a1-Peran Klinisi - Biopsi

8/3/2019 a1-Peran Klinisi - Biopsi

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Klinisi - Biopsy


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DIAGNOSIS


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Praktek TegKesGi

SISTEMIKORAL

Holistic Approach


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Health History

} An accurate health history may disclose predisposingfactors in the disease process or factors that affectthe patients management.

} Up to 90% of systemic diseases can be discoveredthrough history taking.

} Medical conditions that warrant special care include:

Congenital heart defectsCoagulopathiesHypertensionPoorly controlled diabeticsImmunocompromised patients


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History of the Lesion

} Duration of thelesion} Changes in size and rate ofchange} Changes in the character of the

lesion.? Lump to ulcer,etc} Associated systemic

symptoms:? Pain, Swelling, Bleeding, Fever, nausea,anorexia

}Evidence of causative factors

}Previous treatment


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More Questions to Ask

PainAbnormal sensationsAnesthesia

A feeling of swellingBad taste or smellDysphagiaSwelling or tenderness of adjacent lymph

nodes} Character of the pain if present


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Historical Reasons for the Lesions:

}Trauma to the area} Recent toothache} Habits


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Clinical Examination

The clinical examination should alwaysinclude when possible: Inspection

Palpation Percussion Auscultation


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Facts about a lesion

}The anatomic location of the lesion/mass

}The physical character of the lesion/mass

}The size and shape of the lesion/mass

} Single vs. multiple lesions

}The surface of the lesion

}The color of the lesion

}The sharpness of the boundaries of the lesion

}The consistency of the lesion to palpation

} Attachement and degree of mobility

} Presence of pulsation

} Lymph node examination


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Radiographic Examination

}The radiographic appearance may provide cluesthat will help determine the nature of the lesion.

} A radiolucency with sharp borders will often be acyst

} A ragged radiolucency will often be a moreaggressive lesion

} Radiopaque dyes and instruments can helpdifferentiate normal anatomy


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Laboratory Investigation

Oral lesions may be manifestations ofsystemic disease.

If a systemic disease is suspected it

should be pursued.


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Inter-Relationships Between Oral

and Systemic Health and Disease

SISTEMIKORAL

Oral lesions may be manifestations of systemicdisease.

If a systemic disease is suspected it should bepursued.


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These include:

}Tumor of hyperparathyroidism

}Padgets disease

}Multiple myeloma

}Determination of serum calcium,phosphorus,and alkaline phosphatase and protein can bevery useful in excluding certain pathologicalprocesses.


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Indications for Biopsy

} Any lesion that persists for more than 2 weekswith no apparent etiologic basis

} Any inflammatory lesion that does not respondto local treatment after 10 to 14 days.

} Persistent hyperkeratotic changes in surfacetissues.

} Any persistent tumescence, either visible orpalpable beneath relatively normal tissue.

} Bone lesions not specifically identified byclinical and radiographic findings

} Any lesion that has the characteristics ofmalignancy


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Characteristics of lesions that raisethe suspicion of malignancy.} Erythroplasia- lesion is totally red or has a speckled

red appearance.

} Ulceration- lesion is ulcerated or presents as an ulcer.

} Duration- lesion has persisted for more than two

weeks.} Growth rate- lesion exhibits rapid growth

} Bleeding- lesion bleeds on gentle manipulation

} Induration- lesion and surrounding tissue is firm to

the touch} Fixation- lesion feels attached to adjacent structures


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Types of Biopsy

Oral cytology

Aspiration biopsy

Incisional biopsy

Excisional biopsy

Needle biopsy


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Oral Cytology

Developed as a diagnostic screeningprocedure to monitor large tissue areas fordysplastic changes.

} Most frequently used to screen for uterinecervix malignancy

May be helpful with monitoringpostradiation changes, herpes,

pemphigus.


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Aspiration Biopsy

Aspiration biopsy is the use of a needleand syringe to penetrate a lesion foraspiration if its contents.

