Basic Principles of Biopsy Flashcards
Indications for Biopsy
Lesions that persist for two or more weeks w/ no known reason
Any inflammatory lesion doesnt respond to local therapy within 2 weeks
History of Lesion
How long has been there?
Has lesion changed in size? How fast?
Lesion changed in character?
Bulla
Loculated fluid in or under epithelium of mucosa
Erosion
Superficial ulcer
Macule
Circumscribed area of color change w/o elevation
Papule
Small palpable mass, elevated above the epithelial surface
Nodule
Large palpable mass, elevated above epithelial surface
Plaque
Flat elevated lesion, the confluence of papules
Pustules
Cloudy or white vesicles containing pus
Scale
Macroscopic accumulation of keratin
Ulcer
Loss of epithelium
Vesicle
Small loculation of fluid in or under epithelium containing serous fluid (associated with herpes)
Clinical Exam
Size/shape Single/multiple Surface Color Borders (fixed or freely movable)
Lesions that raise suspicion of malignancy
Erythroplasia Ulceration Duration Growth Rate Bleeding Induration Fixation
Types of Biopsies
Oral Cytology Aspiration Biopsy Fine Needle Incisional Excisional
Oral Cytology
Needed - large areas of mucosal change, need monitoring dysplastic tissue (single cells)
Superficial surface area
Not liked by oral paths
Aspiration
Lesions suspected to contain fluid - done before biopsies
Intraosseous lessions
Vascular (stop if so) or avascular check!!!
Fine needle biopsy
Pass needle into suspected mass, small shavings of tissue are obtained in barrel of syringe.
Preliminary diagnosis
Incisional
Greater than 1 cm
Hazardous location
High Suspicion of malignancy
Closure
Incisional Techniques
Representative area
Wedge fashion - deep and narrow
Include normal tissue
Excisional
Less than 1 cm
Benign appearance
Closure
Excisional Technique
Entire lesion
Margin of normal tissue (2-3 mm)
Soft Tissue Biopsy - Local Anesthesia
Wait 10 mins for hemostasis
Block vs local infiltration
Soft Tissue Biopsy - Incision
Avoid electrosurgery
Ellipse converging to form V
Maintain parallel w/ nerves/vessels
2-3 mm border for benign, 5 for malignant
Soft Tissue Biopsy - Specimen Care
10% formalin solution
20 times volume of specimen
Total immersion
Soft Tissue Biopsy Hemostasis
Avoid high volume suction Gauze compress Gauze wrap over low-volume suction Electrocautery Suture ligation
Soft Tissue Biopsy - Closure
Undermine mucosa
Primary closure
Surgical dressing
Intraosseous Lesion Biopsy
Aspiration - radiolucent lesions
Mucoperiosteal Flaps
Sharp incisions
Subperiosteal plane
4-5 mm of sound bone around lesion
