‫بسم الله الرحمن الرحيم‬

Biopsy
Oral Surgery in Relation to pathology
Firstly , Doctor mention about course syllabus and about time of
exam won’t to be changed.
When you see any lesion you must identify nature of this lesion
and after that you can treat it but, HOW can you identify? BY
BIOPSY.
Biopsy defined as: removal of tissue from living individual for
histopathological examination.
BUT if the tissue is non living it’s called autopsy .
A biopsy specimen should be taken without delay whenever difficult is
experienced in diagnosing the true nature of a lesion and sent to
pathological examination to give you the exact diagnosis.
After that you can start with prognosis and treatment.
‘‫أجل نحن الحجاز ونحن نجد‬
‘‫مجد لنا وهناك مجد‬
ّ ‫هنا‬
‫ونحن جزيرة العرب افتداها‬
‘‫ويفديها غطارفةّ وأسد‬

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ion of Indicat
: biopsy

Some of tumor has good prognosis and other has poor prognosis, so the
manage of treatment will be different as radiotherapy , chemotherapy or
surgery excision .
 Characteristics of Lesions that Raise Suspicion of Malignancy:

 There are some dangerous when you take a biopsy

as :
 Spreading tumor cells(as happened in salivary gland) .

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  Hemorrhage .
 Infection .
 Failure of tissue to heal .

 Types of biopsy :
i. Excisional .
ii. Incisional .
iii. Frozen section .
iv. Fine needle aspiration cytology .
v. Oral cytology .
vi. Punch needle aspiration .
vii. Simple aspiration .

○ Excisional biopsy :
it is removal of entire lesion , but when can we do that ? (indications)
1- small lesion . 2- if the lesion is benign.
So it is contraindicated with malignant lesion.

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○ Advantages:
1- Whole lesion is available for examination .
2- Constitutes definitive treatment .
3- No further operation is required .
The procedure for this technique not removed entire lesion only but
remove also 2 -3 mm of clinical tissue around lesion. (safety zone as
previous figure)

○ Incisional biopsy :
removal of representive sample along with margins of clinically normal
tissue .
sometimes we need remove more than one sample why?
1- We need multiple sample of big sample.
2- Lesion has different characteristics at different location .
3- Suspicion of malignancy .
Before we remove the sample we should select the site of area has
completed changes and avoid the necrotic tissue also we must be taken
adequate amount of tissue for sample and better to take a deep , narrow
biopsy rather than a broad , shallow one because superficial changes
may be quite different from those in deeper tissue and this the main
principles .

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 ○ Frozen-section :
Here the Doctor mention some points about frozen-section not all . as
the sample must be fresh and put stain on it and send to lab to freezing
during 20 min not more .
There are some technique for freezing like liquid nitrogen ,dry ice or
CO2 spray .
○ There are some limitation and contraindication :

1- Poor inadequate sample of the mass .

2- Technical defect .
3- Difficulties of interpretation .

○ Fine needle aspiration cytology :

The sample in this aspiration consist of fluids and cells with it .

sometimes we use local anesthesia when we take sample . this
technique used for :
1- Lumps in the neck .
2- Parotid gland tumors .

The critical step for this technique is to make sure about position of the
needle to avoid alot of misleading happened in this technique .
○ Advantages :

1- Requires no elaborate equipment .

2- Quick
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 3- Almost painless .
4- No significant complication .
NOTE : when introduce needle and see through screen of c.t scan to the
tissue you want to examine, if it away you can redirected but there is one
risk of tumor implantation along the tract of the needle.

✔ Simple aspiration :
Aspiration is the use of needle and syringe to penetrate a lesion for
aspiration of it’s content and that’s depend on patient . ?!!! (that’s what
doctor said)
○ Advantages :

1- Simple .
2- Safe .
3- Can be done at chair-side using a wide-bore hypodermic needle and
syringe .
4- Pain free by local anesthesia .
If you introduce needle in tissue it will give indication if the tissues
filled with air , fluid or solid mass .

