Biopsy Procedures and Techniques PDF

BIOPSY Written consent usually indicated A biopsy is a procedure that removes a sample of cells from a tissue to be NEEDLE BIOPSY examined. A needle biopsy is a procedure th...

BIOPSY Written consent usually indicated A biopsy is a procedure that removes a sample of cells from a tissue to be NEEDLE BIOPSY examined. A needle biopsy is a procedure that uses a The cells or tissue are then examined under needle to remove tissue or cells from the a microscope to look for signs of cancer breast or other organs Biopsy and Cytology allow direct sampling There are two types of needle biopsies: of tissue for diagnostic purposes. ○ Fine Needle and BIOPSY ○ Core Needle Biopsy ○ excision of pieces of living tissue with subsequent histopathological analysis Can be done with biopsy forceps, suctions method (small bowel or rectal suction bx) or a needle passed percutaneously (percutaneous liver bx or pancreatic FNA) CYTOLOGY NEEDLE BIOPSIES specimens for cell culture or cytological Fine Needle analysis can be obtained: ○ A thin, hollow needle is used to ○ Using brushes remove a sample of tissue. The Tube on the bronchi and procedure is quick and can be done you do some brushing in a doctor’s office. ○ Using Washings and /or Core Needle ○ Aspirations ○ A larger needle is inserted through a small incision in the skin, and a WHEN A LUMP IS FOUND small core of tissue is removed. When a lump is found, a biopsy is the first This type of needle biopsy is done step in diagnosis and treatment. with the assistance of Although the primary purpose is to diagnose mammography or ultrasound cancer, a biopsy can also be a surgical imaging in a doctor’s office or treatment to remove cancer. hospital outpatient clinic INDICATIONS FOR BIOPSY ADVANTAGES OF NEEDLE BIOPSY Purpose – for histopathology; r/o cancer Simple procedure – does not require surgery ○ Rule out entire cancer Accurate ○ If the entire cancer can be remove, Quick – only takes a few minutes the removal is also can be curative Not painful If entire lesion can be removed may also Inexpensive serve as treatment (curative or cosmetic) Quick results In rare cases, tissue needed for special studies ie: immunofluorescent testing DISADVANTAGES OF NEEDLE BIOPSIES ○ Immuno is antibody Entire lump is not removed ○ Fluorescent is a die that you add to Open biopsy may be necessary identify something. For Fine Needle Only: ○ Specialist needed to read results CONTRAINDICATIONS FOR BIOPSY ○ In situ cancer not distinguishable Significant coagulopathy (ASA (Aspirin), from invasive cancer warfarin and clopidogrel do not need to be stopped) OPEN BIOPSY ○ Coagulapathy is when the patient is An open biopsy is a surgical procedure that taking drugs that can lead to opens the skin to remove tissue. bleeding like ASA Techniques: H/o allergy to anesthetic ○ Punch TOBEY cute so much CCA2-DMD3  ○ Shave Good for: tags, SKs, AKs, compound nevi, ○ Curettage lentigines, small BC’s ○ Excisional ○ Wedge (Incisional) THE PUNCH BIOPSY Obtains a full thick-ness cylindrical specimen or “core-sample” Good choice for small lesions (2, 3, 4 mm) Good choice for suspected melanoma in skin lesions Whole lesion does not need to be removed CAN ALSO USE: with biopsy Sgl.-edge Razor Blade TECHNIQUE– PUNCH BIOPSY 3mm Stretch skin opposite to natural lines of tension (Langer’s) Push unit vertically into the skin & rotate to cut Once dermis is penetrated there is decreased resistance Lift & snip plug Flexible “Biopblade” THE DEEP SAUCER- SHAVE Central aspect of biopsy is sampled into mid-dermis Will heal with a depression vs. flat Goal is to entirely remove lesion Not a choice if melanoma suspected Good for: dysplastic nevi, AKs, DFs INCISIONAL BIOPSY SHAVE BIOPSY A surgical procedure where only a portion Best-suited to remove raised skin lesions of a tumor is removed when full-thickness not required Generally reserved for lumps that are larger Not advised if melanoma suspected Performed under local anesthesia in a Dermal infiltration of anesthetic can help hospital or outpatient clinic elevate lesion Can use blade +/ or RF loop (or both, use INCISIONAL (WEDGE) BIOPSY RF to “feathur-out” borders of defect) Removes a portion of an abnormal lesion Apply topical hemostatic agent to achieve hemostasis TOBEY cute so much CCA2-DMD3  ○ Removing tissue can change the look and feel of the organ HOW LONG IS THE PROCEDURE