骨肿瘤活检标准流程.ppt

Biopsy,骨肿瘤活检流程,术前活检术中冰冻术后病理,simpletechnique,theindicationsofcarefullyselectedthechoiceofneedle(methods)theappropriatesettingtheanatomicsite,thedistributionoftissuethepotentialneedforadjuvanttreatment,病理学家,影像人员,肿瘤学家,活检,活检有必要吗？所有骨肿瘤都必须活检吗？怎样进行恰当的活检？活检标本怎么处理？活检增加危险性吗？,obtainingtheappropriateprebiopsystagingstudies,HistoryPlainradiographsRoutinelaboratoryworkBonescintigraphyCTand/orMRimagingChestradiographyandCTscanningObviatetheneedforbiopsy,benignbonetumorprimarymalignantbonetumormetastaticbonetumorLaststepofstage,明确诊断,肿瘤分期证实肿瘤的特性肿瘤的范围是否是转移瘤解释影像学表现或改变影像学的结果局部复发,活检的意义,活检有必要吗？所有骨肿瘤都必须活检吗？怎样进行恰当的活检？活检标本怎么处理？活检增加危险性吗？,Not:classicosteochondromaorosteoidosteomaobservation:latentoractiveandnonprogressive(Ennekingstage1or2)nonossifyingfibromaorenchondroma.Biopsy:progressive,aggressive(Ennekingstage2or3),ormalignant,活检有必要吗？所有骨肿瘤都必须活检吗？怎样进行恰当的活检？活检标本怎么处理？活检增加危险性吗？,活检技术,方法的选择穿刺部位的选择器具的选择穿刺人员的配备CT、B超引导,方法,OpenBiopsy（goldstandard）incisionalbiopsyexcisionalbiopsyClosedBiopsyFine-NeedleAspiration(FNA)CoreNeedleBiopsy(CNB)TrephineBiopsy,器械,SoftTissueBiopsyNeedle,corebiopsy,MicheleTrephine,JorVetBoneMarrowNeedle,Aspir-Gun,Fineneedleaspirationbiopsy,活检部位选择,决定要取材的肿瘤部位活检道要考虑外科手术在一个间室内远离血管神经束,穿刺部位选择,能够手术切除,离肿瘤最表浅部位,2019/11/18,22,可编辑,Biopsytract,穿刺点的选择,髓腔内取材低度恶性,中心取材软骨肉瘤,肿瘤边缘取材骨肉瘤,T1低信号T2高信号,远离血管神经束,skin,corticalwindow,drain,CT引导,活检有必要吗？所有骨肿瘤都必须活检吗？怎样进行恰当的活检？活检标本怎么处理？活检增加危险性吗？,事先明确病理检查的手段与病理人员协商多点取材标本放在生理盐水纱布上,FNB,涂片染色,细胞学,冰冻免疫组化培养,形态学,CNB,活检有必要吗？所有骨肿瘤都必须活检吗？怎样进行恰当的活检？活检标本怎么处理？活检增加危险性吗？,活检的危险,加速肿瘤生长促进转移局部扩散局部容易复发（切开活检更容易）血管神经损伤切口不愈合或感染病理骨折,（尚无证据）,取材诊断方面,errorsindiagnosis,particularlyingradeinheterogeneoustumorsobtainingnondiagnosticorindeterminatetissueinabilitytoperformresearchstudiesorspecialdiagnosticstudies,Mankin等,year19821996cases329597errors18.2%13.5%complications17.3%15.9%unnecessaryamputations4.5%3%,Inapriorstudy,2wereportedthatsarcomawascorrectlyrecognizedin61(84%)of73consecutiveaspirationsfrom67patientswithsoft-tissuesarcoma,obviatingtheneedforopenbiopsyinmost.Inanotherstudy,wereportedthatinprimarybonetumors,48of66(73%)consecutiveFNABsofprimarybonetumorswerediagnostic.,FNAB,FNABissuccessfulinthediagnosisofbonemalignancies.Previousstudieshaveshownittobehighlyaccurateindiagnosingosteosarcoma,myeloma,andEwingssarcomaaswellasotherbonysarcomas.Inourexperience,FNABcancorrectlyidentifybonysarcomasin93%ofcasesinwhichadequateaspirationspecimensareobtained.,FNABisexcellentatconfirmingthediagnosi