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7/27/2019 Principles of Tissue Biopsy in Oral and Maxillofacial
http://slidepdf.com/reader/full/principles-of-tissue-biopsy-in-oral-and-maxillofacial 1/34
Principles of Tissue Biopsyin Oral and Maxillofacial
SurgerySpeaker:黃傳貴 大夫
Moderator:雷文天 大夫
7/27/2019 Principles of Tissue Biopsy in Oral and Maxillofacial
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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
7/27/2019 Principles of Tissue Biopsy in Oral and Maxillofacial
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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
7/27/2019 Principles of Tissue Biopsy in Oral and Maxillofacial
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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