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DIPC 6005 > Biopsy > Flashcards

Flashcards in Biopsy Deck (23):
1

Diagnoses
comes from the Greek words
dia (“through,” “apart”) and
gnosis (“knowledge”),
meaning literally _______.

to know apart or to distinguish

2

A diagnosis is defined as
The ________________.
An accurate diagnosis is obviously important and occasionally critical to the patient so that the most appropriate treatment can be initiated as soon as possible.

determination of the nature of a disease or pathologic condition.

3

• Occasionally the diagnosis is relatively straightforward
• _________: represents a listing of the more likely diagnostic considerations for a particular pathologic finding or condition, ranked in descending order of probability
• Clinician’s evaluation

Differential diagnosis

4

Construction of the differential
1. Clinical signs
2. Symptoms
3. History
• List of diagnoses is subject to modification or refinement (radiographic imaging and hematologic or serum analysis)
• _________ of the treating clinician

Experience and knowledge base

5

• The designation of ______ is used when the clinician believes that the nature of the disease has been identified to a reasonable degree of certainty.

final diagnosis

6


Depending upon the experience and expertise of the practitioner, a confident final diagnosis may require nothing more than clinical inspection.
HOWEVER, EVEN THE MOST EXPERIENCED DIAGNOSTICIAN REQUIRES _________.

ADDITIONAL INFORMATION FROM APPROPRIATE IMAGING OR LABORATORY STUDIES

7

BIOPSY
It is a surgical procedure in which a ________ from a patient and submitted for laboratory examination.
The word biopsy is of Greek derivation, originating from the words bio (life) and
opsia (to see)

tissue sample is removed

8

Despite the sophisticated images techniques, blood studies, nuclear and positive electron transmission (PET), _______ is the best and most often used dx tools.
The approach to a biopsy depends somewhat on the size, shape, location, and type of disease the practitioner anticipates.

Scapel blade and light microscope

9

BIOPSY
• To aid in deriving a working __________.
• The challenge for the clinician is to provide a ________ that is adequate in quantity, properly fixed, and without artifacts or distortion.

1. diagnosis and confirm the differential diagnosis
2. representative tissue specimen

10

BIOPSY Indications
• When the patent’s clinical presentation, past history, or imaging studies ________.
• Any mucosal, skin, or bone abnormality that _________.
• Any lesions suspected to be of _______ are indicated for biopsy

1. do not allow a definitive diagnosis.
2. persists despite either removal of the associated irritant or treatment with adjunctive means deserves a biopsy. (2 weeks)
3. neoplastic origin

11

BIOPSY
Limitations and Contraindications
• An area of ______ has no need of a biopsy.
• Pts with known ________ may require an alteration in the usual biopsy routine.
• Pts with _________ may need the aid of (CT) or ultrasound (US) to facilitate the determination of the exact type of biopsy needed.
• Pts undergoing treatment with ________ as well as _________.

1. infection
2. allergies to local anesthetics or history of bleeding
3. deeply positioned lesions
4. IV or oral bisphosphonates; prior irradiated bone

12

Types

• Exfoliative Cytology (Brush)
• Fine-Needle Aspiration
• Incisional Biopsy
• Excisional Biopsy
• Punch

13

EXFOLIATIVE CYTOLOGY
• It is a relatively ________ technique that may be used to provide additional information related to lesions of _______.
• Candidiasis, herpesvirus (herpes simplex virus, human herpesviruses 1 and 2) infections, and pemphigus vulgaris

1. inexpensive noninvasive
2. surface origin

14

FINE-NEEDLE ASPIRATION
• (FNA) is a useful method for evaluating _________.
• Most widely used in determining the nature of _______.

1. subcutaneous or more deeply situated mass lesions.
2. salivary gland or neck masses.

15

INCISIONAL BIOPSY
• Indicated for large lesions (_____) and those that could represent ________.
• It is a diagnostic surgical procedure in which a _______ of a lesion is removed

1. > 2 cm
2. unencapsulated or potentially malignant neoplasms
3. sample or portion

16

EXCISIONAL BIOPSY
• Used to manage clinically ______ that are ____ in diameter.
• Defined as a diagnostic surgical procedure in which _______.

1. benign lesions
2. < 2 cm
3. all clinically abnormal tissue is removed

17

PUNCH BIOPSY
• Quick and accurate.
• It allows the pathologist to view the entire biopsy in its natural anatomic arrangement.
• To _________.
• Any _______ punch will require at least one _____. Punch biopsies rarely scar or become infected.

1. remove small lesions or to incisionally biopsy larger ones.
2. larger diameter; suture

18

PREOPERATIVE EVALUATION

• Patient’s general health.
• Malignant potential.
• Physical properties.
• Surgical expertise.

19

PHYSICAL PROPERTIES OF LESION

• Margins.
• Surface characteristics
• Depth of extension
• Size
• Quality of tissue
• Pigmentation
• Vascularity
• Soft tissue or bone
• Growth rate

20

PREOPERATIVE QUESTIONS

• What type of biopsy is best?
• Where do you take the biopsy?
• Multiple sites for biopsy.

21

PRINCIPLES

• Anesthesia via block technique
• Take adequate tissue
• Do not mutilate tissue
• Retract and orient tissue with suture
• Palpate all lesions
• Aspirate all radiolucent lesions

22

• Incise
1. Parallel to vessels and nerves.
2. Parallel to line of tension
3. Elliptical shape
• Send all excised tissue to the pathologist (_________)

(teeth, lesion/granulation tissue, normal tissue)

23

Biopsy steps

• Identification
• Incise
• Anesthesia
• Clear margins
• Representative sample
• Traction suture