biopsy collection

BAU

1. Definition Biopsy is a surgical procedure to obtain tissue from a living organism for its microscopical examination, usually to perform a diagnosis

2. Indication of Biopsy Inflammatory changes of unknown cause that persist for long periods Lesion that interfere with local function Bone lesions not specifically identified by clinical and radiographic findings Any lesion that has the characteristics of malignancy

3. Contraindication Poor general condition An acute very virulent pyogenic infection of the lesion Blood dyscrasia Vascular origin

4. Why biopsy is required? To confirm a diagnosis made on clinical findings To determine the treatment plan Valuable self teaching diagnostic aid As a medical record

5. When Biopsy Sampling is Recommended When skin lesions are acute and severe When therapy for a skin disorder is associated with significant side effects or may be life-threatening to initiating therapy When a nodular lesion,ulcer,or chronic nonhealing lesion is present that could represent a tumor When skin lesions appear unusual When the lesions are active,and prior to use of therapy that may alter the histologic character of the lesions When lesions develop during the course of and while on therapy drug therapy

6. Instrument required for biopsy Disposable punch biopsy instruments Cytological brush Tongue depressors Iris forceps Materials for hemostasis Scalpel Scissors Syringe and needle Suturing materials

7. Types of Biopsy The major types of biopsy are : Exfoliative Cytology Aspiration biopsy Incisional biopsy Excisional biopsy Electrode surgery biopsy Shave biopsy

8. Exfoliative Cytology It is the microscopic examination of shed cells from the epithelial surface It is rapid, no invasive procedure, which is valuable in screening patients with oral lesions

9. Exfoliative Cytology : Indications Oral premalignant lesions Herpes simplex infection, herpes zoster, pemphigus vulgaris In patient who refuse biopsy

10. Procedures of exfoliative cytology biopsy The lesion is scraped repeatedly and firmly with a moistened tongue depressor or cytology brush. then transferred to and smeared on a glass slide. The slide is immediately immersed in a fixing solution or sprayed with a fixative, such as hairspray. The cells can be stained with any of a myriad of laboratory preparations and examined under the microscope.

11. Exfoliative cytology Advantages may be helpful when large areas of mucosal change are noted Disadvantages Not very reliable with many false positives. Not widely available

12. Fig . Exfoliative Cytology

13. Aspiration Biopsy Aspiration biopsy is the use of a needle and syringe to remove a sample of cells or contents of a lesion. Indication To determine the presents of fluid within a lesion To a certain the type of fluid within a lesion When exploration of an intraosseous lesion is indicated

14. Aspiration biopsy Procedures: An 18-gauge needle is connected to a 5 or 10 ml syringe inserted into the center of the mass via a small hole in the lesion. The tip of the needle may inserted into potential fluid center. Withdrawn of the materials submitted for pathologic examination and/or culture

15. Incisional biopsy Removal of small part of the lesion for histopathological study Indications Lesion larger than 2 cm Lesion in dangerous position

16. Technique of Incisional Biopsy 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 incision is better than a broad shallow one Use of sharp blade but avoid local anaesthesia

17. Incisional Biopsy Advantage: Allows evaluation of lesions where examination of the margin between normal and lesional skin is important, and when a larger sample of tissue is needed. Disadvantage: More time consuming and technically difficult than punch biopsy procedure.

18. Punch biopsy A diagnostic test where a small, tube-shaped piece of skin and some other tissue underneath are removed using a sharp cutting tool. It can be done anywhere on the body. The tissue is then examined under a microscope.

19. Punch biopsy : Indications A punch biopsy is used to diagnose many types of cancer, including: non-melanoma skin cancer and melanoma skin cancer mouth (oral cavity) throat ( oropharyngeal and hypopharyngeal ) inflammatory breast cancer Vaginal and Vulvar cancer

20. Punch biopsy: Procedures The skin is cleaned and a local anesthetic is used The skin is stretched and the punch is placed over the area The punch is pushed down into the skin and twisting the punch until it has cut through all layers of skin. The tissue (called the biopsy sample) is lifted out with a needle and cut from the area with scissors. Wound may be closed with 1 or 2 stitches and bandage is placed over the wound.

21. Punch biopsy Advantage: Quick and relatively atraumatic Disadvantages: difficult to obtain adequate, representative tissue deeper than the superficial lamina propria

22. Excisional biopsy An excision biopsy complies complete removal of the lesion Indications Lesion less than 1 cm Lesion appears benign When the complete excision of normal tissue with a margin of normal tissue is possible without multilesion

23. Excisional biopsy: procedures Infiltration of local anesthetic around the lesion is acceptable if the field is wide enough in relation to the lesion The entire lesion with 2 to 3 mm of normal appearing tissue surrounding the lesion is excised The specimen should be immediately placed in 10% formalin solution, and be completely immersed.

24. Excisional biopsy Advantage: Larger sample size facilitates collecting deeper lesions such as panniculitis, and solitary lesions that may be cured by complete removal. Disadvantage: More time consuming and technically difficult than less invasive procedures. Usually requires general anesthesia.

25. Electrode surgery biopsy Refers to the cutting and coagulation of tissue using very high frequency low voltage electrical currents Technique The lesion is rasped with forceps through the loop electrode. The electrode is activated going under lesion, removing the growth

26. Shave biopsy For superficial papular and pustular lesions of the pinnae • the pinna is folded gently with the lesion on the top of the fold • With a scalpel, a portion of the lesional epidermis and superficial dermis from the top of the fold is sliced/shaved •Hemostasis is accomplished by digital pressure • No suture is required • Place small samples within lens paper,gently fold the lens paper,and place in formalin fixative

27. Shaved biopsy Advantage: Provides a quick method to collect multiple samples of superficial lesions without inducing cosmetic damage to the animal. Disadvantage: Does not allow collection of larger epidermal lesions such as large pustules, or deeper lesions in the dermis, such as vasculitis.

28. Biopsy Data Sheet Patient data History Clinical description Nature of biopsy Radiographs and photographs Description of biopsy specimen Biopsy Reports It includes diagnosis as well as complete microscopic description