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Flashcards in Biopsies Deck (10):

Biopsy indications

• To establish a diagnosis
• Absence of an obvious cause
• No response after initial treatment or no
resolution after an acceptable time period
• To confirm clinical diagnosis
• Cancer-phobic patients


Biopsy Contraindications

• Some medically-compromised patients
– Hospital dentistry/oral surgery
• Lesion is obviously cancer
– Refer to oral surgeon or ENT for surgical


Biopsy Types

• Excisional
• Incisional
– Shave
– Punch
• Fine needle aspiration
• Core biopsies
• Smear (cytology)
• Intra-osseous


Excisional Biopsy

• For small or focal lesions
• Excise whole lesion
Excisional biopsy versus
definitive excision, or excision
with margin evaluation… if
margin evaluation is required,
excision must be at least 1.0 cm
in length and be oriented.


Incisional Biopsy

• For large or diffuse lesions
• Obtain a representative area
– Edge of lesion; avoid center of an ulcer
• Ideal for lesions suspicious for malignancy


Fine Needle Aspirations

• For lymph nodes, internal organs, salivary
glands, thyroid gland


Needle Core Biopsies

• Commonly used for initial breast and prostate
• May be CT-guided for internal organs


Selecting Biopsy Site

• Should be representative of the lesion
• Sample multiple sites for large lesions
• Include normal and lesional tissue
• Include erythematous areas if present
• If ulcerated, sample ulcer margin, not center
• Use scalpel instead of electrocautery when
• Aspirate intra-osseous radiolucencies prior to
biopsy, then biopsy well into lesion and
include margin of lesion with normal bone


Frozen Sections

• AKA intra-operative consult
• Tissue is submitted to the histology laboratory
and processed while the patient is still in the
OR (standard 20 min turn-around time for
• Head and neck examples: Thyroid,
parathyroid, lymph nodes, laryngeal,
oropharyngeal biopsies to locate primary
tumor, evaluation of cancer resection margins


Limitation of Frozen Sections

• Histologic artifacts
• Representative tissue
• Unless the histology is obvious, the
pathologist will be as cautious (vague) as
possible in rendering the frozen diagnosis