How could I have missed that lesion? True confessions of a board-certified veterinary radiologist (Proceedings)

Things I have learned:

     • Assumption: premise: a statement that is assumed to be true and from which a conclusion can be drawn

     • If you make an assumption that is not supported by fact, experience, knowledge, you will eventually make a mistake.

     • Mistake: a wrong action attributable to bad judgment or ignorance or inattention

1. There are only seven disease categories:

     • Congenital

     • Degeneration

     • Inflammatory

          o Infection

          o Autoimmune

     • Metabolic

     • Neoplastic

     • Toxic

     • Traumatic

2. There are only three ways you know what something is:

     • Biological behavior-getting bigger, getting smaller, staying the same

     • Biopsy-fine needle aspirate, core, surgical/wedge

     • Disease specific clinicopathologic testing-immunological or DNA testing

3. A mass, lump, tumor-just means an accumulation of tissue either in excess of what should be present or where it should not be; it does not mean cancer!

4. Very few people detect new diseases; most of us see what we know! So keep learning.

5. Control the situation or the situation will control you.

6. Know what the technology "tells you" i.e. reveals.

7. As important, know what the technology does not "tell you" i.e. does not reveal.

8. Definitions:

     • Congenital: Present at birth

     • Degeneration: deterioration; change from a higher to a lower form, especially change of tissue to a lower or less functionally active.

     • Inflammatory: having to do with inflammation, the body's response to either invading foreign substances (such as viruses or bacteria) or to direct injury of body tissue.

     • Metabolic: refers to the chemical processes of an organ or organism.

     • Neoplastic: pertaining to malignancy, neoplasm

     • Etymology: Gk, neos, new, plassein, to mold.

     • Toxic: relating to, or caused by a toxin or other poison.

     • Capable of causing injury or death, especially by chemical means; poisonous.

     • Trauma: A serious bodily injury or shock, as from violence or an accident.

     • A severely disturbing experience that leads to lasting psychological or emotional impairment.

     • Mass: A cohesive aggregate of often similar components, composition, cells or molecules.

     • Lump: A swelling or small palpable mass.

     • Tumor - an abnormal new mass of tissue that serves no purpose.

     • Biopsy: examination, esp. under a microscope, of tissue from a living body to determine the cause or extent of a disease; the sample taken for such an examination

What type of biopsy:

biopsy /bi.op.sy/ (bi'op-se) removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis.

When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When only a sample of tissue is removed with preservation of the histological architecture of the tissue's cells, the procedure is called an incisional biopsy or core biopsy. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy.

     • aspiration biopsy- biopsy in which tissue is obtained by application of suction through a needle attached to a syringe.

     • brush biopsy- biopsy in which cells or tissue are obtained by manipulating tiny brushes against the tissue or lesion in question (e.g., through a bronchoscope) at the desired site.

     • cone biopsy- biopsy in which an inverted cone of tissue is excised, as from the uterine cervix.

     • core biopsy -core needle biopsy needle biopsy with a large hollow needle that extracts a core of tissue.

     • endoscopic biopsy- removal of tissue by appropriate instruments through an endoscope.

     • excisional biopsy- biopsy of tissue removed by surgical cutting.

     • incisional biopsy - biopsy of a selected portion of a lesion.

needle biopsy - biopsy in which tissue is obtained by puncture of a tumor, the tissue within the lumen of the needle being detached by rotation, and the needle withdrawn. Also called percutaneous biopsy.

     • percutaneous biopsy -needle aspiration biopsy.

     • punch biopsy - biopsy in which tissue is obtained by a punch. Removal of a small cylindrical biopsy specimen by means of an instrument that either directly pierces the tissue or enters through the skin or a small incision in the skin.

     • shave biopsy- biopsy of a skin lesion in which the sample is excised using a cut parallel to the surface of the surrounding skin.

     • stereotactic biopsy - biopsy of the brain using stereotactic surgery to locate the biopsy site.

     • sternal biopsy -biopsy of bone marrow of the sternum removed by puncture or trephining.

Wikipedia

Needle aspiration biopsy (NAB), also known as fine needle aspiration cytology (FNAC), fine needle aspiration biopsy (FNAB) and fine needle aspiration (FNA), is a diagnostic procedure sometimes used to investigate superficial (just under the skin) lumps or masses. In this technique, a thin, hollow needle is inserted into the mass to extract cells that, after being stained, will be examined under a microscope. Fine needle aspiration biopsies are very safe, minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead. In 1981, the first fine needle aspiration biopsy in the United States of America was done at Maimonides Medical Center, eliminating the need for surgery and hospitalization. Today, this procedure is widely used in the diagnosis of cancer[1].

A needle aspiration biopsy is safer and less traumatic than an open surgical biopsy, and significant complications are usually rare, depending on the body site. Common complications include bruising and soreness. There is a risk, because the biopsy is very small (only a few cells), that the problematic cells will be missed, resulting in a false negative result. There is also a risk that the cells taken will not enable a definitive diagnosis.

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Punch Biopsy