Porur Escorts (Chennai) 9632533318 Women seeking Men Real Service
Biopsy
1.
2. DR MARZIYE SEHATPOUR
ORAL AND MAXILLOFACIAL DEPARTMENT
ASSISTANT PROFESSOR
3. Biopsy is derived from a Greek word
(By-op-see) =
Bio – meaning LIFE and
Opsy – TO LOOK(Vision)
4.
5. Biopsy is a surgical procedure to
obtain tissue from a living organism
for its microscopical examination,
usually to perform a diagnosis.
6.
7. Specific red and white lesion
Ulceration- lesion is ulcerated or presents as an ulcer.
Duration- lesion has persisted for more than two weeks.
Growth rate- lesion exhibits rapid growth
Bleeding- lesion bleeds on gentle manipulation
Induration- lesion and surrounding tissue is firm to the
touch
Fixation- lesion feels attached to adjacent structures
8. Persistent hyperkeratosis changes in surface
tissue (ex: lips or oral mucosa)
Lesion that interfere with local function
(ex :fibroma)
Any inflammatory lesion that does not
respond to local treatment after 10 to 14
days (that is after removing local irritant)
9. Bone lesions not specifically identified by
clinical and radiographic finding.
Any lesion persists for more than 2 weeks
with no apparent etiology basis.
Any lesion that has the characteristics of
malignancy .
10. WHEN IS ORAL BIOPSY NOT NEEDED?
normal structures
inflammatory or infectious lesions that
respond to specific local treatments, as
pericoronitis, gingivitis or periodontal abscesses.
angiomatous lesions
11. Anticoagulant therapy
Over-whelming sepsis
Severe impaired lung function
Uncontrolled bleeding.
Uncooperative patient
Local infection near the site
12. To confirm a diagnosis made on clinical
findings.
To determine the treatment plan
As a medical record
13. CLASSIFICATION OF BIOPSY
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 an
apparently normal oral mucosa.
14. By the timing of the biopsy/ Clinical timing
of sampling:
• Pre-operative
• Intra-operative
• Post-operative
Purpose of the biopsy.
• Diagnostic Biopsy
• Experimental Biopsy
16. 1.SELECTION OF AREA OF BIOPSY
2.PREPARATION OF SURGICAL FIELD
3.LOCAL ANASTHESIA
4.INCISION
5.HANDLING OF SPECIMEN
6.SUTURING OF THE RESULTING WOUND
17.
18. Indications:
◦ Size limitations
◦ Hazardous location of the lesion
◦ Great suspicion of malignancy
Technique:
◦ Representative areas are biopsied in a wedge
fashion.
◦ Margins should extend into normal tissue on the
deep surface.
◦ Necrotic tissue should be avoided.
◦ A narrow deep specimen is better than a broad
shallow one.
19.
20. Incision should extend from the ulceration out onto clinically
normal tissue
Grasp area to be removed with forceps and make an elliptical incision from
the centre out onto clinically normal tissue: wound after removal of incised
tissue: suturing completed
21. If a lesion is large or has
different characteristics in
various locations more than one
area may need to be sampled
INCISIONAL BIOPSY
22. DISADVANTAGES:
1. Crush, splits and haemorrhage are the
artefacts most frequently found in incisional
oral biopsies.
2. Theoretical seeding of cancer cells into the
adjoining tissues.
24. An excisional biposy implies the complete
removal of the lesion.
Indications:
◦ Should be employed with small lesions. Less than
1cm
◦ The lesion on clinical exam appears benign.
◦ When complete excision with a margin of normal
tissue is possible without mutilation.
25. ◦ The entire lesion with 2 to 3mm of normal
appearing tissue surrounding the lesion is
excised if benign.
28. range in size from 2-10 mm in diameter
the smaller diameters should be avoided due
to the risk of over-manipulating and crushing the tissue .
The technique is easily performed with a low
incidence of postsurgical morbidity.
Suturing in regards to a punch biopsy
procedure is usually not required as the surgical wounds
heal by secondary intention.
29.
30.
31. Advantages :
Ease of technique
Sutures may not be required if small diameter
punch
May produce a more satisfactory specimen in
bound down tissues (e.g. hard palate)
Drawbacks:
May not be adequate for biopsy of deeper
pathology
May be difficult to biopsy freely movable tissues
(e.g. soft palate, floor of mouth)
32. Needle biopsy has been established as a
safe procedure and is routinely performed
under local anaesthesia.
Many pathologists believe that for histologic
study, core tissue is more useful than
cytologic material.
33. Core needle biopsy (CNB) has emerged as an important
sampling method in the diagnosis of musculoskeletal
tumours
34. Typically used as an adjunct to, not a substitute for,
incisional or excisional biopsy procedures
Cytology allows examination of individual cells, but
cannot provide the histologic features crucial for an
accurate and definitive diagnosis
Developed as a diagnostic screening procedure to
monitor large tissue areas for dysplastic changes.
