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Biopsy ( oral pathology)

BIOPSY in oral pathoogy

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Biopsy ( oral pathology)

  1. 1. DR.ASIF IQBAL 2ND YEAR P.G BIOPSY
  2. 2. WHAT IS A BIOPSY?  Biopsy is derived from a Greek word (By-op-see) = Bio – meaning LIFE and Opsy – TO LOOK(Vision) Biopsy is the removal of tissue from a living organism for the purpose of microscopic examination and diagnosis.
  3. 3.  1870, Ruge and Joham Vert in Berlin introduced surgical biopsy as an essential tool for diagnosis.  1889, Emarch put forward an argument that confirmations should be made before surgeries for malignancies.  Williams halsted 1st introduced this principle in United States.  1941, study of exfoliated cells from female genital tract is done by Papanicolaou. HISTORICAL PERSPECTIVE
  4. 4. BIOPSY : WHEN, WHY, WHERE?
  5. 5. CHARACTERISTICS OF LESIONS THAT RAISE THE SUSPICION OF MALIGNANCY  Growth rate– lesion exhibits rapid growth  Bleeding— lesion bleeds on gentle manipulation  Induration– lesion and surrounding tissue is firm to the touch  Fixation– lesion feels attached to adjacent structures
  6. 6. CHARACTERISTICS OF LESIONS THAT RAISE THE SUSPICION OF MALIGNANCY  Erythroplakia—lesion is totally red or has speckled red appearance  Ulceration—lesion is ulcerated or presents as an ulcer  Duration— lesion has persisted for more than 2 weeks
  7. 7. INDICATION FOR BIOPSY  Persistent hyperkeratosis changes in surface tissue (ex: lips or oral mucosa)  Lesion that interfere with local function (ex :fibroma)  Any inflammatory lesion that does not respond to local treatment after 10 to 14 days (that is after removing local irritant)
  8. 8. INDICATION FOR BIOPSY  Bone lesions not specifically identified by clinical and radiographic finding.  Any lesion persists for more than 2 weeks with no apparent etiology basis.  Any lesion that has the characteristics of malignancy .
  9. 9. WHEN IS ORAL BIOPSY NOT NEEDED?  There is no need to biopsy normal structures.  There is no need to biopsy for inflammatory or infectious lesions that respond to specific local treatments, as pericoronitis, gingivitis or periodontal abscesses.  No incisional biopsies should be performed on suspected angiomatous lesions.
  10. 10.  Anticoagulant therapy  Over-whelming sepsis  Severe impaired lung function  Uncontrolled bleeding.  Uncooperative patient  Local infection near the site CONTRA-INDICATIONS
  11. 11. To confirm a diagnosis made on clinical findings. To determine the treatment plan Valuable self teaching diagnostic aid. As a medical record OBJECTIVES OF BIOPSY
  12. 12. CLASSIFICATION OF BIOPSY According to the procedures applied, oral biopsies can be classified by: a) Features of the lesion: • Direct biopsy: when the lesion is located on the oral mucosa and can be easily accessed with a scalpel from the mucosal surface. • Indirect biopsy: when the lesion is covered by an apparently normal oral mucosa.
  13. 13. b) Area of surgical removal: • Incisional biopsy: consists of the removal of a representative sample of the lesion and normal adjacent tissue in order to make a definitive diagnosis before treatment. • Excisional biopsy: is aimed at the complete surgical removal of the lesion for diagnostic and therapeutic purposes. This procedure is elective when the size and location of the lesion allows for a complete removal of the lesion and a wide margin of surrounding healthy tissue.
  14. 14. c) By the timing of the biopsy/ Clinical timing of sampling: • Pre-operative • Intra-operative • Post-operative d) Purpose of the biopsy. Diagnostic Biopsy Experimental Biopsy
  15. 15. TYPES OF BIOPSY  Surgical biopsy- Incisional Biopsy ,Excisional Biopsy and Punch Biopsy.  Fine Needle Aspiration Cytology(FNAC) and CT guided FNAC.  Exfoliative Cytology.  Brush Biopsy.  Frozen Section Biopsy.  Cone Biopsy.  Core Needle Biopsy.  Suction Assisted Core Needle Biopsy.  Laser Biopsy.
  16. 16. STEPS OF BIOPSY  1.SELECTION OF AREA OF BIOPSY  2.PREPARATION OF SURGICAL FIELD  3.LOCAL ANASTHESIA  4.INCISION  5.HANDLING OF SPECIMEN  6.SUTURING OF THE RESULTING WOUND
  17. 17. If a lesion is large or has different characteristics in various locations more than one area may need to be sampled INCISIONAL BIOPSY
  18. 18. Incision should extend from the ulceration out onto clinically normal tissue Grasp area to be removed with forceps and make an elliptical incision from the centre out onto clinically normal tissue: wound after removal of incised tissue: suturing completed
  19. 19. INCISIONAL BIOPSY  Indications:  Size limitations  Hazardous location of the lesion  Great suspicion of malignancy  Technique:  Representative areas are biopsied in a wedge fashion.  Margins should extend into normal tissue on the deep surface.  Necrotic tissue should be avoided.  A narrow deep specimen is better than a broad shallow one.
  20. 20. DISADVANTAGES: 1. Crush, splits and haemorrhage are the artefacts most frequently found in incisional oral biopsies. 2. Theoretical seeding of cancer cells into the adjoining tissues.
