principles of tissue biopsy in oral and maxillofacial

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Principles of Tissue Biopsyin Oral and Maxillofacial

SurgerySpeaker:黃傳貴 大夫 

Moderator:雷文天 大夫 

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Examination & Diagnostic Methods

Health history

History of the lesion

Clinical examinationRadiographic examination

Laboratory investigation

Biopsy

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Definition of Biopsy

Removal of tissue from a living individual

for diagnostic examination

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Indication for Biopsy

 Any lesion persists for more than 2 weeks

with no apparent etiology basis

 Any inflammatory lesion that does not

respond to local treatment after 10 to 14

days (that is,after removing local irritant)

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Indication for Biopsy

Persistent hyperkeratosis changes in

surface tissue (ex:lips or oral mucosa)

 Any persistent tumescence,either visible

or palpable beneath relatively normal

tissue

Lesion that interfere with local function

(ex:fibroma)

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Indication for Biopsy

Bone lesions not specifically identified by

clinical and radiographic finding

 Any lesion that has the characteristics of 

malignancy

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Characteristics of lesions that raise

the suspicion of malignancy

Erythroplasia—lesion is totally red or has

speckled red appearance

Ulceration—lesion is ulcerated or presents

as an ulcer 

Duration— lesion has persisted more than

2 weeks

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Characteristics of lesions that raise

the suspicion of malignancy

Growth rate – lesion exhibits rapid growth

Bleeding— lesion bleeds on gentle

manipulation

Induration – lesion and surrounding tissue

is firm to the touch

Fixation – lesion feels attached to adjacentstructures

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 Aspiration Biopsy

 Aspiration biopsy is the use of a needle

and syringe to penertrate a lesion for 

aspiration of its content

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Indication of Aspiration Biopsy

 Aspiration should be carried out on all lesions

thought to contain fluid or any intraosseous

lesion before surgical exploration

a fluctuant mass in the soft tissues should alsobe aspirated to determine its contents

 Any radiolucency in the bone of the jaw should

be aspirated to rule out a vascular lesion that

can cause life threatening hemorrhage

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Technique of Aspiration Biopsy

 A 18-gauge needle is connected to a 5 or 

10 ml syringe

The tip of needle may have to be

repeatedly repositioned to locate a fluid

center 

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Excisional Biopsy

Removal of the entire lesion

 A perimeter of normal tissue surround the

lesion is also excised to ensure total

removal

Constitute definitive treatment

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Indication of Excisional Biopsy

Smaller lesions(<1cm, in diameter) that,on

clinical examination, appear to be benign

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Principle of Excisional Biopsy

The entire lesion, along with 2 to 3 mm of 

normal appearing surrounding tissue, is

excised

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Principle of Excisional Biopsy

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Incisional Biopsy

Samples only a particular or 

representative part of the lesion

Lesion is large

Lesion has different characteristics at

different location

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Indication of Incisional Biopsy

Extensive size (>1 cm in diameter)

Hazardous location

 A great suspicious of malignancy

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Principles of Incisional Biopsy

Representative areas of lesion should be

incised in wedge fasion

Selected in an area that shows complete

tissue changes(the lesion extends into

normal tissue at the base and/or margin

of the lesion)

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Principles of Incisional Biopsy

Necrotic tissue should be avoided

Taken from the edge of the lesion to

include some normal tissue

 A deep, narrow biopsy rather than a

broad,shallow one

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Principles of Incisional Biopsy

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 Anesthesia

Block local anesthesia techniques are

employed when possible

The anesthesic solution should not be

injected within the tissue to be removed,

because it can cause artificial distortion of 

the specimen

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 Anesthesia

When blocks are not possible, infilitration

of local anesthesia may be used

locally,but the solution should be injected

at least 1 cm away from the lesion

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Tissue Stabilization

Tongue or soft palate

--Heavy retractive sutures

--Towel clips Lip

-- assistant’s finger pinching the lip on both 

sides of the biopsy area

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Tissue Stabilization

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Identification of Surgical Margins

Marked with a silk suture to orient the

specimen for the pathologist

If the lesion is diagnosed as requiring

additional treatment, the pathologist can

determine which margin, if any had

residual

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Identification of Surgical Margins

One must be certain to illustrate the

orientation of the lesion and the method

with which the specimen was marked in

the pathology data sheet

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Hemostasis

 Avoid suction device

Gauze wrapped over the tip of the low

volume suction device

Simple gauze compression

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Specimen Care

Immediately placed in 10% formalin

solution that is at least 20 times the

volume of surgical specimen

Totally immersed in the solution

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Specimen Care

Care should be taken to be sure that the

tissue has not become lodged on the wall

of the container above the level of the

formalin

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Surgical Closure

Primary closure of the elliptic wound is

usually possible

Palatal biopsy: best managed

postoperatively with the use of an acrylic

splint

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Surgical Closure

Dorsum or lateral border of the tongue:

sutures to be placed deeply and at

frequent intervals into the substance of the

tongue to retain closure

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Final Diagnosis

The final diagnosis should correspond to

the clinical course before and after biopsy

 A negative pathology report for cancer 

should not lull the dentist into a false

sense of security when the clinical

characteristics of the lesion still indicate

malignant potential

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Final Diagnosis

If the pathology report does not

corroborate the clinical impression of the

lesion, the biopsy procedure should be

repeated

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Thank You for 

Your Attention