骨肿瘤活检标准流程课件

Biopsy骨肿瘤活检流程术前活检术中冰冻术后病理simpletechniquetheindicationsofcarefullyselectedthechoiceofneedle(methods)theappropriatesettingtheanatomicsite,thedistributionoftissuethepotentialneedforadjuvanttreatment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？obtainingtheappropriateprebiopsystagingstudiesHistoryPlainradiographsRoutinelaboratoryworkBonescintigraphyCTand/orMRimagingChestradiographyandCTscanningObviatetheneedforbiopsybenignbonetumorprimarymalignantbonetumormetastaticbonetumorLaststepofstage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Not:classicosteochondromaorosteoidosteoma

observation:latentoractiveandnonprogressive(Ennekingstage1or2)

nonossifyingfibromaorenchondroma.Biopsy:progressive,aggressive(Ennekingstage2or3),ormalignant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超引导器械SoftTissueBiopsyNeedlecorebiopsyMicheleTrephineJorVetBoneMarrowNeedleAspir-GunFineneedleaspirationbiopsy穿刺部位选择能够手术切除离肿瘤最表浅部位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corticalwindowdrainCT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？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,particularlyingradeinheterogeneoustumors

obtainingnondiagnosticorindeterminatetissue

inabilitytoperformresearchstudiesorspecialdiagnosticstudies

Mankin等year19821996cases329597errors18.2%13.5%complications17.3%15.9%unnecessaryamputations4.5%3%Inapriorstudy,2wereportedthat

sarcoma

wascorrectlyrecognizedin61(84%)of73consecutiveaspirationsfrom67patientswithsoft-tissuesarcoma,obviatingtheneedforopenbiopsyinmost.Inanotherstudy,wereportedthatinprimarybonetumors,48of66(73%)consecutiveFNABsofprimarybonetumorswerediagnostic.FNABFNABissuccessfulinthediagnosisofbonemalignancies.Previousstudieshaveshownittobehighlyaccurateindiagnosingosteosarcoma,myeloma,andEwing’ssarcomaaswellasotherbonysarcomas.Inourexperience,FNABcancorrectlyidentifybonysarcomasin93%ofcasesinwhichadequateaspirationspecimensareobtained.FNABisexcellentatconfirmin