2. TREPHINE BIOPSY
It is the pathologic analysis of samples of bone marrow obtained by bone marrow biopsy and
bone marrow aspiration
SITES FOR BONE MARROW COLLECTION
Posterior iliac crest
sternum
4. INDICATIONS
Detect and stage malignancy
Differentiate benign haematologic disease ( aplastic anaemia)
Diagnosis and stage of lymphomas and leukemias
Metastatic disease
Immunodeficiency syndrome
Confirmation of unusual infection in the marrow (military tuberculosis , fungi)
CONTRAINDICATIONS
In patients with soft bone secondary to radiation therapy , multiple myeloma and
osteoporosis
5. BONE MARROW ASPIRATION
SITE: sternum, posterior iliac crest
SALAH BM aspiration needle is used (strong wide needle with stylet)
Stains with Romanowskys stain pearls reaction for iron on smears
INDICATIONS- anaemias , leukaemias , granulomatous conditions , myelomas
TIME 1-2 hrs
6. INTRAOSSEOUS BIOPSY
A lesion either on or within the osseous tissues of the jaws requires
investigations. The most commonly seen intraosseous lesions are
periapical granuloma and cysts of jaw done in both maxilla and
mandible
TECHNIQUE
1. ASPIRATION BIOPSY OF THE RADIOLUCENT LESIONS-provides
information about the nature of lesion before surgical procedure
2. MUCOPERIOSTEAL FLAPS –based on size and location of lesion
3. OSSEOUS WINDOW
4. REMOVAL OF SPECIMEN
8. SHAVE BIOPSY
When a lesion is raised shave biopsy can be obtained for selected lesions using either a
scalpel or razor blade to scrape lesion performed superficially or deeply
Shave biopsy usually extends to the level of the middle dermis with the subcutaneous
tissue left undisturbed
INDICATIONS
Benign exophytic lesions
Superficial inflammatory lesions
Dermal components such as seborrheic keratosis , fibrous papules
CONTRAINDICATIONS
Melanomas
9. TECHNIQUE
The blade is held horizontal to the skin surface and brought below the
lesion and the other hand is used to stretch and stabilize the skin
surrounding the lesion during the shave biopsy
Smooth unidirectional cutting with the blade separates the lesion above
from the deep dermis below
10. FINE NEEDLE ASPIRATION CYTOLOGY
It is the technique of aspiration of cells, fluid, tissue fragments using a fine needle for
examination under a microscope
18 – 24 gauge needle is used
INDICATIONS
Used to obtain tissue for specific studies
In cases where biopsy is contraindicated on medical background
To rule out vascular lesions prior to open surgery
Non palpable lesions or areas difficult to take biopsy used as a diagnostic screening test at community levels
for head and neck masses
Indicated for known tumors to assess effect of treatment
11. TECHNIQUE
An 18 gauge needle is inserted into the centre of the mass via a small hole in lesion
The tip of the needle may need to be positioned in multiple directions to locate a potential fluid centre
The fluid withdrawn during aspiration is placed on the glass slide and sent for pathological
examination
The inability to withdraw fluid or air indicates that the lesion is probably solid
12. ADVANTAGE
• Obtain cells from any sites of body
• Fast and inexpensive
• Permits early start of treatment
• Taken repeatedly on most masses/lesions
• Painless procedure
DISADVANTAGE
• Needle can damage vital structure
• Internal bleeding possible
• Dissemination of tumor cells into the damaged
vessels
• Requires great skills
13. CORE BIOPSY
Is an another method of tissue diagnosis – a way of sampling cells in a suspicious
lump or mass
It is sometimes used instead of FNAB and it is more invasive procedure
NEEDLE USED
TRU – CUT needle biopsy
VIM SILVERMAN needle biopsy
14. Technique
I. A small incision is made on the skin
II. A large needle is then passed through this incision and several narrow samples of the
lump tissues to be investigated are taken
III. A core biopsy may result in a small very fine scar where the incision was made
IV. The procedure usually take 30-60 minutes
V. After the procedure the biopsy area will be covered with simple dressings
15. With a core biopsy sample , the larger needle allows the cells to be
removed with their relationship to each other intact this gives an
more accurate diagnosis than FNAB
ADVANTAGE
Easy to interpret than aspiration cytology to the pathologist
Distinguish between reactive changes and recurrent malignancy in possible
cervical metastasis
DISADVANTAGE
Possible spread of tumor cells along the large bore needle track
16. EXFOLIATIVE CYTOLOGY
Study of morphology of exfoliated cells under microscope using special stain
Used as an adjunct aid to biopsy and cannot be used as diagnostic procedure
Used stain PAP stain
INDICATIONS
• To study and confirm the false , negative biopsy results
• To assess the oral candidiasis and viral infection
• Individuals who are debilitated
• Prior diagnosis of premalignant and malignant mucosal lesions
• Mucosal lesions which cannot be biopsed
17. TECHNIQUE
Clean the surface of the lesion
Use moistened tongue blade to scrape surface of lesions many times in one direction only
Lesions obtained is spread in a rotatory motion on a clean glass side
Make thin uniform smear
Place the smear in a fixative for 15-30 minutes staining the smear
18. ADVANTAGE
Helpful when large areas of mucosal changes are noted or in areas with difficult surgical
access
DISADVANTAGE
Not very reliable with many false positives
Expertise in oral cytology is not widely available
19. BRUSH BIOPSY
Firm pressure with a circular brush is applied and is rotated five to ten minutes causing light
abrasion
The cellular materials picked up by the brush is transferred to a glass side , preserved and
dried
Indicated for screening in suspected premalignancy and malignancy
20. ADVANTAGE
useful for diagnosis of oral epithelial dysplasia
non invasive method
high sensitivity and specificity
DISADVANTAGE
Cannot be used as a substitute for scalpel biopsy
False findings may be observed due to sampling error
21. TOUCH IMPRESSION OR IMPRINT
CYTOLOGY
It is a method in which gentle grazing or sliding of glass slide over the cut surface of a
resected tumour immediately after surgery
The imprint slide is immediately fixed in 95% of ethyl alcohol for 5 to 6 seconds and then
stained (haematoxylin and eosin)
INDICATIONS
detect the malignancy at the tumor margin
diagnosis of certain inflammatory lesions
diagnosis of certain neoplastic lesions
