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MOS Lecture Slides > Biopsy > Flashcards

Biopsy Flashcards

1
Q

Define the term “biopsy”

A

the complete or partial removal of tissue or other material from the living body for microscopic examination to obtain diagnosis, exclude disease, or stage disease

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2
Q

What are the indications for a biopsy

A
  • any lesion that persists for more than 2 weeks for which no cause has been found
  • an inflammatory lesion which does not resolve following the removal of the cause e.g. sharp tooth
  • lesions that inferfere with function e.g. epulis or polyp
  • all red patches
  • most white patches, if non homogenous or speckeld
  • lesions that possesses malignant signs, induration, rapid growth, fixation to underlying tissues, bleeding or ulceration
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3
Q

What areas require a referral for biopsy ASAP if an ulcer is present?

A
  • floor of mouth
  • border of tongue
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4
Q

Outline the different methods of a biopsy

A
  • incisional
  • excisional
  • punch
  • trephine
  • aspiration
  • exfoliative cytology (smear)
  • lavial gland biopsy
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5
Q

What is an incisional biopsy?

A

removal of a portion of normal and abnormal tissue for larger lesiosn to establish the diagnosis and subsequent treatment options including potentially malignant lesions

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6
Q

What is an excisional biopsy?

A

complete removal with surroundng tissue (width and depth) for small and presumed benign lesiosn

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7
Q

What is a punch biopsy?

A

core of abnormal tissue biopsied - takes a block of tissue

it is rarely performed in the mouth

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8
Q

What is a trephine biopsy?

A

removes a core of tissue- suitable for deep seated lesions

makes use of thin needles

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9
Q

What is an aspiration biopsy?

A

fine needle aspiration cytology (FNAC), for deep soft tissue lesions, such as potentially malignant neck lymph nodes

technique sensitive

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10
Q

What is exfoliative cytology (smear)?

A

abrasive removal of superficial cells
(can include deeper cells)

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11
Q

Outline the procedure for biopsy

A
  • LA placement
  • stabilise tissues
  • incision with scalpel blade 11/15 elliptical incision
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12
Q

Biopsies should NOT be _______ and ________ but _______ and ________

A
  • they should not be broad and shallow
  • they should be narrow and deep
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13
Q

Why should an elliptical incision be used for biopsies?

A
  • for margin approximation to allow primary intention
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14
Q

What should be included in a biopsy kit?

A
  • mirror
  • probe
  • scalpel
  • toothed tweezers
  • non toothed tweezers
  • needle holder
  • scissors
  • specimen pot
  • suture pack
  • gauze
  • LA cartridge/syringe
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15
Q

What warnings should you give to patients following a biopsy ?

A
  • pain
  • swelling
  • bruising
  • infection
  • suture placement
  • para/anaesthesia
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16
Q

Biopsies are a ________ procedure

A

4 handed

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17
Q

What are the essential requirements of a specimen?

A
  • be representative of the lesion
  • contain adjacent normal tissue
  • be removed and transported atraumatically
18
Q

What is the aim of a pathologist form?

A

to give the pathologist as much information as possible

19
Q

What should be included in a pathologist form?

A
  • patient details
  • consultant/surgeon
  • biopsy site
  • clinical description
  • related lesions
  • previous biopsy results/special investigations
  • MH and smoking /alcohol
  • differential clinical diagnosis
20
Q

What transport medium should be used for biopsies? What is the purpose of the transport medium?

A

10% buffered formalin for routine processing

  • to fix the protein
21
Q

Give an example of a type of biopsy will require a different transport medium ?

A

immunofluorescence

22
Q

What is used to fix the protein ?

A

the 10% formalin in the transport medium

23
Q

Excisional biopsies are the most appropriate for what type of lesions?

A

small lesions
<10mm in size

24
Q

Give a potential cause of hypertrophic polyps

A

repetitive cheek biting

25
Q

How can hypertrophic polyps be treated?

A

using excisional biopsies

26
Q

Following a block incision in the palate or gingivae, how can you prevent dead space following the placement of a suture?

A

coepack or dressing plate

27
Q

What is the consequence of leaving dead space following a biopsy?

A

undermines adjacent tissue in order for tension free closure

28
Q

What is must you remember when taking muscle biopsies ?

A

to always cut in the direction of the muscle fibres

29
Q

How can you stabilise a mucocele or polyp for an excisional biopsy?

A
  • traction suture- suture placed underneath mucocele or polyp
  • forceps
30
Q

Punch biopsies are more commonly used on …

A

skin

31
Q

Punch biopsies make use of circular blades which come in differing _________.

A

diameters

2-8mm range

32
Q

What type of handles can be used for punch biopsy blades?

A
  • sterile plastic handled
  • sterilisable surgical steel handled
33
Q

Punch biopsies are designed specifically for what kind of biopsies?

A

full thickness biopsies

epidermis-dermis- subcutaneous tissue

34
Q

When is the trephine technique useful?

A

for lesions where access may be difficult

35
Q

The trephine technique is used for what type of lesions?

A
  • deep seated soft tissue lesions
  • bone lesions
36
Q

What is the benefit of using the trephine technique?

A

retains tissue architecture

37
Q

Fine needle aspiration cytology is used for soft tissue masses. Give examples of such masses

A
  • lymph nodes
  • salivary glands
38
Q

Outline the technique used for FNAC

A
  • 10/20ml syringe
  • 21 gauge needle
  • insert into the centre of the mass
  • pull plunger back
  • undertaken several times
  • deliver sample onto microscopic slide
  • spread and fix
39
Q

What equipment can you use for the exfoliative cytology technique?

A
  • wooden spatula
  • brushes
40
Q

Exfoliative cytology is used in conjunction with _______. Why?

A
  • in conjunction with biopsies
  • to monitor lesions which may undergo malignant change
41
Q

When should you refer a patient for biopsy?

A
  • lack of appropriate skill , training, equipment, transport medium
  • if unsure about whether you will be able to harvest a representative sample/ repair the biopsy site due to position and size of lesion
  • blistering or bullous lesion as there require special handling of samples and/or transport medium
  • if you suspect lesion to be vascular
  • if you suspect lesion to be malignant
  • you are concerned about co-morbidity/patients abilitty to cope with procedure

MOS Lecture Slides (7 decks)

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