FOR A NEEDLE BIOPSY? A fine needle aspiration only takes a few minutes. A core needle biopsy takes under one hour. WILL AN AESTHETIC BE USED DURING THE BIOPSY A local anesthetic is used in needle biopsies. EXCISIONAL BIOPSY A person can have either a local anesthetic A surgical procedure that removes the and/or a sedating anesthesis in an open entire suspected area plus some biopsy. surrounding normal tissue. Standard procedure for lumps that are INITIAL STEPS IN TISSUE PROCESSING smaller than an inch or so in diameter Similar to a lumpectomy in breast masses SPECIMEN ASSESSMENT Performed under local anesthetic or general anesthesia in a hospital or outpatient clinic Used to remove entire lesion, full-thickness Will require undermining and suture closure Not my technique of choice due to time-limitations and variance in margin recommendations: ○ Benign lesions 1-2mm ○ BC 3mm ○ SC 5mm ○ MIS 10mm Soaked in 10% formalin GROSS EXAMINATION & SAMPLING They place it in caset ADVANTAGES OF OPEN BIOPSY Quick – takes only one hour More accurate than a needle biopsy Larger samples provide information for treatment plan Excisional Only: ○ Removes entire lump ○ May be the only surgical treatment needed DISADVANTAGES OF OPEN BIOPSIES Surgical procedure Expensive Side effects such as infection or blood collection under the skin Excisional Only: TOBEY cute so much CCA2-DMD3 STAINING MOUNTING MICROSCOPIC EXAMINATION TOBEY cute so much CCA2-DMD3 INTEGRATING ORAL HEALTH AND MEDICAL believe that tooth loss is inevitable, CARE and have medical conditions reflected in their oral health. ORAL HEALTH More than teeth and gums! DENTALLY RELATED AGING CHANGES Also includes supporting tissues, hard and Xerostomia soft palate, mucosal lining of the mouth and ○ is a condition, resulting from certain throat, tongue, lips, salivary glands, chewing disorders and medications, that muscles, and upper and lower jaws involves decreased flow of saliva. these tissues allow us to speak and smile; Periodontal disease sigh and kiss; smell, taste, touch, chew, and ○ is an increasing problem in the swallow; cry out in pain; and convey a world older population. The tissues of of feelings and emotions through facial older patients may be slower to expressions heal. ○ The essence of our humanity!! Dental decay Progressive and cumulative – become more ○ increases in the form of coronal and complex over time root caries and recurrent decay Dental caries (tooth decay) around defective restorations. ○ is the single most common chronic Dark and brittle teeth childhood disease – 5 times more ○ result from deposition of secondary common than asthma dentin that have gradually reduced Over 50 percent of 5- to 9-year-old children the size of the pulp chamber. have at least one cavity or filling, and that Bone resorption proportion increases to 78 percent among ○ results in loss of the alveolar ridge. 17-year-olds. ○ These are improvements compared WHY THE DISPARITIES to a generation ago! There are many factors that influence Poor children suffer twice as much dental vulnerability to oral disease caries as their more affluent peers, and their ○ Socioeconomic factors disease is more likely to be untreated. Lack of resources to pay for care VULNERABLE POPULATIONS Inability to take time away Those who suffer the worst oral health are from work found among the poor of all ages, with poor Lack of transportation children and poor older Americans Physical disability or other particularly vulnerable illness that limits access Members of racial and ethnic minority groups ○ Lack of understanding and experience a disproportionate level of oral awareness of the importance of oral health problems health ○ Cultural values influence oral THE AGING POPULATION health and well-being and can play Aging is the irreversible and inevitable an important role in care utilization changes that occur with time. practices and in perpetuating Stages of the older population: acceptable oral health and facial ○ Young/old: People 65 to 74 years norms. old, better educated and more “You cannot be healthy without oral health” demanding of health services, retain more of their natural teeth. CARDIOVASCULAR DISORDERS ○ Old: People 75 to 84 years old, Heart disease: beginning to have multiple health ○ leading cause of death problems, have more fixed and Angina: removable prostheses. ○ severe pain in the chest associated ○ Old/old: People 85 years old or with an insufficient supply of blood older have fewer natural teeth, to the heart TOBEY cute so much CCA2-DMD3  Myocardial infarction: heart attack ○ Intermediate disease, or confused Treatment-plan modifications phase ○ Vital-sign checks throughout the ○ Late disease, or dementia phase procedure Treatment-plan modifications ○ Use of supplemental oxygen ○ Thorough dental examination in ○ Use of prophylactic sublingual early stages nitroglycerin ○ Special attention to daily care of the ○ Avoidance of epinephrine mouth Hypertension: ○ Alertness to signs of xerostomia ○ Referred to as high blood pressure, it results when the heart must work Seizures harder as it pumps against ○ are an abrupt suspension of motor, resistance (e.g., a blocked artery). sensory, and/or body function. Major factors associated with hypertension: Epilepsy ○ Stress ○ Petit mal seizures usually last 5 to ○ Age 10 seconds. ○ Heredity ○ Grand mal seizures have many ○ Smoking causes and arise in people in all ○ Obesity age groups. Treatment-plan modifications Congestive heart failure ○ Maintenance of oral hygiene ○ is a condition where the heart ○ Surgical reduction of gingival cannot pump enough blood to the hyperplasia body’s other organs. ○ Questioning before any procedure This lack of circulation throughout the body with regard to eating, stress, pain, can result from: and alcohol consumption ○ Narrowed arteries ○ Interference with the heart muscle Multiple sclerosis by scar tissue from a past heart ○ is a debilitating and degenerative attack disorder of the central nervous ○ High blood pressure system that involves progressive ○ Heart-valve disease weakening of the lower extremities, ○ Heart defect causing muscle weakness, ○ Infection of the heart valve or unsteady gait, and paralysis. muscle (endocarditis or Treatment-plan modifications myocarditis) ○ Adrenal suppressants to relax muscles. A patient with cardiac disease or a prosthetic ○ Extra time for procedures, if the replacement carries an increased risk of patient is wheelchair-bound infection with bacteria carried in the blood. Endocarditis Stroke, or cerebrovascular accident, ○ is a severe infection of the cardiac ○ is a minor to severe loss of central valves and supporting structures nervous system function caused by caused by bloodborne pathogens a sudden vascular lesion of the that gain entry to the bloodstream brain, such as hemorrhage, from such places as the mouth and embolism, thrombosis, or ruptured gastrointestinal tract. aneurysm. Treatment-plan modifications NEUROLOGIC DISORDERS ○ Midmorning scheduling with Alzheimer disease is a brain disorder that is additional time set aside marked by deterioration of mental capacity. ○ Modification of oral-hygiene aids The disease progresses in three stages: ○ Early disease, or forgetfulness phase TOBEY cute so much CCA2-DMD3 PULMONARY DISORDERS Treatment-plan modifications Disorders that affect the lungs and are ○ Make modifications for any surgical characterized by airway obstruction. procedures. ○ Bronchial asthma: Often arising ○ Antibiotic prophylaxis may need to from allergies characterized by an be prescribed for high risk increased hypersensitivity to procedures various stimuli, which results in bronchial edema and widespread MUSCULAR DISORDERS narrowing of the bronchial airways. The musculoskeletal system includes the ○ Treatment-plan modifications bones, muscles, and joints. Minimizing stress Older patients are more likely to have Shortening appointments chronic progressive arthritis with stiffening Minimizing the use of of joints. epinephrine and aspirin Muscular dystrophy involves the striated muscles in the body, resulting in progressive “Chronic obstructive pulmonary disease” atrophy and weakness. ○ is the general term for pulmonary Treatment-plan modifications diseases characterized by airflow ○ See arthritic patients in the blockage during respiration. morning. Bronchitis ○ Avoid sedation in patients whose ○ is a narrowing of the bronchial breathing is impaired. airways resulting from chronic inflammation. ENDOCRINE DISORDERS Emphysema Glands throughout the body release ○ is an irreversible enlargement of the hormones into the bloodstream to help size of the air spaces, resulting in regulate metabolism. labored breathing and increased Hyperthyroid susceptibility to infection. ○ is an overactive