Incisional Biopsy

Incisional biopsies are usually done when a needle biopsy is nondiagnostic or technically not feasible. Common examples include a pancreatic mass in which attempts at obtaining cytology by endoscopic brushings or fine-needle aspiration via endoscopic ultrasound have been nondiagnostic, or for a retroperitoneal mass that is potentially a lymphoma. For these intraabdominal tumors, the minimally invasive laparoscopic approach offers advantages of obtaining adequate tissue material as well as staging information that might not be appreciated by imaging modalities. For tumors outside the abdomen, care should be taken in planning an incisional biopsy to keep the biopsy within the area of the definitive operation. Biopsies of the extremity should be done along the line of the long axis of the extremity (Figure 4.3). An improperly placed trans verse incision on the extremity can lead to an unnecessarily morbid procedure because the definitive resection must achieve negative margins around the area of previous dissection (Figure 4.4). Impeccable hemostasis should be obtained during incisional biopsy procedures because the complication of a postoperative hematoma can lead to the dissemination of tumor cells into tissue planes well beyond the area that would be resected for definitive surgical therapy. For large cutaneous lesions, a punch biopsy represents a form of incisional biopsy that will sample all layers of the skin including the subcutaneous fat (Figure 4.5A). This procedure can be performed under local anesthesia in the outpatient setting using disposable punch biopsy tools (Figure 4.5B).

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