Biopsy: Reza Fu Rqon S

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Reza F
Biopsy is a surgical procedure to

obtain tissue from a living organism for
its microscopical examination, usually
to perform a diagnosis.
Indications
Inflammatory changes of unknown cause
that persist for long periods
Lesion that interfere with local function
Bone lesions not specifically identified by
clinical and radiographic findings
Any lesion that has the characteristics of
malignancy
Characteristics of lesions
that raise the suspicion of
Erythroplasia- lesion is totally red or has a
.malignancy
speckled red appearance.
Ulceration- lesion is ulcerated or presents as an
ulcer.
Duration- lesion has persisted for more than two
weeks.
Growth rate- lesion exhibits rapid growth
Bleeding- lesion bleeds on gentle manipulation
Induration- lesion and surrounding tissue is firm to
the touch
Types of Biopsy
cytology
aspiration biopsy
incisional biopsy
excisional biopsy
Aspiration Biopsy
Aspiration biopsy is the use of a needle and
syringe to remove a sample of cells or
contents of a lesion.
The inability to withdraw fluid or air indicates
that the lesion is probably solid
Aspiration
Procedures:
An 18-gauge needle is connected to a 5 or 10 ml
syringe and is inserted into the center 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The material withdrawn during aspiration biopsy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.
The inability to withdraw fluid or air indicates

that the lesion is probably solid.
A radiolucent lesion in the jaw that yields
straw-colored fluid on aspiration is most likely
a cystic lesion.
If purulent exudate (pus) is withdrawn, then an
inflammatory or infectious process should be
considered..
Incisional Biopsy
The intent of an incisional biopsy is to sample
only a representative portion of the lesion.
If the lesion is large or has many differing
characteristics, more than one area may
require sampling.
Indications of incisional
biopsy
whenever the lesion is difficult to excise
because of its extensive size
in cases where appropriate excisional surgical
management requires hospitalization or
complicated wound management.
Incisional biopsy
Representative
areas
are
biopsied in a wedge fashion.
Margins should extend into
normal tissue on the deep
surface.
Necrotic tissue should be
avoided.
The sample should be taken
from the edge of the lesion to
include surrounding normal
tissue
It should be deep enough to
include underlying changes
of the surface lesion.
Exisional biopsy
An
excisional
biposy
implies
the
complete
removal of the lesion.
A perimeter of normal
tissue
(2-3
mm)
surrounding the lesion is
included
with
the
specimen.
Excisional biopsy should be
performed
on
smaller
lesions (less than 1 cm in
diameter)
that
appear
clinically benign.
Pigmented and vascular lesions

should be removed, if possible,
in their entirety. This avoids
seeding
of
the
melanin
producing tumor cells into the
wound site or in the case of a
hemangioma,
allows
the
clinician to address the feeder
vessels.
When obtaining samples from
Anesthesia
Block anesthesia is preferred to infiltration
When blocks are not possible distant
infiltration may be used
Never inject directly into the lesion
Incisions
Incisions should be made with a scalpel.
They should be converging
Should extend beyond the suspected depth of
the lesion
They should parallel important structures
Margins should include 2 to 3mm of normal
appearing tissue if the lesion is thought to be
benign.
5mm or more may be necessary with lesions that
appear malignant, vascular, pigmented, or have
diffuse borders.
Tissue Stabilization
Digital stabilization
Specialized retractors/forceps
Retraction sutures
Towel Clips
Hemostasis
Suction devices should be avoided
Gauze compresses are usually adequate
Gauze wrapped low volume suction may be
used if needed
Handling of the Tissue

Specimen
special care should be undertaken to hold the

specimen gently at the periphery of the
sample.
Injection of large amounts of anesthetic
solution in the biopsy area, while providing
hemostasis, can produce hemorrhage, which
masks the normal cellular architecture.
Infiltration of local anesthetic around the
lesion is acceptable if the field is wide enough
in relation to the lesion;
Handling of the Tissue

Specimen
injection directly into the lesion should be avoided.
Use of electrocautery to excise the specimen
remains a common complicating factor in
determining an accurate microscopic diagnosis.
Heat produced by these units alters both the
epithelium and the underlying connective.
Small tissue biopsies to rule out malignancy are
usually nondiagnostic if excised by electrocautery,
as the presence of epithelial atypia is typically
obscured
If electrocautery is to be used, the incision margin
should be far enough away from the interface of the
lesion to prevent thermal changes at that interface.
Specimen Care
The specimen should be immediately placed
in 10% formalin solution, and be completely
immersed.
Margins of the Biopsy

Margins of the tissue should be identified to
orient the pathologist. A silk suture is often
adequate. Illustrations are also very helpful
and should be included.
Surgical Closure
Primary closure of the wound is usually
possible
Mucosal undermining may be necessary
Elliptical incision on the hard palate or
attached gingiva may be left to heal by
secondary intention.
Biopsy Data Sheet

A biopsy data sheet should be completed and
the specimen immediately labeled.
All
pertinent history and descriptions of the lesion
must be conveyed.
The biopsy report

the name of the clinician,
date the specimen was obtained
pertinent characteristics of the specimen.
The location/site, size, color, number, borders

or
margins,
consistency,
and
relative
radiodensity of the lesion are all important
findings that should be included in the
description of the specimen.
If the lesion is evident on radiographs, it is
very important to submit good quality
radiographs with the specimen to aid in
pathologic correlation and diagnosis.
Thank you

Biopsy: Reza Fu Rqon S

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y

Biopsy is a surgical procedure to

The inability to withdraw fluid or air indicates

Pigmented and vascular lesions

Handling of the Tissue

special care should be undertaken to hold the

Handling of the Tissue

Margins of the Biopsy

Biopsy Data Sheet

The biopsy report

The location/site, size, color, number, borders

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