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Review Article

Oral biopsy: Oral pathologist’s perspective

ABSTRACT K. L.
Many oral lesions may need to be diagnosed by removing a sample of tissue from the oral cavity. Biopsy is widely used in the medical Kumaraswamy,
field, but the practice is not quite widespread in dental practice. As oral pathologists, we have found many artifacts in the tissue specimen M. Vidhya1,
because of poor biopsy technique or handling, which has led to diagnostic pitfalls and misery to both the patient and the clinician. This Prasanna Kumar
article aims at alerting the clinicians about the clinical faults arising preoperatively, intraoperatively and postoperatively while dealing Rao2,
with oral biopsy that may affect the histological assessment of the tissue and, therefore, the diagnosis. It also reviews the different Archana
techniques, precautions and special considerations necessary for specific lesions. Mukunda

Department of
Oral Pathology
KEY WORDS: Biopsy, oral biopsy, surgical considerations in biopsy and Microbiology,
Farooquia Dental
College, Mysore,
1
Department of Oral
INTRODUCTION CONTRAINDICATIONS
Pathology, AB Shetty
Memorial Institute of
Biopsy, a Greek-derived word (bio-life; opsia-to see) Although absolute contraindications are not Dental Sciences, Nitte
loosely translated as “view of the living,” is defined present, there are some conditions where decision University, Mangalore,
as removal of tissue from the living organisms to proceed with biopsy should be done with
2
Department of
Oral Medicine and
for the purpose of microscopic examination and caution. These are bleeding diathesis secondary to
Radiology, Yenepoya
diagnosis. The term “Biopsy” was introduced anticoagulation, lesion located near vital structures Dental College,
into medical terminology in 1879 by Ernest that could be injured by biopsy and in medical Yenepoya University,
Besnier.[1] One of the earliest diagnostic biopsies conditions that do not allow for the use of local Deralakatte,
was developed by the Arab physician Abulcasim anesthetics. The potential morbidity associated Karnataka, India.
(1103–1107AD). A needle was used to puncture a with a biopsy done in a previously irradiated For correspondence:
goiter and material was characterized.[2] region should be considered in deciding whether Dr. Kumaraswamy
biopsy is advisable.[5] Biopsy is not advised in the KL,
INDICATIONS case of multiple neurofibromas due to the risk of Department of
Oral Pathology
neurosarcomatous transformation, or in tumors and Microbiology,
It is an accepted fact that microscopic analysis of the greater salivary glands. Such biopsies must Farooquia Dental
is the gold standard for the diagnosis of most be performed by specialized surgeons in order to College, Mysore,
lesions. According to the American Academy of avoid damaging the nearby anatomical structures Karnataka, India.
E-mail: kumsdent@
Oral and Maxillofacial Pathology, any abnormal and causing the spread of tumor cells, as this would
yahoo.com
tissue removed from the oral and maxillofacial adversely affect the prognosis.[4]
region should be submitted preferably to an oral
and maxillofacial pathologist. The exceptions are in Special considerations in specific lesions of the oral
cases such as tori, exostosis, carious teeth lacking cavity [Table 1].
attached soft tissue, extirpated dental pulp and
clinically normal tissues.[3] It is important for the PREMALIGNANT LESIONS AND ORAL SQUAMOUS
clinician to decide whether a lesion needs to be CELL CARCINOMA
biopsied or not before treating it. With regard to
oral soft tissues, any lesion in question, if persisting Oral premalignant lesions and early oral cancers
Access this article online
for more than 2 weeks even after the removal are quite varied in appearance. Although clinical Website: www.cancerjournal.net
of the irritating factor (if any), biopsy should be characteristics can raise the suspicion, biopsy of the DOI: 10.4103/0973-1482.98969
performed. Biopsy is also advisable in bony lesions lesion is required to establish a definitive diagnosis. PMID: ***
that cannot be diagnosed radiographically and Accurate diagnosis of malignant lesions depends on Quick Response Code:

which are usually accompanied by pain, sensation
alterations or other symptoms.[4] Any abnormal
tissue removed from the oral cavity should be sent
for histopathological analysis however confident
the clinician may be with the diagnosis.
the quality of biopsy, adequate clinical information
and correct interpretation of the biopsy.[6] Selection
of the area to take a biopsy specimen of large red
and white lesions may pose a problem because
oral cancer originates at any location within the

