3. DEFINITION
• A BIOPSY IS A PROCEDURE TO REMOVE A PIECE OF
TISSUE OR A SAMPLE OF CELLS FROM YOUR BODY
SO THAT IT CAN BE ANALYSED IN A LABORATORY.
• WHEN AN ENTIRE LUMP OR SUSPICIOUS AREA IS
REMOVED, THE PROCEDURE IS CALLED
AN EXCISIONAL BIOPSY. AN INCISIONAL
BIOPSY SAMPLES A PORTION OF THE ABNORMAL
TISSUE WITHOUT ATTEMPTING TO REMOVE THE
ENTIRE LESION OR TUMOR.
4. INDICATIONS OF BIOPSY
• TO CONFIRM THE CLINICAL DIAGNOSIS OF MALIGNANCY.
• TO RULE OUT MALIGNANCY IN A SUSPICIOUS LESION.
• ANY SUSPICIOUS LESION THAT CANNOT BE DIAGNOSED CLINICALLY.
• ANY LESION WITHOUT DEFINITE CAUSE THAT PERSISTS BEYOND 2
WEEKS MEDICAL TREATMENT.
• DIAGNOSE CHRONIC CONDITIONS LIKE INFECTIONS (TUBERCULOSIS),
AUTOIMMUNE DISEASES.
• TO MATCH ORGAN TISSUES BEFORE TRANSPLANT .
• ANY LESION CAUSING EXTREME CONCERN TO THE PATIENT
(CANCERPHOBIA)
5. CONTRA-INDICATIONS
BIOPSY HAS CERTAIN CONTRAINDICATIONS
WHICH ARE AS FOLLOWS :
• ANTICOAGULANT THERAPY.
• OVERWHELMING SEPSIS.
• SEVERE IMPAIRED LUNG FUNCTION.
• UNCONTROLLED BLEEDING.
• UNCOOPERATIVE PATIENT.
• LOCAL INFECTION NEAR THE SITE.
6. OBJECTIVES OF BIOPSY
• TO CONFIRM A DIAGNOSIS MADE ON
CLINICAL FINDINGS.
• TO DETERMINE THE TREATMENT PLAN.
• AS A MEDICAL RECORD.
8. STEPS OF BIOPSY
• SELECTION OF AREA OF BIOPSY.
• PREPARATION OF SURGICAL FIELD.
• APPLICATION OF LOCAL ANESTHESIA.
• INCISION.
• HANDLING OF SPECIMEN.
• SUTURING OF RESULTING WOUND.
10. EXCISIONAL BIOPSY
• AN EXCISIONAL BIOPSY IMPLIES TO THE COMPLETE REMOVAL
OF THE LESION FOR MICROSCOPIC STUDY.
TECHNIQUE:
• THE ENTIRE LESION WITH 2 TO 3MM OF NORMAL APPEARING
TISSUE SURROUNDING THE LESION IS EXCISED IF BENIGN.
ADVANTAGE:
• BOTH DIAGNOSTIC AND THERAPEUTIC.
• NEED NOT PERFORM SEPARATE SURGERY.
11. INDICATIONS:
• SHOULD BE EMPLOYED WITH SMALL LESIONS, LESS
THAN 2CM.
• THE LESION ON CLINICAL EXAM APPEARS BENIGN.
• WHEN COMPLETE EXCISION WITH A MARGIN OF
NORMAL TISSUE IS POSSIBLE WITHOUT MUTILATION
CONTRAINDICATION:
• IN LARGE LESION >2CM.
12.
13. INCISIONAL BIOPSY
• IF A LESION IS LARGE OR HAS DIFFERENT CHARACTERISTICS
IN VARIOUS LOCATIONS IN MORE THAN ONE AREA MAY NEED
TO BE SAMPLED.
INDICATIONS:-
• LESION LARGER THAN 2 CM.
• DANGEROUS LOCATION OF THE LESION.
14. • 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.
• SHARP BLADE SHOULD BE USED.
• DO NOT INJECT LA.
17. TECHNIQUE :
• RANGE IN SIZE FROM 2-10 MM IN DIAMETER.
• THE SMALLER DIAMETERS SHOULD BE AVOIDED DUE TO THE RISK OF OVER
MANIPULATING AND CRUSHING THE TISSUE.
• THE TECHNIQUE IS EASILY PERFORMED WITH A LOW INCIDENCE OF POSTSURGICAL
MORBIDITY.
• SUTURING IN REGARDS TO A PUNCH BIOPSY PROCEDURE IS USUALLY NOT REQUIRED
AS THE SURGICAL WOUNDS HEAL BY SECONDARY INTENTION
18. ADVANTAGES:
• EASE OF TECHNIQUE.
• SUTURES MAY NOT BE REQUIRED IF SMALL DIAMETER PUNCH IS
THERE.
• MAY PRODUCE 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)
19. EXFOLIATIVE CYTOLOGY
• STUDY OF MORPHOLOGY OF EXFOLIATED CELLS UNDER
MICROSCOPE USING SPECIAL STAIN.
