Soft Tissue Disease (Deluke) Flashcards
What is the goal of the incisional biopsy and excisional biopsy?
Either get the entire lesion (excisional) or take a representative sample of the lesion (incisional)
The following factors dictate what type of biopsy:
- Lesion suspected to be malignant
- Not clear whether lesion is inflammatory or neoplastic
- Not clear whether a large mucosal lesion is hyperkeratosis or dysplasia
- Lesion would require extensive surgery or is in a hazardous location
Incisional biopsy
What is a biopsy that takes out the whole thing?
Excisional biopsy
What is a biopsy that takes just a sample or portion?
Incisional
How deep should an incisional biopsy extend?
Deep enough to include the actual lesion (e.g. at least to the basal cell layer)
If the lesion is not homogenous, what biopsy should be done?
Incisional biopsy more than one area
What are 2 things you should never biopsy?
- Pigmented lesion
2. Vascular lesion
What biopsy method is indicated for a small lesion not suspected to be malignant?
Excisional
What is the most preferred biopsy (i.e. do this biopsy method whenever possible)?
Excisional
What should be included in the local anesthetic and why when biopsying?
Epinephrine for hemostasis
Should injection of local be done directly into the lesion to be biopsied?
No
How should the biopsy specimen be handled?
Do not crush it
What should you always do with a biopsy specimen?
Send for histologic diagnosis
Why is it important to properly design an incision?
To avoid cutting out the lesion and leave a space that when closed creates an anatomical dead space that can get infected
Which biopsy type is used for the following indications:
- Diagnosis of cystic lesion
- Diagnosis of suspected vascular lesion
- Lesions that are not readily accessible for any of the other types of biopsy (e.g. salivary tumor)
Fine needle aspiration biopsy
What is a biopsy where only surface cells are captured / biopsy is limited to only superficial cells?
Exfoliative cytology
What is a biopsy that gives a transepithelial tissue sample, can even get down to the basal layer, but does not involve a scalpel?
Brush biopsy
What is indicated for any ulcer that has been present for more than 2 weeks and has not healed?
Biopsy
What is indicated if the diagnosis returned from a brush biopsy differs from your clinical impression?
Repeat the biopsy
What are 4 things to consider int he treatment of benign tumors?
- Character of the lesion
- Anatomy
- Preservation of function
- Esthetics
What are 4 descriptors of a lesion’s character?
- Sessile (base is the widest part of the lesion)
- Pedunculated (base is narrower than the widest part of the lesion)
- Submucosal
- Infiltrating
What design would be used to remove a sessile or pedunculated lesion?
Elliptical
What are 4 blood vessels to avoid in the mouth when designing biopsy?
- Palatal
- Incisive
- Mental
- Lingual
What are 2 sensory nerves to avoid intramurally when doing biopsy?
- Mental
2. Lingual
What is a motor nerve to avoid when doing intramural biopsy?
Marginal mandibular
What are 2 ducts to avoid when doing intramural biopsy?
- Parotid
2. Submandibular
Correct incisions are always in what relation to major anatomical structures?
Always parallel to major anatomical structures
What are 3 areas of concern with respect to function when planning biopsy?
- Commissures of the lips
- Tongue
- Soft palate
When palpating a submucosal lesion, what should first be determined?
Is it fixed or is it mobile?
If a submucosal lesion is fixed / immovable on palpation, what is indicated?
Infiltrating lesion requiring deeper biopsy
What is the biopsy shape, the wound margin management, and closure type for a sessile and pedunculated lesion?
- Elliptical modified wedge excision
- Undermine wound margins
- Primary closure
What is the lesion biopsy design and closure for a submucosal (fixed / immobile) lesion?
- Include overlying mucosa when excising lesion
- Include a 0.5cm margin of normal tissue
- Achieve proper hemostasis
- Close in layers
What is the advantage of using CO2 laser for biopsies?
Seals vessels and small nerve ending reducing post op pain and eliminating need for sutures
What is the preferred biopsy method when feasible?
Excisional
What biopsy is preferred for suspected malignant lesion?
Incisional
What should you always use to confirm your clinical diagnosis of a lesion?
Histologic exam
All biopsy patients require what?
Adequate follow-up
What is the biopsy patient that should be followed-up diligently?
Those with dysplastic mucosal lesions