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Kumaraswamy et al.: Oral biopsy
Table 1: Special considerations for specific clinical lesions
Clinical diagnosis Special considerations
Oral squamous cell Ulcer margin including normal
carcinoma epithelium; 4–5 mm in diameter and
depth (because of hyperkeratosis)
Leukoplakia/erythroplakia Both red and white areas in speckled
lesions; biopsy from most representative
areas
Oral lichen planus Gingiva and erosive areas to be avoided
Vesiculobullous lesions Longer, broader, shallower, perilesional
tissue specimen; additional fresh tissue
specimen for immunofluorescence
Mucocele Excisional biopsy along with feeder
minor salivary glands
Sjogren’s syndrome Labial mucosa of lower lip, size around
neonatal hemochromatosis 1 cm in diameter
Minor salivary gland tumor Deep incisional biopsy that includes the
in palate lesion
Major salivary gland FNAC preferred
tumors
Oral candidiasis Smear from lesional areas; smear from
fitting surface of denture stomatitis
precancerous lesion, and it is often difficult to diagnose early
cancerous transformation clinically. Therefore, multiple areas
must be sampled and include both white and red lesions in
speckled cases. Adjuvant aid such as using toluidine blue or
direct fluorescence visualization can help a clinician highlight
the most severe or significant site for biopsy.[7] Incisional,
excisional or punch biopsy can be done based on the size
of the lesion. Biopsies of the mucosa should be at least 4–5
mm in diameter and also in depth, as these lesions can have
characteristic thickened epithelium with hyperkeratosis.[6] If
the lesion is ulcerated, always including an area of adjacent
intact epithelium is a good practice. For smaller, discrete
lesions, an excisional biopsy may be more ideal.
Oral lichen planus
Diagnosis of oral mucosal lichen planus may be established
clinically. [8] Biopsy of nonerosive lesional tissue offers
definitive diagnosis. Erosive areas of lichen planus should be
avoided as it may show nonspecific inflammatory changes.
The history, typical oral lesions and skin or nail involvement
are usually sufficient to make a clinical diagnosis of oral
lichen planus. But, around 25% of the cases show only oral
findings without skin manifestation.[9] Therefore, biopsy
of lesional tissue offers definitive diagnosis. Also, biopsy
is required to differentiate between oral lichen planus and
other chronic white or ulcerative oral lesions. In case of
gingival erosive lichen planus, direct immunofluorescence
(DIF) is more suitable to differentiate from the other oral
vesiculoulcerative conditions, as biopsy of this area would
just suggest a nonspecific inflammatory process.[8] Adjacent
perilesional tissue can be chosen if DIF is indicated. Positivity
for oral lichen planus is considered when there is IgA, IgG, IgM
or C3 deposition throughout the basement membrane zone
and fibrinogen in the basement membrane in an irregular
pattern.[8] Although adjacent perilesional tissue is indicated
for immunofluorescence studies, Sano et al. in their study
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have proposed that no difference in sensitivity of DIF between
biopsies performed in perilesional tissue (radius up to 1 cm
from lesion) or distant tissue (radius greater than 1 cm) was
seen.[10] Intraoral areas most sensitive to DIF are buccal floor,
upper labial mucosa, hard palate and cheek mucosa.[8] While
standard hematoxylin and eosin processing of tissue sample
may be sufficient to rule out neoplasms, differentiation of
lichen planus from other immunologic conditions such as
benign mucous membrane pemphigoid and pemphigus may
be improved by DIF analysis.
Oral vesiculobullous lesions
Oral mucosa may exhibit vesicles or bullae as a result of a
variety of infections immunologically mediated, drug induced
and hereditary diseases or mechanical injury.[11] In addition,
