What Is a Core Needle Biopsy?

Acupuncture biopsy, alias acupuncture biopsy, orthopedic / bone tumor surgery / diagnostic surgery.

Needle biopsy

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Acupuncture biopsy, alias acupuncture biopsy, orthopedic / bone tumor surgery / diagnostic surgery.

Needle biopsy

Needle biopsy; needle puncture biopsy; puncture biopsy; puncture biopsy

Orthopaedics / Bone Oncology Surgery / Diagnostic Surgery

77.4002

Needle biopsy (also known as puncture biopsy) has the advantages of simple method, can be performed under local anesthesia in the clinic, puncture damage to the tissue is small, less bleeding, so it is safer,

Needle biopsy is suitable for:

1. When clinical or X-ray examination fails to diagnose bone or soft tissue tumors, and it is difficult to rule out malignant changes, do not wait for observation, and prompt biopsy should be used to confirm the diagnosis.

2. The clinical and X-ray examination results and diagnostic opinions are inconsistent, and it is difficult to determine local or extensive resection in treatment. Even amputees need biopsy to confirm the tumor cell type and degree of differentiation, etc., as the basis for selecting the surgical method.

3. For patients who decide to perform amputation due to malignant tumors, although they have relatively complete clinical examination data and X-ray films before surgery, they still need to have pathological examination to confirm that the pathological examination report of biopsy is necessary for correct diagnosis and treatment. For a strong legal basis.

4. Some parts are deep and the anatomical structure is complicated, such as neck, chest, lumbar spine biopsy is more difficult, you can first use needle biopsy to confirm the diagnosis.

5. Tumors that invade the bone marrow, such as lymphoma, multiple myeloma, etc., the diagnosis of bone marrow aspiration is particularly valuable; for the diagnosis of myeloma or multiple myeloma, sacral puncture is more valuable than sternal puncture. The positive rate is higher.

1. Patients with severe heart, lung, liver, kidney and other organ dysfunction should be carried out with caution.

2. Patients with severe hypertension, diabetes, pulmonary heart disease, emphysema or concurrent systemic infection, high fever and local skin disease.

1. Basically the same as "surgical biopsy", the physician performing the puncture must fully understand the medical history, be familiar with the X-ray image of the tumor site, and be able to analyze the tumor's parenchyma and pathologically representative sites. Familiar with the anatomy of the puncture site and the path of important blood vessels and nerves. To be good at finding the point of puncture, and to reach the tumor through the most direct and less damaging way, it is best to take the needle and take the material under the guidance of X-ray fluoroscopy or CT, ultrasound and other images.

2. Fully prepare special puncture needles for biopsy, their disinfection lists and instruments (cups or bottles for holding specimens, fixed preservation solution), etc.

3. Do the ideological work of the patient well before puncturing, and strive for the cooperation of the patient.

4. Select a suitable biopsy needle for bone and soft tissue tumor biopsy: Ordinary thick puncture needle: 1.5 to 2 mm in diameter and 11 to 12 cm in length (or modified with a thick epidural anesthesia needle). The front end of the outer cannula is evenly serrated to cut the tissue with rotation. The front end of the inner sleeve is slightly longer and sharper, which enhances the penetration of the tissue. After the core is pulled out, the back end of the outer sleeve is connected to 30-50ml. The syringe can suck the tissue cut from the front end; Silverman puncture needle, the outer diameter is 2 2.5mm, and the length is 11 12cm. It consists of an outer tube, a solid needle core, and a split needle core. The usage is basically the same, but the split needle core can clip pathological tissue. The CCASCS biopsy instrument was designed by Hua Jinming et al. (1991). The system is similar in appearance to ordinary puncture needles. It has three layers of inner, middle and outer sleeves. The front end of the sleeve has serrations and side holes. Complete 6 functions including core, clamp, aspiration, spoon, cutting, and rotation scraper. The method of use is similar to the first two types of puncture needles.

Local anesthesia is usually used, but if the puncture site of the chest or lumbar spine is deep, the effect of local anesthesia may not be complete, and basic anesthesia may be increased as appropriate. The prone position is usually taken; the prone position is the best for thorax or lumbosacral biopsy.

1. Select the injection point and local anesthesia, and inject 1% procaine in layers. The needle entry point should be selected in a short-cut area that can directly enter the tumor. It is necessary to grasp the needle insertion direction and depth, and try to avoid large blood vessels and major nerves and organs, so as not to cause accidental injury.

2. The method of needle insertion is generally vertical needle insertion from the skin intact direction (with a beveled core). If the needle is inserted in a thick and tough part of the skin, the skin can be punctured with a small sharp knife and inserted into the needle. If it is estimated that the puncture part has relatively hard bone (spine, clavicle, sacrum), it is advisable to pierce the needle obliquely and rotate the needle to make it easier to penetrate the cortical bone and enter the bone marrow cavity. Pay attention to any large blood vessel damage at any time, especially deep puncture. Take a step deeper and remove the needle core for suction. If there is bleeding, stop observation immediately or change the puncture direction. When the needle tip touched a larger nerve, the patient immediately had a reflex action that seemed to be intense and involuntary. This phenomenon is more common during spinal puncture. If the needle accidentally enters a large blood vessel, as long as it is pulled out in time, the blood vessel wall will constrict itself to close the needle eye to stop bleeding.

