Excisional And Incisional Biopsy

Incisional Biopsy

This is the excision of a portion of lesion for microscopic examination.
This method is employed on large, diffse lesions which has the size of 2 cm in its greatest dimension.
This method can also be dome on lesions suspected for malignancy.
Aim of this method is to remove a portion of lesional tissue in question along with the sample of normal adjacent tissue for comparison.

“Difference Between Excisional And Incisional Biopsy”

Incisional Biopsy Types

Punch biopsy: This is done by using a surgical punch of diameter 4, 8 or 10 mm. This incisional biopsy is done in mass screening programmes.
Wedge biopsy: It is done by making the wedge-shaped incision which begins 2 to 3 mm from normal tissue and penetrates in the region surrounding abnormal tissue. Tissue should always be incised narrow and deep.

Exisional Biopsy

This procedure should be done for the small lesions which are clinically benign.
In this complete lesion should be removed for examination and diagnosis. So it is both diagnostic and curative.

“Recovery After Excisional Biopsy”

Exisional Biopsy Application

This procedure is performed on the lesions which need complete removal for diagnostic and therapeutic purposes.
It is indicated in lesions which are diagnosed as benign and need complete removal

“When Is An Excisional Biopsy Performed”

Advantages

It allows histopathological examination of an entire lesion.
Amount of tissue which is removed from one biopsy site,ensure adequate sample for various studies such as culture, histopathology, immunoflorescence and electron microscopy.

Disadvantages

If the tumor is highly infiltrative margin of excision cannot be exactly elecited, further surgery should be needed.
Cancerous cells actively multiply attumor margins, debulking of the mass results in residual cancer cells left behind.
Excision needs greater precision and skill of surgeon.

“Risks Of Excisional And Incisional Biopsy”

Procedure of incisional or excisional biopsy

Anesthesia: Give a block to anesthetize the region where specimen is to be obtained. Local infitration and injections
into the tissue which should be biopsied is avoided as it leads to the artifacts in the specimen. If a block is not
effctive give local infitration atleast l cm away from the lesion.
Stabilization of tissue: Soft tissue biopsies are done over the movable tissues of oral cavity i.e. tongue, lips etc. Dental assistant stabilizes the tissue by stretching it.
Hemostasis: Gauze pieces are the best means for compressing the tissue and achieving hemostasis. Gauze piece can also be placed to cover the mouth of the suction tip and is used to prevent the specimen from being sucked inside.

“When Is An Incisional Biopsy Recommended”

Incisions: Use a sharp scalpel. Provide two incisions which form an elliptical incision and converge to form a V at the base, this provides a good specimen and a wound which is easy to close.
Alternatively, a triangular-shaped incision can be made which converges in the form of a tip of a pyramid at the base.
Incisions should be given parallel to the nerves and vessels in that region to avoid damage.
Handling of tissues: Tissue which has to be removed should be handled carefully so that histopathological examination can be performed.
A non-toothed tissue-holding forceps is used and care is taken not to crush the tissues.
Care of specimen: After removal of the tissues, the specimen is transferred to a botte containing 10% formalin which should be at least 20 times the volume of the specimen obtained.
Surgical closure of wound: Primary closure is possible in most cases. Where it is not possible, the tissues are under-
mined to facilitate closure.

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