there are diseases that mimic vesiculobullous diseases, which
need to be critically differentiated.[11] Vesiculobullous lesions
involving the oral cavity are common characteristics of a
wide variety of diseases; the clinician attempting to diagnose
intraoral ulcerative and vesiculobullous diseases is frequently
confronted with several diseases having a similar if not
identical clinical appearance. Histopathological evaluation as
well as immunofluorescence provides critical information to
facilitate a definitive diagnosis.
Biopsy of a fresh intact vesicle or bulla is difficult as it ruptures
rapidly in the oral environment. Therefore, the site of biopsy
for a vesiculobullous disease should be adjacent to bulla
(perilesional) where epithelium is intact.[12,13] Intact epithelium
and connective tissue are critical in evaluating a specimen with
vesiculobullous lesions.[12,13] It is better to provide longer, broader
shallower biopsy specimen than a deeper and narrow specimen
in vesiculobullous lesions as it is a surface phenomenon. Gingival
biopsy should be avoided as chronic inflammation of gingiva
may confuse the histological aspects.[14] In most cases, oral
lesions precede skin manifestations. Thus, earlier detection
helps in controlling the disease at the initial stage. Biopsy
and immunofluorescence are essential for making a diagnosis
[Figure 1]. The histological analysis of the lesions that usually
begin in the oral epithelium is essential as earlier diagnosis
will allow proper treatment, delaying or even preventing the
dissemination of the lesions.[14] It is important to note that if
the patient is on topical steroids, biopsy should be taken only
after discontinuing it for a period of 1 months, else it can alter
the histopathologic and DIF findings.[12,15]
IMMUNOFLUORESCENCE TECHNIQUES AND BIOPSY
When the choice is made to perform a diagnostic biopsy
for any of the bullous diseases, the specimen must contain
epithelium. A sample solely from ulcer or erosion will be of
little diagnostic value. The reason is simple: the target antigens
that will be exposed to immunofluorescence lie intraepithelial,
or around the basement membrane for vesiculobullous lesions.
Without the epithelium, the antigen cannot be identified using
direct immunofluorescent techniques. In obtaining a biopsy
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Kumaraswamy et al.: Oral biopsy
in patients with vesiculobullous lesions, there are several
important factors to be considered for immunofluorescence
techniques [Table 2].
SALIVARY GLAND LESIONS
Salivary gland biopsy is usually performed to diagnose any
autoimmune disorder such as Sjogren’s syndrome or to confirm
any tumor affecting the gland or therapeutic removal in case
of mucocele. In diagnosing Sjogren’s syndrome, labial salivary
gland biopsy (LSG) is usually performed apart from other
parameters as change in the minor salivary glands mirrors
those in the major salivary glands. The LSG is performed on
lower lip following administration of local anesthesia. Usually,
a 1.5–2.0-cm horizontal incision is made on clinically normal
labial mucosa, parallel to the vermillion border and lateral
to the midline. Five or more accessory salivary gland lobules
should be obtained for analysis. Care should be taken not to
damage the muscle layer, arteries or the sensory nerve.[4,13,17]
Shane[18] has described that neonatal hemochromatosis (NH)
can be safely and effectively diagnosed using minor salivary
gland biopsy of the lower lip of neonates. In this study, lower
lip biopsy for minor salivary gland was done similar to that
done for Sjogren’s syndrome, establishing the diagnosis of NH
by demonstrating glandular iron deposition by a special stain,
i.e. Perl’s iron stain.
Other systemic disorders such as sarcoidosis and amyloid
polyneuropathy can also be confirmed with lip biopsy.[19]
Mucoceles arise from blockage and subsequent rupture of
minor salivary gland ducts. Excision of mucoceles must