✔ Oral cytology :
A- Exfoliative oral cytology :
Examination for tumor cells, which use as a diagnostic procedure for
detection of uterine cervical malignancy. Although application to the oral
cavity has been be used as an adjacent to, not a substitute for incisional
or excisional biopsy.
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 ○ Indication :

1- Ulceration following radiotherapy . if suspicion of reccurance of tumor ,

and only positive finding are informative .
2- Follow up leukoplakia \ erythroplakia .
3- Diagnosis of infection .
○ Disadvantage :

1- False negative over 30% .

2- Oral cavity readily accessible for biopsy .
3- Positive finding need to be confirmed by biopsy .

A-Oral brush cytology :

Use special brush to collect the epithelial cells.
Note: nature of carcinoma in the mouth is non separating
stages not as carcinoma in cervix.

✔ Punch\drill\trucut needle biopsy : (‫)قصة حفر الكوسه‬

This technique used for obtaining samples of deep-seated solid lesion as

intra-osseous lesion .
There are some high risk of seeding of malignant cells along the tract of
instrument .

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 Toluidine blue marking :
It is dye we applied to the area in the mouth suspected of dysplastic or
cancer change in cells activity like DNA replication and cell division
they will be take up toluidine blue will be appear more pigment and
give indication for preferable site for biopsy.

 Helping the pathologist to establish accurate

diagnosis will depend on :
 Obtaining of deep specimen with margins of clinical normal
tissue .
 Specimen should not be crushed , torn or burned .
 Specimen should be fixed in 10% formal saline .
 The margins of specimen should be marked .
 Orientation of the lesion and method which the specimen
was marked should be illustrated on pathology data sheet
by a drawing .
 Patients details relevant and medical history , clinical and
lab findings .

Done by : ‫محمد مخلف الشمري & أحمد عارف‬

‫الجهني‬

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extra information:"thanks hussain al-shaikh"

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 ‫‪:‬الهداءات‬
‫الشريف انور الشمري) حفيد بركات الشريف( ‪ -‬حسين الشيخ‪ -‬نااااصررر العنزي‪ -‬طلل‬
‫الظفيري)الصفيري(‪ -‬عبدال القحطاني)سلم سلم(‪ -‬محمد العنزي‪ -‬محمد شعبان – صالح اليافعي‪-‬‬
‫عبدالرحمن بشناق‪ -‬خالد الحربي‪ -‬محسن المحروقي)الساحر(‪ -‬محمد الجباب‪ -‬ملحم الحمري‪ -‬سلطان‬
‫القحطاني‪ -‬حمود الظفيري‪ -‬عبدال العسيري‪ -‬جاسم الشطي‪ -‬خالد السبيعي‪ -‬زياد الغامدي‪ -‬مضحي‬
‫العنزي‪ -‬فهد الخالدي)عنك(‪ -‬سعيد الثبيتي– محمد الرشيدان – علي الثاني‪ -‬ناصر الشمري)الصليبية(‪-‬‬
‫وجدي ابو صبيح‪ -‬هاشم مهيدات‬
‫ماجد باجنيد ‪ -‬فهد الردعي العتيبي‪ -‬ابراهيم الشمري‪ -‬حسين الهاجري‪ -‬محمد البخيتي‪ -‬محمد الحصين‪-‬‬
‫السيد علوي الجفري‪ -‬حمد بوقريص‪ -‬بدر المطيري‪ -‬فيصل السبيعي‪-‬انس السيد ‪ -‬انس صوالحة – زين‬
‫العابدين)فاست سابقا( – هيثم طه‪ -‬عبدال حلحولي‪ -‬عبدال عوضي‪ -‬نور حليم‪ -‬خالد فيري – معاذ‬
‫ابوهدبة‪ -‬انس ربحي‪ -‬خليل الرهوان)مهند سابقا( ‪ -‬باسل رزق‪ -‬امين مدلج )حاييم كاشييم(‪ -‬ادهم كزلي‪-‬‬
‫اياس‪ -‬خالد القصري – عزام سلمة‪ -‬صالح القاضي‪ -‬منتصرتفاحة‪ -‬فؤاد غانم‬
‫وباقي الدفعة لهم اجمل الهداءات وخصوصا‬
‫‪Group A & D‬‬
‫ا‬

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