BIOPSY• DEFINATION-

» Biopsy is a removal of tissues from the living organisms for the purpose of microscopic examination & diagnosis.

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INDICATIONS

• 1. Any lesion that persist for more than two weeks with no apparent etiological basis 2. Any inflammatory lesion that does not respond to local treatment after 10 to 14 days(that is after removal of local irritant) 3 . Persistent hyperkeratosis changes in surface tissues 4. Any persistent tumescence either visible or palpable beneath relatively normal tissues.

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INDICATIONS

5 . Inflamatory changes of unknown cases that persist for long periods 6 . Lesions that interfer with local function 7 . Bone lesions not specifically identified by clinical and radiographic findings 8 . Any lession that has the charecteristics of malignancies

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• 1. Erythroplasia : Lesion is totally red or has a sp[eckeled red and white appearnce 2 . Ulceration : Lesion is ulcerated or presents as an ulcer 3 . Duration : Lesion has persisted more than 2weeks 4 . Growth rate : Lesion exhibits rapid growth

CHARACTERISTICS OF LESION THAT RAISE THE SUSPICION OF MALIGNANCYS

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CHARACTERISTICS

• 5. Bleeding : Lesion bleeds on gentle manipulation 6. Induration : Lesion and surrounding tissue is firm to touch 7. Fixation : Lesions feels attached to adjacent structures

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TYPES OF BIOPSY

• There are four major types of biopsy 1. Cytology 2. Aspiration biopsy 3. Incisional biopsy 4. Excisional biopsy

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ORAL CYTOLOGY

• 1. cytologic examination for tumour cells first described as diagnostic procedures for detection of uterine cerivical cancer 2. studies have shown that oral cytology to be unrelieble 3. cytology allows examination of individual cell but cannot provide the histologic architecture so important to an accurate diagnosis

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ORAL CYTOLOGY

• INDICATIONS: When an areas of mucosal changes vmust be monitored for dysplastic changes such as post irradiation changes and pe mphiguscytology may be used

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TECHNIQUE

• 1. The lesion is scraped repeatedly and firmly with a moistened toungue depressor 2. The cells obtained are smeared evenly on a glass slide 3. The slide is emmersed in afixing solution 4. The cells are stained and the cellular charectiristics examined under the microscope

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ORAL CYTOLOGY

• Report of cytologic smear is classified into five classes A)Class 1-(Normal)

Indicates that only normal cells were observed

B) Class 2-(Atypical) Indicates the

presense of minor atypia but no evidence of malignant change

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ORAL CYTOLOGY

• Class 3-(Indeterminate )This is an in between cytology

that separates cancer from non cancer diagnosis .The cells display wider atypia that may be suggestive of cancer but they are not clear cut & may represent precancerous lesion .Biopsy is recomended

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ORAL CYTOLOGY

• Class 4-(Suggestive of cancer)A few cells with malignant

charecteristics or many cells with borderline charecteristics.Biopsy is mandatory Class 5-(Positive for cancer)

Cells that are obviously malignant. Biopsy is mandatory.

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ASPIRATION BIOPSY

• Aspiration biopsy is a use of needle syringe to penetrate a lesion for aspiration of its contents Aspiration biopsy can yields extremely valueble information about the nature of lesion 1. A radiolucent lesion in jaw that yield straw coloured fluid on aspiration is most blikely acystic lesion

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ASPIRATION BIOPSY

• 2. If pus is aspirated an inflamatory process should be considered {abscess} 3. Blood on aspiration suggests several lesions, the most important are the vascular malformation such as hemangioma 4. Air on aspiration could suggest a lesion may be hard

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ASPIRATION BIOPSY

• INDICATIONS : Any lesion that thought to contain fluid or any intraoseous lesion before surgical exploration

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ASPIRATION BIOPSY

• TECHNIQUE: 1. An 18 gauge needle is connected to a 5 ml syringe 2. Area anesthetise and needle is inserted into the depth of then mass during aspiration 3. The tip of the needle may be repositioned in an effort to locate afluid centre

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INCISIONAL BIOPSY

• An incisional biopsy is a biopsy that samples only a particular or representative part of the lesion

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INCISIONAL BIOPSY

• INDICATIONS 1.If the areas under investigation appears difficult to excise because of its extensive size (larger than 1 cm ) 2 .The location of the lesion is hazardous location 3.Whenever there is a great suspicion of malignancy,incisional biopsy is indicated .

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INCISIONAL BIOPSY

• PRINCIPLES : 1.Representative areas of the lesion should be biopsied in wedge fashion 2.The biopsy site should be selected in an area that shows complete tissue changes 3.Necrotic tissue should be avoided ,because it is useless in biopsies

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INCISIONAL BIOPSY

• 4.The material should be taken from the edges of the lesion to include some normal tissue 5.The specimen should be taken deep, narrow to see the changes in the deeper tissues

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EXCISIONAL BIOPSY

• An excisional biopsy implies removal of the entire lesion at the time the surgical procedure is performed A perimeter of normal tissue surrounding the lesion is also excised to ensure total removal

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EXCISIONAL BIOPSY

• INDICATIONS 1.Excisional biopsy should be performed with smaller lesion (smaller thjan 1 cm )on clinical examinations 2.Any lesion that can be removed completely without mutilating the patient best treated by excisional biopsy 3.Pigmented lesion & small vascular lesion

should be removed to there entirity

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EXCISIONAL BIOPSY

• PRINCIPLES 1.The entire lesion along with 2 to 3 mm of surrounding tissue is excised

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ARMAMENTERIUM FOR BIOPSY

• INTRUMENTS FOR SOFT TISSUE BIOPSY 1.Local anesthesia equipments -scalpel (no.15 blade )

-scissors with pointed tips -fine tissue forceps -small heamostat -gauge spounges -needle holder ,needle,suture

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ARMAMENTERIUM FOR BIOPSY

• ADITIONAL INSTRUMENTS FOR HARD TISSUE BIOPSY OF SOFT TISSUE WITHIN BONE -Periosteal elevator -Ronguer -Bur & rotary handpeace -Sterile saline for irrigation -Currets

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ARMAMENTERIUM FOR BIOPSY

• INTRUMENTS FOR ASPIRATION BIOPSY -5 or 10 ml syringe -18 gauge needle

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FIXATIVES

• Fixatives used for biopsy is 10% formaline

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REFERRENCE-

• Peterson –second edition Shaffer –fourth edition

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