Biopsy Flashcards

1
Q
Diagnoses
comes from the Greek words
dia (“through,” “apart”) and
gnosis (“knowledge”),
meaning literally \_\_\_\_\_\_\_.
A

to know apart or to distinguish

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2
Q

A diagnosis is defined as
The ________________.
An accurate diagnosis is obviously important and occasionally critical to the patient so that the most appropriate treatment can be initiated as soon as possible.

A

determination of the nature of a disease or pathologic condition.

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3
Q
  • Occasionally the diagnosis is relatively straightforward
  • _________: represents a listing of the more likely diagnostic considerations for a particular pathologic finding or condition, ranked in descending order of probability
  • Clinician’s evaluation
A

Differential diagnosis

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4
Q
Construction of the differential 
1. Clinical signs
2. Symptoms
3. History
• List of diagnoses is subject to modification or refinement (radiographic imaging and hematologic or serum analysis)
• \_\_\_\_\_\_\_\_\_ of the treating clinician
A

Experience and knowledge base

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5
Q

• The designation of ______ is used when the clinician believes that the nature of the disease has been identified to a reasonable degree of certainty.

A

final diagnosis

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6
Q

Depending upon the experience and expertise of the practitioner, a confident final diagnosis may require nothing more than clinical inspection.
HOWEVER, EVEN THE MOST EXPERIENCED DIAGNOSTICIAN REQUIRES _________.

A

ADDITIONAL INFORMATION FROM APPROPRIATE IMAGING OR LABORATORY STUDIES

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7
Q

BIOPSY
It is a surgical procedure in which a ________ from a patient and submitted for laboratory examination.
The word biopsy is of Greek derivation, originating from the words bio (life) and
opsia (to see)

A

tissue sample is removed

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8
Q

Despite the sophisticated images techniques, blood studies, nuclear and positive electron transmission (PET), _______ is the best and most often used dx tools.
The approach to a biopsy depends somewhat on the size, shape, location, and type of disease the practitioner anticipates.

A

Scapel blade and light microscope

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9
Q

BIOPSY
• To aid in deriving a working __________.
• The challenge for the clinician is to provide a ________ that is adequate in quantity, properly fixed, and without artifacts or distortion.

A
  1. diagnosis and confirm the differential diagnosis

2. representative tissue specimen

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10
Q

BIOPSY Indications
• When the patent’s clinical presentation, past history, or imaging studies ________.
• Any mucosal, skin, or bone abnormality that _________.
• Any lesions suspected to be of _______ are indicated for biopsy

A
  1. do not allow a definitive diagnosis.
  2. persists despite either removal of the associated irritant or treatment with adjunctive means deserves a biopsy. (2 weeks)
  3. neoplastic origin
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11
Q

BIOPSY
Limitations and Contraindications
• An area of ______ has no need of a biopsy.
• Pts with known ________ may require an alteration in the usual biopsy routine.
• Pts with _________ may need the aid of (CT) or ultrasound (US) to facilitate the determination of the exact type of biopsy needed.
• Pts undergoing treatment with ________ as well as _________.

A
  1. infection
  2. allergies to local anesthetics or history of bleeding
  3. deeply positioned lesions
  4. IV or oral bisphosphonates; prior irradiated bone
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12
Q

Types

A
  • Exfoliative Cytology (Brush)
  • Fine-Needle Aspiration
  • Incisional Biopsy
  • Excisional Biopsy
  • Punch
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13
Q

EXFOLIATIVE CYTOLOGY
• It is a relatively ________ technique that may be used to provide additional information related to lesions of _______.
• Candidiasis, herpesvirus (herpes simplex virus, human herpesviruses 1 and 2) infections, and pemphigus vulgaris

A
  1. inexpensive noninvasive

2. surface origin

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14
Q

FINE-NEEDLE ASPIRATION
• (FNA) is a useful method for evaluating _________.
• Most widely used in determining the nature of _______.

A
  1. subcutaneous or more deeply situated mass lesions.

2. salivary gland or neck masses.

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15
Q

INCISIONAL BIOPSY
• Indicated for large lesions (_____) and those that could represent ________.
• It is a diagnostic surgical procedure in which a _______ of a lesion is removed

A
  1. > 2 cm
  2. unencapsulated or potentially malignant neoplasms
  3. sample or portion
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16
Q

EXCISIONAL BIOPSY
• Used to manage clinically ______ that are ____ in diameter.
• Defined as a diagnostic surgical procedure in which _______.

A
  1. benign lesions
  2. < 2 cm
  3. all clinically abnormal tissue is removed
17
Q

PUNCH BIOPSY
• Quick and accurate.
• It allows the pathologist to view the entire biopsy in its natural anatomic arrangement.
• To _________.
• Any _______ punch will require at least one _____. Punch biopsies rarely scar or become infected.

A
  1. remove small lesions or to incisionally biopsy larger ones.
  2. larger diameter; suture
18
Q

PREOPERATIVE EVALUATION

A
  • Patient’s general health.
  • Malignant potential.
  • Physical properties.
  • Surgical expertise.
19
Q

PHYSICAL PROPERTIES OF LESION

A
  • Margins.
  • Surface characteristics
  • Depth of extension
  • Size
  • Quality of tissue
  • Pigmentation
  • Vascularity
  • Soft tissue or bone
  • Growth rate
20
Q

PREOPERATIVE QUESTIONS

A
  • What type of biopsy is best?
  • Where do you take the biopsy?
  • Multiple sites for biopsy.
21
Q

PRINCIPLES

A
  • Anesthesia via block technique
  • Take adequate tissue
  • Do not mutilate tissue
  • Retract and orient tissue with suture
  • Palpate all lesions
  • Aspirate all radiolucent lesions
22
Q
• Incise
1. Parallel to vessels and nerves.
2. Parallel to line of tension
3. Elliptical shape
• Send all excised tissue to the pathologist (\_\_\_\_\_\_\_\_\_)
A

(teeth, lesion/granulation tissue, normal tissue)

23
Q

Biopsy steps

A
  • Identification
  • Incise
  • Anesthesia
  • Clear margins
  • Representative sample
  • Traction suture