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Haga clic pa= ra cambiar el estilo de título
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La biopsia en la patología músculo esquelética=
( 1ª par= te)
Dr Manuel González Gaitano
H.U.C.
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Complicaciones y errores
n1982: Henry J. Mankin: The hazard of the = biopsy:
n20% de biopsias están mal realizadas y conducen a un cambio en el tratamiento correcto
n18% dan complicaciones locales= o generales que pueden conducir a diseminación tumoral.
n5% de las amputaciones se deben a biopsias mal = realizadas.
n1996: Henry J. Mankin: the hazard  of the biopsy revisited , = J. Bone Joint Surg. Am. 78: 656-663
nPrácticamente encuentra los mismos error= es.
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COMPLEJIDAD ACT= UAL
nAntes: Hematoxilina & Eosina
nHoy suma:
nCitoqueratina, Vimentina, Desmin= a
nCitometria de flujo <= /span>
nÍndices de ADN
nInmunohistoquimica=
Mayor tamaño de la muestra
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A QUIEN REALIZAR BIOPSIA?
nDon´t Touch Me  (No necesitan biopsia)
nLesiones fibrosas:
nFibroma no osificante
nDisplasia fibrosa
nExostosis
nEncondroma
nQuiste óseo simple.
nA toda lesión dudosa sin filiar o con cambios = inesperados tanto clínicos como de imagen
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QUIEN DEBE REALIZAR LA BIOPSIA?
nThe hazard of the biopsy
nMusculoskeletal Society:
n18% producen error diagnostico&#= 13;
n9% presentaron complicaciones de= la herida
n10% produjeron un cambio en el tratamiento ideal:
n3% de muertes atribuidas a este = cambio de tratamiento
n
= La realizara la persona que ha dirigido el estudio diagnostico o el preoperatorio y que va a relizar el = tratamiento definitivo del tumor
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QUE DEBE SER BIOPSIADO?
La muestra se intentara tomar del centro de la lesi&o= acute;n , ya que si  la toma es periférica  podemos obtener tejido = de la zona reactiva que exist= e en el tumor con el consiguien= te fracaso diagnostico.= 3;
En el caso de las biopsias cerradas beberemos guia= rnos con R.X. o con T.A.C
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file:///C:/E32AAC8D/BIOPSIAm_archivos/slide0006.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation
QUE TIPO DE BIOPSIA = REALIZAR? (en 2ª parte)
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.39em'>nAguja
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.39em'>nTru-cut
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.39em'>nIncisional
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.39em'>nExcisional
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CUANDO SE DEBE REALIZAR = LA BIOPSIA?
nDeberemos realizarla como ultimo paso dia= gnostico, una vez realizados todos los estu= dios de imagen tanto locales como de exte= nsión.
nLa realización previa a los estudios de imagen alterara el resultado de dichos estudios.
nSiempre la realizaremos pensando en la incisión definitiva quirúrgica , pues la cicatriz deber&aac= ute; extirparse con un adecuado margen.
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HUMERO PROXIMAL
= Para evitar contaminar compartimentos, se realizara directamente a la lesión a través de las fibras musculares sin realizar disec= ciones musculares.
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TIPO DE CORTE
En los huesos tubulares= largos deberemos evitar= los cortes angulares en el = hueso para no producir l&iacu= te;neas de stres que facilitaran las fracturas óseas.
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INCISION
La incisión ser&= aacute; siempre longitudinal, <= /b>ya que la  cicatriz deberá ser extir= pada en el acto quirú= rgico definitivo y por otro <= /b>lado la incisión= transversa producir&aac= ute; diseminación de<= span style=3D'mso-spacerun:yes'>  células tumorale= s por varios compartimentos musculares.<= /span>
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Incisión
Masa tumo= ral
Incisi&oa= cute;n Biopsia
Incisión definit= iva con escisión del tra= cto de la biopsia