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Oral Surgery III > Principles of Tissue Biopsy in Oral and Maxillofacial Surgery > Flashcards

Principles of Tissue Biopsy in Oral and Maxillofacial Surgery Flashcards

1
Q

what is the definition of a biopsy

A

an exam of tissue removed from a living person to discover the presence, cause, or extent of cause

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2
Q

what are biopsies important for

A

an important diagnostic tooth for the diagnosis of lesions ranging from peri-apical lesions to malignancies in the oral cavity

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3
Q

what are the indications for biopsy

A
  • persistent hyperkeratosis changes in tissue
  • any persistent swelling, either visible or palpable beneath relatively normal tissue
  • lesion that interferes with local function (fibroma)
  • bone lesions identified by radiographic finding
  • any lesion that has the characteristics of malignancy
  • any suspicious lesion persists for more than 2 weeks with no apparent etiology basis
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4
Q

what are characteristics of lesions that raise the suspicion of malignancy

A
  • erythema
  • ulceration
  • growth rate
  • bleeding
  • induration
  • fixation
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5
Q

what is erthryoplakia

A

lesion that is totally red or has speckled red appearance

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6
Q

describe the ulceration that raises the suspicion of malignancy

A

presents an ulcer and the lesion has persisted more than 2 weeks

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7
Q

describe the growth rate that raises the suspicion of malignancy

A

rapid growth

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8
Q

describe the bleeding that raises the suspicion of malignancy

A

bleeds on gentle manipulation

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9
Q

describe the induration that raises the suspicion of malignancy

A

lesion and surrounding tissue is hard to the touch

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10
Q

describe the fixation that raises the suspicion of malignancy

A

lesion feels attached to adjacent structures

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11
Q

what needs to be done before the biopsy

A
  • health history
  • history of the lesion
  • clinical exam
  • imaging studies
  • lab investigation
  • biopsy (hist-pathological exam)
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12
Q

what systemic disease might cause a pathologic condition in the head or neck region

A
  • browns tumors of hyperparathyroidism
  • hairy leukoplakia- HIV pt
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13
Q

what questions do you ask in the history of the lesion

A
  • duration
  • changes in size and rate of change
  • changes in the character of the lesion - lump to ulcer
  • changes in color
  • pain
  • anesthesia
  • swelling or tenderness of adjacent lymph nodes
  • associated systemic symptoms such as: fever or dysphagia
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14
Q

the clinical exam should include when possible:

A
  • inspection
  • palpation
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15
Q

what should be looked for on clinical exam

A
  • the anatomic location of the lesion/mass
  • the size and shape of the lesion/mass
  • single vs multiple lesions
  • the surface of the lesion
  • the color of the lesion
  • the sharpness of the boundaries of the lesion
  • the consistency of the lesion to palpation
  • presence of pulsation
  • lymph node examination
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16
Q

a radiolucency with defined borders is often a:

A

cyst

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17
Q

a ragged radiolucency will often be a more _____ lesion

A

aggressive

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18
Q

apart from regular xrays, whenever necessary it is important to use more advanced imaging modalities such as:

A
  • CBCT
  • Conventional CT
  • MRI
  • ultrasound
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19
Q

if a systemic disease is suspected, the appropriate lab investigations should be pursued ____ performing a biopsy procedure

A

before

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20
Q

hyperparathyroidism can cause what elevation in the serum calcium level

A

10/5 to 11.6 mg/dl

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21
Q

what is a normal serum calcium level

A

8-10 mg/dl

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22
Q

hypercalcemia is defined as a serum calcium level greater than:

A

10.5mg/dl

23
Q

what are the types of biopsies

A
  • excisional biopsy
  • incisional biopsy
    -bone biopsy
  • punch biopsy
  • fine needle aspiration biopsy
24
Q

what is an excisional biopsy

A
  • total excision of a lesion for microscopic study
  • removal of the entire lesion
  • a perimeter of normal tissue surround the lesion is also excised to ensure total removal
    -constitute definitive treatment
25
Q

when are excisional biopsies done

A

slow growing lesions that appear benign on clinical exam

26
Q

what is the principle of excisional biopsy

A

the entire lesion along with 2-3 mm of normal appearing surrounding tissue is excised

27
Q

when are incisional biopsies used

A

some lesions are too large to excise initially without having established dx or are of such a nature that excision would be inadvisable

