BRITISH DENTAL JOURNALVOLUME 196 NO 6 MARCH 27 2004 - PDF document

PRACTICE BRITISH DENTAL JOURNALVOLUME 196 NO. 6 MARCH 27 2004 P. Sloanand M. N. Pemberton Biopsies are an important diagnostic tool for the diagnosis of lesions ranging from simple periapical lesions to malignancies.Planning prior to performing a biopsy is essential. It will be beneficial to the receiving pathologist in reaching a helpful and avoid them. The authors feel it will be ofvalue to both general dental practitionersand junior hospital staff. Problems relatedto specific areas will be covered includingapical lesions and those associated with thedental hard tissues. Mucosal and soft tissuebiopsies together with general points PRACTICE BRITISH DENTAL JOURNALVOLUME 196 NO. 6 MARCH 27 2004 submitted in 10% neutral buffered formalinlar laboratory, but it should be borne inbiopsy being undertaken in a hospital set-Simple excisional biopsies of polyps orcurative at the same time. Before embark-biopsy is being taken for must be answered(Table 1). The provisional clinical diagno-(Table 2).If the reason for the biopsy was to excludemalignancy in a long-standing ulcer, a that cytokeratins were present in theof metastasis in such patients. However, therelation to oral cancer is low, but this areaBiopsies are commonly taken to confirmcutaneous conditions. To aid in the histo-in the diagnosis. Adjacent normal tissue isfixed one to allow direct immunofluores-the biopsy should be taken from the most Mitchell's trimmer

. For the precancerous lesions of leukoplakiabiopsy. If the lesion is extensive or there areCare should be exercised when handlingwithin the mucosa that is to be removed,and hold the ends of the suture in anbiopsy. A tight knot close to the specimen,however, is to be avoided as it may resultas the tongue. It also helps the pathologisting. The ‘traditional’ technique usingtoothed tissue forceps to grasp the speci-men is acceptable providing care is takenand the area grasped is away from thenative to the traditional incisional biopsy.ly, the specimen can be lifted from thewith a scalpel. Care should be taken if aspi-men being sucked away. The resultant Table 1 Points to consider prior to mucosal biopsy1.Why is biopsy being taken? Eg to confirm a mucosal disease such as lichen planus or to exclude malignancy.2.What information is required from the pathologist? Eg is the lesion 3.Is the biopsy to exclude malignancy? Therefore take the biopsy from the edge 4.Is the biopsy incisional or excisional? Eg For excisional biopsies a margin of5.Will the specimen be required to be orientated? This is important for excisional margin, the surgeon knows where to perform a re-excision if necessary.6.Is a fresh specimen required? For vesiculobullous lesions these are often 06p329-333.qxd 27/02/2004 10:19 Page 330 PRACTICE BRITISH DENTAL JOURNALVOLUME 196 NO. 6 MARCH 27 2004 and can make separation of the specimenshould be 10% n

eutral buffered formalinwhich has a pungent and distinct odour.Occasionally, formalin is further dilutedtion and artefactual change. Formalin fixesprocess does not occur, soon after removalautolysis rendering the tissues progressivelyundecipherable histologically. diagnosis can now be performed on fixed examine surgical margins perioperatively.laboratory. Both the tissue and the formalinavailable from the laboratory or the Postfixative if leakage occurs. Paper towels or sive tape. Specific cardboard boxes withwhich should be labelled ‘PATHOLOGICALSPECIMEN—FRAGILE WITH CARE’ andbiopsy.Occasionally, specimens are required forelectron microscopy, these should ideallybe fixed in glutaraldehyde, but formalin is makes histopathological interpretation(Coe-PakTM, GC America Inc.) can be usedpatient’s name, date of birth, date of biop-same container, they must be clearlymarked, which is most readily done bymitted because when they are fixed thisTable 3. Accompanying information suchAdequate clinical history supplied on theAdditionally, on the request form, it is desir-enable comparison to be made if necessary.biopsy as it is an unusual procedure for Table 3 Information to accompany mucosal biopsies1.Patient demographic data 2.Description of the clinical appearance of the lesion and suspected diagnosis3.The site of the biopsy 4.The relationship of the lesion to restorations, particularly amalgam5.A detailed drug history 6.

Medical history including blood dyscrasias7.Smoking and alcohol consumption 06p329-333.qxd 23/02/2004 10:50 Page 332 PRACTICE BRITISH DENTAL JOURNALVOLUME 196 NO. 6 MARCH 27 2004 swelling and bruising can result from pro-ther gland damage and ‘recurrence’. Kearns reported a recent study into pain psychological morbidity. 1.Diamanti N, Duxbury A J, Ariyaratnam S, Macfarlane T2002; 2.Lavery K, Blomquist J E, Awty M D, Stevens P J.3.Walton R E. Routine histopathologic examination ofOral Surg Oral Med Oral Pathol Oral Radiol4.Baughman R A. To biopsy or not. (Letter). Oral SurgOral Med Oral Pathol Oral Radiol Endod 5.Bànkfalvi A, Piffko J. Prognostic and predictive factorsJ Oral Pathol Med 291-298.6.Kinsukawa J, Suefuji Y, Ryu F, Noguchi R, Iwamoto O,Kameyama T. Dissemination of cancer cells intoJ Oral Pathol Med303-307.7.Speight P M, Morgan P R. The natural history andpathology of oral cancer and precancer. (Suppl 1): 31-41.8.Eisen D. The oral mucosal punch biopsy. Report of 140Arch Dermatol 815-817.9.Lynch D P, Morris L F. The mucosal punch biopsy:121: 10.Moule I, Parsons P A, Irvine G H. Avoiding artefacts inbiopsy. Br J Oral Maxillofac Surg 11.Kerawala C J. Incisional biopsy: reducing artefact. Oral Maxillofac Surg12.Staines K, Felix D H. Surgical emphysema: an unusualcomplication of punch biopsy. Oral Diseases 41-42.13.Golden D P, Hooley J R. Oral mucosal biopsy14.Sciubba J J. Improving detection of precancero

us andthe oral brush biopsy. 15.Orell S R, Sterrett G F, Waters M N, Whitaker D.Manual and Atlas of Fine Needle Aspiration Cytology.16.Southam J C, Bradley P F, Musgrove B T. Fine needleOral Maxillofac Surg1991; 219-222.17.Pearse A G E. The chemistry and practice of fixation. InPearse A G E (Ed) Histochemistry. Theoretical and18.Shi S R, Cote R J, Taylor C R. Antigen retrieval19.Odell E W, Morgan P R. Practitioner biopsy services.2002; 20.Margarone J E, Natiella J R, Vaughan C D. Artefacts inJ Oral Maxillofac Surg 21.Krause L S, Cobb C M, Rapley J W, Kilroy W J, SpencerP. Laser irradiation of bone. I. An in vitroJ Periodontol 22.Medical Devices Agency. Catgut sutures-cessation ofsupply. 2001. http://www.medical-devices.gov.UK/23.Kearns H P O, McCartan B E, Lamey P-J. Patients' pain2001; ONLINE SUBMISSIONto the British Dental Journal www.bdj.co.uk•Authors from anywhere in the world can quickly and easily enter their contact details intoAuthor files will be automatically converted into a PDF (Portable Document Format) file,website —cutting out the time that manuscripts traditionally spend in the postal system.Authors who, for whatever reason, are unable to submit online can also benefit from thetimeliness of electronic peer review. Authors are encouraged to submit their manuscripts onMaking use of online submission and electronic peer review will enable us to speed up the 06p329-333.qxd 27/02/2004 10:20 Page