0:00

Let's discuss another couple of tips on how

0:03

to have both safe and accurate sampling.

0:07

With most core biopsy needles,

0:09

there are really three different options that you can use

0:14

to be able to take biopsies.

0:15

Uh, these do vary a little bit between devices.

0:17

You have to check and see what is available

0:20

with your device and how you do it.

0:22

But there's often two different buttons, one

0:23

and two A and B and so on.

0:26

So the way that I do the vast majority

0:29

of my biopsies is the one step method.

0:32

So I'm gonna position the tip about five millimeters

0:34

proximal to the lesion.

0:36

I'm gonna deploy it, it is going to, uh, fire the needle

0:39

through and take the sample,

0:41

and then I'm going to remove the needle.

0:43

So one step, the two step method,

0:46

you'd again position the tip about five

0:49

millimeters proximal to the lesion.

0:51

In this case, you are going to use the button,

0:54

which will open the chamber, but not take the biopsy.

0:58

So step one, open chamber check its position is okay,

1:02

and then do step two to take the biopsy

1:04

and then remove the needle.

1:05

I rarely use this particular approach.

1:08

I don't find it's particularly advantageous to me.

1:11

Um, but this is something you may want

1:13

to use in certain circumstances.

1:16

The third option, which I do use quite a lot

1:18

as I'll discuss in a moment, is the open chamber method.

1:21

So in this case, I'm going to do that single deploy,

1:23

open the chamber, uh,

1:25

before I ever put the needle into the skin

1:28

or into the introducer.

1:29

If I'm using an introducer, I will position it in the lesion

1:33

and then I will deploy it

1:34

to take the biopsy and remove the needle.

1:37

So which one do I use? Well, generally I'm going to use

1:40

that single step method as I found

1:42

that lesions may push away with you with that two step

1:45

or with the open chamber method in particular.

1:47

However, I do use the open chamber in

1:51

particular circumstances.

1:53

So if I have a very superficial lesion,

1:56

I'm gonna very carefully introduce my open needle into it.

2:00

Um, perhaps I have vessels on the other side of it.

2:03

So, um, for example, in lymph node biopsies in the axilla,

2:07

I'm gonna want to be very clear that I don't want

2:10

to have a big throw

2:12

that might go into a major vessel on the

2:14

other side of a lymph node.

2:16

So may use a one step approach to very carefully wiggle

2:20

that needle forward into that lymph node With implants.

2:24

Again, I often don't want the stroke throw

2:26

to risk going into implant

2:28

or something that's maybe, um, very close to the chest wall.

2:32

And I want to use that open chamber method.

2:35

Again, inserting that needle very, very carefully,

2:39

wiggling it forward, often rotating it a little bit, I find

2:42

that makes it, um, helps it go through

2:44

until it's in the lesion with no risk of, um,

2:48

damaging anything beyond it.

2:50

So here's a little video clip of taking just biopsies

2:54

with irregular one step methods.

2:56

So it's going to advance the open chamber

2:59

And then do the cutting, um, chamber closed all in one go.

3:03

As I said, I start usually about five

3:05

millimeters proximal to the lesion.

3:08

In contrast,

3:09

this clip on the left shows me just gradually advancing

3:14

via an introducer.

3:16

The biopsy needle, the chamber is open,

3:19

getting it into the lesion before it's deployed.

3:22

Um, you can with all of these, see the biopsy chamber sort

3:26

of very clearly.

3:27

If you just rotate your probe a little bit

3:29

to make sure you know exactly where you are,

3:31

and then at that point I will deploy it.

3:34

Another couple of tips.

3:35

If you are using the opioid chamber, I find

3:38

that if you elevate the needle slightly

3:40

before your biopsy, you get better sampling

3:43

as you're just kind of bringing the lesion into

3:46

that sampling chamber.

3:47

And as I said before, if you are having trouble

3:50

with the lesion pushing away as you're trying

3:54

to advance it in this situation,

3:56

try rotating your biopsy needle a little bit

3:58

as you gently advance.

4:01

So how many samples do you need?

4:03

Um, we usually do four

4:05

or more biopsies with a 14 gauge needle or pathologists.

4:08

Uh, often sending these up for a lot of, um,

4:11

additional testing like genetic testings

4:14

and have requested that we do at least four biopsies.

4:17

Obviously, if your sampling's not good,

4:19

you're gonna need to do more.

4:21

I do more for 18 gauge biopsies

4:23

because those are really little dweeby biopsies.

4:27

I usually do more for vacuum assisted biopsies

4:30

to get good sampling in that case.

4:33

And if you need some kind of special testing

4:35

or need more, um, obviously you need to check

4:37

for specimen adequacy each time you do a biopsy.

4:40

So take a look at it.

4:42

The samples are usually gonna go into formula in, um,

4:45

different ways to do that.

4:46

You can squirt it off some saline.

4:48

You can use a needle to pick it off.

4:51

You can wipe it onto a Teflon pad

4:54

and then put that into the sample.

4:56

So whatever works for you at your institution,

4:59

I would not recommend that you dunk your needle in formula

5:02

as formula is toxic

5:04

and not supposed to be then inserted into patients

5:08

for pathology.

5:09

For lymphoma testing, they may require a saline sample

5:14

to be able to do their full testing, uh,

5:16

with the flow cytometry in this case.

5:18

So just check with your local pathology department. I.