骨肿瘤活检标准流程__培训课件.ppt

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 studies or special diagnostic studies Mankin等 year 1982 1996 cases 329 597 errors 18.2% 13.5% complications 17.3% 15.9% unnecessary amputations 4.5% 3% In a prior study,2 we reported that sarcoma was correctly recognized in 61 (84%) of 73 consecutive aspirations from 67 patients with soft-tissue sarcoma, obviating the need for open biopsy in most. In another study,we reported that in primary bone tumors, 48 of 66 (73%) consecutive FNABs of primary bone tumors were diagnostic. FNAB FNAB is successful in the diagnosis of bone malignancies. Previous studies have shown it to be highly accurate in diagnosing osteosarcoma, myeloma, and Ewing’s sarcoma as well as other bony sarcomas. In our experience, FNAB can correctly identify bony sarcomas in 93% of cases in which adequate aspiration specimens 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） 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 setting the anatomic site, the distribution of tissue the 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 appropriate prebiopsy staging studies History Plain radiographs Routine laboratory work Bone scintigraphy CT and/or MR imaging Chest radiography and CT scanning Obviate the need for biopsy benign bone tumor primary malignant bone tumor metastatic bone tu