28
Q

what is the use of incisional biopsy

A

for large lesions or when there is a suspicion of malignancy

29
Q

what are the principles of incisional biopsy

A
  • representative ares of lesion should be incised in wedge fashion
  • selected in an area that shows complete tissue changes (the lesion extends into normal tissue at the base and/or margin of the lesion)
  • necrotic tissue should be avoided
  • taken from the edge of the lesion to include some normal tissue
  • a deep, narrow biopsy rather than a broad shallow one
30
Q

describe aspiration

A
  • the use of a needle and syringe to penetrate a lesion for aspiration of its content
  • an 18 gauge needle is connected to a 5 or 10 mL syringe
  • the tip of the needle may have to be repeatedly repositioned to locate a fluid center
31
Q

what are the indications for aspiration

A
  • should be carried out on all lesions throught to contain fluid or any intraosseous lesion before surgical exploration
  • a fluctuant mass in the soft tissues should also be aspirated to determine its contents
  • any radiolucency in the bone of the jaw should be aspirated to rule out a vascular lesion that can cause life threatening hemorrhage
32
Q

any intraosseous lesion like tumors, cysts, infections (osteomyelitis) diseases like fibro osseous lesions require a _____ biopsy procedure

A

bone

33
Q

bone and other hard tissues that contain calcium takes _____ for processing in the histopath lab

A

extra time

34
Q

what is a punch biopsy

A

a surgical instrument is used to punch out a representative portion of tissue

35
Q

describe the punch biopsy procedure

A
  • the punch comprises a circular blade attached to a plastic handle, diameters of two to ten millimeters are available
  • the punch removes a core of tissue the base of which can be simply and atraumatically released using carving scissors
  • the resultant wound may not require suturing if using the smaller diameter punches
36
Q

what is the use for fine needle aspiration biopsy

A

to biopsy deep seated lesions

37
Q

what is the technique for fine needle aspiration biopsy

A

uses very thin needle and a syringe to take out a small amount of fluid and very small pieces of tissue from tumor/mass

38
Q

in cases where the tumor is deep seated then you can use:

A

CT scan guided or ultrasound guided fine needle aspiration

39
Q

what are the advantages and disadvantages of the fine needly aspiration biopsy

A
  • advantages: does not require incision on the skin, biopsy results available same day
  • disadvantages: needle cannot remove enough tissue for diagnosis
40
Q

what are the considerations with anesthesia and biopsies

A
  • block local anesthesia techniques are employed when possible
  • the anesthetic solution should not be injected within the tissue to be removed, because it can cause artificial distortion of the specimen
  • if necessary infiltration of local anesthesia may be used locally but the solution should be injected at least 1 cm away from the lesion
41
Q

what should be used as tissue stabilization

A
  • tongue or soft palate: heavy retraction sutures
  • lip: assistants finger pinching the lip on both sides of the biopsy area
42
Q

how should you achieve hemostasis

A
  • avoid suction device
  • gauze wrapped over the tip of the low volume suction device
  • simple gauze compression
43
Q

for dx the excised specimen needs to be:

A

fixed to stop tissue autolysis prior to the sample reaching the pathology lab

44
Q

what is the solution of choice for specimen care

A

10% formaling fixative (neutral, phosphate buffered)

45
Q

specimen must be _____ in the solution

A

totally immersed

46
Q

care should be taken to be sure that the tissue has not:

A

become lodged on the wall of the container above the level of the formalin to present specimen from becoming dry and unfixed

47
Q

what type of tissue should be chosen in lichenoid reactions

A

non erosive lesional tissue - adjacent normal tissue is not required for such lesions

48
Q

why is sampling an erosive area not a good idea

A

it will show non specific inflammatory changes associated with ulceration and will not aid in the dx

49
Q

for suspected vesiculo-bullous disorders the site of the biopsy should be:

A

adjacent to bulla where epithelium is still intact

50
Q

what solution should suspected vesiculo bullous lesions be in

A

michel’s transport medium for direct immunofluorescence

51
Q

what is the direct immunofluorescence stain for intra oral pemphigus

A

immunoglobulin G deposited in the intercellular regions of the keratinocytes of the epithelium

52
Q

in the cause of soft tissue biopsies how long does the result take

A

1 week

53
Q

how long does a mineralized sample such as bone or tooth take to get back and why

A

it may require decalcification before it can be processed. the time for decalcification will vary according to the size and consistency of the specimen as well as the methods employed by a particular lab
- can take 2-3 weeks

54
Q
A

Oral Surgery III (11 decks)

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