骨肿瘤活检标准流程培训课件

1、术前活检术中冰冻术后病理骨肿瘤活检标准流程10/9/20221术前活检骨肿瘤活检标准流程10/3/20221 simple techniquethe indications of carefully selected the choice of needle(methods)the appropriate settingthe anatomic site,the distribution of tissuethe potential need for adjuvant treatment骨肿瘤活检标准流程10/9/20222 simple techniquethe indicatio病理学家

2、影像人员肿瘤学家活检骨肿瘤活检标准流程10/9/20223病理学家 肿瘤学家活检骨肿瘤活检标活检有必要吗？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？骨肿瘤活检标准流程10/9/20224活检有必要吗？骨肿瘤活检标准流程10/3/20224obtaining the appropriate prebiopsy staging studiesHistoryPlain radiographsRoutine laboratory workBone scintigraphyCT and/or MR imagingChest radiography and CT sc

3、anningObviate the need for biopsy 骨肿瘤活检标准流程10/9/20225obtaining the appropriate prebbenign bone tumorprimary malignant bone tumormetastatic bone tumorLast step of stage明确诊断骨肿瘤活检标准流程10/9/20226benign bone tumor明确诊断骨肿瘤活检标准流程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骨肿瘤活检标准流程10/9/20227肿瘤分期活检的意义骨肿瘤活检

4、标准流程10/3/20227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？骨肿瘤活检标准流程10/9/20228活检有必要吗？骨肿瘤活检标准流程10/3/20228Not:classic osteochondroma or osteoid osteoma observation: latent or active and nonprogressive (Enneking stage 1 or 2) nonossifying fibroma or enchondroma. Biopsy:progressive, aggressive (Enneki

5、ng stage 2 or 3), or malignant骨肿瘤活检标准流程10/9/20229Not:classic osteochondroma or 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？骨肿瘤活检标准流程10/9/202210活检有必要吗？骨肿瘤活检标准流程10/3/202210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超引导骨肿瘤活检标准流程10/9/202211活检技术方法的选择骨肿瘤活检标准流程10/3/202211方法Open Biopsy （gold standard ） incisional b

6、iopsy excisional biopsyClosed Biopsy Fine-Needle Aspiration (FNA) Core Needle Biopsy (CNB) Trephine Biopsy 骨肿瘤活检标准流程10/9/202212方法Open Biopsy （gold standard ） 器械Soft Tissue Biopsy Needle骨肿瘤活检标准流程10/9/202213 器械Soft Tissue Biopsy Needle骨core biopsy骨肿瘤活检标准流程10/9/202214core biopsy骨肿瘤活检标准流程10/3/20221骨肿瘤活检

7、标准流程10/9/202215骨肿瘤活检标准流程10/3/202215Michele TrephineJorVet Bone Marrow Needle骨肿瘤活检标准流程10/9/202216Michele TrephineJorVet Bone MaAspir-GunFine needle aspiration biopsy骨肿瘤活检标准流程10/9/202217Aspir-GunFine needle aspiratio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骨肿瘤活检标准流程10/9/202218活检部位选择决定要取材的肿瘤部位骨肿瘤活检标准流程10

8、/3/穿刺部位选择能够手术切除骨肿瘤活检标准流程10/9/202219穿刺部位选择能够骨肿瘤活检标准流程10/3/202219离肿瘤最表浅部位骨肿瘤活检标准流程10/9/202220离肿瘤最表浅部位骨肿瘤活检标准流程10/3/202220Biopsy tract骨肿瘤活检标准流程10/9/202221Biopsy tract骨肿瘤活检标准流程10/3/2022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 高信号骨肿瘤活检标准流程10/9/202222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远离血管神经束骨肿瘤活检标准流程10/9/202223

9、远离血管神经束骨肿瘤活检标准流程10/3/202223skin骨肿瘤活检标准流程10/9/202224skin骨肿瘤活检标准流程10/3/202224cortical windowdrain骨肿瘤活检标准流程10/9/202225cortical windowdrain骨肿瘤活检标准流程1CT引导骨肿瘤活检标准流程10/9/202226CT引导骨肿瘤活检标准流程10/3/202226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？骨肿瘤活检标准流程10/9/202227活检有必要吗？骨肿瘤活检标准流程10/3/202227事先明确病理检查的手段与病

10、理人员协商多点取材标本放在生理盐水纱布上骨肿瘤活检标准流程10/9/202228事先明确病理检查的手段骨肿瘤活检标准流程10/3/20222FNB涂片染色细胞学 冰冻 免疫组化 培养形态学CNB骨肿瘤活检标准流程10/9/202229FNB涂片细胞学 冰冻形态学CNB骨肿瘤活检标准流程10/3骨肿瘤活检标准流程10/9/202230骨肿瘤活检标准流程10/3/202230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？骨肿瘤活检标准流程10/9/202231活检有必要吗？骨肿瘤活检标准流程10/3/202231活检的危险加速肿瘤生长促进转移局部扩散

11、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）骨肿瘤活检标准流程10/9/202232活检的危险加速肿瘤生长（尚无证据）骨肿瘤活检标准流程10/3取材诊断方面errors in diagnosis, particularly in grade in heterogeneous tumors obtaining nondiagnostic or indeterminate tissue inability to perform research studies or special diagnostic studies 骨肿瘤活检标准流程10/9/202233取材

12、诊断方面errors in diagnosis, parMankin等 year 1982 1996 cases 329 597errors 18.2% 13.5%complications 17.3% 15.9%unnecessary amputations 4.5% 3%骨肿瘤活检标准流程10/9/202234Mankin等 year In a prior study,2 we reported that sarcoma wascorrectly recognized in 61 (84%) of 73 consecutiveaspirations from 67 patients wit

13、h soft-tissue sarcoma,obviating the need for open biopsy in most. In anotherstudy,we reported that in primary bone tumors, 48of 66 (73%) consecutive FNABs of primary bonetumors were diagnostic.FNAB骨肿瘤活检标准流程10/9/202235FNAB骨肿瘤活检标准流程10/3/202235FNAB is successful in the diagnosis of bone malignancies.Pr

14、evious studies have shown it to be highlyaccurate in diagnosing osteosarcoma, myeloma, andEwings sarcoma as well as other bony sarcomas. Inour experience, FNAB can correctly identify bony sarcomasin 93% of cases in which adequate aspirationspecimens are obtained. FNAB is excellentat confirming the diagnosis of giant cell tumorFNAB骨肿瘤活检标准流程10/9/202236FNAB is successful in the diag骨肿瘤活检标准流程10/9/202237骨肿瘤活检标准流