This document discusses biopsy techniques and procedures. It covers indications for biopsy, contraindications, different biopsy methods including excisional, incisional, punch and needle biopsies. Potential dangers of biopsy like hemorrhage and infection are mentioned. Considerations for specific lesions in the oral cavity and techniques to avoid errors are provided. The document aims to guide dentists on proper biopsy methods.
2. Introduction
Indication
Contraindication
Techniques of biopsy
Procedure
Dangers of biopsy
Common errors
Consideration of specific lesion
3. “ THE BEST SURGEONS IS A CLINICAL
PATHOLOGIST WHO PERFORMS OPERATIONS”
4. BIOPSY (Bio-life; Opsis-vision)
Biopsy is the removal of the tissue from
the living organism for the purpose of
microscopic examination and diagnosis
5. 1. Confirm presumptive diagnosis
2. Type of treatment
3. Self teaching diagnostic aid
4. Cancer phobia
5. Medico legal report
6. More than 2 weeks
Local treatment
Persistent hyperkeratotic lesion
Suspect of neoplasm
Interfere with local function
Any tissue surgically excised
Expelled from body orifice
7. Bone lesions
Draining sinus
Cystic lesions
Per apical lesions
Soft tissue lesions
Inflammatory and glaucomatous disease
Any lesion that has characteristics of
malignancy.
9. 1) General health
2) Acute infections
3) Blood dyscrysis
4) Lesion of vascular origin
10. At least 1cms x0.5cms in size
Accessible area
Thin deep sections
If several lesions are present
If lesion is intraosseous
If the lesion is ulcer
A biopsy of skin and mucosa
11. 1) Antiseptic
2) Local anesthetics and syringe
3) Scalpel
4) Small pointed scissors
5) Tissue forceps
6) Surgical haemostats
7) Sponges
8) Sutures
9) Niddle holder
12. 10) Wide mouthed bottle containing formalin
10%-15times the volume of specimen
11) Periosteal elevator
12) Bone bur
13) Bone chisel
14) Mallet
15) Curettes
16) Syringes for aspiration
17) Biopsy punch
13. Main steps in the biopsy procedures are
I. Injecting local anesthesia
II. Incision
III. Suture is used to create tissue tension
IV. Sample is placed in 10% formalin
16. It is the removal of the entire lesion at the
time of surgical diagnostic procedure.
Indication
a. lesion less than 1 cms
b. Benign
c. Pigmented and vascular
Advantages
1. Entire lesion is available
2. Part of the treatment
3. Diagnosis and treatment
complication
17. Only a portion of the lesion is removed for
examination
Indication
Lesion under examination is more than 1
cms in diameter.
When lesion is in hazardous position
Suspect of malignancy
Commonest lesions are hyperkeratotic
lesions of the oral cavity.
Contraindication
Pigmented and vascular lesions
Melanomas.
Necrotic area should be avoided
18. A tissue punch is inserted into the centre of
lesion, and a small plug of tissue is
removed.
Used in surgically inaccessible site.
In this technique tissue gets bruised, or
damaged.
Curettage
This is removal small bits of tissue with sharp
instruments.
For bony cavity
Sinus tract
Boney space maxillary ant rum
19. Here trephine sharpened niddles of
different sizes are attached to syringe
Separation of the specimen depends on the
sharp cutting action of the special needles
Useful in diagnosis of lymph nodes
Salivary glands and thyroid glands
Soft tissue and boney lesions
Advantage
1) Simple to perform
2) Saves time
3) Saves hospital costs
20. It is a high speed drill technique described
by deelay(1980)
Ellis biopsy drill
Useful for central-fibro osseous lesion
Advantage
1) Less trauma and damage
2) Spread of lesion is avoided
Disadvantage
1) In negative Not used in lesions less than 2
cms
2) Drill lesion can be missed
21. Disadvantage
IN negative Not used in lesions less than 2
cms
Drill lesion can be missed
Clinical application
Breast, thyroid, oral cavity, salivary glands,
osteolytic lesions,hepatic
malignancy,lymphnode masses,
22. It is the means of obtaining material from the
body cavity, cystic space or fluid containing
lesion.
In 1930 introduced by Martin and Ellis and
Stewart
This procedure is a type of exfoliate cytology
study provides as the same aid to diagnosis.
Indication
1) Differentiation
2) Causative organism
3) Identification
4) Research
23. Advantage
1. Quick report
2. Less painful
3. Inexpensive
4. Easily repeatable
Limitations
False positive and false negative
Equipment
1. Fine Niddle
2. Syringe
3. Slides
4. fixatives
24. Cleansing
Lido cane injection
Vacuum is created
Specimen in the Niddle is put on the slide
Spared
Interpretation
Inability to aspirate
Aspiration in molar region
Aspiration of air in cyst in lower jaw.
Aspiration of pus
Presence of keratin
Straw cloured fluid
Aspiration of blood
25. • This is the withdrawal of fluid from body cavity
through large Niddle by –ve pressure.
Cytological Examination
• As an adjunct but not a substitute to biopsy
• Report is based on the morphological features
of cells.
Endoscopic biopsy
• For abdominal pathology
• Advantage is visualization of pathology and
removal of the tissue from the same
• Limited in head and neck pathology
26. Spreading of tumor cells
Hemorrhage
Infection
Wounding of the cancerous tissue
Operative trauma
27. Iodine
For dermatologic diagnosis plain L A
Tissues must be grasped with minimal
When orienting the excised tissue
In winter formalin might become frozen
Formaldehyde may evaporate
While using electrocautery
Injection of large amount of anesthetic
solution to biopsied area causes tissues
changes
28. Delayed inadequate fixation produces some
tissue changes
Freezing artifact
Hard tissue inclusion within the tissue
29. Some lesions have additional consideration in
biopsy technique
1. Precancerous lesion
Selection of the area
In speckled red and white
More severe dysplasia
2. Salivary gland
In case of major salivary glands
breach in capsule leads to potential cell spillage
Release of mucoid material containing viable
tumor cells.
30. Lymph node
It is difficult tissues to fix because of their dense
capsule and their cellularity.
Sagital plane
Niddle aspiration
Cystic lesions
Every attempt should be made to remove the
lesion without rupture.
Mucoepidermoid tumors
Boney cysts(dentigerous cysts)
31. Tooth
Drill the crown or apical third of the root to
allow for pulpal fixation
Vesicle or bullae
Biopsy is performed on a fresh, intact blister
Pempigus vulgaris
Longer border shallow biopsy as this is a
surface phenomenon
Intra osseous lesion
Ex – perapical granuloma,cysts of jaw,
Aspiration biopsy
32. The healing of a biopsy wound of the oral
cavity is either by primary healing or
secondary healing .
Depends whether edges are brought into
close apposition by suturing .
33. 1) Patient’s name, adress, age, sex,
2. Pertainent history
3. Clinical description
4. Nature of biopsy
5. Radiograph, photograph
6. Coments on biopsy specimen
34. A biopsy report should include a diagnosis as
well as microscopic description on even the.
most routine submition
Negative report means no serious desease
It does not rule out disease in adjacent site
or future date.