This document discusses biopsy techniques and procedures. It covers indications for biopsy, contraindications, different biopsy methods including excisional, incisional, punch and needle biopsies. Potential dangers of biopsy like hemorrhage and infection are mentioned. Considerations for specific lesions in the oral cavity and techniques to avoid errors are provided. The document aims to guide dentists on proper biopsy methods.

1. DR DAVIS NADAKKAVUKARAN
SENIOR LECTURER
MALABAR DENTAL COLLEGE
MANOOR .EDAPPAL

2.  Introduction
 Indication
 Contraindication
 Techniques of biopsy
 Procedure
 Dangers of biopsy
 Common errors
 Consideration of specific lesion

3. “ THE BEST SURGEONS IS A CLINICAL
PATHOLOGIST WHO PERFORMS OPERATIONS”

4.  BIOPSY (Bio-life; Opsis-vision)
 Biopsy is the removal of the tissue from
the living organism for the purpose of
microscopic examination and diagnosis

5. 1. Confirm presumptive diagnosis
2. Type of treatment
3. Self teaching diagnostic aid
4. Cancer phobia
5. Medico legal report

6.  More than 2 weeks
 Local treatment
 Persistent hyperkeratotic lesion
 Suspect of neoplasm
 Interfere with local function
 Any tissue surgically excised
 Expelled from body orifice

7.  Bone lesions
 Draining sinus
 Cystic lesions
 Per apical lesions
 Soft tissue lesions
 Inflammatory and glaucomatous disease
 Any lesion that has characteristics of
malignancy.

8.  Erythroplasia
 Ulceration
 Duration
 Growth rare
 Bleeding
 Indurations
 Fixation

9. 1) General health
2) Acute infections
3) Blood dyscrysis
4) Lesion of vascular origin

10.  At least 1cms x0.5cms in size
 Accessible area
 Thin deep sections
 If several lesions are present
 If lesion is intraosseous
 If the lesion is ulcer
 A biopsy of skin and mucosa

11. 1) Antiseptic
2) Local anesthetics and syringe
3) Scalpel
4) Small pointed scissors
5) Tissue forceps
6) Surgical haemostats
7) Sponges
8) Sutures
9) Niddle holder

12. 10) Wide mouthed bottle containing formalin
10%-15times the volume of specimen
11) Periosteal elevator
12) Bone bur
13) Bone chisel
14) Mallet
15) Curettes
16) Syringes for aspiration
17) Biopsy punch

13.  Main steps in the biopsy procedures are
I. Injecting local anesthesia
II. Incision
III. Suture is used to create tissue tension
IV. Sample is placed in 10% formalin

14. biopsy
surgical Non surgical
Soft tissue Bone
Diagnostic
curative
Incitional
Punch
Electo
curretage
Excessional
Diagnostic
curative
Curretage
Trephenation
aspiration
enucliation
aspiration cytology
Exfolative cytology
fnac

15. 1. Excisional biopsy
2. Incisional biopsy
3. Punch biopsy
4. Curettage
5. Niddle biopsy
6. Drill biopsy
7. Aspiration biopsy
8. Paracentesis
9. Cytological examination
10. Endoscope biopsy
11. Cross biopsy
12. Open biopsy

16.  It is the removal of the entire lesion at the
time of surgical diagnostic procedure.
Indication
a. lesion less than 1 cms
b. Benign
c. Pigmented and vascular
Advantages
1. Entire lesion is available
2. Part of the treatment
3. Diagnosis and treatment
complication

17.  Only a portion of the lesion is removed for
examination
Indication
 Lesion under examination is more than 1
cms in diameter.
 When lesion is in hazardous position
 Suspect of malignancy
 Commonest lesions are hyperkeratotic
lesions of the oral cavity.
Contraindication
 Pigmented and vascular lesions
 Melanomas.
 Necrotic area should be avoided

18.  A tissue punch is inserted into the centre of
lesion, and a small plug of tissue is
removed.
 Used in surgically inaccessible site.
 In this technique tissue gets bruised, or
damaged.
Curettage
This is removal small bits of tissue with sharp
instruments.
For bony cavity
Sinus tract
Boney space maxillary ant rum

