What is soft tissue biopsy and how is it done?

The biopsy can be performed under the guidance of ultrasound or computed tomography (CT), mostly under ultrasound guidance, from superficially located soft tissue masses such as the skin, subcutaneous or anterior abdominal wall, peritoneum-omentum, muscle structures in extremities such as limbs, and anterior chest wall.

Depending on the size and location of the mass, fine-needle aspiration biopsy (FNAB) or trucut (core) biopsy can be performed. If FNAB is to be performed, a biopsy can be taken without the need for any specific preparation.

Before Trucut biopsy, bleeding and coagulation parameters such as hemogram, INR, APTT, and blood values can be checked according to the size and location of the mass. The procedure is usually done with a technique called the coaxial (double-needle system) technique. With ultrasound or CT, the place to enter the mass and the safe route of the needle are determined. After cleaning the skin, a local anesthetic is injected into the area where the needle will pass under the skin. Pain relievers or sedative medications can be given through the existing vascular access. After the point of entry is determined, the needle that allows a thinner needle to pass through, which we call the coaxial needle, is inserted into the mass under ultrasound or CT guidance, avoiding the vessels. After it is seen that we are in the mass, the fine needle in the coaxial needle is removed and the appropriate automatic biopsy needle is inserted, and a piece of the mass is obtained from different parts 3-4 times with this needle. The obtained materials are evaluated by the pathologist during the process and if sufficient material is obtained, the process is terminated. In centers where onside pathology specialists are not available, the material is prepared appropriately and sent to the pathology laboratory. Fine-needle aspiration biopsy (FNAB) can also be performed in cases where a core biopsy cannot be taken safely because it is small in size and very close to the vessels. Afterward, first, the automatic biopsy needle and then the coaxial needle are withdrawn, and the control ultrasound or CT is taken and bleeding, etc. check if there is. The skin is cleaned in a sterile way and covered with small gauze we call a sponge. The patient is kept under observation for approximately 1-2 hours and then discharged after clinical and, if necessary, blood test control.