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Biopsy Principles Pathway
Updated: Oct 4 2016

Guided Needle Biopsy of Malignant Lesion

Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Radiographic templating

  • template part of the lesion to be biopsied
  • plan the biopsy tract

2

Execute surgical walkthrough

  • describe the steps of the procedure to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • guiding needle

2

Room setup and equipment

  • Standard OR table
  • fluoroscopy

3

Patient positioning

  • depends on the area of the lesion
G

Biopsy Tract

1

Mark incision over lesion

  • define what part of the lesion needs to be biopsied
  • plan the safest anatomic route to the lesion

2

Make a longitudinal incision

  • transverse incisions are contraindicated because of the need for a wider resection at the time of surgery
H

Entry Hole to Bone

1

Create cortical window

  • oblong holes with rounded edges have the greatest residual strength
I

Remove Tissue

1

Use a knife or curette to remove the tissue

  • care must be taken not to crush the sample

2

Send frozen section

  • ensure that the obtained tissue is adequate
J

Hemostasis

1

Seal the cortical window

  • plug the window with methacrylate to limit hematoma formation
K

Wound Closure

1

Perform layered closure

  • use 3-0 vicryl for subcutaneous tissue
  • use 3-0 nylon for skin

2

Place dressings

  • place soft dressings over incision
Postoperative Patient Care
Private Note

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