- Biopsy is recommended for lesions persisting over 2 weeks to evaluate through histopathological examination. It involves removing a tissue sample. - The key steps of a biopsy are obtaining a health history, clinical exam, potential radiographs or labs, and surgically removing a sample for pathological analysis. - The goals are obtaining a representative sample for diagnosis while minimizing patient discomfort. Proper technique and sample handling are important for accurate results.

1. Dr. Reham Lotfy Aggour
Lecturer of oral Medicine,
Periodontology, Oral
diagnosis and Radiology

2. •A detailed health history
•A history of the specific lesion
•A clinical examination
•A radiographic examination
•Laboratory investigations
•Surgical specimens for histopathologic
evaluation

3. Biopsy is strongly recommended for
the evaluation of most lesions that
persist for 2 weeks or longer after the
potential irritants are removed

4. Biopsy is the removal of
tissue for the purpose
of diagnostic
histopathologic
examination.

5. Indications
Contraindications

6.  Blade handle with a no. 15 blade
 Fine tissue forceps with teeth
 Local anesthetic solution and syringe
 Retractor appropriate for the site
 Suture for traction (if needed)
 Needle holder
 Suture for closure (if indicated)
 Fine-tipped scissors
 Laser or electrocautery device for fulguration (if
indicated)
 Specimen bottle containing formalin and biopsy data
sheet
 Gauze sponges

7.  There is often more than one method of
undertaking the surgery successfully.
Whatever the method used, however, the aim
is to:
1. Provide a suitably representative sample for
the pathologist to interpret.
2. Minimizing perioperative discomfort for the
patient.

8.  Local anesthetic: regional blocks or field blocks,
which are accomplished by means of nerve block
or infiltration peripheral to the lesion.
 An assistant may need to stabilize the area by
using an instrument or his or her fingers.
 Suction devices should be used with caution or
completely avoided during excisional biopsy to
prevent inadvertent loss of the specimen.
 Elliptical wounds can be closed easily; however,
depending on the location of the biopsy site and
the size of the wound, mucosal undermining may
help in producing a tension-free closure.

9.  Flaps should be full thickness
 Mucperiosteal flaps should be designed to allow
adequate access for incisional/excisional biopsy.
 Incisions should be over sound bone
 Cortical perforation must be considered when
designing flaps
 Major neurovascular structures should be
avoided
 Osseous windows should be submitted with the
specimen
 Osseous preformations can be enlarged to gain
access

10. The lip is being held by a clinician and an
assistant.

11. The tongue is being stabilized for biopsy.

12. wedge-shaped specimen with a length-to-width ratio of 3:1.

13. Fine-Needle Aspiration Biopsy
Fine needle aspiration cytology is a procedure whereby the
pathologist uses a special needle and syringe to enter the
tissue and collect cells for histological examination.
Commonly used in salivary gland tumors.

14. Any radiolucent lesion should have an aspiration
biopsy performed prior to surgical exploration.
Information from the aspiration will provide valuable
information about the lesion.
Solid, Fluid Filled,Vascular,Without Contents

15.  Avoiding unnecessary damage to vital
structures.
 Low risk of infection.
 Patient comfort.
 Disadvantages of FNAB:
 False-negative rates.
 Insufficient room in the oral cavity to
properly perform the movements necessary to
aspirate material.

16. Excisional biopsy

17.  The size of the lesion.
 The location of the lesion.
 The nature of its attachment to the underlying
tissue.
 The accessibility of the lesion.
 The regional anatomy
Small, pedunculated, exophytic masses in
accessible areas are excellent candidates for
excisional biopsy.

18. Laser excision with biopsy for
tongue growth.

19. Incisional biopsy
Incisional
biopsies only
require removal
of a section of
tissue

20.  Indications:
Size limitations
Hazardous location of the
lesion
Great suspicion of malignancy

21.  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.
 Soft tissue overlying the lesion should be
reapproximated following thorough irrigation of
the operative site.

22. The biopsy site should be
carefully considered..
For ulcerated oral lesion.
Selecting only the center
of an ulcer results in an
inadequate specimen
devoid of mucosa and
with nonspecific
vasculitis at the base. In
this case, the edge of the
ulcer would be of more
value in establishing a
diagnosis.
 For dark staining
lesions→ Biopsy
should be focused on
the area of greatest
staining.

24. Incisional biopsy can lead to a diagnosis
of mild or moderate dysplasia despite
the presence of invasive cancer within
millimeters of the biopsy site.
Therefore, a diagnostic adjunct may be
used to guide the clinician to the biopsy
site that is most likely to be associated
with carcinoma in situ or invasive
cancer.

25.  Toluidine blue : a dye that predictably stains
affected mucosa and not unaffected areas.
 Binds to DNA
 A few drops of toluidine blue are applied to
the lesion and surrounding mucosa. Patients
then rinse their mouths several times with a
mild acetic acid solution.
 When properly applied, toluidine blue
staining is a highly sensitive and specific test
for carcinoma in situ and invasive oral cancer.

26. Under illumination, normal epithelium absorbs the
light, appearing light blue, while abnormal tissue
reflects the light and appears white, with sharper,
more distinct margins.

28.  Scrape off surface of lesion to
BM if possible.
 Useful for : HSV, Candidiasis,
pemphigus, some bacteria,
cellular atypia.

30. Computer-Assisted Transepithelial Oral Brush
Biopsy
The oral biopsy brush is firmly pressed against lesion and
rotated until pinpoint bleeding is observed.
The brush is then rotated onto the enclosed glass slide,
transferring the cellular material. This unique tissue specimen is
then subjected to specialized, computer-assisted laboratory
analysis.

31.  During the biopsy procedure, the lesion is
grasped with an Allis forceps or secured with
a traction suture.

32. Intraosseous lesions are most
often the result of problems
associated with the dentition.

33.  Any intraosseous lesion that fails to respond
to routine treatment of the dentition.
 Any intraosseous lesion that appears
unrelated to the dentition.

34.  The specimen should be removed from the
field and placed into a solution of 10%
formalin.
 The volume of formalin should be at least 20
times the volume of the specimen
 Special tests may require that a second
specimen be submitted in a different
solution. e.g: immunofluorescent studies.
Specimens for direct immunofluorescence
testing must be submitted in Michel solution.

36.  When the health of the patient requires
special management that the dentist feel
unprepared to handle
 The size and surgical difficulty is beyond the
level of skill that the dentist feels he/she
possesses
 If the dentist is concerned about the
possibility of malignancy