Indications:To determine the presents of fluid within

a lesionTo a certain the type of fluid within a

lesion When exploration of an intraosseouslesion is indicated


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Aspiration

} An 18 gauge needle on a 5 or 10 ml syringeis inserted into the area under investigationafter anesthesia is obtained.

}The syringe is aspirated and the needleredirected if necessary to find the fluidcavity.


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Incisional Biopsy

An incisional biopsy is a biopsy that samplesonly a particular portion or representativepart of a lesion.

If a lesion is large or has differentcharacteristics in various locations morethan one area may need to be sampled


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Incisional Biopsy

Indications: Size limitations Hazardous location of the lesion Great suspicion of malignancy

Technique: Representative areas are biopsied in a wedge

fashion. Margins should extend into normal tissue on the

deep surface. Necrotic tissue should be avoided. A narrow deep specimen is better than a broad

shallow one.


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Excisional Biopsy

An excisional biposy implies the completeremoval of the lesion.Indications:

Should be employed with small lesions.Less than 1cm

The lesion on clinical exam appearsbenign.

When complete excision with a marginof normal tissue is possible withoutmutilation.


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Excisional Biopsy

Technique: The entire lesion with 2 to 3mm of

normal appearing tissue surrounding

the lesion is excised if benign.


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CLINICAL

PATHOLOGY

ARTIFACT


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Anesthesia

} Block anesthesia is preferred to infiltration} When blocks are not possible distant

infiltration may be used

} Never inject directly into the lesion


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Tissue Stabilization

} Digital stabilization} Specialized retractors/forceps} Retraction sutures

}Towel Clips


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Hemostasis

Suction devices should be avoidedGauze compresses are usually adequate} Gauze wrapped low volume suction may

be used if needed


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Incisions

} Incisions should be made with a scalpel.}They should be converging

} Should extend beyond the suspected depth of thelesion

}They should parallel important structures} Margins should include 2 to 3mm of normal appearing

tissue if the lesion is thought to be benign.

} 5mm or more may be necessary with lesions that

appear malignant, vascular, pigmented, or havediffuse borders.


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Handling of the Tissue Specimen

} Direct handling of the lesion will expose itto crush injury resulting in alteration thecellular architecture.


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Specimen Care

}The specimen should be immediatelyplaced in 10% formalin solution, and becompletely immersed.


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Margins of the Biopsy

} Margins of the tissue should be identifiedto orient the pathologist. A silk suture isoften adequate. Illustrations are also very

helpful and should be included.


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Surgical Closure

} Primary closure of the wound is usuallypossible

} Mucosal undermining may be necessary

} Elliptical incision on the hard palate orattached gingiva may be left to heal bysecondary intention.


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Biopsy Data Sheet

} A biopsy data sheet should be completedand the specimen immediately labeled. Allpertinent history and descriptions of thelesion must be conveyed.


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Intraosseous and Hard TissueBiopsy

} Intraosseous lesions are most often theresult of problems associated with thedentition.


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Indications for IntraosseousBiopsy

} Any intraosseous lesion that fails torespond to routine treatment of thedentition.

} Any intraosseous lesion that appearsunrelated to the dentition.


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Palpation of the area of the lesion with comparisonto the opposite side.

Any radiolucent lesion should have an aspirationbiopsy performed prior to surgical exploration.

Information from the aspiration will providevaluable information about the lesion.

Solid

Fluid Filled

VascularWithout Contents

Clinical Exam


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Principles of Surgery

} Mucperiosteal flaps should be designed to allowadequate access for incisional/excisional biopsy.

} Incisions should be over sound bone

} Cortical perforation must be considered whendesigning flaps

} Flaps should be full thickness

} Major neurovascular structures should be avoided


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Principles of Surgery

} Incisional biopsies only require removal ofa section of tissue

} Soft tissue overlying the lesion should be

reapproximated following thoroughirrigation of the operative site.

}The specimen should be handled aspreviously described


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Biopsy Results: What If ?

They dont corroborate your clinicalimpression Repeat the biopsy!!!

Determine if the tissue was looked atby an Oral Pathologist

The results show malignancy


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