics
        University of Jordan
                Professor Freih Abuhassan -
  1/15/2011                                   ١
                   University of Jordan
 Pillars of the Dx.
A. Clinical Hx. & Exam.
       g g
B. Imaging.
C. Blood tests.
D. Biopsy

             Professor Freih Abuhassan -
 1/15/2011                                 ٢
                University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣
               University of Jordan
Will confirm the Dx.
Guide to the R/
             Professor Freih Abuhassan -
 1/15/2011                                 ٤
                University of Jordan
= Myositis Ossificans
= Stress #


Bx           read as Osteosarcoma
                 Professor Freih Abuhassan -
 1/15/2011                                     ٥
                    University of Jordan
Searching for 1ry tumor
                    mets.
 with obvious bone mets

              Professor Freih Abuhassan -
  1/15/2011                                 ٦
                 University of Jordan
Why we still doing it wrongly ?




              Professor Freih Abuhassan -
  1/15/2011                                 ٧
                 University of Jordan
Most bi i         i l
M t biopsies are simple.

              Professor Freih Abuhassan -
  1/15/2011                                 ٨
                 University of Jordan
                    py
      Poor & bad biopsy
                q
          technique



            Professor Freih Abuhassan -
1/15/2011                                 ٩
               University of Jordan
          Bx.
1.Taking Bx away of the site
of possible future Surgery




             Professor Freih Abuhassan -
 1/15/2011                                 ١٠
                University of Jordan
                            I.M
2. Dissection and opening I M
planes,             ---etc
                    ---etc.
                       etc.
planes joint cavity ---etc
             contamination
     Tumor contamination.




              Professor Freih Abuhassan -
  1/15/2011                                 ١١
                 University of Jordan
3. Hematoma spread of
         cells.
 tumor cells
                       Bx
4. large incision Open Bx.




              Professor Freih Abuhassan -
  1/15/2011                                 ١٢
                 University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ١٣
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ١٤
               University of Jordan
           O Sarcoma
Paraosteal O.Sarcoma
Bx of the tumor surface
interpreted as Osteochondroma.




             Professor Freih Abuhassan -
 1/15/2011                                 ١٥
                University of Jordan
            OPD aspiration




                Professor Freih Abuhassan -
1/15/2011                                     ١٦
                   University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ١٧
               University of Jordan
              597 Patients
Major      i D      13.5%.
M j errors in Dx. = 13 5%
Complication rate =15.9%.
Unnecessary amputations = 3%.


 Mankin et al ,JBJS, 1996.
                   Professor Freih Abuhassan -
  1/15/2011                                      ١٨
                      University of Jordan
Which biopsy t h i
Whi h bi     technique
*   Incisional biopsy !!! ??
*                  (Trucut).
    Needle biopsy (Trucut)
*           biopsy (Jamshidi)
    Trocar biopsy.(Jamshidi)
*              biopsy
    Excisional biopsy.
                Professor Freih Abuhassan -
    1/15/2011                                 ١٩
                   University of Jordan
                  Biopsy?.
Who should do the Biopsy?
= Not the radiologist. Except.!!
= Not the resident Dr.
= Not the Dr who thinks always
           Dr.
  amputation for tumors
= Not the Dr. in the peripheral H.
          Dr.
= Not the Dr who is not dealing
  regularly with Tumors.
    g     y
                Professor Freih Abuhassan -
   1/15/2011                                  ٢٠
                   University of Jordan
Bx. should be done by y
the Surgeon who is
going to do the final R

             Professor Freih Abuhassan -
 1/15/2011                                 ٢١
                University of Jordan
1- Careful studying of the
   imagings
   i    i
2-                    incision.
2 Small longitudinal incision
3- Sharp dissection.
3
      g       y
4- Plug bone by PMMA.
             Professor Freih Abuhassan -
 1/15/2011                                 ٢٢
                University of Jordan
        Site f     i
        Si of the biopsy
                    p
Extra Osseous Component
of the Tumor, Why????
  >Dx (Center necrosed)
* >Dx (Center necrosed)
* To avoid #.
* F.S. can be done quickly.
               Professor Freih Abuhassan -
   1/15/2011                                 ٢٣
                  University of Jordan
5- Drain tract in incision line.
6- Close in layers.
7- Subcuticular ki
7 S b ti l skin.


              Professor Freih Abuhassan -
  1/15/2011                                 ٢٤
                 University of Jordan
1/15/2011   Professor Freih Abuhassan ٢٥
                                      -
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٢٦
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٢٧
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٢٨
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٢٩
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣٠
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣١
               University of Jordan
            General Surgeon biopsy
             Professor Freih Abuhassan -
1/15/2011                                  ٣٢
                University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣٣
               University of Jordan
                                           front




                                          and back

            Professor Freih Abuhassan -
1/15/2011                                            ٣٤
               University of Jordan
            Our technique

              Professor Freih Abuhassan -
1/15/2011                                   ٣٥
                 University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣٦
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣٧
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣٨
               University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٣٩
               University of Jordan
Potentially malignant. T.




              Professor Freih Abuhassan -
  1/15/2011                                 ٤٠
                 University of Jordan
                       lesions.
Only in obvious benign lesions




              Professor Freih Abuhassan -
  1/15/2011                                 ٤١
                 University of Jordan
     e o y be g so
   The only benign soft
      tissue lesions.
Hematoma, Lipoma
H   t     Li




            Professor Freih Abuhassan -
1/15/2011                                 ٤٢
               University of Jordan
Unnecessary B or oper.
U           Bx
   asymp.
on asymp benign lesions




             Professor Freih Abuhassan -
 1/15/2011                                 ٤٣
                University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٤٤
               University of Jordan
FDO.PROGRESSIVA

                  Professor Freih Abuhassan -
1/15/2011                                       ٤٥
                     University of Jordan
Ignoring the team approach



              Professor Freih Abuhassan -
  1/15/2011                                 ٤٦
                 University of Jordan
                Nursing
                N rsing &
                Support staff
psychiatrist                                       Radiologist

                    Surgeon

Oncologist
                                                 Cytopathologist
             Histopathologist


                   Professor Freih Abuhassan -
 1/15/2011                                                       ٤٧
                      University of Jordan
         p
Bx were performed
      g        g
through a large incision
with contamination of
tissues. !!!!!!!

             Professor Freih Abuhassan -
 1/15/2011                                 ٤٨
                University of Jordan
   ‫ﻗﻄﻊ اﻻﻋﻨﺎق وﻻ ﻗﻄﻊ اﻻرزاق‬




               ‫ق‬      ‫ﻗﻄﻊ‬
 ‫ﻊ اﻻﻋﻨﺎق وﻻ ﺑﺘﺮ اﻻﻃﺮاف‬
            ‫- ‪Professor Freih Abuhassan‬‬
‫1102/51/1‬                                 ‫٩٤‬
               ‫‪University of Jordan‬‬
            Conclusion
       y           q
1- Easy but bad sequale
   Bx.
2- Bx by the definitive
 Surgeon
 Surgeon.
3- At the end of staging.
               Professor Freih Abuhassan -
1/15/2011                                    ٥٠
                  University of Jordan
4-Careful
4 Careful studying of the
  imagings
  Risk f
5-Ri k of unnecessary
  amputation
  amputation.
  Limb l
6-Li b salvage
              Professor Freih Abuhassan -
  1/15/2011                                 ٥١
                 University of Jordan
            Professor Freih Abuhassan -
1/15/2011                                 ٥٢
               University of Jordan

				
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posted:10/14/2011
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