3.Tumor tissue is taken about 1 cm deep into the tumor, then the needle core can be pulled out, connected to a 20-50ml syringe, sucked vigorously, or using a lobed needle core, or the accessory of the CCASCS system Can be taken as needed. In the suction-type material extraction, the tumor tissue is continuously sucked by the negative pressure of a large suction, so the negative pressure suction force should be maintained when the needle is withdrawn until the tumor is withdrawn. The surrounding part of the tumor is the most active area for growth and development, so the tissue cells there are the most pathologically representative.

4. Observation of the removed tissue The extracted tissue should be pushed out immediately with a needle core. Observe whether the tumor is indeed tumor tissue with the naked eye. If it is not reliable, the puncture direction and depth can be appropriately adjusted and re-punctured. However, the number of punctures should not be too much, so as not to increase tumor spread. Aspiration samples should be stored and not lost.

Spinal puncture is difficult to locate and is best performed under the surveillance of a CT image enhancement machine CT ultrasound.

5. The puncture of cervical 1-3 vertebrae requires complete anesthesia. Sometimes it can be performed under general anesthesia with nasal intubation. Generally, it is a shortcut to take a puncture from the front of the vertebra. The patient takes an open mouth and pushes the uvula and trachea intubation to one side, and the posterior wall of the pharynx can be fully exposed. The oral cavity can be coated with 0.1% degree milfene, and then rubbed and sterilized with 75% ethanol at the needle entry point of the posterior pharyngeal wall to select a suitable location for needle injection. It is best to use a fluorescent screen to perform vertebral plane positioning. If the tumor has penetrated the vertebral body and a bulge can be seen in the posterior pharyngeal wall, it is easier to determine the plane of the vertebral body required for the needle. A long and thick puncture needle can be used. Generally, it can penetrate 1 to 2 cm deep, and most of them can enter the vertebral body. A large syringe is connected to suck the tumor tissue.

6. Cervical 4 ~ thoracic 1 vertebra puncture In this section, the blood vessels, nerves and trachea in front of the cervical vertebra are concentrated, so it is safer to take a lateral approach. The patient takes the supine position, the head is deflected to the opposite side, and the needle is inserted at the posterior edge of the sternocleidomastoid muscle at the puncture plane of the vertebral body. cm, pull out the needle core and aspirate it once, check whether it has entered the blood vessel by mistake, if there is no blood return, continue to move forward. The desired vertebral body can be reached by penetrating approximately 3.5 cm deep. If you accidentally puncture a blood vessel and draw back blood, you should immediately withdraw the needle and readjust the needle insertion direction. If necessary, you can take an X-ray film at the operating table to determine the needle puncture direction. When the tip of the needle reaches the vertebral cortex of the tumor, there is a sense of needle resistance. At this time, it can be pushed forward 2 to 5 mm to enter the tumor. organization.

7. Thoracic 2-9 vertebrae are best punctured with a vertebral body needle locator designed by Ottolenghi. The advantage is that the angle of the needle has been calculated accurately. Usually, the point of insertion is 4-6cm next to the midline of the spinous process on the back (depending on the height, fat, thinness, and gender). It is usually 4-5cm in the upper lumbar spine and about 5cm in the lower lumbar spine. The angle with the back skin is 35 °. If the puncture needle is stuck in the transverse process or rib, the needle insertion direction can be adjusted slightly. Suction should be performed once every 2 to 3 mm. If a large amount of fresh blood is drawn, the needle must be retracted 1 to 2 cm, and the direction of the needle must be adjusted again. Usually the depth of the vertebral body from the skin penetration point is 6cm or more. If the puncture needle is seen at the pedicle of the pedicle under perspective, only a little further forward can reach the side of the vertebral body. If necessary, take an X-ray at the operating table to confirm that if the position is correct, the needle can pierce the vertebral body. After the needle core is pulled out, connect the syringe and draw several specimens as required.

8. Thoracic puncture from 12 to 5 vertebrae is most commonly used. The method is the same as that of the thoracic vertebral puncture, but the midline of the spinous process should be slightly more than 5cm after the point of the needle is inserted, and the direction of the acupuncture should be 125 ° with the horizontal level of the back. For example, if the <125 ° puncture is in front of the vertebral body, large blood vessels such as the aorta or inferior vena cava can be mistakenly entered, so puncture should be performed with caution. The depth of lumbar puncture is generally 6 to 7 cm, which can reach the vertebral body. If necessary, it can be verified by radiographs.

Acupuncture biopsies cause less damage to patients, fewer complications occur, and there is no special postoperative treatment. However, those with inexperience should still pay great attention, especially the acupuncture biopsy of the spine.