• CANNOT BE USED AS DIAGNOSTIC PROCEDURE .
• USED AS ADJUNCT/AID TO BIOPSY.
• MOST COMMONLY USED STAIN-PAP STAIN.
20. INDICATION:
• MUCOSAL LESION THAT APPEARS CLINICALLY INNOCUOUS
AND OTHERWISE WOULD NOT BE BIOPSIED.
• FOLLOW UP OF PATIENTS WITH PRIOR DIAGNOSIS OF
PREMALIGNANT AND MALIGNANT MUCOSAL LESION.
• INDIVIDUAL WHO ARE DEBILITATED TO ASSESS THE ORAL
CANDIDIASIS AND VIRAL INFECTION.
• TO STUDY AND CONFIRM THE FALSE, NEGATIVE BIOPSY
RESULT
21. TECHNIQUE :
• CLEAN THE SURFACE OF THE LESION.
• USE MOISTENED TONGUE BLADE OR CEMENT SPATULA TO SCRAPE
SURFACE OF LESION MANY TIMES (ONE DIRECTION ONLY).
• MATERIAL OBTAINED IS SPREAD IN A ROTATORY MOTION ON A CLEAN
GLASS SLIDE.
• MAKE THIN UNIFORM SMEAR.
• KEEP IT IN JAR CONTAINING FIXATIVE FOR 15-30 MIN.
• STAIN THE SMEAR.
22. ADVANTAGE:
• DEVELOPED AS A DIAGNOSTIC SCREENING PROCEDURE TO
MONITOR TARGET TISSUE AREAS FOR DYSPLASTIC CHANGES.
• MAY BE HELPFUL WITH MONITORING POST RADIATION
CHANGES, HERPES, PEMPHIGUS.
DISADVANTAGE:
• NOT VERY RELIABLE WITH MANY FALSE POSITIVES.
• EXPERTISE IN ORAL CYTOLOGY IS NOT WIDELY AVAILABLE.
23. ASPIRATION CYTOLOGY
• ASPIRATION BIOPSY IS THE USE OF A NEEDLE AND SYRINGE
TO PENETRATE A LESION FOR ASPIRATION OF ITS CONTENTS.
• 18-24 GAUGE NEEDLE IS USED.
INDICATIONS;
• TO DETERMINE THE PRESENCE OF FLUID WITHIN A LESION.
• TO KNOW THE TYPE OF FLUID WITHIN A LESION.
• WHEN EXPLORATION OF AN INTRAOSSEOUS LESION IS
INDICATED.
24. PROCEDURES:·
• AN 18-GAUGE NEEDLE IS CONNECTED TO A 5 OR 10 ML SYRINGE AND IS INSERTED INTO
THE CENTRE OF THE MASS VIA A SMALL HOLE IN THE LESION.
• THE TIP OF THE NEEDLE MAY NEED TO BE POSITIONED IN MULTIPLE DIRECTIONS TO
LOCATE A POTENTIAL FLUID CENTER.
• THE MATERIAL WITHDRAWN DURING ASPIRATION BIOPSY CAN BE SUBMITTED FOR
PATHOLOGIC EXAMINATION AND/OR CULTURING.
25. ADVANTAGE:
• OBTAIN CELLS FROM ANY SITES OF BODY.
• LESS LABOUR THAN BIOPSY.
• FAST
• PERMITS EARLY START OF TREATMENT
• CAN BE DONE REPEATEDLY ON MOST MASSES/LESIONS.
DISADVANTAGE
• CAN BE PAINFUL
• REQUIRES GREAT SKILLS
• NEEDLE CAN DAMAGE VITAL STRUCTURE
• INTERNAL BLEEDING POSSIBLE
• NOT A DIAGNOSTIC PROCEDURE
26.
27. BRUSH BIOPSY
• DIAGNOSIS OF ORAL EPITHELIAL DYSPLASIA HAS TRADITIONALLY BEEN BASED UPON
HISTOPATHOLOGICAL EVALUATION OF A FULL THICKNESS BIOPSY SPECIMEN FROM
LESIONED 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.
28. TECHNIQUE:
• FIRM PRESSURE WITH A CIRCULAR BRUSH IS APPLIED, ROTATED FIVE TO
TEN TIMES, CAUSING LIGHT ABRASION.
• THE CELLULAR MATERIAL PICKED UP BY THE BRUSH IS TRANSFERRED TO
A GLASS SLIDE, PRESERVED, AND DRIED.
ADVANTAGES:
• QUICK AND EASY FOR YOUR DENTIST TO PERFORM
• SAMPLES A LARGER AREA THAN SCALPEL BIOPSY
• REQUIRES NO MEDICATION OR ANAESTHESIA
29. DANGERS OF BIOPSY
• SPREADING OF INFECTION
• HAEMORRHAGE
• INFECTION
• OPERATIVE TRAUMA
• WOUNDING OF CANCER TISSUE
