Post on 24-May-2015
Principles of Tissue Biopsy Principles of Tissue Biopsy in Oral and Maxillofacial in Oral and Maxillofacial
SurgerySurgery
Speaker: Speaker: 黃傳貴 大夫黃傳貴 大夫Moderator:Moderator: 雷文天 大夫雷文天 大夫
Examination Examination && Diagnostic Methods Diagnostic Methods
Health historyHealth history History of the lesionHistory of the lesion Clinical examinationClinical examination Radiographic examinationRadiographic examination Laboratory investigationLaboratory investigation BiopsyBiopsy
Definition of BiopsyDefinition of Biopsy
Removal of tissue from a living individual fRemoval of tissue from a living individual for diagnostic examinationor diagnostic examination
Indication for BiopsyIndication for Biopsy
Any lesion persists for more than 2 weeks Any lesion persists for more than 2 weeks with no apparent etiology basiswith no apparent etiology basis
Any inflammatory lesion that does not respAny inflammatory lesion that does not respond to local treatment after 10 to 14 days ond to local treatment after 10 to 14 days (that is,after removing local irritant) (that is,after removing local irritant)
Indication for BiopsyIndication for Biopsy
Persistent hyperkeratosis changes in surfaPersistent hyperkeratosis changes in surface tissue (ex:lips or oral mucosa)ce tissue (ex:lips or oral mucosa)
Any persistent tumescence,either visible oAny persistent tumescence,either visible or palpable beneath relatively normal tissuer palpable beneath relatively normal tissue
Lesion that interfere with local function (ex:Lesion that interfere with local function (ex:fibroma)fibroma)
Indication for BiopsyIndication for Biopsy
Bone lesions not specifically identified by Bone lesions not specifically identified by clinical and radiographic findingclinical and radiographic finding
Any lesion that has the characteristics of Any lesion that has the characteristics of malignancy malignancy
Characteristics of lesions that raise Characteristics of lesions that raise the suspicion of malignancythe suspicion of malignancy
Erythroplasia—lesion is totally red or has Erythroplasia—lesion is totally red or has speckled red appearancespeckled red appearance
Ulceration—lesion is ulcerated or presents Ulceration—lesion is ulcerated or presents as an ulceras an ulcer
Duration— lesion has persisted more than Duration— lesion has persisted more than 2 weeks2 weeks
Characteristics of lesions that raise Characteristics of lesions that raise the suspicion of malignancythe suspicion of malignancy
Growth rate– lesion exhibits rapid growthGrowth rate– lesion exhibits rapid growth Bleeding— lesion bleeds on gentle manipuBleeding— lesion bleeds on gentle manipu
lation lation Induration– lesion and surrounding tissue iInduration– lesion and surrounding tissue i
s firm to the touchs firm to the touch Fixation– lesion feels attached to adjacent Fixation– lesion feels attached to adjacent
structuresstructures
Aspiration BiopsyAspiration Biopsy
Aspiration biopsy is the use of a needle anAspiration biopsy is the use of a needle and syringe to penertrate a lesion for aspiratid syringe to penertrate a lesion for aspiration of its contenton of its content
Indication of Aspiration Biopsy Indication of Aspiration Biopsy
Aspiration should be carried out on all lesions thAspiration should be carried out on all lesions thought to contain fluid or any intraosseous lesion ought to contain fluid or any intraosseous lesion before surgical explorationbefore surgical exploration
a fluctuant mass in the soft tissues should also a fluctuant mass in the soft tissues should also be aspirated to determine its contentsbe aspirated to determine its contents
Any radiolucency in the bone of the jaw should bAny radiolucency in the bone of the jaw should be aspirated to rule out a vascular lesion that can e aspirated to rule out a vascular lesion that can cause life threatening hemorrhagecause life threatening hemorrhage
Technique of Aspiration BiopsyTechnique of Aspiration Biopsy
A 18-gauge needle is connected to a 5 or A 18-gauge needle is connected to a 5 or 10 ml syringe10 ml syringe
The tip of needle may have to be The tip of needle may have to be repeatedly repositioned to locate a fluid repeatedly repositioned to locate a fluid centercenter
Excisional BiopsyExcisional Biopsy
Removal of the entire lesionRemoval of the entire lesion A perimeter of normal tissue surround the A perimeter of normal tissue surround the
lesion is also excised to ensure total lesion is also excised to ensure total removal removal
Constitute definitive treatmentConstitute definitive treatment
Indication of Excisional BiopsyIndication of Excisional Biopsy
Smaller lesions(Smaller lesions(<1cm, in diameter) that,on <1cm, in diameter) that,on clinical examination, appear to be benignclinical examination, appear to be benign
Principle of Excisional BiopsyPrinciple of Excisional Biopsy
The entire lesion, along with 2 to 3 mm of The entire lesion, along with 2 to 3 mm of normal appearing surrounding tissue, is normal appearing surrounding tissue, is excisedexcised
Principle of Excisional BiopsyPrinciple of Excisional Biopsy
Incisional BiopsyIncisional Biopsy
Samples only a particular or Samples only a particular or representative part of the lesionrepresentative part of the lesion
Lesion is largeLesion is large Lesion has different characteristics at Lesion has different characteristics at
