原文題目(出處)： Oral soft-tissue biopsy: An overview. J Can Dent Assoc 2012;78:c75
原文作者姓名： Sylvie-Louise Avon, Hagen BE Klieb 通訊作者學校： Sunnybrook Health Sciences Centre, Canada 報告者姓名(組別)： Intern G 組 楊理涵
報告日期： 102/3/8
內文：
Abstract
Biopsy is the removal of a tissue sample from a living body with the objective of providing the pathologist with a representative, viable specimen for histopathologic interpretation and diagnosis.
Types of Oral Lesions
stratified squamous epithelium overlying mesenchymal tissues
appropriate depth varies from one lesion to another, depending on the thickness and location of the mass
I Benign/malignant neoplasms => from any of these tissue II White/red => epithelial origin
1 Hyperplasia => accumulation of keratin
2 Atrophy => visualization of underlying vasculature III Ulceration/papillary or verruciform
Preliminary Examination of the Lesion
I Comprehensive dental examination => visual and tactile
II Beginning with eliciting and documenting the pertinent history, including duration,any antecedent event, symptoms and changes in appearance, as well as prior diagnostic and therapeutic measures
III Location, size, colour, and consistency or texture of the lesion should be documented => photography
IV Differential diagnosis => biopsy sample => Referral to clinician with expertise in the diagnosis and management of oral disease
Indications for Biopsy
I Suspicion of malignancy 1 Enlarging mass
2 Chronic ulceration
3 Tissue friability induration on palpation
4 Persistence of mucosal changes despite removal of local irritants
II New or enlarging pigmented lesions => irregular border and nonhomogenous coloration
III Entities that appear to be clinically benign or reactive=>pyogenic granuloma/mucocele
IV widespread mucosal erythema and ulceration 1 Lichen planus
2 Mucous membrane pemphigoid 3 Pemphigus vulgaris
4 Other immune-mediated disorders Contraindications for Biopsy
I Vascular lesion => significant hemorrhage
II Location of the lesion in an esthetic region / floor of mouth III medically compromised patients
1 severe or poorly controlled systemic diseases
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2 significant risk of hemorrhage
3 bisphosphonate therapy or radiotherapy Biopsy Techniques
Scalpel biopsy, for both incisional and excisional procedures, is the most common technique and generally produces the most satisfactory samples.
I
Incisional Biopsy
1 Differential diagnosis includes malignancy 2 Does not allow study of the entire lesion
3 Sample the tissue that has been most severely and significantly affected 4 Multiple biopsy samples => lesion is extensive / variety of clinical
presentations
5 Principle guiding site selection → most representative sample
II
Excisional Biopsy
1 Complete removal of a lesion 2 Lesion certainly benign
3 Size, accessibility and regional anatomy of the lesion must all be considered
III Punch Biopsy
1 Either incisional biopsy or excision of small lesion at accessible site =>
lateral tongue / buccal mucosa
2 Must be feasible for the device to approach the mucosal surface perpendicularly
3 Placed on the lesional tissue, and a downward, twisting motion is applied
4 Not appropriate for vesiculobullous diseases
IV Electrosurgery and Laser Techniques
1 With caution for diagnostic biopsy / information margins is required 2 Lasers may be of great value => wound left by scalpel biopsy in areas
of the mouth => closure is difficult or inappropriate
3 Laser produces a zone of thermal coagulation smaller than that of electrosurgery
V
Adjunctive Techniques
1 Brush biopsy=> screening modality for innocuous lesions not be sampled.
2 Nuclear stains => metachromatic dye (toluidine blue)
3 Autofluorescence => delineate field changes => guide excision Special Considerations and Pitfalls
I Extensive epithelial sloughing can make this type of biopsy extremely challenging.
II Palatal biopsy => take into account the underlying vascular anatomy III Gingival biopsy => recession => esthetic defects and exposure of the root IV Lip biopsy
1 Hemorrhage / mobility of labial tissue
2 Local paresthesia may occur if nerves are severed Biopsy Procedure
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I
Armamentarium
II
Consent
Verbal and written informed consent should be obtained before any biopsy III Anesthesia
1 Lidocaine 2% combined with epinephrine (for local hemostasis), at a ratio of 1:100 000
2 Less than one carpule, or 1.8 mL 3 Infiltrated
IV Handling of the Specimen
1 Crush artifact => inappropriate compression from forceps.
2 Thermal artifact => laser or electrosurgery 3 Freezing
V
Hemostasis
1 Small biopsy wound => single interrupted sutures using resorbable plain gut
2 Gingival and palatal biopsies => absorbable gelatin sponge
3 Small wounds in the floor of the mouth => without primary closure =>
chemical cautery 4 Laser or electrosurgery VI Postoperative Instructions
VII Submission of Biopsy
specimen should always be accompanied by pertinent clinical information
=> patient’s demographic data, clinical appearance, location of the lesion and any relevant medical history
VIII Follow-up and Reporting of Biopsy Result to the Patient
1 Patients should be seen 1 to 2 weeks postoperatively to ensure healing and to discuss the results of the biopsy
2 Explain diagnosis ans further management => clinician Conclusion
I Tissue biopsy is an indispensable tool
II When in doubt => referred to a specialist(oral pathologist or oral surgeon)
題號 題目
1 Which one isn’t indication of biopsy?
(A) Lesion does not respond to routine clinical management (B) Any lesion with malignant characteristics
(C) Lesions persist no longer than 10~14 days
(D) Lesion that is the basis of extreme concern to the patient 答案(C ) 出處：ORAL AND MAXILLOFACIAL SURGERY
CH21 Principle of differential diagnosis and biopsy P.433 BOX21-2 indication for biopsy
題號 題目
2 Which type of biopsy is noninvasive?
(A) Oral cytology-based procedure
(B) Incisional biopsy
(C) Excisional biopsy
(D) Aspiration biopsy
答案( A) 出處：ORAL AND MAXILLOFACIAL SURGERY CH21 Principle of differential diagnosis and biopsy P.433~437
