BIOPSY

By Group 2
Biron, Chan, Chavez, Corsiga, Dela Cruz
WHAT IS BIOPSY?

 isa sample of tissue taken from the body in

order to examine it more closely.
 is a procedure to remove a piece of tissue
or a sample of cells from your body so that
it can be analyzed in a laboratory.
Why Are Biopsies Done?

 Biopsies
are most often done to look
for cancer.
 But
biopsies can help identify many other
conditions.
EXAMINATIONS OF BIOPSY
 Types of biopsy
1. Needle biopsy - most biopsies are needle
biopsies, meaning a needle is used to access the
suspicious tissue.
 Needle biopsy procedures include:
 Fine-needle aspiration
 Core needle biopsy
 Vacuum-assisted biopsy
 Image-guided biopsy .
2. CT-guided biopsy - A person rests in a CT-scanner;
the scanner's images help doctors determine the exact
position of the needle in the targeted tissue.
3. Ultrasound-guided biopsy - An ultrasound scanner
helps a doctor direct the needle into the lesion.
4. Bone biopsy - A bone biopsy is used to look
for cancer of the bones. This may be performed via
the CT scan technique or by an orthopedic surgeon.
5. Bone marrow biopsy. A large needle is used to enter
the pelvis bone to collect bone marrow. This
detects blood diseases such as leukemia or lymphoma.
6. Liver biopsy. A needle is injected into
the liver through the skin on the belly,
capturing liver tissue.
7. Kidney biopsy . Similar to a liver biopsy, a
needle is injected through the skin on the back, into
the kidney.
8. Aspiration biopsy. A needle withdraws material
out of a mass. This simple procedure is also
called fine-needle aspiration.
9. Prostate biopsy. Multiple needle biopsies are
taken at one time from the prostate gland. To reach
the prostate, a probe is inserted into the rectum.
10. Skin biopsy. A punch biopsy is the main biopsy
method. It uses a circular blade to get a cylindrical
sample of skin tissue.
 Skin biopsy procedures include:
 Shave biopsy
 Punch biopsy.
 Incisional biopsy
 Excisional biopsy
11. Surgical biopsy. Either open or laparoscopic
surgery may be necessary to obtain a biopsy of
hard-to-reach tissue. Either a piece of tissue or the
whole lump of tissue may be removed.
What do cancer stages and grades mean?
 The stage of a cancer describes the size of a tumor and how far
it has spread from where it originated. The grade describes the
appearance of the cancerous cells.
Cancer stages
 Different types of staging systems are used for different types
of cancer.
 stage 0 – indicates that the cancer is where it started (in situ)
and hasn't spread
 stage I – the cancer is small and hasn't spread anywhere else
 stage II – the cancer has grown, but hasn't spread
 stage III – the cancer is larger and may have spread to the surrounding
tissues and/or the lymph nodes (part of the lymphatic system)
 stage IV – the cancer has spread from where it started to at least one
other body organ; also known as "secondary" or "metastatic" cancer
Cancer grades
 The grade of a cancer depends on what the cells
look like under a microscope.
 In general, a lower grade indicates a slower-
growing cancer and a higher grade indicates a
faster-growing one. The grading system that's
usually used is as follows:
 grade I – cancer cells that resemble normal cells and
aren't growing rapidly
 grade II – cancer cells that don't look like normal cells
and are growing faster than normal cells
 grade III – cancer cells that look abnormal and may
grow or spread more aggressively
Biopsy Techniques
The four major types
of biopsy generally performed in and
around the oral cavity
(1) cytologic biopsy
 (2) incisional biopsy
(3) excisional biopsy, and
(4) aspiration biopsy.
Oral Brush Cytologic
Examination
 often imprecisely referred to as oral brush “biopsy”

-handheld rotary wire

brush is used to collect
epithelial
cells
 Brush contacts tissue in
area where cells are
desired and is rotated 5
to 10 times with
moderate pressure.