different locationdifferent location
Indication of Incisional BiopsyIndication of Incisional Biopsy
Extensive size (Extensive size (>1 cm in diameter)>1 cm in diameter) Hazardous locationHazardous location A great suspicious of malignancyA great suspicious of malignancy
Principles of Incisional BiopsyPrinciples of Incisional Biopsy
Representative areas of lesion should be iRepresentative areas of lesion should be incised in wedge fasionncised in wedge fasion
Selected in an area that shows complete tiSelected in an area that shows complete tissue changes(the lesion extends into norssue changes(the lesion extends into normal tissue at the base and/or margin of thmal tissue at the base and/or margin of the lesion)e lesion)
Principles of Incisional BiopsyPrinciples of Incisional Biopsy
Necrotic tissue should be avoided Necrotic tissue should be avoided Taken from the edge of the lesion to includTaken from the edge of the lesion to includ
e some normal tissuee some normal tissue A deep, narrow biopsy rather than a broad,A deep, narrow biopsy rather than a broad,
shallow oneshallow one
Principles of Incisional BiopsyPrinciples of Incisional Biopsy
AnesthesiaAnesthesia
Block local anesthesia techniques are empBlock local anesthesia techniques are employed when possibleloyed when possible
The anesthesic solution should not be injeThe anesthesic solution should not be injected within the tissue to be removed, becacted within the tissue to be removed, because it can cause artificial distortion of the suse it can cause artificial distortion of the specimen pecimen
AnesthesiaAnesthesia
When blocks are not possible, infilitration oWhen blocks are not possible, infilitration of local anesthesia may be used locally,but f local anesthesia may be used locally,but the solution should be injected at least 1 cthe solution should be injected at least 1 cm away from the lesion m away from the lesion
Tissue StabilizationTissue Stabilization
Tongue or soft palate Tongue or soft palate
--Heavy retractive sutures--Heavy retractive sutures
--Towel clips--Towel clips LipLip
-- assistant’s finger pinching the lip on both-- assistant’s finger pinching the lip on both
sides of the biopsy areasides of the biopsy area
Tissue StabilizationTissue Stabilization
Identification of Surgical MarginsIdentification of Surgical Margins
Marked with a silk suture to orient the Marked with a silk suture to orient the specimen for the pathologistspecimen for the pathologist
If the lesion is diagnosed as requiring If the lesion is diagnosed as requiring additional treatment, the pathologist can additional treatment, the pathologist can determine which margin, if any had determine which margin, if any had residualresidual
Identification of Surgical MarginsIdentification of Surgical Margins
One must be certain to illustrate the One must be certain to illustrate the orientation of the lesion and the method orientation of the lesion and the method with which the specimen was marked in with which the specimen was marked in the pathology data sheetthe pathology data sheet
HemostasisHemostasis
Avoid suction deviceAvoid suction device Gauze wrapped over the tip of the low Gauze wrapped over the tip of the low
volume suction devicevolume suction device Simple gauze compressionSimple gauze compression
Specimen CareSpecimen Care
Immediately placed in 10Immediately placed in 10% formalin % formalin solution that is at least 20 times the solution that is at least 20 times the volume of surgical specimenvolume of surgical specimen
Totally immersed in the solutionTotally immersed in the solution
Specimen CareSpecimen Care
Care should be taken to be sure that the Care should be taken to be sure that the tissue has not become lodged on the wall tissue has not become lodged on the wall of the container above the level of the of the container above the level of the formalinformalin
Surgical Closure Surgical Closure
Primary closure of the elliptic wound is Primary closure of the elliptic wound is usually possible usually possible
Palatal biopsy: best managed Palatal biopsy: best managed postoperatively with the use of an acrylic postoperatively with the use of an acrylic splintsplint
Surgical ClosureSurgical Closure
Dorsum or lateral border of the tongue: Dorsum or lateral border of the tongue: sutures to be placed deeply and at sutures to be placed deeply and at frequent intervals into the substance of the frequent intervals into the substance of the tongue to retain closuretongue to retain closure
Final DiagnosisFinal Diagnosis
The final diagnosis should correspond to The final diagnosis should correspond to the clinical course before and after biopsythe clinical course before and after biopsy
A negative pathology report for cancer A negative pathology report for cancer should not lull the dentist into a false should not lull the dentist into a false sense of security when the clinical sense of security when the clinical characteristics of the lesion still indicate characteristics of the lesion still indicate malignant potentialmalignant potential
Final DiagnosisFinal Diagnosis
If the pathology report does not If the pathology report does not corroborate the clinical impression of the corroborate the clinical impression of the lesion, the biopsy procedure should be lesion, the biopsy procedure should be repeatedrepeated
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