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The first 25 slides, exactly as they appear. The full deck has 112 content slides.
Radiology
Image-guided Needle Biopsies and Personalized Medicine
Built from Fundamentals of Diagnostic Radiology
What’s inside
10 sections · 112 slides
Overview
- What this topic covers
Personalized Medicine
Tailoring care to the individual using molecular and genomic data.
- What personalized medicine is
- What a biomarker is
- “
- Why oncology now needs molecular sampling
- The radiologist's role
- The spectrum of personalized medicine
Modalities and Equipment
Image guidance, navigation tools, and the needles that sample tissue.
- What image guidance does
- Fusion, co-registration, and tracking
- Choosing the imaging modality
- Commonly used imaging modalities for planning and image-guided tissue biopsy
- Commonly used imaging modalities for planning and image-guided tissue biopsy (continued)
- Two ways to sample with a needle
- Aspiration versus core needle biopsy
- Aspiration techniques
- Core needle biopsy
- Cytopathologist help during biopsy
Preprocedure Clinical Evaluation
Indication, consent, bleeding risk, anticoagulants, and labs.
- Act as a consultant first
- Get to know the patient
- Informed consent
- Bleeding history and anticoagulants
- Guidelines for periprocedure anticoagulant management
- Labs before biopsy
Biopsy Technique
Setup, ultrasound and CT guidance, and how samples are taken.
- The basic setup
- The path of an image-guided biopsy
- Ultrasound-guided biopsy
- Keeping the needle visible on ultrasound
- CT-guided biopsy
- CT approaches for tricky lesions
- Obtaining the sample
- Core needle biopsy technique
- Why confirm the needle position
- Combined ultrasound- and CT-guided biopsy
Thyroid Biopsy
Nodule workup, fine needle aspiration, and post-biopsy care.
- Thyroid nodules are common
- 2-6%
- Which thyroid nodules to biopsy
- NCCN guidelines for thyroid nodule evaluation
- Thyroid fine needle aspiration
- 70%
- When thyroid core biopsy helps
- Molecular testing of the thyroid
- Thyroid post-biopsy care
Lung, Pleural, and Mediastinal Biopsy
Indications, technique, and the management of pneumothorax.
- When to biopsy the lung
- Lung biopsy pre-procedure
- Lung biopsy technique
- Sampling for lung cancer
- Some commonly used fixative solutions
- CT-guided lung nodule fiducial marker placement and biopsy
- After the lung biopsy
- Post-lung-biopsy care and pneumothorax management
- Pneumothorax after lung biopsy
- 54%
- What raises pneumothorax risk
- Anterior chest wall chest tube for pneumothorax
- Managing pneumothorax
- Hemorrhage and hemoptysis
- Rare lung biopsy complications
Abdomen, Pelvis, and Musculoskeletal Biopsy
Liver, kidney, and other sites, then bone and soft tissue.
- Why biopsy the liver
- Focal liver lesions
- Liver biopsy cautions
- Liver access planning
- Landmark-based CT-guided biopsy
- Transjugular liver biopsy
- Transjugular liver biopsy
- After liver biopsy
- Liver biopsy: pain
- Liver biopsy: bleeding
- Liver biopsy: needle tract seeding
- Other liver biopsy complications
- Why biopsy the kidney
- Renal biopsy can avoid surgery
- 38.5%
- Renal biopsy technique
- Nontargeted renal biopsy
- After renal biopsy
- Renal biopsy bleeding
- Renal bleeding risk factors
- Other renal complications
- Prostate and pancreatic biopsy
- Splenic biopsy
- Gallbladder biopsy
- Adrenal biopsy
- Bowel and peritoneal biopsy
- Lymph node biopsy
- Why biopsy the musculoskeletal system
- Do-not-touch lesions
- Bone biopsy
- Soft tissue biopsy
Sample Analysis, Biomarkers, and the Future
Adequacy, biomarker applications, ethics, and emerging concepts.
- Why sample adequacy matters
- How much tissue is enough
- What a sample actually yields
- Fixatives and sample handling
- How biomarkers are used
- Predictive biomarkers
- Common cancer types with associated biomarkers and targeted agents
- Common cancer types with associated biomarkers and targeted agents (continued)
- Ethics of genomic data
- Ethics of research biopsies
- Radiogenomics and quantitative radiology
- Molecular imaging and smart needles
- Liquid biopsy
- The radiologist's future role
- Key takeaways
References
Sources cited in this topic.
- References
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- References
- Brant and Helms' Fundamentals of Diagnostic Radiology