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Flashcards in Basic Principles of Biopsy Deck (29):
1

Indications for Biopsy

Lesions that persist for two or more weeks w/ no known reason

Any inflammatory lesion doesnt respond to local therapy within 2 weeks

2

History of Lesion

How long has been there?

Has lesion changed in size? How fast?

Lesion changed in character?

3

Bulla

Loculated fluid in or under epithelium of mucosa

4

Erosion

Superficial ulcer

5

Macule

Circumscribed area of color change w/o elevation

6

Papule

Small palpable mass, elevated above the epithelial surface

7

Nodule

Large palpable mass, elevated above epithelial surface

8

Plaque

Flat elevated lesion, the confluence of papules

9

Pustules

Cloudy or white vesicles containing pus

10

Scale

Macroscopic accumulation of keratin

11

Ulcer

Loss of epithelium

12

Vesicle

Small loculation of fluid in or under epithelium containing serous fluid (associated with herpes)

13

Clinical Exam

Size/shape
Single/multiple
Surface
Color
Borders (fixed or freely movable)

14

Lesions that raise suspicion of malignancy

Erythroplasia
Ulceration
Duration
Growth Rate
Bleeding
Induration
Fixation

15

Types of Biopsies

Oral Cytology
Aspiration Biopsy
Fine Needle
Incisional
Excisional

16

Oral Cytology

Needed - large areas of mucosal change, need monitoring dysplastic tissue (single cells)

Superficial surface area
Not liked by oral paths

17

Aspiration

Lesions suspected to contain fluid - done before biopsies
Intraosseous lessions

Vascular (stop if so) or avascular check!!!

18

Fine needle biopsy

Pass needle into suspected mass, small shavings of tissue are obtained in barrel of syringe.
Preliminary diagnosis

19

Incisional

Greater than 1 cm
Hazardous location
High Suspicion of malignancy
Closure

20

Incisional Techniques

Representative area
Wedge fashion - deep and narrow
Include normal tissue

21

Excisional

Less than 1 cm
Benign appearance
Closure

22

Excisional Technique

Entire lesion
Margin of normal tissue (2-3 mm)

23

Soft Tissue Biopsy - Local Anesthesia

Wait 10 mins for hemostasis
Block vs local infiltration

24

Soft Tissue Biopsy - Incision

Avoid electrosurgery
Ellipse converging to form V
Maintain parallel w/ nerves/vessels
2-3 mm border for benign, 5 for malignant

25

Soft Tissue Biopsy - Specimen Care

10% formalin solution
20 times volume of specimen
Total immersion

26

Soft Tissue Biopsy Hemostasis

Avoid high volume suction
Gauze compress
Gauze wrap over low-volume suction
Electrocautery
Suture ligation

27

Soft Tissue Biopsy - Closure

Undermine mucosa
Primary closure
Surgical dressing

28

Intraosseous Lesion Biopsy

Aspiration - radiolucent lesions

29

Mucoperiosteal Flaps

Sharp incisions
Subperiosteal plane
4-5 mm of sound bone around lesion