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Minor Oral Surgery > Biopsy > Flashcards

Biopsy Flashcards

1
Q

What is a biopsy ?

A

this is the removal of part, or all, of a lesion to enable histopathological examination and definitive diagnosis of the lesion

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2
Q

List some indications for a biopsy

A
  • any lesion that persists for more than 3 weeks and no cause can be found
  • an inflammatory lesion which does not resolve following the removal of the cause e.g. sharp tooth
  • lesions which interfere with function e.g. epulis or fibro-epithelial polyp
  • all red patches
  • most white patches, especially if speckled or non- homogenous for which no cause is found
  • any lesions which possesses malignant signs e.g. induration (hardness), fixation to underlying tissues, rapid growth, bleeding or ulceration
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3
Q

Where should LA be placed when taking a biopsy sample?

A

it should be placed away from the site as it could cause damage to the specimen

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4
Q

State some criteria required for a biopsy

A
  • should include a portion of clinically normal tissue
  • site of the sample should be from an area that is most representative of the rest of the lesion
  • if the lesion contains regions of varying clinical appearance, multiple biopsies should be undertaken
  • areas of necrosis or ulceration should be avoided as they are limited diagnostic use
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5
Q

What are the types of biopsies are mainly performed in the oral cavity?

A
  • excisional
  • incisional
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6
Q

Give examples of clinically diagnosed lesions that are not suitable for biopsy in a general dental practice and require referal to hospital

A
  • chronic ulcer or SCC
  • erythro/leukoplakia
  • bullous lesions e.g. pemhigoid
  • granulomatous disease e.g. crohns
  • minor salivary gland tumour
  • hard tissue lesions
  • erosive lichen planus
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7
Q

Give examples of clinically diagnosed lesions that are suitable for biopsy in a general dental practice

A
  • lichen planus-reticular/striated requires surgical experience
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8
Q

Exicisonal lesions are more amenable to what kinds of lesions?

A

small benign lesions
<1cm

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9
Q

Give examples of small benign lesions suitable for excisional biopsy

A
  • fibro-epithelial polpys
  • pyogenic granuloma and epulis
  • fibroma
  • papilloma
  • hyperplastic tissue
  • mucocele
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10
Q

What is a mucocele ?

A

common lesion of the oral mucosa that results from an alteration of the minor salivary glands due to mucous accumulation causing limited swelling

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11
Q

Incisional biopsies are more amenable to what types of lesions?

A

large or suspicious lesions

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12
Q

Give examples of large/suspicious lesions that are suitable for incisional biopsies

A
  • chronic ulcer
  • squamous cell carcinoma
  • leuko/erythroplakia
  • lichen planus
  • bullous lesions
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13
Q

Give an example of a lesion that is amenable/suitable for a punch biopsy

A

bullous lesion

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14
Q

Give examples of lesions that are suitable for fine needle aspiration biopsies

A
  • soft tissue masses prior to surgical exploration
  • bony cysts prior to surgical exploration

in nodes and salivary glands

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15
Q

What is an excisional biopsy ?

A

one that removes the entire lesion and a small margin of normal tissue

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16
Q

The nature of an excisional biops makes it both _______ and _________

A
  • curative and diagnostic
17
Q

Outline how you would perform an excisional biopsy of a fibro-epithelial polyp

A
  • suture can be placed beneath the lesion with a loose knot; held with an artery clip (ensure suture is placed beneath the lesion and not through the area of interest) - this is an optional step
  • make an elliptical incision around the base of the lesion including a small margin of tissue around the lesion
  • as fibro-epithelial polyps are superficial , sharp dissection is then used to seperate the lesion from the underlying tissues
  • closure is achieve with superficial, simple interrupted sutures

Video helped with further understanding

18
Q

Outline how you would perform an excisional biopsy of a mucocele

A
  • suture can be placed beneath the lesion with a loose knot; held with an artery clip (ensure suture is placed beneath the lesion and not through the area of interest) - this is an optional step
  • make an elliptical incision around the base of the lesion including a small margin of tissue around the lesion
  • as mucoceles are more fragile/deeper, blunt dissection is then used to seperate the lesion from the underlying tissues
  • closure is achieve with superficial, simple interrupted sutures
19
Q

What is the benefit/purpose of placing a suture beneath the lesion?

