From the Guidelines
Trucut biopsy and excision biopsy are distinct procedures with different indications, benefits, and limitations, and the choice between them should be based on the specific clinical context and the suspected diagnosis, with trucut biopsy being preferred for initial diagnosis and excision biopsy for complete removal of the lesion. The key differences between trucut biopsy and excision biopsy lie in their technique, extent of tissue removal, and clinical applications. A trucut biopsy is a minimally invasive procedure that uses a hollow needle with a cutting mechanism to extract a small core of tissue, typically 1-2mm in diameter, and is often performed under local anesthesia with imaging guidance, leaving only a small puncture wound 1. In contrast, an excision biopsy involves surgically removing the entire abnormal area or lesion along with a margin of surrounding normal tissue, typically requiring more extensive anesthesia and resulting in a surgical wound requiring sutures. Some studies suggest that core needle biopsy has accuracy rates ranging from 88% to 96% when adequate samples are obtained, and may be used as an alternative to open biopsy for diagnosing musculoskeletal lesions, with cost savings realized in selected patients 1. However, excisional biopsy is preferred for diagnosis, although core-needle biopsy may suffice when not feasible, as stated in the Lugano classification for Hodgkin and non-Hodgkin lymphoma 1. The choice between trucut biopsy and excision biopsy depends on various factors, including:
- Location and size of the lesion
- Suspected diagnosis
- Whether complete removal is therapeutically beneficial
- Need for preserving surrounding tissue
- Previous biopsy results
- Requirement for examining architectural features of the tissue for accurate diagnosis. For instance, excisional biopsy may be the most practical option for <5 cm superficial lesions, as recommended for soft tissue sarcomas 1. Ultimately, the decision between trucut biopsy and excision biopsy should be made on a case-by-case basis, considering the individual patient's needs and the specific clinical context.
From the Research
Difference between Trucut Biopsy and Excision Biopsy
- Trucut biopsy is a diagnostic procedure where a small sample of tissue is removed from the body using a special needle, whereas excision biopsy involves the removal of an entire lesion or a larger sample of tissue.
- Trucut biopsy is less invasive and can be performed under local anesthesia, whereas excision biopsy may require general anesthesia and a longer recovery time 2, 3.
- The diagnostic accuracy of trucut biopsy is high, with a sensitivity of 95.1% and specificity of 100% in the diagnosis of breast lesions 3.
- Excision biopsy is considered a more definitive diagnostic procedure, as it allows for the removal of the entire lesion and provides a complete histopathological examination.
- Trucut biopsy can be used as a first step in the diagnosis of breast lesions, and can help avoid unnecessary surgeries and reduce the number of diagnostic errors 4.
- The choice between trucut biopsy and excision biopsy depends on the specific clinical situation and the suspected diagnosis, as well as the availability of resources and expertise.
Advantages of Trucut Biopsy
- Less invasive and less painful than excision biopsy
- Can be performed under local anesthesia
- Faster recovery time than excision biopsy
- High diagnostic accuracy in the diagnosis of breast lesions
- Can be used as a first step in the diagnosis of breast lesions, reducing the need for unnecessary surgeries
Disadvantages of Trucut Biopsy
- May not provide a complete histopathological examination, as only a small sample of tissue is removed
- May require repeat biopsies if the initial result is inconclusive
- May not be suitable for all types of lesions or clinical situations
Comparison with Fine Needle Aspiration Cytology
- Trucut biopsy has a higher diagnostic accuracy than fine needle aspiration cytology (FNAC) in the diagnosis of abdominal lesions 2.
- Trucut biopsy provides a tissue sample, whereas FNAC provides only a cytological sample.
- Trucut biopsy can be used to diagnose a wider range of lesions, including those that are difficult to diagnose using FNAC 5, 6.