1、Biopsy,骨肿瘤活检流程,术前活检术中冰冻术后病理,simple technique,the indications of carefully selected the choice of needle(methods)the appropriate settingthe anatomic site,the distribution of tissuethe potential need for adjuvant treatment,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？,obtaining the
2、 appropriate prebiopsy staging studies,HistoryPlain radiographsRoutine laboratory workBone scintigraphyCT and/or MR imagingChest radiography and CT scanningObviate the need for biopsy,benign bone tumorprimary malignant bone tumormetastatic bone tumorLast step of stage,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
3、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:classic osteochondroma or osteoid osteoma observation: latent or active and nonprogressive (Enneking stage 1 or 2) nonossifying fibroma or enchondroma. Biopsy:progressive, aggressive (Enneking stage 2 or 3), or malignant,活检有必
4、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,Open Biopsy （gold standard ） incisional biopsy excisional biopsyClosed Biopsy Fine-Needle Aspiration (FNA) Core Needle Biopsy (CNB) Trephine Biopsy,器械,Soft Tissue Biopsy Needle,core biopsy,Michele Trephine,JorVet Bon
5、e Marrow Needle,Aspir-Gun,Fine needle aspiration biopsy,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,Biopsy tract,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,cortical window,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
6、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,errors in diagnosis, particularly in grade in heterogeneous tumors obtaining nondiagnostic or indeterminate tissue inability to perform research stu
7、dies or special diagnostic studies,Mankin等,year 1982 1996 cases 329 597errors 18.2% 13.5%complications 17.3% 15.9%unnecessary amputations 4.5% 3%,In a prior study,2 we reported that sarcoma wascorrectly recognized in 61 (84%) of 73 consecutiveaspirations from 67 patients with soft-tissue sarcoma,obv
8、iating 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,FNAB is successful in the diagnosis of bone malignancies.Previous studies have shown it to be highlyaccurate in diagnosing ost
9、eosarcoma, 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 tumor,FNAB,小结,活检对骨肿瘤的诊断是有帮助的活检对某些骨肿瘤的诊断、治疗是有必要的活检技术必须规范化并非所有的骨肿瘤都有必要进行活检病理结果仅供参考活检是有风险的（并发症、误诊等）,
