Biopsy refers to removal of living tissues from the site of lesion for the purpose of microscopic examination of that part and to reach a confirm diagnosis. It not only helps in diagnosis but also serves as a treatment option for smaller lesions in oral cavity by excising. Various types of biopsy are: Incisional biopsy, Excisional biopsy, Frozen section biopsy, punch biopsy and brush biopsy. Incisional biopsy of oral lesions is also called as diagnostic biopsy and is done in case of large oral lesions. Excisional biopsy for oral lesion is done when the lesion is small and is less than 1centimeter and is removed completely for purpose of microscopic examination.
How is the Oral Biopsy procedure done?
After proper cleaning of the site, the lesion is anesthetized with local anesthesia which will make the area numb. It will take a couple of minutes to work. The procedure is painless. A section of tissue is taken from the most representative area of the lesion with sharp scalpel and should be fixed in 10% formalin solution. A small hole is left after the biopsy which requires stitching. The whole process will take less than 30mins. The stitches will usually dissolve in 10-14days.
Sutures after excision biopsy of lesion present on the dorsum of tongue
The section is labeled and is sent for the microscopic examination.
To get immediate histological diagnostic report of oral lesion, frozen section biopsy of oral lesion can be done in which a portion of lesion is removed from the site and is kept frozen and is then sectioned, stained and examined.
Punch is used to remove piece of tissue to be examined in case of punch biopsy. It is particularly used for back oropharyngial region.
For brush biopsy, no anesthesia is required and with a soft nylon brush, transepithelial specimen is obtained and it is then analyzed by computer. Results are accurate with brush biopsy. Brush biopsy is mainly used to detect oral cancer.
No special precaution is taken before the biopsy procedure. .Patient can take medicaments and eat and drink as normal before the appointment. The meals should not be missed before the appointment.
The area which is biopsied might be sore and may cause discomfort for which pain meds such as ibuprofen and paracetamol can be taken. A person can eat and drink normally after the biopsy procedure but it is advised not to take too hot food stuffs. Patient is advised to avoid spitting and rinsing too much and to avoid physical exertion for the next 24hours as this can increase the swelling or can also dislodge the clot at the site of operation which can further lead to more of bleeding.
Patient is advised to do warm saline rinses or use a mild antiseptic mouth wash to facilitate the healing and to avoid infection at the biopsy site.
There may be pain, swelling, limited mouth opening, scarring, tenderness, numbness at the biopsy site. For the pain, pain meds can be taken. For the swelling, ice pack against cheek adjacent to the biopsy site will reduce the swelling. The swelling will regress on its own in some time. The tenderness and the scarring after the biopsy procedure will usually disappear with time.
While doing the biopsy, if the nerves get damaged, then the numbness might be there for quite a long. It takes months for numbness to go.
Healing of the Biopsy Wound of oral cavity:
The healing of the Biopsy wound of the oral cavity is identical with the healing of a similar wound in any other part of the body and thus may be classified as either primary healing or secondary healing. The nature of healing process depends upon whether the edges of the wound can be brought into apposition, often by suturing or whether the lesion must fill in gradually with the granulation tissue.
The excisional Biopsy of oral soft tissues performed by a scalpel or laser with an associated patient cost for the procedure is in the range of $225-$400. There is an additional pathology cost which is covered by patient’s medical insurance. The incisional biopsy may even cost more than the excision biopsy. The biopsy cost may or may not be covered by the insurance companies.
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