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Biopsy
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Biopsy
Tissue biopsy is the gold standard for definitive diagnosis
ofsoft and hard tissue lesions.
An incisionalbiopsyevaluates a small representativesample,
whereas an excisionalbiopsyinvolves removal and
evaluation of the entire lesion. Biopsies may be submittedin
formalin for routine histopathology or in saline orMichels medium
for direct immunofluorescence and otheradvanced studies (including
tissue culture) that requirenonfixed tissue. Immunohistochemical
studies can beperformed in many cases on both formalin fixed and
freshtissue samples and may be useful for determining orrefining
the diagnosis. The pathology laboratory should beconsulted in
advance when there are any questions as tohow a specimen should be
submitted.
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In areas where the tissue is closely attached to
underlying bone, as seen on the hard palate
and gingiva, a simple wedge biopsy with a
scalpel is generally easier than using a skin
punch. Small, well-defined lesions may be
excised fully. Placement ofsimple interruptedresorbable sutures
or application ofsilver
nitrate will effectively control bleeding
following most incisional biopsies. Painfollowing biopsy is
typically mild, requiring
only acetaminophen or ibuprofen in most
cases; occasionally opiates are needed.
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There are several important points to consider
when performing a biopsy. If the lesion is
nonhomogeneous, more than one area within
the lesion should be sampled because early
malignancies can present only focally in a field
of dysplastic changes. If the differentialdiagnosis includes a
vesiculobullous disorder,
the biopsy site should be perilesional,
specifically avoiding any area of ulceration.
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Ulcerated lesions lack epithelial layers and
as such, direct immunofluorescence testing
cannot be adequately performed onspecimens taken from such
areas.
All specimens should be carefully mapped
and oriented. Regardless of the presumed
clinical diagnosis, any tissue that is excised
should be submitted for histopathological
analysis. It is generally preferable to send
specimens to a pathology laboratory with aboard certified oral
pathologist on staff or
general pathologist with special training in
oral pathology.
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Oral punch biopsy armamentarium that
includes a 4.0-mm disposable punch, tissue
forceps, and surgical scissors
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Punch biopsy of an area of
leukoplakia on the hard palate.
(a) After rotation of the punch
down to periosteum, prior
to excision with forceps andscissors. (b) Excised surgical
specimen placed in formalin
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(a) Excisional biopsy of a recurrent benign tongue neoplasm
(spindle cell
tumor). (b) Outline of excision marked with surgical pen to
ensure adequate
margins. (c) Gross pathology of excised specimen. (d)
Postoperative suturedexcision site
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Selection of multiple biopsy sites
in a patient with a large area of
erythroleukoplakia to ensure
adequate sampling.
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Perilesional biopsy in a patient with an ulcerative lesion
undergoing evaluation for autoimmune vesiculobullous
disease.
The biopsy specimen was divided into equal fragments and
submitted for both routine histopathology and direct
immunofluorescence.
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Oral cytology specimen of a suspected fungal infection
demonstrating Candida hyphae (linear organisms; solid
arrow) and conidiae (ovoid budding organisms; broken
arrow).
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Oral cytology specimen of a suspected herpes simplex
virus infection demonstrating classic viral cytopathic
changes in the cell above the normal keratinocyte.
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Oral hairy leukoplakia of the right lateral
tongue with focal linear white plaques
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Severe smokers palate showing
heavy keratinization
and intensely inflamed duct orifices.
