soft tissue lesions + biopsy Flashcards
What is a biopsy and what are they used for?
A sample of tissue usually for histopathological analysis
Can confirm or establish a diagnosis and determine the prognosis of a patients condition
What questions should be asked when thinking of biopsy?
Should i biopsy this?
Why am i biopsying this?
What questions am i asking the pathologist? - usually send the pathologist a differential diagnosis list
Name 4 tissue sampling techniques
Aspiration
Aspiration from lesions eg - abscess
Fine needle aspiration biopsy
Surgical biopsy
Give an example of aspiration sampling
Blood sample eg - for FBC, U&E and haematinics
What are the benefits of aspirating lesions?
Avoids contamination by oral bacteria
Protects anaerobic species
Will determine whether a lesion is solid or fluid filled
How is fine needle aspiration carried out and when is it used?
Aspiration of cells from solid lesions
Used in neck swellings and SG lesions
Sample sent to cytology, not histopathology
Commonly used to diagnose breast cancer
What are the 3 types of surgical biopsy?
Incisional biopsy
Punch biopsy
Excisional biopsy
Describe an excisional biopsy and when its used
Removal of all clinically abnormal tissue
Used when fairly confident of provisional diagnosis
Usually on benign lesions eg - fibrous overgrowths, denture hyperplasia and mucoceles
Used on discrete lesions
Describe an incisional biopsy and when its used
A representative tissue sample
Used on larger lesions with uncertain diagnosis eg - leukoplakia, lichen planus and SSC
Don’t want to remove all signs of the lesion
Describe a punch biopsy and when it is used
Type of incisional biopsy
Uses hollow trephine 4, 6 or 8mm diameter
Removes core of tissue with minimal damage
May not require of suture or only minimal number of sutures
What should be considered when selecting an area to biopsy?
Must be large enough
Must be representative
Maybe more than one biopsy is needed
Include perilesional tissue
Refer if lesions are suspicious or lumps in the upper lip (these are often SG neoplasm)
How should samples be sent to the pathology lab?
Sample placed into 10% formalin
Suture may help pathologist orientate the sample (label mesial and distal)
Include relevant clinical info on pathology form to aid diagnosis, diagrams are helpful
Don’t use gauze, it distorts the sample
May use filter paper to reduce sample distortion - most of the time you don’t need anything
What is a crushed sample?
Sample is rolled on instead of flat
This distorts the anatomy
Why does a teared sample affect the histopathology analysis?
Can give the impression of a different disease process
What is a pregnancy epulis?
Histologically the same as a pyogenic granuloma
May be related to calculus and often bleeds
Hormonal changes enhance the response to tissue irritation
