10 - Soft tissue lesions and biopsy techniques Flashcards
What is the function of biopsy?
- sample tissue for histopathological analysis
- confirm or establish diagnosis
- determine prognosis
What considerations should be taken before biopsy?
- should I biopsy? or refer
- why am I biopsying?
- what do I need to ask the pathologist?
What are the different tissue sampling techniques?
- aspiration
- surgical
What are the types of aspiration biopsy?
- blood sample
- aspiration from lesion
- fine needle aspiration
Describe a blood sample.
- type of biopsy as blood is tissue
- venous blood typically used
- FBC, U and Es, haematinics etc
Describe an aspiration from a lesion.
- aspiration from an abscess prevents contamination form oral fluids
- protects anaerobic species
- aspiration determines if lesion is solid or fluid filled
Describe a fine needle aspiration.
- aspiration of cells from solid lesion
- useful in neck swellings, salivary gland lesions
- sent to cytology
What are the types of surgical biopsy?
- excisional
- incisional
- punch
Describe an excisional biopsy.
- removal of all clinically abnormal tissue
- should be confident of provisional diagnosis
- typically benign lesions
- discrete lesions
Describe an incisional biopsy.
- representative tissue sample of larger lesions
- in uncertain of diagnosis
- typically leukoplakia, lichen planus, SCC
Why is an incisional biopsy preferred for a suspected SCC?
Leave evidence of lesion for surgeons who require a clear margin
Describe a punch biopsy.
- type of incisional biopsy
- removes core of tissue with minimal damage
+/- sutures to close - hollow trephine 4/6/8mm diameter
How should you select an area to biopsy?
- large enough
- representative
- may require more than one biopsy
- include periolesional tissue when biopsying ulcers
When should you refer to a specialist to complete a biopsy?
- suspicious lesions
- lumps within upper lip
Why are lumps within the upper lip of concern?
- always assume cancerous until proven otherwise
- small salivary neoplasm are very common in this site
How should you sent a sample to pathology?
- in 10% formalin
- suture can aid orientation
- relevant clinical information should be included in referral
- can be placed on filter paper, but gauze distorts
What areas should you avoid biopsying?
- salivary gland orifices
- tip of tongue
- areas close to nerves and large blood vessels
Define pedunctulated.
Attached with stalk like projection
What is a fibrous epulis?
- swelling arising from gingivae
- hyperplastic response to irritation (eg plaque, calculus, restoration)
- smooth surface, rounded swelling, pink, pendunculated