include few lobules of minor mucous glands that drain into
the mucocele. This minimizes the recurrence potential of
these lesions.[13]
Biopsy of the major salivary gland should be avoided as biopsy
of parotid salivary gland can lead to scarring and increased
vascularity, which makes it difficult to preserve the branches of
facial nerve. Fine needle aspiration biopsy is done if abnormal
lumps are found.[4] The biopsy needle removes a small core
of gland tissue that is sent to the laboratory for analysis. For
palatal swellings that are suspected salivary glands tumors,
Table 2: Points to consider for sending biopsy for
immunofluorescent studies[16]
• To send fresh frozen tissue or submitted in special transport
media (Michel’s medium). Fixation in formalin will destroy antigen
proteins and render DIF examination useless.
• Perilesional tissue is best for DIF testing of bullous diseases
• Sample of patients’ serum is required for indirect
immunofluorescence (IIF)
• Inform the pathologist of the exact site of tissue
• Second additional specimen should be sent for routine histology
• Communicate with the pathologist before biopsying lesions for
immunofluorescence studies.
194
incisional biopsies should be as deep as possible, as the lesion
can be present in considerable depth, beneath the mucosa;
therefore, superficial biopsy may give a false-negative result.[13]
CANDIDAL INFECTIONS
Oral candidiasis is an opportunistic infection of the oral cavity.
Oral candidiasis is caused by an overgrowth or infection of
the oral cavity by a yeast-like fungus, Candida. Oropharyngeal
candidiasis manifests clinically as acute pseudomembranous,
acute atrophic, chronic atrophic, chronic hyperplastic and
angular cheilitis. Smears, swabs and oral rinse samples are
the common specimens for diagnosing candidiasis.
For smear preparation, lesion should be scraped with spatula
or tongue blade and smeared gently on labeled glass slide and
fixed immediately in 95% ethyl alcohol or with spray fixative.
To diagnose Candida, two to three sequentially numbered
glass slides should be made and labeled. Care should be
taken that when they are fixed they do not stick together. In
cases of denture stomatitis, which is a common but usually
undiagnosed condition among the elderly, a smear of the fitting
surface of the denture should be taken.[20]
In cases where culture is indicated, material should be collected
with swabs. Samples are obtained by rubbing a sterile cotton-
tipped swab over the lesional tissues. The swabs should be
transported to the laboratory as quickly as possible to prevent
desiccation. Candida albicans can survive at least 24 h on a
moist swab without loss of viability, but immersion of the
swabs in buffered charcoal (Amies transport medium) may be
done to prevent desiccation or in an enrichment medium to
increase the isolation sensitivity.[21]
In the oral rinse technique, the patient is requested to rinse
the mouth for 1 min with 10 mL of phosphate-buffered saline
supplied in a universal container (denture has to be removed
if the person is a denture wearer) and then expel it back to
the universal container and sent to the laboratory.[21] Oral rinse
method is used for culturing and differentiating oral yeast
carriage and candidal infection.
In cases of chronic hyperplastic candidosis, biopsy specimen
is usually advisable.
TOOTH
If there is a need to study the histopathology of the dental pulp,
once the tooth is removed, the clinician should drill away the
crown or apical third of the root to facilitate the penetration of
the fixative into the pulp chamber. When the tooth specimen
is sent for biopsy, one should inform the tissue of interest.
This is because in case of enamel, the ground sections have
to be prepared whereas for the study of the dental pulp
decalcification sections are required.
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Kumaraswamy et al.: Oral biopsy

