Biopsies Flashcards Preview

Oral Path > Biopsies > Flashcards

Flashcards in Biopsies Deck (10):
1

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

2

Biopsy Contraindications

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

3

Biopsy Types

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

4

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.

5

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

6

Fine Needle Aspirations

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

7

Needle Core Biopsies

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

8

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
possible
• Aspirate intra-osseous radiolucencies prior to
biopsy, then biopsy well into lesion and
include margin of lesion with normal bone

9

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
diagnosis)
• Head and neck examples: Thyroid,
parathyroid, lymph nodes, laryngeal,
oropharyngeal biopsies to locate primary
tumor, evaluation of cancer resection margins

10

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