Basic Principles of Biopsy

Question 1

Indications for Biopsy

Answer 1

Lesions that persist for two or more weeks w/ no known reason

Any inflammatory lesion doesnt respond to local therapy within 2 weeks

Question 2

History of Lesion

Answer 2

How long has been there?

Has lesion changed in size? How fast?

Lesion changed in character?

Question 3

Bulla

Answer 3

Loculated fluid in or under epithelium of mucosa

Question 4

Erosion

Answer 4

Superficial ulcer

Question 5

Macule

Answer 5

Circumscribed area of color change w/o elevation

Question 6

Papule

Answer 6

Small palpable mass, elevated above the epithelial surface

Question 7

Nodule

Answer 7

Large palpable mass, elevated above epithelial surface

Question 8

Plaque

Answer 8

Flat elevated lesion, the confluence of papules

Question 9

Pustules

Answer 9

Cloudy or white vesicles containing pus

Question 10

Scale

Answer 10

Macroscopic accumulation of keratin

Question 11

Ulcer

Answer 11

Loss of epithelium

Question 12

Vesicle

Answer 12

Small loculation of fluid in or under epithelium containing serous fluid (associated with herpes)

Question 13

Clinical Exam

Answer 13

Size/shape
Single/multiple
Surface
Color
Borders (fixed or freely movable)

Question 14

Lesions that raise suspicion of malignancy

Answer 14

Erythroplasia
Ulceration
Duration
Growth Rate
Bleeding
Induration
Fixation

Question 15

Types of Biopsies

Answer 15

Oral Cytology
Aspiration Biopsy
Fine Needle
Incisional
Excisional

Question 16

Oral Cytology

Answer 16

Needed - large areas of mucosal change, need monitoring dysplastic tissue (single cells)

Superficial surface area
Not liked by oral paths

Question 17

Aspiration

Answer 17

Lesions suspected to contain fluid - done before biopsies
Intraosseous lessions

Vascular (stop if so) or avascular check!!!

Question 18

Fine needle biopsy

Answer 18

Pass needle into suspected mass, small shavings of tissue are obtained in barrel of syringe.
Preliminary diagnosis

Question 19

Incisional

Answer 19

Greater than 1 cm
Hazardous location
High Suspicion of malignancy
Closure

Question 20

Incisional Techniques

Answer 20

Representative area
Wedge fashion - deep and narrow
Include normal tissue

Question 21

Excisional

Answer 21

Less than 1 cm
Benign appearance
Closure

Question 22

Excisional Technique

Answer 22

Entire lesion

Margin of normal tissue (2-3 mm)

Question 23

Soft Tissue Biopsy - Local Anesthesia

Answer 23

Wait 10 mins for hemostasis

Block vs local infiltration

Question 24

Soft Tissue Biopsy - Incision

Answer 24

Avoid electrosurgery
Ellipse converging to form V
Maintain parallel w/ nerves/vessels
2-3 mm border for benign, 5 for malignant

Question 25

Soft Tissue Biopsy - Specimen Care

Answer 25

10% formalin solution 20 times volume of specimen Total immersion

Question 26

Soft Tissue Biopsy Hemostasis

Answer 26

``` Avoid high volume suction Gauze compress Gauze wrap over low-volume suction Electrocautery Suture ligation ```

Question 27

Soft Tissue Biopsy - Closure

Answer 27

Undermine mucosa Primary closure Surgical dressing

Question 28

Intraosseous Lesion Biopsy

Answer 28

Aspiration - radiolucent lesions

Question 29

Mucoperiosteal Flaps

Answer 29

Sharp incisions Subperiosteal plane 4-5 mm of sound bone around lesion