Biopsy Principles and Techniques Flashcards
___ is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1cm (0.5 inch)
papule
___ is a circumscribed change in the color of skin (usually brown) that is neither raised nor depressed; they are completely flat and can only be appreciated by visual inspection and not by touch
macule
a macule is greater in size than ___, and may be referred to as a ___
- 1cm
- patch
a ___ is a raised solid lesion >1cm; it may be in the epidermis, dermis, or subcutaneous tissue
nodule
a ___ is a solid, raised, flat-topped lesion greater than 1cm in diameter
plaque
a ___ is a raised lesion <1cm in diameter that is filled with clear fluid
vesicle
___ are circumscribed fluid-filled lesions >1cm in diameter
bullae
___ means attached directly by its base without a stalk or peduncle; a fibroma is an example
sessile
___ means a lesion can be moved around because the base is narrower than the body of the lesion; most common is a squamous papilloma
pedunculated
what are the 5 main options when you see a lesion?
- watch it for 2 weeks
- cytology (we won’t do this)
- brush biopsy (need to induce bleeding to get the basal cells; no great - only right half the time)
- fine needle aspiration (we won’t do this)
- soft tissue scalpel biopsy (laser or electrosurgical)
what are 3 early detection techniques/devices?
- toluidine blue staining (acidophilic: DNA, RNA)
- vizilite - chemiluminescent light stick
- veloscope autoluminescence
are most oral lesions benign or malignant?
benign
T or F:
clinical inspection can often differentiate precancerous and cancerous lesions from common benign lesions
false
is it practical to subject every innocuous looking lesion to scalpel biopsy?
No
what is SaliMark OSCC?
a molecular DNA test for the early detection of oral squamous cell carcinoma
what are the indications for a brush biopsy?
- white or red spots
- chronic ulcerations
- mucosal lesions with an abnormal epithelial surface
what are the contraindications for brush biopsy?
- lesions with intact normal epithelium (fibromas, mucoceles, hemangiomas, submucosal masses, pigmented lesions/masses)
- highly suspicious lesions (immediate scalpel biopsy)
- lesions with obvious etiology (herpes, apthous ulcerations, traumatic ulcerations, trauma)
what classifies “negative” oralCDx biopsy results?
no cellular abnormalities
what classifies “positive” oralCDx biopsy results?
definitive cellular evidence of epithelial dysplasia or carcinoma
what classifies “atypical” oralCDx biopsy results?
abnormal epithelial changes warranting further investigation
which oralCDx lesion classifications require scalpel biopsy and histology?
atypical and positive
what do “negative’ oralCDx lesion classifications require?
the same careful clinical follow-up as “negative” histologically sampled lesions
does oralCDx substitute for a scalpel biopsy?
no, rather it identifies which oral lesions require histologic evaluation
what are the 4 indications for a scalpel biopsy?
- whenever clinical examination fails to lead to a diagnosis (when in doubt, cut it out)
- whenever a recognized premalignant lesion is encountered
- whenever clinical signs and symptoms suggest a malignancy
- whenever there is a lesion that fails to respond to a recognized therapy
what are the 6 biopsy principles?
- do not delay
- obtain representative specimen of the tissue
- avoid distortion or destruction (laser or electrosurgical)
- handle specimen properly and fix at once
- submit good case history (location, size, morphology, color, duration, habits, etc)
- submit radiographs and/or photographs as needed
what is the difference between an incisional biopsy and an excisional biopsy?
- incisional - remove just a part of the lesion
- excisional - remove the entire lesion
what are some options if the biopsy results don’t corroborate with your clinical impression?
- repeat the biopsy (this is a last resort)
- determine if the tissue was looked at by an oral pathologist
- ask for a second opinion
- call your pathologist (specimen mix-up?)
what are the 3 cases that you should refer your patient?
- when the health of the patient requires special management that the dentist feels unprepared to handle
- the size and surgical difficulty is beyond the level of skill that the dentist feels he/she possesses
- if the dentist is concerned about the possibility of malignancy
