ORAL BIOPSY: Introduction Definition History Uses of Oral Biopsy Indication for Oral Biopsy Contraindication of Oral Biopsy Precaution in Oral Biopsy Armamentarium Types of Oral Biopsy Special consideration Biopsy Arifact Obtaining a Good Oral Biopsy Complication of Oral Biopsy Conclusion

1. ORAL BIOPSY
-Dr.Aldrin Jerry.J
Dr.Aldrin Jerry

2. CONTENT
• Introduction
• Definition
• History
• Uses of Oral Biopsy
• Indication for Oral Biopsy
• Contraindication of Oral Biopsy
• Precaution in Oral Biopsy
• Armamentarium
• Types of Oral Biopsy
• Special consideration
• Biopsy Arifact
• Obtaining a Good Oral Biopsy
• Complication of Oral Biopsy
• Conclusion Dr.Aldrin Jerry

3. INTRODUCTION
• The clinical presentation of any pathology can
be the mucosal surface change or it can be
submucosal structural alterations.
• The diagnosis of such pathology depends on
the history, examination, laboratory studies,
biopsy and other diagnostic techniques.
• GOLD STANDARD-Biopsy
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4. Definition
• Biopsy (Greek terms) :bios (life) and opsis (vision):
vision of life
• Biopsy is the surgical removal of a tissue
specimen from a living organism for
microscopic examination and final diagnosis.
(Oral Surgery,Fragiskos D Fragiskos)
Dr.Aldrin Jerry

5. History
• early 16th century, Sir Marcello
Malphigi, "Father of microscopical anatomy,
histology, physiology and embryology"
• First, 1875 by M. M. Rudnev
• Term, 1879 by Ernest Besnier
• Late 19th century
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6. Uses of Oral Biopsy
• Diagnostic
• Planning proper treatment
• Checking progression
• Checking the extension
• Evaluating end results
• Research
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7. INDICATION
• ulcerated lesion
• growth
• White or red patches
• Intra-osseous arid
• Inflammatory lesion
• Persistent keratotic changes
• Persistent tumescence
• characteristics of malignancy
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8. Contraindication of Oral Biopsy
• Normal structures
• Anatomical variation
• Responding lesion
• Compromised/ill patient
• Systemic disorder/therapy
• Difficult access
• Vascular lesion
• Intrabony radiolucent lesions without initial
aspiration
• pulsatile
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9. Precaution in Oral Biopsy
• Avoid dyes/coloured antiseptic
• Planned incision
• Avoid crush
• Encapsulated lesion remove toto/ remove entire
mass
• Avoid tumor spilling
• Deep penetration but not to periosteam
• Surgeon should not section specimen
• Avoid drying of specimen
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10. Armamentarium
Minimum requirement
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11. Types of Oral Biopsy
Tissue piece:
a) Incisional biopsy (including geographical
biopsies and vital staining)
b) Punch biopsy
c) Excisional biopsy
d) Electro-surgery biopsy
e) Curetting
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12. Tissue core Biopsy:
a. Tru-cut needle biopsy.
b. Vin Silverman needle biopsy.
Cell aspirate:
Fine needle aspirate biopsy.
Scrapings:
Exfoliative cytology.
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13. INCISIONAL BIOPSY
• Gold standard
• Removal of only a portion of a relatively more
extensive lesion
• Larger than 1 or 2 cm
• Multiple biopsy-Diagram
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14. Principle:
• Representative areas should be biopsied in
wedge fashion from the edge of the lesion
including some of the normal tissue.
• Deep narrow biopsy
• Necrotic areas should be avoided
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15. Demerits:
• Tumor spillage & leaking of residual disease
• Spread of malignant cells
• Scar
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19. PUNCH BIOPSY
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21. 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)
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23. Excisional Biopsy
Entire lesion/tumor is excised
Indication:
clinically benign lesions, be they superficial or
deep, soft or hard tissue
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24. Principle
• The entire lesion with 2 to 3mm of normal
appearing tissue surrounding the lesion is
excised if benign
Surface-elliptical approach Base-V
cut
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28. ELECTRO-SURGERY BIOPSY
• Cutting and coagulation of tissue using very
high-frequency, low-voltage electrical
currents.
• Bloodless operative field.
• Demerit: heat artifact in histology
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29. The lesion is grasped
with forceps through
the loop electrode.
The electrode is
activated going under
the lesion, removing
the growth.
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31. CURRETTAGE BIOPSY
• CURRETTE is a French word ‘Curer’- meaning to clean.
• It is indicated for intraosseous lesions and cystic lesions within the jaws.
• Also used in very friable cellular lesions like sinuses and fistulae within the
soft tissues when only small amounts of surface material are necessary for
evaluation.
• Although the sample produced is usually soft tissue but it may include
bone fragment as well.
• These extremely small segments of tissue after fixation are centrifuged
and then the sediment is placed in medium such as agar, they are then
sectioned as a cellblock.
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32. TISSUE CORE/TREPHINE BIOPSY
• Core biopsy specimen is larger in size and
suitable for conventional histopathological
analysis than the cytologic material obtained
from FNB.
• Simpler, easier and faster
• It also eliminates the possibility of inadvertent
suction of specimen & fragments
• Demerit: spread of tumor cells along the
large-bore needle track
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36. In large lesions
Accessible area
Characteristic portion.
For multiple lesions
Most representative site.
Material curetted from interior of the lesion .
SPECIAL CONSIDERATIONS
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37. For red & white lesions include both red & white
area Dr.Aldrin Jerry

38. ULCERS
Include margin,
deep part of
ulcer and site of
maximal clinical
activity.
AVOID
Superficial
ulcers &
necrotic tissue
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39. For Polypoid lesions include base
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40. For Vesiculobullous lesions
Fluid is more representative. Intact vesicle or bulla
should be biopsied.
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41. For LICHEN PLANUS – representative area should
be biopsied
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42. For LEUKOPLAKIA – Most dysplastic
area should be biopsied
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43. For MUCOCELE lesions – careful excisional biopsy
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44. For GRANULOMATOUS LESIONS –
deep incisional biopsy + fresh sample to
microbiology if infective agent suspected
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45. Do not cut into pigmented and vascular lesions
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46. BIOPSY ARTIFACTS
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53. Obtaining a Good Oral Biopsy
• Selection of the area of biopsy
• Preparation of the surgical field
• Local anaesthesia
• The incision
• Tissue handling
• Suture
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54. •Orientation
•Fixation and preservation
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55. COMPLICATION OF ORAL BIOPSY
•Haemorrahage
•Infection
•Poor wound Healing
•Spread of tumor cells
•Injury to adjacent organs
•Others: post op pain, parasthesia, swelling,
recurrence, duct damage
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56. CONCLUSION
•It is not easy to procure a good biopsy specimen, nor is it very intricate
• But the procedure must be carefully premeditated and expeditiously
carried out, and the provisional diagnosis must be borne in mind prior
to biopsy.
Dr.Aldrin Jerry

57. THANK YOU
Dr.Aldrin Jerry