  21. 21. Excisional Biopsy The entire lesion with 2 to 3mm of normal appearing tissue surrounding the lesion is excised if benign.
  22. 22. EXCISIONAL BIOPSY An excisional biposy implies the complete removal of the lesion.  Indications:  Should be employed with small lesions. Less than 1cm  The lesion on clinical exam appears benign.  When complete excision with a margin of normal tissue is possible without mutilation.
  23. 23. EXCISIONAL BIOPSY  Technique:  The entire lesion with 2 to 3mm of normal appearing tissue surrounding the lesion is excised if benign.
  24. 24. FOR MUCOCELE LESIONS – CAREFUL EXCISIONAL BIOPSY
  25. 25. PUNCH BIOPSY
  26. 26. Advantages :  Ease of technique  Sutures may not be required if small diameter punch  May produce a more satisfactory specimen in bound down tissues (e.g. hard palate) Drawbacks:  May not be adequate for biopsy of deeper pathology  May be difficult to biopsy freely movable tissues (e.g. soft palate, floor of mouth)
  27. 27. CORE BIOPSY  Fine needle biopsy has been established as a safe procedure and is routinely performed under local anaesthesia. Many pathologists believe that for histologic study, core tissue is more useful than cytologic material
  28. 28. Core needle biopsy (CNB) has emerged as an important sampling method in the diagnosis of musculoskeletal tumours
  29. 29. FINE NEEDLE ASPIRATION CYTOLOGY  It is the “Technique of aspiration of cells/ fluid/ tissue fragments using a fine needle for examination under a microscope”
  30. 30.  ADVANTAGES 1. The technique is relatively painless, produces speedy results. 2. It is an inexpensive technique. 3. It requires little equipment. 4. The technique can be done as an out patient or a bed side procedure. 5. There is no problem with wound healing. 6. The technique is readily repeatable
  31. 31.  INDICATIONS  1. Non palpable lesions, or area difficult to biopsy but can be localized by CT, MRI, Ultrasound.  2. To rule out vascular lesions prior to open surgery.  3. In cases where Biopsy is contraindicated on medical background.  4. Used as a diagnostic screening test at community level for head and neck masses.  5. Indicated for known tumors to assess effect of treatment.  6. Used to obtain tissue for specific studies.
  32. 32. FINE NEEDLE WITH ASPIRATION
  33. 33. FOR MAJOR SALIVARY GLAND/LYMPH GLAND LESIONS FNAC MAY BE USEFUL
  34. 34. BRUSH BIOPSY  Diagnosis of oral epithelial dysplasia has traditionally been based upon histopathological evaluation of a full thickness biopsy specimen from lesional tissue.  It has recently been proposed that cytological examination of “brush biopsy” samples is a non- invasive method of determining the presence of cellular atypia, and hence the likelihood of oral epithelial dysplasia.
  35. 35.  Exfoliative Cytology It is a quick and simple procedure, is an important alternative to biopsy in certain situations. In exfoliative cytology, cells shed from body surfaces, such as the inside of the mouth, are collected and examined. This technique is useful only for the examination of surface cells and often requires additional cytological analysis to confirm the results.
  36. 36. DANGERS OF BIOPSY  Spreading of infection  Haemorrhage  Infection  Operative trauma
  37. 37. INJECTION
  38. 38. For red & white lesions include both red & white area
  39. 39. For Vesiculobullous lesions Fluid is more representative. Intact vesicle or bulla should be biopsied.
  40. 40. ULCERS Include margin,deep part of ulcer and site of maximal clinical activity. AVOID Superficial ulcers & necrotic tissue
  41. 41. BIOPSY DATA SHEET  PATIENT DATA  HISTORY  CLINICAL DESCRIPTION  NATURE OF BIOPSY  RADIOGRAPHS & PHOTOGRAPHS  DISCRIPTION OF BIOPSY SPECIMEN
  42. 42. BIOPSY REPORT  IT SHOULD INCLUDE DIAGNOSIS AS WELL AS A COMPLETE MICROSCOPIC DESCRIPTION
  43. 43. ARTIFACT = Artificial (man made) product  Artifacts are alteration in the tissue morphology that results from various forms of mechanical, chemical, or thermal insult to the tissue specimens removed for diagnostic purposes, anywhere from fixation to processing to staining. Numerous types of artefacts can affect the biopsy specimen.
  44. 44. CLASSIFICATION PRE BIOPSY ARTIFACTS: They are introduced prior to the collection of the tissue BIOPSY ARTIFACTS Injection of L.A. into the lesion. Injection Artifacts Improper handling of the tissue Errors during manipulation of tissue Forceps/ Squeeze Artifact Problems in orienting excised tissue Heat Artefact(Fulguration Artifact) Foreign Bodies or Starch Artifact.
  45. 45. INJECTION ARTIFACT IMPROPER REMOVAL
  46. 46. HEAT ARTEFACT
  47. 47. FORCEPS ARTIFACT CRUSH ARTIFACT SPLIT ARTIFACT
  48. 48. It is not easy to procure a good biopsy specimen, nor is it very difficult, but the procedure must be carefully planned and carried out.
  49. 49. THANK YOU

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BIOPSY in oral pathoogy

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