Biopsies

Question 1

Biopsy indications

Answer 1

• To establish a diagnosis
• Absence of an obvious cause
• No response after initial treatment or no
resolution after an acceptable time period
• To confirm clinical diagnosis
• Cancer-phobic patients

Question 2

Biopsy Contraindications

Answer 2

• Some medically-compromised patients
– Hospital dentistry/oral surgery
• Lesion is obviously cancer
– Refer to oral surgeon or ENT for surgical
evaluation

Question 3

Biopsy Types

Answer 3

• Excisional
• Incisional
– Shave
– Punch
• Fine needle aspiration
• Core biopsies
• Smear (cytology)
• Intra-osseous

Question 4

Excisional Biopsy

Answer 4

• For small or focal lesions
• Excise whole lesion
Excisional biopsy versus
definitive excision, or excision
with margin evaluation… if
margin evaluation is required,
excision must be at least 1.0 cm
in length and be oriented.

Question 5

Incisional Biopsy

Answer 5

• For large or diffuse lesions
• Obtain a representative area
– Edge of lesion; avoid center of an ulcer
• Ideal for lesions suspicious for malignancy

Question 6

Fine Needle Aspirations

Answer 6

• For lymph nodes, internal organs, salivary

glands, thyroid gland

Question 7

Needle Core Biopsies

Answer 7

• Commonly used for initial breast and prostate
biopsies
• May be CT-guided for internal organs

Question 8

Selecting Biopsy Site

Answer 8

• Should be representative of the lesion
• Sample multiple sites for large lesions
• Include normal and lesional tissue
• Include erythematous areas if present
• If ulcerated, sample ulcer margin, not center
• Use scalpel instead of electrocautery when
possible
• Aspirate intra-osseous radiolucencies prior to
biopsy, then biopsy well into lesion and
include margin of lesion with normal bone

Question 9

Frozen Sections

Answer 9

• AKA intra-operative consult
• Tissue is submitted to the histology laboratory
and processed while the patient is still in the
OR (standard 20 min turn-around time for
diagnosis)
• Head and neck examples: Thyroid,
parathyroid, lymph nodes, laryngeal,
oropharyngeal biopsies to locate primary
tumor, evaluation of cancer resection margins

Question 10

Limitation of Frozen Sections

Answer 10

• Histologic artifacts
• Representative tissue
• Unless the histology is obvious, the
pathologist will be as cautious (vague) as
possible in rendering the frozen diagnosis