thyroid gland. Treatment-plan modifications Hypothyroid ○ Minimizing stress ○ is an underactive thyroid gland that ○ Shortening appointments produces fewer hormones. ○ Setting morning appointments Treatment-plan modifications ○ Considering the use of sedation ○ Medical consultation is essential. techniques ○ Such patients are highly sensitive to ○ Consider the use of humidified epinephrine and other “amine” oxygen anesthetics. ○ Refraining from fully reclining the patient Diabetes mellitus ○ Avoidance of anticholinergic drugs ○ is a disease characterized by a ○ Avoidance of appointments in hot sustained high blood glucose level and humid weather resulting from an absolute or a relative lack of insulin. BLOOD DISORDERS Type 1 disease Disorders that involve the cellular elements ○ renders the patient insulin of the body dependent. Leukemia Type 2 disease ○ is an excessive increase in the ○ is controlled with the use of diet and number of white blood cells. oral medications. Hemophilia Treatment-plan modifications ○ is a disease marked by excessive ○ Minimizing stress bleeding, caused by a congenital ○ Schedule appointments for lack of a protein substance midmorning necessary for blood clotting. TOBEY cute so much CCA2-DMD3 BEHAVIORAL AND PSYCHIATRIC DISORDERS 2. What possible benign or malignant can be a Anxiety differential diagnosis in this case? ○ is a feeling of impending disaster. 3. Briefly describe some diagnostic approach in Depression this case. ○ is a condition of general emotional 4. What are the significance of studying rejection and withdrawal. neoplasia for future dentists? Schizophrenia ○ is a disturbance in thinking and Patient history: perception with delusions, Age: 55 hallucinations, and impaired Tobacco user for over 20 years reality testing. Lesion noticed several months ago Treatment-plan modifications No pain or other symptoms reported ○ Addition of a fluoride supplement and salivary substitutes because of Lesion characteristics: xerostomia Location: Lateral border of the tongue ○ Importance of regular hygiene Size: Approximately 1.5 cm in diameter ○ Understanding that gaining Surface: Irregular, firm, nodular informed consent may be difficult Non-tender on palpation THE PHYSICALLY COMPROMISED PATIENT 1. Benign neoplasms: Wheelchair-bound patient Fibroma: ○ Transferring the patient is a ○ A benign tumor of fibrous concern. connective tissue, often related to Vision-impaired patient chronic irritation. ○ This patient relies on his or her Pleomorphic adenoma: sense of touch and oral ○ A benign salivary gland tumor, communication. typically painless and slow-growing. Hearing-impaired patient Lipoma: ○ Face your patient. ○ A benign tumor of adipose tissue, ○ Speak slowly. usually soft and mobile, though less ○ Keep directions simple. common in the oral cavity ○ Give written instructions. 1. Malignant neoplasms (more concerning in OTHER SYSTEMIC LINKS this case): Many systemic diseases and conditions Squamous cell carcinoma (SCC): have oral manifestations – may be the initial ○ The most common malignancy in sign of clinical disease the oral cavity, particularly Pharmaceuticals and other therapies associated with tobacco use and commonly used in treating systemic affecting the lateral tongue. conditions can cause oral complications Verrucous carcinoma: ○ A variant of squamous cell A 55-year-old male patient presents with a painless, carcinoma with a warty slow-growing lesion on the lateral border of the appearance, often linked to tobacco tongue, which he reports having noticed several use, particularly smokeless months ago. Upon examination, the lesion appears to tobacco. be a firm, nodular mass with an irregular surface. The Lymphoma: patient denies any history of trauma to the area but ○ Oral manifestations of systemic has a history of tobacco use, both smoking and lymphomas, though rare, could chewing, for over 20 years. present as a mass. 1. Based on what we learned in Neoplasia, what are the predisposing factors found in SIGNIFICANCE FOR DENTIST this patient can lead to the development of a 1. Early Detection and Diagnosis: neoplasia? 2. Biopsy Skills and Referral: ] 3. Interdisciplinary Collaboration: TOBEY cute so much CCA2-DMD3  4. Patient Education and Prevention: 5. Ongoing Monitoring On the way to the throat and between the ears! Check the teeth and oral tissues!!! THE END!!! GOOD LUCK FUTURE DENTIST