Lesions that lend themselves to cytologic examination
may include; post-radiation changes, herpes, fungal
infections, and pemphigus.
35. In a cytologic examination, the lesion is scraped
repeatedly and firmly with a moistened tongue
depressor or cytology brush.
The cells are then transferred to and smeared
evenly on a glass slide.
The slide is immediately immersed in a fixing
solution or sprayed with a fixative, such as
hairspray.
The cells can be stained with any of a myriad of
laboratory preparations and examined under the
microscope.
36. Advantages
Cytology may be helpful when large areas
of mucosal change are noted, or in areas
with difficult surgical access
Disadvantages
Not very reliable with many false positives.
Expertise in oral cytology is not widely
available
37. Diagnosis of oral epithelial dysplasia has
traditionally been based upon
histopathological evaluation of a full
thickness biopsy specimen from lesional
tissue.
It has recently been proposed that cytological
examination of “brush biopsy” samples is a
non-invasive method of determining the
presence of cellular atypia, and hence the
likelihood of oral epithelial dysplasia.
38. Firm pressure with a
circular brush is
applied, rotated five
to ten times, causing
light abrasion.
The cellular material
picked up by the brush
is transferred to a
glass slide, preserved,
and dried.
39.
40. Exfoliative Cytology
quick and simple
an important alternative to biopsy in certain situations
cells shed from body surfaces, such as the inside of the
mouth
useful only for the examination of surface cells and
often requires additional cytological analysis to
confirm the results.
41. It is the “Technique of aspiration of cells/
fluid/ tissue fragments using a fine needle for
examination under a microscope”
42. ◦ To determine the presents of fluid within a lesion
◦ To a certain the type of fluid within a lesion
◦
◦ When exploration of an intraosseous lesion is
indicated
Indications:
43. Procedures:
An 18-gauge needle is connected to a 5 or 10 ml
syringe and is inserted into the center of the mass via
a small hole in the lesion.
The tip of the needle may need to be positioned in
multiple directions to locate a potential fluid center.
The material withdrawn during aspiration biopsy can
be submitted for pathologic examination and/or
culturing.
44. The inability to withdraw fluid or air indicates
that the lesion is probably solid.
A radiolucent lesion in the jaw that yields
straw-colored fluid on aspiration is most
likely a cystic lesion.
If purulent exudate (pus) is withdrawn, then
an inflammatory or infectious process should
be considered..
45. The aspiration of blood might indicate a
vascular malformation within the bone.
Any intrabony radiolucent lesion should be
aspirated before surgical intervention to rule
out a vascular lesion.
If the lesion is determined to be vascular in
nature, the flow rate (high versus low) should
be determined because uncontrollable
hemorrhage can occur if incised
47. ADVANTAGES
Painless
produces speedy results
inexpensive technique
little equipment
can be done as an outpatient or a bedside
There is no problem with wound healing
readily repeatable
48. INDICATIONS
1. Non palpable lesions, or area difficult to biopsy
but can be localized by CT, MRI, Ultrasound.
2. To rule out vascular lesions prior to open surgery.
3. In cases where Biopsy is contraindicated on
medical background.
4. Used as a diagnostic screening test at community
level for head and neck masses.
5. Indicated for known tumors to assess effect of
treatment.
6. Used to obtain tissue for specific studies.
51. The specimen should be immediately placed
in 10% formalin solution, and be completely
immersed.
52. PATIENT DATA
HISTORY
CLINICAL DESCRIPTION
NATURE OF BIOPSY
RADIOGRAPHS & PHOTOGRAPHS
DISCRIPTION OF BIOPSY SPECIMEN
53. It should include
the name of the clinician,
date the specimen was obtained
pertinent characteristics of the specimen.
IT SHOULD INCLUDE DIAGNOSIS AS WELL AS A
COMPLETE MICROSCOPIC DESCRIPTION
54.
55.
56. Material and Methods
42 patients underwent FNAC over a period of 7 years
(2007-2013), of which 37 (88.1%) aspirates were
diagnostic.
Histopathology correlation was available in 33 cases and
diagnostic accuracy of FNAC was calculated.
57. Results
Lesions were categorized into inflammatory 3, cysts/hamartomas 15 and
neoplasms 19.
Mandibular and maxillary involvement was seen in 21 and 16 patients
respectively.
Of these, benign cysts and malignant lesions were commonest,
accounting for 27% lesions (10 cases) each.
One case of cystic ameloblastoma was misdiagnosed as odontogenic cyst
on cytology.
Overall, sensitivity and specificity of FNAC were 94.7% and 100%
respectively with a diagnostic accuracy of 97.3%.
Definitive categorization of giant cell lesions, fibro-osseous lesions,
odontogenic tumors and cystic lesions was not feasible on FNAC.
58.
59.
60. Conclusions
FNAC is a simple, safe and minimally invasive first
line investigation which can render an accurate
preoperative diagnosis of intraosseous jaw lesions,
especially the malignant ones in the light of clinic
radiological correlation.