 which are then fixed

on a glass slide and
submitted for
evaluation
 The brush with its collected cellular material is
smeared on a provided glass slide and is flooded
with the fixative solution. After the slide is dry, it
is sent to a laboratory where the specimen is
examined, first by a computer and then by an
oralmaxillofacial pathologist who is trained in
computer-assisted analysis
Incisional Biopsy
 An incisional biopsy is a biopsy procedure that
removes only a small portion of a lesion. If the
lesion is large or demonstrates differing
characteristics in different locations, then more
than one area of the lesion may require sampling.
 biopsy is generally excised as a wedge of
tissues in such a manner as to include
normal- and abnormal-appearing tissues in
the sample
Excisional Biopsy
 An excisional biopsy implies removal of a
lesion in its entirety, to include a 2- to 3-
mm perimeter of normal tissue around the
lesion
Surface view. An elliptical incision is
made around the lesion, at least 3
mm away from the lesion.

Side view. The incision is made

deep enough to remove lesion
completely.

End view. Incisions are made convergent to

depth of wound. Excision made in this way
facilitates closure.
 Excisionalbiopsy is reserved for smaller
lesions (<1 cm in diameter). Lesions that
can be removed in their entirety without
excessively compromising the patient’s
features or oral function must be removed
to eliminate the threat to the patient’s
well-being.
Aspiration Biopsy

 Aspirationbiopsy is performed with a

needle and syringe by penetrating a
suspicious lesion and aspirating its
contents.
Two main types of aspiration biopsy

 biopsy to explore whether a lesion contains

a fluid;
 and (2) biopsy to aspirate cells for
pathologic diagnosis. This latter is termed
fine-needle aspiration (FNA) and is often
performed by pathologists trained in the
technique.
 Aspiration is performed on any fluid-filled lesion,
except a mucocele. A 16- to 18-gauge needle
connected to an aspirating syringe is used. The
needle tip may have to be repositioned
repeatedly in an effort to locate a suitable fluid-
containing cavitation.
fine-needle aspiration (FNA)

 is used when a soft tissue mass is detected

beneath the skin or mucosal surface and the
patient wishes to avoid a scar or adjacent
anatomic structures pose a risk. FNA is an
especially effective diagnostic tool for neck
masses, from which it can be difficult to obtain a
biopsy surgically.
Soft Tissue Biopsy Techniques and
Surgical Principles
Anesthesia
 Block local anesthesia techniques are preferred
over infiltration, whenever possible.Peripheral
infiltration of local anesthetic with a
vasoconstrictor is often helpful it should be
injected at least 1 cm away from the lesion
perimeter to prevent tissue architectural
distortions.
Tissue Stabilization

 Oral and perioral soft tissue biopsies frequently

involve mobile surfaces and structures
 Accurate surgical incisions can be placed with
greater ease when the involved tissues are first
stabilized.
 The surgical assistant
can grasp the lips on
both sides of the
biopsy site with his
or her fingers, which
also retracts and
immobilizes the lips
 This may also help
reduce bleeding by
compressing area blood
vessels and their
tributaries. The
surgeon must be
careful to avoid
iatrogenic scalpel
injury to the assistant’s
stabilizing fingers
When used, retraction
sutures should be
placed deeply into the
tissues, away
from the planned
biopsy site so that they
will function without
pulling through and
damaging the tissues.
Hemostasis

