Specimen Handling

Numerous samplings have to be performed in different sites of the lesion (1). Most authors believe that the larger the sample of tissue obtained by the biopsy, the easier the histologic

FIGURE 23 Examples of the tangential approach for biopsy of the ribs and sternum, vertebral neural arch, and cranial vault.

diagnosis (9,10). Material should be obtained for both histologic diagnosis and bacteriological studies. Core biopsies for histopathologic examination are fixed in 10% formalin, decalcified, mounted in paraffin block, sectioned transversally, and stained. For electron microscopy, the tissue must be preserved in buffered glutaraldehyde solution. Prints of the tissue core are taken or smears of the needle aspirate are prepared for cytologic examination each time a tumor is suspected. Blood aspirated from the lesion is fixed and analyzed as a bone specimen. It may contain neoplastic cells sometimes not found in the solid tissue. In infection, a lavage of the lesion with several millimeters of sterile saline solution is done if no pus is aspirated. At least one tissue fragment should also be cultured. Samples must be delivered immediately to the laboratories. Blood cultures are sometimes positive in the hours following the biopsy due to the discharge of microorganisms by the lesion opening and should be performed in the hours following the biopsy even if the patient has no fever, each time an infection is suspected. If any question arises as to the proper specimen handling, the microbiologist or the pathologist should be consulted prior to the procedure. Close cooperation with them is imperative. In some cases, when a fragile microorganism is suspected, the bacteriologist should be present in the biopsy room to ensure immediate seeding of specific culture milieus. They must be given all clinical information available. The exact origin of the samples must be indicated in a diagram of the lesion.

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