BIOPSY

Biopsy:
• Definition
• Indications
• Contraindications
• Armamenterium
• Points must be considered to ensure obtaining proper
specimen
• Types of biopsy
Excisional biopsy
Incisional biopsy
Punch biopsy
Needle biopsy
Aspiration biopsy
Exfoliative cytology
Definition:
Bios – life Opsis – vision

Removal of tissue from living

beings for macroscopic examination
,microscopic
analysis, bacterial analysis & combination
of above is called “BIOPSY”.
INDICATIONS:
1.To determine the nature of lesion which does not
readily respond to conservative & simple therapy.
2.To determine the nature of the lesion which is
unknown.
3.To establish the diagnosis where there is suspecion of
neoplasm.
4.To determine nature of any intraosseous lesion which
can’t be identified radiographically.
5.To determine the nature of all abnormal tissue
removed from the oral cavity including cysts &
granulomas.
Contraindications:
A) Relative contraindications:
1.In cases of inflammatory lesions may be
due to allergy ,viral ,fungal, or bacterial
lesion. e.g. candidiasis.
2.Compromised generalised health of patient.
e.g. patient on anticoagulant therapy.
3.Proximity of lesions to vital , anatomic,
physiologic, neural, vascular, or glandular
structures.
B) Absolute contraindications:

1.Pulsatile vascular lesions. e.g.

angiosarcoma.
2.Pigmented lesion should not be biopsied.
e.g.
Melanoma.
3.Intrabony radiolucent lesions should not be
biopsied or removed without prior
investigational aspiration.
ARMAMENTERIUM:
1.Mouth mirror & probe, 8.Periosteal elevator
colourless antiseptic agent.
9.Chiesel
2.LA & syringe.
3.Surgical scalpel. 10.Bow curette
4.Long pointed surgical 11.Suture material
scissors. 12.Needle holder
5.Tissue forceps
13.Sponges
6.Biopsy punch
7.Bone burs 14.Wide mouthed bottle
with10% neutral
buffered formalin
Points must be considered to
ensure obtaining proper
specimen:
1.Do not paint the surface of the area to be biopsied
with iodine or other highly coloured antiseptic.
2.Don’t inject LA into the lesion.
3.Use sharp scalpel to avoid tearing of tissue.
4.Use care not to mutilate the specimen when
grasping it with forceps.
5.Fix the tissue immediately upon removal in 10%
formalin or 70% alcohol.
6.If the specimen is thin, place it upon a piece of
glazed paper & drop into fixative which prevents
curling of tissue.
TYPES OF BIOPSY:

1.Excisional biopsy
2.Incisional biopsy
3.Scalpel biopsy
4.Punch biopsy
5.Needle/trephine/drill
6.Aspiration biopsy
7.Exfoliative cytology
EXCISIONAL BIOPSY:

*Definition: Total excision of a small

lesion
for microscopic study is
called
“excisional biopsy”.
*Use : Lesions smaller than 1cm in
meter.
Method:

• Give LA which should not be closer than

2cm from the site.
• Stabilize the lesion via the suture.
• Incise mucosa around the base of the
lesion in an elliptical shape.
• Place specimen immediately in a
fixative.
• Close the wound using suture.
INCISIONAL BIOPSY:
Definition: Some lesions are too large to
excise initially without having
established diagnosis or are of such a
nature that excision would be inadvisable
in such instances a small section is
removed for examination called incisional
or diagnostic biopsy.
Use : For large lesions or there is a
suspicious
of malignancy.
Method:
• Administer LA.
• Identify the apparent junction between normal
tissue & the lesion select the specimen across
region.
• Stabilize the specimen with a suture.
• Dissect the specimen from the edge of the lesion
& include a margin of apparently normal tissue.
• The specimen should include representative area
of the lesion.
• Place the specimen immediately in a prescribed
specimen bottle containing 10% formalin.
• Close surgical site by sutures.
PUNCH BIOPSY:

• A surgical instrument is used to

punch out a representative portion of
tissue.
• Since resulting specimen is often
damaged
by the procedure so biopsy by
scalpel is preffered.
Needle/trephine/drill biopsy:

• Use : to biopsied deep-seated fibro-

osseous lesions.
• The resulting specimen is smaller
may be non-representative & again
often damaged by the procedures so
they are not often used.
Aspiration biopsy:
• Use – Applicable to many cystic &
fluctuant lesions
Method-
Clean the tissue over the proposed
aspiration site.
-Inject LA solution over the lesion.
-Select a wide bore needle & 10 ml syringe.
-Penetrate tissue & aspirate fluid.
-Transfer the aspirate into a screw top specimen
bottle.
ORAL EXFOLIATIVE
CYTOLOGY:
Oral epithelium is the harbour for many
pathology lesions of varied origin, where the
cells denude at the surface.Such cells can
be used as an ADJUNCT to diagnose
epithelial malignancies,viral lesions &
dermatologic diseases with oral
manifestations.The technic by which we
study the exfoliating oral cells is termed
as”Oral exfoliative cytology”.
Collection of smear:

-A clean cotton tip applicator or a wooden

spatula is used for collecting the specimen.
-If the area to be scrapped is dry applicator or
spatula should be moistened.
-The material to be collected is obtained either
by scrapping the surface of lesion or by
rolling motion against the lesion.
-Scrapping obtained should be smeared in the
center of the previously marked slide.
Fixation of smear:
This is to maintain the almost same status as it was
in the oral cavity.
Fixatives used are :
1) Equal parts of ether & 95% ethyl alcohol give
superstaining qualities.
2) Carbowax/Aquawax – This contains
-Polyethyl glycol
-Distilled water
-Glacial acetic acid
The slide should be immersed into fixative
before the smear dries out and remain it in the
fixative ror 30 minutes.
Staining of the smear:

This is done by using “The Modified

Papnicolaou technique”.-1946
utilizing Mayer’s haematoxylin,
Orange G stain,combination of eosin
& light green stains.
Screening criteria:
-Normal cells: Parabasal & immature prickle cells.
Cells are spherical or cuboidal with centrally placed &
EVEN CHROMATIN DISTRIBUTION.
Cytoplasm stains green or bluish green.
-Intermediate cells: irregularity of cytoplasmic morphology
with some degree of contraction of nucleaus.
Cytoplasm stains red or pink.
-Mature cells: Flattened with pyknotic nucleus, may be
anucleated
cytoplasm stains, orange or yellow.
Criteria of malignant cells:
1.Irregular cell and nuclear borders.
2.Basal & parabasal cells. i.e in superficial part.
3.Cells with pyknotic nuclei or abscence of nuclei in
an abnormal location.
4.Altered cytoplasm to nucleus ratio.
5.Epithelial giant cells.
6.Poikilocarynosis.
7.Abnormal miosis.
8.Hyperchromatism.
9.Abnormal chromatin pattern & distribution.