Biopsy is the removal of tissue samples from the body for microscopic examination. There are several types of biopsies including incisional, excisional, punch, fine needle aspiration, and brush biopsies. Proper labeling of biopsy specimens with patient information and details of the lesion is important. While biopsies are useful for diagnosis, limitations include sampling error or non-specific histological findings that require further investigation.

1. Dr.AEBEENA BABU
PG –FIRST MDS
DEPT OF ORAL AND MAXILLOFACIAL PATHOLOGY

2.  Biopsy is the removal of tissue from the living organism for the
purpose of microscopic examination and diagnosis

3.  Surgical biopsy
Incisional biopsy
Excisional biopsy
Punch biopsy
 Fine needle aspiration cytology(FNAC)& CT guided FNAC
 Exfoliative cytology
 Brush biopsy
 Frozen section biopsy
 Endoscopic biopsy
 Cone biopsy
 Core needle biopsy
 Suction assisted core needle biopsy
 Laser biopsy

4. Lesion is totally excised for histological evaluation- Excisional
biopsy
Done in case of small lesions
Excised tissue is then processed and histologically analyzed
under microscope to determine the true nature of the tissue

6.  Small section of the tissue is removed from a lesion for the purpose of
histological evaluation is known as incisional biopsy.
 Indicated :
1)Lesion is too large to excise initially without knowing the exact diagnosis.
2)lesion is of such a nature that the total excision would be irrational

8.  Punch biopsy is useful in obtaining tissue samples from the skin and mucous
membrane
 Frequently by dermatologists and oral pathologists.
 Helps in removing tissue samples from a variety of lesions
eg: Oral cancers and pre cancers
Vesiculobullous lesions
Moles, Small lumps etc

10.  Surgical biopsy and removes the tissue which is cylindrical or cone shaped
 Advantage – large sample of the tissue

11.  Done by aspirating needle from inside a lesion
 Commonly performed in cases in glandular cystic lesion
 How its done???
Needle is inserted into the lesion
Vaccum is created so that the tissue samples are sucked in to syringe
Sample is used to prepare a smear and seen under microscope

13. Same as FNAC
 Needle is inserted to the target lesion
 Needle is advanced within the deeper cell layer to remove the
core tissue
 Needle has a cutting tip that helps in removing tissue

15.  Core biopsy syringe is attached to a suction associated with vaccum
device

16.  Performed in order to get an immediate histological report of the
lesion
 The tissue is obtained from a lesion and the fresh tissue is quickly
frozen at about -70 degree Celsius in liquid nitrogen or dry ice.
 The frozen tissue is then sectioned in a refrigerated microtome and
then stained and diagnosed
 Disadvantage: Slide cannot be preserved for future references .
Photomicrographs of the slide are taken

17. Used to collect cells from the surface as well as sub surface
layer of the suspected lesion for microscopic examination.
A round stiff brush is rotated vigorously at a particular
site of the lesion until bleeding starts, which ensure a
sufficiently deep sample
Smear is prepared from the sample and scanned under
microscope to detect any abnormal cells.

18. The area of the wound from where the biopsy will be taken is
cleaned first.
 The area is anesthetized.
The most representative site of the wound is identified.
 A section of tissue from the identified site of wound (or sometimes
the entire wound) is removed.
The tissue is cleaned and put into 10 percent formalin solution for
fixation.
 The biopsy site is sutured after achieving hemostasis.
 The biopsy specimen is sent to the histopathologist for diagnosis
after labeling it properly.

19. Before the biopsy, specimen should be properly labeled in the following
manners.
 Mention the name, age and sex of the patient.
 Mention the date and time of biopsy.
 Mention the type of biopsy, the site from where it is obtained and the
nature of the tissue (e.g. bone tissue or soft tissue, etc.).
 Mention the brief clinical, radiological and other relevant features of
the lesion (if any).
 Mention the provisional diagnosis.

20.  A negative report should not be considered final, especially if it is
totally
unexpected than what was thought earlier.
 Biopsy should be repeated, if there is any doubt regarding the
diagnosis.
 If further investigations are required, e.g. histochemistry,
immunohistochemistry,
tissue culture or animal inoculation, etc. should be done.

21.  Specimen obtained from unrepresentative site of the lesion.
 Damaged or improperly fixed specimen. •
 Specimen of insufficient depth.
 Microscopic features are too difficult to interpret as in poorly
differentiated lesions.
 Lesion with non-specific histological findings, e.g. aphthous ulcer.

23.  Exfoliative cytology is the microscopic study of cells obtained from
the surface of an organ or lesion after suitable staining.

24. Herpes simplex.
 Herpes zoster
Pemphigus vulgaris
Pemphigoid
Squamous cell carcinoma
 Aphthous ulcer
 Candidiasis

25.  First ,surface of the lesion is cleaned by removing all the debris and mucins, etc.
 Gentle scrapping is done on the surface of the lesion with a metal cement spatula
or a moistened tongue blade for several times.
 Materials present on the surface of the lesion are adhered or collected at the
border of the instrument.
 Collected material is then evenly spread over a microscopic slide and is fixed
immediately with either 95 percent alcohol or equal parts of alcohol and ether.
 Slide is then air-dried and is stained by a special stain called PAP stain
(papanicolaou stain).

27.  Not a substitute for surgical biopsy.
 Anesthesia is not required in this technique
 It is a quick, simple, painless and bloodless procedure.
 It helps to check the false-negative biopsy cases
 Special procedures like immunohistochemistry can be performed in
exfoliative cytology samples.
 Helpful in follow up detection of recurrent cancer cases.
 Helps in screening a large number of lesions, which do not look like
cancers clinically.