What is Excisional Biopsy?

What is Excisional Biopsy?
Excisional Biopsy is used to completely remove the tumor mass.


What are the indications?/when is it performed?

• When tumor masses are small and discrete, about 2-3 cm in diameter.
• When complete removal with wide excision is possible without any interference.
• Performed when the entire lesion has to be examined.
• When a definitive diagnosis cannot be made from tissue removed by incisional biopsy.
• Eg, superficial squamous or basal cell carcinomas or malignant melanomas.
• Also used for polypoid lesions of the colon, for thyroid and breast nodules, for small skin lesions.

What are the contraindications?/ When is it not performed?

• It is contraindicated in large tumor masses because there are chances of spilling of tumor cells throughout a wide surgical field, which can be corrected only by total surgical resection of that part.
• Eg, skeletal and soft tissue sarcomas.

Excisional Biopsy

Facts :

• The excisional biopsy margins are always marked with sutures or metal clips so that if further excision is needed, the margin of previous excision can be properly located.
• Orientation of biopsy incisions is also extremely important, otherwise additional tissue planes will be opened up unnecessarily.This will lead to wider radiotherapy fields or more extensive ultimate surgical resections.
• Biopsy of tumors in extremities or limbs is done using incisions that run parallel to the long axis of that limb. This will lead to a definitive total or en bloc resection that also includes the biopsy track.
• Biopsy incisions are closed carefully because a hematoma can lead to spilling of tumor cells and contamination of tissue planes.

Biopsy and Lymph Nodes

• Lymph nodes should always be carefully selected for biopsy.
• Enlargement of the upper cervical nodes points at metastases or secondary spread usually caused by laryngeal,oropharyngeal, and nasopharyngeal primary tumors.
• On the contarary, supraclavicular nodes are usualy enlarged due to metastases from  the thoracic or abdominal cavities or breast, which is the primary site.
• Axillary nodes are chosen for biopsy over groin nodes if both are enlarged as this decreases likelihood of postoperative infection.
• Cervical lymph nodes are not biopsied until a primary tumor has been searched using nasopharyngoscopy, esophagoscopy, and bronchoscopy.
• After the biopsy, a specimen is usually sent for pathological exam by preparing a frozen section or a permanent section.
• Frozen sections are made at the time of biopsy itself, and the result can be obtained within 10-20 minutes.

lymph nodes Biopsy

Procedures like mediastinoscopy, laparoscopy (peritoneoscopy), thoracoscopy, exploratory thoracotomy, or even laparotomy are performed to obtain  'representative tissue' samples for microscopic examination to confirm diagnosis or tumor stage.

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Cancer and surgery.
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What is Cancer-related fatigue?
What is psycho-oncology?
12 causes of cancer.
Cancer in 21st century.