BIOPSY

[drmithila]

 The word biopsy originates from the Greek terms bios
(life) and opsis (vision): vision of life. A biopsy consists of
the obtainment of tissue from a living organism with the
purpose of examining it under the microscope in order to
establish a diagnosis based on the sample (1).
The technique allows us to establish the histological characteristics of suspect lesions, their differentiation, extent
or spread, and to adopt an adequate treatment strategy.
Biopsies establish evolutive control of disease processes, and
are able to document healing or relapse. In turn, the biopsy
findings are of irrefutable legal medical value (2,3).
A biopsy is indicated in application to any lip or oral
mucosal lesions following the exclusion of local irritants
(of traumatic or inflammatory origin), when the lesions in
question are seen to persist for more than two weeks, and
may be suggestive of malignancy (1,4). In general, lesions
appearing in the oral mucosa should be explored and evaluated for the possible presence of local irritative factors. If
such factors are identified, they must be eliminated, after
which an observation period of approximately 15-20 days is
indicated. After this period of time, and if the lesions persist, histopathological study is required to discard possible
malignancy (3). Such a study is also indicated in the case
of radiotransparent bone lesions presenting radiological
features suggestive of malignancy – even when such features constitute casual findings in the course of a routine
radiological study.
All maxillary cysts, and particularly keratocysts, must also
be processed for histological studyA biopsy is also indicated in the case of bone lesions accompanied by pain, sensitivity alterations or other symptoms, and in application to bone lesions showing important
changes or rapid expansion as evidenced by successive
radiological evaluations.
A biopsy is also required of those oral mucosal surfaces
that show important and persistent color changes (becoming very white, red or pigmented) or changes in appearance
(cracking, proliferation or ulceration), with deep-lying hard
masses detected upon palpation.
Likewise, evaluation is required of premalignant mucosal
lesions or states such as lichen planus or leukoplakia, in
persistent atrophic-erosive areas (4).
A biopsy is also very useful for the detection of certain systemic illnesses requiring histological confirmation in order
to establish the definitive diagnosis, e.g., lupus, amyloidosis,
scleroderma, or Sjögren’s syndrome – which can be confirmed by an oral tissue biopsy. As an example, confirmation
of Sjögren’s syndrome requires the obtainment of a sample
of the lesser salivary glands of the lips (1,3,4).
A biopsy is also used as complement in the diagnosis of
certain disorders of infectious origin, such as lesions suggestive of syphilis or tuberculosis, based on an oral sample
– though prior confirmation of the positivity of tests specific
of such disease processes is required.
Another indication for biopsy is confirmation of the diagnosis of blister lesions, in mucocutaneous diseases affecting
the oral mucosa, such as vulgar pemphigus or cicatricial
pemphigoid.
Benign tumors, with the exception of those of a vascular
nature, are to be removed, sending the entire sample for
histopathological study to determine the histological origin
of the lesion, after establishing a tentative diagnosis (4).
On the other hand, a biopsy is contraindicated in veryseriously ill patients, in those subjects with some systemic
disorder that may worsen, or where secondary complications
may develop (4).
Likewise, a biopsy should be avoided in the case of lesions
located in very deep regions or in areas of difficult access
where the surgical technique proves complicated or hazardous, with the risk of damage to neighboring structures. In
such cases the patient should be referred to a specialist. The
same considerations apply in the case of suspected vascular
lesions such as hemangiomas, due to the risk of massive and
persistent bleeding (1,5).
Biopsy is not advised in the case of multiple neurofibromas,
due to the risk of neurosarcomatous transformation, or in
tumors of the greater salivary glands. Such biopsies must
be performed by specialized surgeons, in order to avoid
damaging nearby anatomical structures and causing the
spread of tumor cells, as this would adversely affect the
prognosis (1).
In turn, a biopsy would be needless in application to banal
irritative lesions or normal anatomical variants such as
physiological gingival pigmentation, geographic tongue,
linea alba, lingual indentations, protuberances, exostosis,
etc