A

this is to apply tension to the lesion without crushing any artefact which may arise if tissue forceps are used to steady the tissue

20
Q

Briefly outline a summary of information that should be noted on the pathology form for a biopsy

A
  • patient details; DOB, name, gender, race
  • history of lesion
  • MH detailing drugs
  • SH: smoking, alcohol
  • clinical appearance of lesion
  • associated pathology or restorations
  • investigations with results
  • biopsy type
  • labelled diagram
  • clinical diagnosis
  • consultants (dentists) name and address
21
Q

What types of sutures can be used to close a wound following excisional biopsy ?

A
  • resorbable (vicyrl) are the most often placed
  • black silk suture can also be placed
22
Q

When is an incisional biopsy indicated?

A
  • when complete removal of the lesion would be difficult e.g. lichen planus or a diffuse white patch
  • if clinical diagnosis is uncertain
    *
23
Q

What are the requirements of an incisional biopsy?

A
  • deep enough to include the basement membrane and underlying connective tissue (at least 3-4mm)
  • a general guide is as follows- the length should be 3x the width of the biopsy
  • must include normal tissue together with abnormal to act as a reference
24
Q

What does the length of an incisional biopsy depend on?

A

largely depends on the area that has been chosen to be biopsied

25
Q

Briefly describe how an incisional biopsy would be carried out

A
  • elliptical incision made to the required depth ad the sample of tissue is excised
  • one end of the ellipsed incision is held and lifted with tissue forceps or a holding suture (ensure the forcep or holding suture is held away from the pathology) and then a sample is carefully dissected out
  • primary closure is achieved with sutures
26
Q

What is an artefact?

A

this is something that alters the appearance of a sample tissue when mounted on a microscopic slide and can result from crush injuries from forceps, haemorrhage, fragmentation and splits

27
Q

What is the most common artefact observed following biopsies perfromed by a GDP?

A

crush injuries

It is also significantly more than crush injuries found in biopsies performed by oral and maxillofacial surgeons (thhe same was true for haemorrhage artefacts)

28
Q

State some causes of crush artefacts in biopsies

A
  • grasping soft tissue with forceps
  • using a suture for traction and tying the knot over a lesion too tightly
  • using a blunt scalpel blade
29
Q

What is usually the cause of haemorrhage artefacts ?

A

it is usually the result of intralesional injection of LA
It can be avoided by infiltrating LA away from the area of interest or a regional block

30
Q

What is the purpose of a labelled diagram on the pathology form?

A

A labelled diagram on the pathology form can show position and size of lesion (indicating where lesion was taken from)

31
Q

What clinical details should be noted following an incisional biopsy?

A
  • size
  • shape
  • duration
  • changes
  • colour
  • texture
  • radiographic appearance
  • relevant MH or DH
  • clinical diagnosis by surgeon where possible
32
Q

State the instrumentation required for a soft tissue biopsy

A
  • LA
  • scalpel with No.15 blade
  • sharp-pointed scissorys
  • small clip- mosquito clip
  • fine tissue forceps
  • needle holders and suture material
  • sterile gauze and saline
  • biopsy pot containing 10% formalin
  • pathology form
33
Q

Some samples need to be sent fresh to the pathologist. Give an example of this and state a brief explanation why.

A
  • vesiculo-bullous disorder
    this is because these samples require immunofluorescent techniques
34
Q

What is the ideal way to manage samples post-operatively?

A
  • placed immediately into a sealable container with 10% neutral buffered formalin
  • there should be 10x more fixative than specimen
35
Q

If in doubt about the transport medium to use, what medium is acceptable in the meantime?

A

normal saline

36
Q

How should packages containing specimen be sent from the practice to the lab?

A
  • container should be surrounded with absorbent material to absorb leakages
  • placed in a sealed plastic bag and in turn placed into a rigid box
  • box should be labelled “PATHOLOGICAL SPECIMEN” and “fragile- handle with care”
37
Q

What are the advantages of performing simple biopsies in general practice for the patient ?

A
  • confidence of having a known and trusted clinician perform the procedure
  • less waiting time for the procedure and results
  • less travelling
38
Q

What are the advantages of performing simple biopsies in the general practice for hospitals?

A
  • reduction in referrals and therefore waiting lists

Minor Oral Surgery (36 decks)

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