 The use of a suction device for keeping the surgical field free of blood during
the procedure should be minimized as much as possible, especially the high-
volume suction devices found in modern dental offices.
 The assistant can often use gauze sponges to blot the site.
 Suctioning not only can increase bleeding but also increases the risk of the
biopsy tissue sample being accidentally aspirated into the suction. If suction is
needed, it is helpful to place a gauze over the end of the suction tip to serve
as a filter.
Incisions
 A sharp scalpel, usually with a No. 15 blade, should be used to incise the
tissues. Two football-shaped surface incisions can be angled in such a way as
to converge at the base and will yield an optimal specimen and a resulting
wound that is easy to close
 Variations in the size of the ellipse and degree of convergence toward the
base of the lesion depend on the depth of encroachment of the lesion on
normal tissue
 Palpation may offer clues regarding the depth and expanse of the submucosal
portions of the lesion.
 When performing an excisional biopsy, the surgeon must ensure a perimeter
of normal tissue beneath the lesion as well. As noted previously, in most cases
thin, deep specimens are preferable to wide, shallow specimens
 To the maximal extent possible, incisions should parallel the normal course of
nerves and blood vessels, as well as lines of muscular tension (i.e., smile lines
and facial creases), to minimize secondary injuries and for esthetic reasons.
 As noted previously, a 2- to 3-mm band of normal tissue should ideally be
included around the specimen during an excisional biopsy. If the lesion
appears malignant, pigmented, or vascular or has diffuse borders, an
additional 2 to 3 mm of normal-appearing peripheral tissues should be excised
with the specimen.
Wound Closure

 If the wound is deep, incorporating different tissue layers, deep closure

should be carried out for each layer, using a resorbable suture material (e.g.,
polyglycolic acid or chromic gut;)
 Following excision of the
specimen and any
closure of deeper
tissues, the mucosa (or
skin) is undermined by
using a spreading action
of the tips of small
scissors (e.g., iris or
Metzenbaum scissors) to
separate the mucosal
from the submucosal
tissues
 Protective periodontal dressings or vacuum-
formed or acrylic splints, lined with a tissue-
conditioning liner, may be used to protect the
healing area(s), enhance patient comfort, and
promote healing. If necessary, these customized
postsurgical splints may be secured to adjacent
teeth with circumdental fine wires or heavy
suture material to aid retention. Postsurgical
splints are usually left in place for 7 to 10 days.
 Biopsy wounds on the dorsum or lateral border of the tongue require deeply
placed sutures at close intervals to counteract inherent muscle movements
and maintain closure
 Resorbable sutures may be used, but gut sutures are not recommended
because they have poor knot security (resulting in lost sutures) and undergo
rapid enzymatic degradation.
Handling of Tissues; Specimen Care

 Specimens that have been crushed, frozen, desiccated, burned, or otherwise

compromised may not be microscopically diagnostic once they reach the oral-
maxillofacial pathologist, necessitating a repeat biopsy (which may or may
not be feasible).
 avoid instrument damage to the specimen during manipulation
 The removed tissue sample should not be wrapped in gauze (wet or dry)
because it is then at risk of getting thrown out accidentally along with the
gauze.
 The specimen also should not be set on paper or linen drapes and allowed to
dry out while the surgery is being completed. Rather, the specimen should be
immediately placed in a glass or plastic container that contains a quantity of
10% formalin solution (4% formaldehyde) that is at least 20 times the volume
of the specimenitself and that can be capped
The specimen must
be totally immersed in the
preservative solution at all
times, even if
the container is tilted sideways
during transport.
Intraosseous Biopsy
Technique and Principle
 Beforeperforming intraosseous biopsy , the
dentist should carefully palpate the area of
the jaw and compare it with contralateral
side.
 Biopsyprocedures and principles within
hard tissues are no different from those
guiding soft tissue biopsy……
Mucoperiosteal Flaps
Precautionary Aspiration
 Aspirationof all intraosseous lesions should
be performed routinely before opening into
the osseous defect to determine whether it
contains fluid including blood.
 Local anesthesia
 Use16 or 18 gauge needle connected to a
5-10 ml syringe.
 OSSEOUS WINDOW
Intraosseous lesions
of the jaws generally
require creation of cortical window
for access.
SPECIMEN MANAGEMENT

 Oncethe lesion is completely freed from

attachment, it is removed and placed
immediately into the formalin preservative.
 Thepathology report may take 2 weeks or
longer.
POSTBIOPSY FOLLOW-UP
Follow-up and Reporting of Biopsy Result
to the Patient