SURGICAL CONSIDERATIONS hyperchromatic, making it useless for diagnosis, especially if

the specimen is small. Hence, use of electrosurgery to obtain
Apart from the representative site selection, there are many
issues to be kept in mind while performing biopsy.

Remove sufficient tissue

Generally, the larger the sample, the greater the chance of an
accurate diagnosis. Fixation causes shrinkage, color changes
and firming of the tissue. The greater size of tissue biopsy allows
for that shrinkage and permits the pathologist to better orient
and cut the specimen avoiding tangential sectioning.[7] Tiny
samples may inhibit the histology technician from producing
a quality slide and may also impair the pathologist’s ability
to provide an unequivocal diagnosis.

Avoid the use of solutions that stain the surface

Toluidine blue staining can be used to select the most
representative portion of the precancerous lesion and
malignant oral lesions. But, the preparation of the area of
biopsy with iodine tincture or other colored solutions is not Figure 1: Biopsy and blood for diagnosing vesiculobullous disease
recommended as it can interfere with tissue processing and
staining procedures.[22]

For the surgical procedure of biopsy, local anesthesia should be

given away from the lesion to avoid artifacts in the sample. If
block anesthesia is not possible, infiltration should be given
at least 3–4 mm away from the lesion. Four-point anesthesia
technique [Figure 2] can be used as cardinal reference (top,
bottom, left, right).[4] Intralesional injection of anesthetic
solution produces hemorrhage with extravasation and
separation of connective tissue bands with vacuolization.[4]

Inclusion of undesired material in the sample

Foreign body inclusion into the sample such as the cotton,
glove starch, calculus or restorative material can make the
interpretation of the specimen quite difficult. Cotton in the
section can mimic amyloid-like substance, and presence of
Figure 2: Four-point anesthesia technique
glove starch leads to starch artifacts that can appear as atypical
epithelial cells in histopathological sections.[23,24]

If it is a hard tissue lesion, it is important to take a radiograph

of the specimen so that it might also help in assessing whether
the lesion is been removed to its entirety.

Handling tissues gently

Using sharp instruments is a minimum requirement for better
biopsy technique. Crushing of tissue with tissue forceps
during the procedure or rough handling of tissue can destroy
the histological features, rendering accurate microscopic
assessment difficult. Tissue distortion or artifacts is also caused
when using electrosurgery or laser. Although electrosurgery
or laser has the advantage of producing hemostasis, it
also induces profound artefactual alterations by producing
heat, leading to tissue protein coagulation, resulting in an
amorphous epithelial and connective tissue appearance. In Figure 3: An excisional biopsy specimen showing orientation margins
such situations, epithelial cells appear detached, fusiform and with long- and short-length sutures

