Lecture 1: Diagnostic techniques for evaluating oral diseases Flashcards
List the INDICATIONS of oral exfoliative cytology:
- Innocuous lesion
- Suspicious lesion with negative biopsy
- Patient refuses biopsy
- Follow up of treated malignancy
- Lesion where patient is poor candidate for surgery
List the CONTRAINDICATIONS of oral exfoliative cytology:
- Keratotic or crusty mucosa
- Red, vesiclular or velvety mucosa
- Submucosa swelling with normal mucosa
- Suspicion of malignancy
T/F: Exfoliative cytology is indicated as a follow up for treated malignancy. Exfoliative cytology is contraindicated if there is suspicion of malignany
Both statements true
List the INDICATIONS of culture and sensitivity testing:
- Life-threatening infection
- Unsuccessful previous antibiotic therapy
- Immunosuppressed patient
Why is culture and sensitivity testing limited in dentistry?
Because it is difficult for anaerobic conditions
Assist in the detection of early potentially malignant mucosal changes that are difficult to discern by visual inspection alone:
Oral cancer screening aids
Increases the ability to distinguish the lesional mucosa and healthy mucosa:
Tissue Autofluorescence imaging
Tissue autofluorescence imaging has ______ sensitivity but ____ specificity in distinguishing pre-malignant and chronic inflammatory lesions
HIGH sensitivity; LOW specificity
Tissue autofluorescence imaging has _____ sensitivity and _____ specificity in identifying areas of dysplasia and invasive cancer that extend beyond the evident lesion
HIGH sensitivity; HIGH specificity
What drives autofluorescence of oral mucosa?
Refractory index of tissue
With autofluorescence of oral mucosa, we see:
500-600nm
With autofluorescence of oral mucosa, blue light of the scope =
400-460nm
With autofluorescence of oral mucosa, UV=
<400 nm
What are some of the ENDOGENOUS fluorescing products?
- Tryptophan
- Porphyrins
- Collagen
- Elastin
- Flavins
- NADH
- Fluorophores
What does flavin adenine dinucleotide (FAD) excited at?
515 nm
What does nicotinamide adenine dinucleotide (NADH) excite at?
450 nm
Information that can be measured or perceived by the investigating clinician:
Objective information
-Temperature, size
-color, duration
-consistency
-surface contour
These are all examples of:
Signs
Signs are _____ information
objective
Patients own interpretation of a clinical circumstance. They rely on neurologic and psychologic experiences:
Subjective information
-Patient awareness of presence of a lesion
-pain intensity
-pain quality (stabbing, burning, shocking, etc.)
These are all examples of:
Symptoms
Symptoms are _____ information
Subjective
What is involved in a differential diagnosis?
- Orderly sequential approach
- Gathering and analyzing data
- Knowledge and experience enable recognition of abnormal findings
- Include/exclude disease processes based on an educated assessment of process
-Orderly sequential approach
-Gathering and analyzing data
-Knowledge and experience enable recognition of abnormal findings
-Include/exclude disease processes based on an educated assessment of process
These are all steps in:
Differential diangosis
When obtaining a differential diagnosis, one must gather and analyze data- what does this entail?
-History
-Specific signs
-Specific symptoms
-Lab data
What should you be aware of when obtaining a differential diagnosis?
Be aware of radiographic appearances, clinical manifestations, age, gender, location
What are examples of clinical descriptions?
-Single vs. multiple
-Location
-Relative proximity to adjacent structures
-Size in dimension (mm)
-Outline (well demarcated vs. diffuse)
-Color (red, white, mixed, pigmented)
-Consistency (firm, flaccid, compressible)
-Intensity (mild, moderate, intense, striated, lacy)
-Base and surface
-Single vs. multiple
-Location
-Relative proximity to adjacent structures
-Size in dimension (mm)
-Outline (well demarcated vs. diffuse)
-Color (red, white, mixed, pigmented)
-Consistency (firm, flaccid, compressible)
-Intensity (mild, moderate, intense, striated, lacy)
-Base and surface
These are all examples of:
Clinical descriptions
What are descriptive terms for SURFACE?
-Smooth
-Corrugated
-Eroded
-Raised
-Depressed
What are descriptive terms for BASE?
-Pedunculated
-Sessile
-Nodular
-Dome shape
Compressing tissue with a glass slide to determine the vascular nature of a lesion:
Diascopy
To feel and press a lesion to yield information about texture, consistency, temperature, and function:
Palpation
It is palpation with an instrument (perio probe, caries explorer, needle tip, etc.)
Probing
Striking tissues with fingers or an instrument and listening to resulting pressure changes in tissues:
-give an example of when this would be useful
Percussion; ankylosis
The withdrawal of fluids from a body cavity:
Aspiration
Listening for sounds within the body:
Auscultation
What are the 3 diagnostic lab tests for oral lesions:
- Biopsy (incisional, excisional, needle)
- Immunofluorescence
- Exfoliative cytology
What are some biopsy indications?
-Lesion with >14 day duration
-Unusual location
-Unusual appearance
-Any excised tissue
-Confirmed diagnosis of systemic disease
-Suspicion of neoplasia
A possible indication to biopsy is if there is suspicion of neoplasia:
-Persistant ulceration
-Persistent erythroplasia
-Induration
-Fixation
-Chronicity
-Lymphadenopathy
What is being performed in this image?
excisional biopsy
Describe the following surface textures:
- smooth
- granular
- verrucous
- papillomatous
Describe the following surface textures:
- papillomatosous (pebbly)
- papillomatosous (cobblestone)
- bosselated
- lobulated
Describe the lesion:
Nodular smooth
Describe the lesion:
Nodular smooth
Describe the lesion:
Verrucoid plaque
What is being performed in this image?
Diascopy
What is being performed in this image?
Probing
What is being performed in this image?
Palpation
What is being performed in this image?
Percussion
What is being performed in this image?
Aspiration
What is being performed in this image?
Auscultation
What is being performed in this image?
Incisional biopsy
What is being performed in this image?
Suture pull
What is being performed in this image?
Needle biopsy
A needle biopsy may also be referred to as:
-fine needle
-fine needle aspiration & cytology
List the INDICATIONS for a needle biopsy:
- to determine the cause of tissue enlargement
- to distinguish between benign and malignant processes
- to stage metastatic cancer
List the LIMITATIONS to a needle biopsy:
- more technique sensitive with additional preservative and lab processes
- does not localize cells to affected tissues
- appositional information to adjacent tissues is lost
A technique for determining the location of an antigen or antibody in tissues by reaction with an antibody or antigen labeled with fluorescent dye:
Immunofluorescence
