BIOPSY
PRESENTATION BY: DR NIDHI SENTA
(PART III OMR)
GUIDED BY: DR BHAVIN DUDHIA
CO GUIDED BY : DR PARUL BHATIA
What is biopsy ?
The word biopsy originates from the Greek word
(By-op-see) = Bio- LIFE and
Opsy- TO LOOK (vision)
Biopsy can be defined as the removal of suitably
representative tissue from a living subject for
histological microscopic evaluation and analysis
to obtain diagnosis
Why Biopsy ?
Diagnosis of the lesions
Grade the tumor
To monitor treatment, recurrence, prognosis, for
research purpose
Indications:
Persistent hyperkeratosis changes in surface
tissue eg: lips or oral mucosa
Any inflammatory lesion that does not respond
to local treatment after 10-15 days (that is after
removing of local irritant)
Bony lesions not specifically identified by
clinical and radiographic findings
Any lesion that has characteristics of
malignancy
Persistent Swelling /mass
Contraindications :
Relative:
Acute/ Subacute inflammatory condition –bacterial, viral
infection
Compromised general health of patient, h/o bleeding diathesis
Proximity of lesion in vital anatomic, vascular, neural or ductal
structures and lesion in area of difficult surgical access.
Absolute:
those suggestive of a vascular nature should be referred for
more in depth evaluation(eg: hemangioma)
Classification
According to the procedure applied, oral biopsies can be classified by:
A. Features of the lesion:
Direct biopsy: when the lesion is located on the oral mucosa and can
be easily accessed with a scalpel
from the mucosal surface.
Indirect biopsy: when the lesion is covered by apparently normal
oral mucosa.
B. Area of surgical removal:
Incisional biopsy : consists of the removal of a representative sample of the
lesion and normal adjacent tissue in
order to make a definitive diagnosis
before treatment.
Excisional biopsy: is aimed at the complete removal of the lesion for
diagnostic and therapeutic
purposes. This procedure is
elective when the size and location of the lesion allows
for a complete removal of the lesion and a wide
margin of surrounding healthy tissue
C. Clinical timing of Sampling/ By the timing of the
biopsy:
Pre-operative
Intra-operative
Post-operative
D. Purpose of biopsy
Diagnostic biopsy
Experimental biopsy
TYPES OF BIOPSY
Surgical biopsy: incisional biopsy, excisional biopsy and punch biopsy
Fine Needle Aspiration Cytology(FNAC) and CT guided FNAC.
Exfoliative cytology
Brush biopsy
Frozen section biopsy
Core needle biopsy
ARMAMANTERUM FOR
SURGICAL BIOPSY
The minimal requirements are as follows:
Blade handle and no. 15 blade, or punch or silvermans needle
Fine tissue forceps (preferably adson forceps)
Syringe and local anesthetic
Retractor appropriate for the site
Sutures, if needed
Needle driver
Curved scissors
Hemostatic agents (silver nitrate or absorbable gelatin sponge)
Gauze sponges
Specimen bottle containing 10% neutral buffered formalin
Biopsy data sheet
Principles of biopsy:
Choose most suspicious area eg: vital staining
Vital staining :
Toluidine blue detection test
Avoid sloughs or necrotic areas
Give regional or local anaesthetic –not into
the lesion
Specimen should preferably be at least
1*0.6 by 2mm deep
Specimen edges should be vertical not
bevelled
The specimen should be immediately placed in
10% neutral buffered formalin solution and be
completely immersed
Suture and control bleeding
Pass a suture through the specimen to control it and
prevent it being swallowed or aspirated by the
suction
Include every fragment for histological
examination
Label specimen bottle with patients name and
clinical details
PUNCH BIOPSY
INDICATIONS
Flat lesions
Mucocutaneos lesions like erythroplakia, pemphigus
vulgaris, lupus erythematous, vesicles, ulcerative
lesions.
Small fibroma that can be excised along with punch
In case of reduced mouth opening in oral submucous
fibrosis where surgical incisional biopsy cannot be
obtained accurately
Technique:
local anaesthesia.
small part of lesion is obtained as a
specimen using an especially
developed sharp cylindrical circular
blade punch, attached to the handle.
Varying sizes are available, diameter
ranging from 4 to 10mm.
The punch is inserted into the
suspicious area tissue, through full
thickness of lesion and gently rotated
so core of the tissue is separated from
its surrounding area.
The base of this can be removed a
traumatically using curved scissors.
The tissue is then transferred for
histopathological examination.
ADVANTAGES
Easy to use
No complex operator skills are required
No suturing is required if small diameter punch
Biopsy wound heals by primary healing
DISADVANTAGES
May not be adequate for biopsy of deeper pathology
Difficult to obtain biopsy from freely moving tissues like
soft palate or floor of the moth
EXFOLIATIVE CYTOLOGY
It is a quick and simple procedure and in certain cases it is used as
an alternative of surgical biopsy
In exfoliative cytology cell shed from body surface such as oral
cavity which are swabbed and collected for examination
INDICATIONS
Mucosal lesion that appears clinically innocuous and otherwise would
not be biopsied
Follow up of patients with prior diagnosis of premalignant and
malignant mucosal lesion
To assess the oral candidiasis and viral infection
Technique:
Clean the surface of the lesion
Use moistened tongue blade or
cement spatula to scrape surface
of lesion many times(one
direction only)
Material obtained is spread in a
rotatory motion on a clean glass
slide
Make thin uniform smear
Keep it in jar containing fixative
for 15-30min
Staining the smear
ADVANTAGES
Painless
Speedy results
Little equipments
No problem with wound healing
Technique is repeatable if insufficient sample is obtained
DISADVANTAGES
Not reliable
Does not show the nature of dysplasia
FNAC (Fine Needle Aspiration Cytology)
It is the technique of aspirations of cells/fluid/tissue
fragments using fine needle for examination under
microscope
INDICATION
Non palpable lesions which are difficult to biopsy but can be
localized by ct mri or ultrasound
To rule out vascular lesion
In case where biopsy is contraindicated
Used to obtain tissue fluid for specific study
THANK YOU