 Patients should be seen 1 to 2 weeks postoperatively to

ensure healing and to discuss the results of the biopsy. It
is the responsibility of the clinician (not the assistant or
secretary) to explain the diagnosis and any further
management if necessary. If the microscopic diagnosis is
inconsistent with the clinical impression, the clinician is
strongly advised to discuss any concerns directly with the
pathologist.
Biopsy Procedure
 Armamentarium
 The minimal requirements are as follows
 blade handle and no. 15 blade
 fine tissue forceps (preferably Adson forceps)
 syringe and local anesthetic
 retractor appropriate for the site
 sutures, if needed
 needle driver
 curved scissors
 hemostatic agents (silver nitrate or absorbable gelatin sponge)
 gauze sponges
 specimen bottle containing 10% neutral buffered formalin
 biopsy data sheet
OTHER SIGNIFICANT
LABORATORY TEST
Complete blood count test

 CBC is the calculation of the cellular (formed elements) of blood.

 A complete blood count (CBC) is a common blood test that your
doctor may recommend for the following reasons:
 To help diagnose some blood cancers, such as leukemia and
lymphoma
 Find out if cancer has spread to the bone marrow
 Determine how a person’s body is handling cancer treatment
 To diagnose other, noncancerous conditions
What does a complete blood count measure?

 Red blood cells

 White blood cells
 platelets
Blood Chemistry Test

 It give important information about how well a person’s

kidneys, liver, and other organs are working.
 It used to help diagnose and monitor the general health of
the patient prior, during, and after surgery ,procedure or
treatment.
 Also called blood chemistry study
Blood Chemistry test
 Blood Urea Nitrogen (BUN): BUN is a measure of kidney
function.
 Normal Values: 8-25mg/100ml (USA) 2.9-8.9 mmol/L
(International)
 Carbon Dioxide (CO2): This test result is an indication of
how well the kidneys, and sometimes the lungs, are
managing the bicarbonate level in the blood.
 Normal Values: 24-30 mEq/L (USA) 24-30 mmol/L
(International)
 Creatinine: High levels = kidney impairment, low blood
pressure, high blood pressure or another condition.
Blood Chemistry Test

 Glucose: High levels of glucose = presence of diabetes or

another endocrine disorder.
 Serum Chloride (Cl):
 Serum Potassium (K): important to monitor the level of
potassium after surgery.
 Serum Sodium (Na):
Test for Oral Cancer

 Oral cancer screening is an examination performed by a

dentist or doctor to look for signs of cancer or precancerous
conditions in your mouth.
 goal of oral cancer screening is to detect mouth cancer or
precancerous lesions that may lead to mouth cancer at an
early stage
Risks
 Oral exams for oral cancer screening have some
limitations, such as:
 Oral cancer screening could lead to additional tests.
 Oral cancer screening can't detect all mouth cancers.
 Oral cancer screening hasn't been proved to save
lives.
Signs and symptoms

 A lip or mouth sore that doesn't heal

 A white or reddish patch on the inside of your mouth
 Loose teeth
 A growth or lump inside your mouth
 Mouth pain
 Ear pain
 Difficult or painful swallowing
 Additional tests for oral cancer screening
 During an oral cancer screening exam, your dentist looks over the inside of
your mouth to check for red or white patches or mouth sores. Using gloved
hands, your dentist also feels the tissues in your mouth to check for lumps
or other abnormalities.
 Some dentists use special tests in addition to the oral exam to screen for
oral cancer. It's not clear if these tests offer any additional benefit over the
oral exam. Special oral cancer screening tests may involve:
 Rinsing your mouth with a special blue dye before an exam. Abnormal
cells in your mouth may take up the dye and appear blue.
 Shining a light in your mouth during an exam. The light makes healthy
tissue appear dark and makes abnormal tissue appear white.
THANK YOU FOR LISTENING!!!