19.  Here trephine sharpened niddles of
different sizes are attached to syringe
 Separation of the specimen depends on the
sharp cutting action of the special needles
 Useful in diagnosis of lymph nodes
 Salivary glands and thyroid glands
 Soft tissue and boney lesions
 Advantage
1) Simple to perform
2) Saves time
3) Saves hospital costs

20.  It is a high speed drill technique described
by deelay(1980)
 Ellis biopsy drill
 Useful for central-fibro osseous lesion
 Advantage
1) Less trauma and damage
2) Spread of lesion is avoided
Disadvantage
1) In negative Not used in lesions less than 2
cms
2) Drill lesion can be missed

21. Disadvantage
 IN negative Not used in lesions less than 2
cms
 Drill lesion can be missed
Clinical application
Breast, thyroid, oral cavity, salivary glands,
osteolytic lesions,hepatic
malignancy,lymphnode masses,

22.  It is the means of obtaining material from the
body cavity, cystic space or fluid containing
lesion.
 In 1930 introduced by Martin and Ellis and
Stewart
 This procedure is a type of exfoliate cytology
study provides as the same aid to diagnosis.
 Indication
1) Differentiation
2) Causative organism
3) Identification
4) Research

23.  Advantage
1. Quick report
2. Less painful
3. Inexpensive
4. Easily repeatable
Limitations
False positive and false negative
Equipment
1. Fine Niddle
2. Syringe
3. Slides
4. fixatives

24.  Cleansing
 Lido cane injection
 Vacuum is created
 Specimen in the Niddle is put on the slide
 Spared
Interpretation
 Inability to aspirate
 Aspiration in molar region
 Aspiration of air in cyst in lower jaw.
 Aspiration of pus
 Presence of keratin
 Straw cloured fluid
 Aspiration of blood

25. • This is the withdrawal of fluid from body cavity
through large Niddle by –ve pressure.
Cytological Examination
• As an adjunct but not a substitute to biopsy
• Report is based on the morphological features
of cells.
Endoscopic biopsy
• For abdominal pathology
• Advantage is visualization of pathology and
removal of the tissue from the same
• Limited in head and neck pathology

26. Spreading of tumor cells
Hemorrhage
Infection
Wounding of the cancerous tissue
Operative trauma

27.  Iodine
 For dermatologic diagnosis plain L A
 Tissues must be grasped with minimal
 When orienting the excised tissue
 In winter formalin might become frozen
 Formaldehyde may evaporate
 While using electrocautery
 Injection of large amount of anesthetic
solution to biopsied area causes tissues
changes

28.  Delayed inadequate fixation produces some
tissue changes
 Freezing artifact
 Hard tissue inclusion within the tissue

29. Some lesions have additional consideration in
biopsy technique
1. Precancerous lesion
 Selection of the area
 In speckled red and white
 More severe dysplasia
2. Salivary gland
 In case of major salivary glands
 breach in capsule leads to potential cell spillage
 Release of mucoid material containing viable
tumor cells.

30. Lymph node
 It is difficult tissues to fix because of their dense
capsule and their cellularity.
 Sagital plane
 Niddle aspiration
Cystic lesions
 Every attempt should be made to remove the
lesion without rupture.
 Mucoepidermoid tumors
 Boney cysts(dentigerous cysts)

31. Tooth
 Drill the crown or apical third of the root to
allow for pulpal fixation
Vesicle or bullae
Biopsy is performed on a fresh, intact blister
Pempigus vulgaris
Longer border shallow biopsy as this is a
surface phenomenon
Intra osseous lesion
Ex – perapical granuloma,cysts of jaw,
Aspiration biopsy

32.  The healing of a biopsy wound of the oral
cavity is either by primary healing or
secondary healing .
 Depends whether edges are brought into
close apposition by suturing .

33. 1) Patient’s name, adress, age, sex,
2. Pertainent history
3. Clinical description
4. Nature of biopsy
5. Radiograph, photograph
6. Coments on biopsy specimen

34.  A biopsy report should include a diagnosis as
well as microscopic description on even the.
most routine submition
 Negative report means no serious desease
 It does not rule out disease in adjacent site
or future date.

35. 