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Biopsy |
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Types of biopsy: May be incisional—fine needle aspirations, punch biopsy, trephines, ‘true-cut’ needle biopsy. The commonest technique is to excise an ellipse of tissue including a portion of the lesion and surrounding normal tissue. Excisional biopsy provides information on the whole lesion. It is generally reserved for lesions< 1cm.
What should be biopsied? Nearly everything that is worth excising is worth histological review, and so all excised specimens should be examined histopathologically. Any soft tissue lesion not amenable to accurate clinical diagnosis should be biopsied. All red lesions of oral mucosa and most white patches should be biopsied.
Special considerations: Frozen sections are biopsy specimens taken during major surgery, either when the extent of the procedure will depend on the histological diagnosis of the lesion or to verify clearance of the excision. It is essential to contact the pathology lab in advance to warn them. This may also be necessary for certain special tests e.g. immunohistochemistry.
Technique: For simple incisional biopsy stabilise the sample, give LA in tissues around lesion, and cut an ellipse of tissue including lesion and normal surrounding tissue. Lift up and dissect out. Close wound with sutures.
Biopsy and oral cancer: There is a theoretical risk of seeding malignant cells into the circulation with an incisional biopsy. If you suspect an oral malignancy refer before biopsy because most consultants have a preferred approach.
Samples: Preserve in 10% formalin for most specimens. Be sure to ask, as some specimens are needed fresh. Make sure the histopathology form is completed with as much information as possible, including orientation of the specimen. Make a diagram of larger samples and add clinical details.
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A biopsy is a sample of tissue taken from a patient for histopathological examination |
