Biopsy

00:01 Biopsy is very quick presentation because it's...

00:06 at your level, you will know exactly what I'm talking about.

00:10 You know what is a biopsy? You know the indication, you know the purpose.

00:17 So this is all very straightforward theory.

00:20 But what will be honest, the exam is the types of biopsy.

00:25 So FNAC, commonest things we do are thyroid and breast.

00:31 Common things for FNAC.

00:34 Advantage and disadvantage: simple, cheap, and minimally invasive.

00:39 The biggest disadvantages, it doesn't really show anything.

00:42 It just says there is some cancer cell or there is no cancer cell.

00:46 But if there is cancer cell, you just don't know what type of cancer, you don't know whether the DCIS or LCAS or Foley clot.

00:53 You don't know nothing.

00:54 So that is a simplest form of investigation you do.

00:58 Classically they say, you are the researcher or registrar in the clinic and the boss is away and you have a patient with an enlarged lymph node.

01:07 What investigation can you do then? The only thing you can do is FNA, because that's a simple thing to stick a needle, take some cells out.

01:15 Okay, you just can't leave the patient will go home because your boss is away.

01:18 You need to do something, so you can refer the patient to have an ultrasound or do an FNA.

01:25 Some in us is a fairly basic investigation.

01:29 Similarly, brush cytology, very specific for cervical smear.

01:34 Again, risk and benefit are very similar to FNAC and higher risk of false negatives.

01:40 So it is not a good investigation.

01:41 There are more like screening.

01:44 As you go to core biopsy, this is where you are getting into the real meat of the issue.

01:50 You get, it allows for architectural evaluation.

01:54 But clearly there is risk of bleeding painful, and it may alter morphology.

02:01 What is alter morphology mean? In which condition would you not do a core biopsy? Classically.

02:08 Let's say you have a some tumor.

02:09 I'm talking about some tumor.

02:13 Will alter morphology if you do a core biopsy? Core biopsy is putting a thing and taking core out.

02:19 Melanoma.

02:21 Okay, because melanoma you need to get the brush load depth too accurately.

02:25 You don't want to mess about putting a core in, pulling it out and then the whole architecture is distorted.

02:31 Okay, so that's an absolute contraindication for doing a core biopsy or incision biopsy.

02:37 The only biopsy you're allowed to do in a melanoma is an excisional biopsy.

02:42 Okay.

02:43 So core biopsy very, very commonly do in clinic, breast.

02:48 Okay, so triple assessment, your component, one of the component will be core biopsy.

02:55 Then you have your endoscopic biopsy, which you do to avoid open surgery, operator dependent, risk of bleeding, perforation.

03:12 Apparently, a couple of days ago, they had a patient with a colonoscopy.

03:16 Two days ago and patient returned with splenic rupture.

03:24 Yes, are the investigations done injustice real apparently? So anyway, so they took a biopsy from the cecum for a cecal tumor and two days after the splenic rupture the patient had a perforated bowel from the cecum.

03:41 Because if they were pushing the scope and (inaudible) and hit the spleen.

03:54 And then, they went in took a biopsy from the cecum and got a perforation from that.

03:59 So, I'm sure yeah.

04:04 Okay, so endoscopic biopsy always has a risk of perforations you need to consider that.

04:08 Then the Incisional biopsy, excisional biopsy.

04:11 And now, incision and excision biopsy, usually for skin cancer is very straightforward.

04:16 If you have a big squamous cell carcinoma, if you can cut out the whole thing, go for it.

04:22 There's no point messing about taking a small piece of tissue and bringing the patient again.

04:27 You go for excisional biopsy, just cut the whole thing out.

04:29 But if you can't, you want to have some histology, you go for incisional biopsy.

04:34 That's it.

04:37 Okay, sorry. Anything so far? I think it's all logical, isn't it? Frozen section.

04:43 When do you do frozen section? What's indication? Okay, would you do frozen section thyroid? This tutorial can do for a second, what to say advantage of frozen section? Frozen section, you can do for something a basal cell carcinoma, say on the face, say here.

05:09 You do something that called the mohs, M-O-H-S.

05:12 We come across Mohs, micrographic surgery.

05:15 Mohs, M-O-H-S, is very specialized, that is exactly frozen section.

05:21 Basically let's say, imagine this is the eye, this is the medial canthus and you have BCC here.

05:35 Ideally, if you go for a 3 to 5 millimeter extension model, you will end up cutting out this much.

05:40 Got it? So you can't do that because you are taking on the medial canthus lacrimal duct, etc.

05:45 So that's when you do something called the mohs surgery.

05:49 Mohs, micrographic surgery, where the patient is on table the dermatologist or trail them and cuts it out, since it for frozen section, waits for the report and then if it says in six o'clock position that is bit of tumor, then they cut off that much, then they say okay little bit of here, they cut it out.

06:07 So essentially, they cut on exactly what is required rather than anything more than what is required.

06:14 So in specific anatomic areas is very useful and that's for that unit frozen section.

06:19 So the patient is under general anesthetic or local for the whole duration.

06:23 Sometimes you can take four hours, but the dermatologist probably haven't got anything much anyway, so for us is not bad.

06:30 So any dermatologist here? No.

06:32 I shouldn't say that.

06:33 Anyway, so that is Mohs and that is your frozen section.

06:40 Okay anything on that? That's all they will ask you.

06:43 Punch biopsy.

06:47 That is more like a core biopsy or an incision, so it's a combination of the two.

06:53 So we normally do, in, say, non-healing venous leg ulcers, big ulcer, the best way to take a biopsy.

07:08 It's a core biopsy but there is no core in a non tumors area.

07:14 When they use the word core biopsy, it means it's for tumor.

07:18 Yeah, punch biopsy is same principle, going in, taking it out but it's not a tumor area.

07:28 Yes.

07:29 Yeah, punch biopsy.

07:30 We don't do punch biopsy for breast cancer for exam.

07:33 You need to have a core biopsy is much more sturdy resented.

07:36 You really go make sure.

07:38 It's painful, but yeah.

07:43 Okay, the last bit before the break is local anesthetic.