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Kumaraswamy et al.: Oral biopsy
routine biopsy specimens should be discouraged. If used, it
should be limited to relatively large specimen, as the artifact
could obscure all details of a smaller specimen.[4,24,25]
DIFFERENT TECHNIQUES TO MINIMIZE THE ARTIFACTS
The specimen obtained with oral biopsy techniques are
typically small, and chance for artifacts is considerable. Most
of the artifacts caused because of improper handling goes
unnoticed clinically but might pose potential diagnostic
problems to the pathologist during histopathological
examination. There are many techniques available to reduce
the artifacts in the specimen.
Traditional method of using the toothed tissue forceps to grasp
the specimen should be avoided. Alternatively, blunt forceps
instead of toothed forceps can be used to grasp the tissue
and to grasp the tissue away from the main site of interest.
Inadvertent use of toothed forceps leads to perforation,
leaving gaps and compression zones around the tissue.[4] A
better option to handle the tissue is to pass the suture and
hold it with the artery forceps, which provides the traction
and controls the specimen, aiding biopsy. The same suture can
also be used to orient the biopsy sample for sectioning. In the
traditional scalpel biopsy, incisions are placed on either side
in the shape of an ellipse that converges in a “V” to join in
deeper sublesional tissue. In this method, the length should
be approximately three-times more than the width.
Alternately, punch biopsy is becoming popular these days to
the traditional scalpel biopsy. The oral mucosal punch is a rapid
and simple tool for obtaining the representative sample. The
instrument consists of a cylindrical cutting blade attached
to a plastic handle. Diameter from 2 to 8 mm with stepwise
increments of 0.25–0.50 mm is available.[4] This removes a
core of tissue (usually around 4 mm), the base of which can
be released using curved scissors or a scalpel. Previous studies
have indicated that oral mucosal punch induces fewer artifacts
compared with the conventional incisional scalpel biopsy.
But, this oral mucosal punch may be difficult to biopsy freely
movable tissues (e.g., soft palate, floor of mouth)
Other instruments such as B forceps (B standing for biopsy)
can also be used to obtain a biopsy. This forceps is based on
the chalazion forceps, which consists of autopressure forceps
with two elongated rectangular plates at the operator ends.
These forceps are placed and the handle is released, which
exerts spontaneous pressure on the tissue. The compressive
effect makes the tissue to be raised within the window and
the pressure induces ischemia in the work zone. Biopsy with
a scalpel or punch is then carried out. The so-called B forceps
designers propose several advantages, including speed,
because the ischemia produced by the clamp stabilizes the
tissue and increases visibility, facilitating dissection and also
reducing artifacts.[26,27]
196
Lasers and electrosurgical knives are also often used to
perform oral biopsies. These techniques have the advantage
of producing a completely bloodless surgical area, but it can
induce thermal artifacts. Hence, it is best to excise with a
scalpel and use electrosurgery to control hemorrhage at the
biopsy site.
ORIENTATION
Orientation is important for all surgical specimens submitted
for microscopic examinations. Orientation of mucosal biopsies
(particularly superficial lesion) is important, especially because
they are small and have limited morphologic characteristics
after being immersed in formalin. Proper orientation of
the surface lesion specimen assists the oral pathologist in
sectioning the specimen to avoid tangential cuts. Improper
orientation will lead to the sectioning of either epithelium or
the connective tissue alone, but not both. Surgeons can place
sutures in the specimen to assist in orientation and provide
a written description of the specimen in relation to suture.
At least two adjoining margins must be clearly identified to
ensure correct orientation, with the help of short suture and
a long suture[12] [Figure 3]. Illustrations are also very helpful
and should be included. By providing this information to the
pathologist, it is possible to assess anterior, posterior, superior
and inferior margins, allowing for the identification of areas
that might require further excision.
SPECIMEN PREPARATION AND FIXATION
The specimen obtained with oral biopsy procedures are
typically small and mucosal biopsies, which do not include
underlying muscle tissue, tend to curl and distort. This creates
difficulty in orientation of the specimen for tissue processing.
This problem can be overcome by placing it with the mucosal
surface up on a piece of stiff sterile paper immediately after
biopsy and then dropping into the formalin fixative slowly.[12,24]
Also, this curling artifact can be avoided if sufficient depth of
the specimen is included.
When more than one specimen is removed from a patient,
each specimen should be placed in separate containers with
appropriate descriptions for each labeled container. Once
the specimen is placed in the container, it should be labeled
with patient name, date of biopsy, site of biopsy and hospital
number.
The clinician should make sure that the specimen is placed in a
wide mouth container. If a narrow-mouthed container is used,
the specimen may have to be handled roughly or the container
needs to be broken to get the fixed specimen out. Therefore,
a suitable wide-mouthed inert, clean and clear (not brown)
container must always be used. The dark-colored bottles
should be avoided as we cannot see whether the tissue is into
the fixative or it is adhering to the wall of the bottle. Most
histopathology laboratories will supply suitable containers
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Table 3: Indications for fresh tissue
Fresh tissue specimen indications
• Immunofluorescence/immunostaining studies
• Genetic testing
• Flow cytometry
• Culture studies (suspected microbiological infected cases)
• Frozen sections
containing appropriate volume of 10% neutral buffered
formalin for fixation. Fixation is mandatory to inhibit autolysis
of tissue once they are removed from the patient. Sometimes,
formalin is further diluted with water by ancillary staff or
specimens are placed in alternative solutions such as saline
or tap water, which results in poor fixation and artefactual
changes.[13] The volume of fixative should exceed 10–15-times
the volume of the specimen for proper fixation. Formalin fixes
specimens by forming intermolecular bridges between proteins
and cross-links between protein end groups. Disadvantage of
this protein cross-linking produced by formalin is that it makes
unsuitable for immunofluorescent techniques.[13] Specimens
to be submitted for immunofluorescence testing (in cases of
autoimmune or vesiculobullous disorders) need some special
consideration. Perilesional skin is used for immunofluorescence
for DIF patients. Monkey or guinea pig esophagus rat bladder
epithelium for paraneoplastic pemphigus or blister fluid can
be used for DIF. Quick freezing is the most widely used method
for handling biopsy specimens for immunofluorescent studies.
This can be performed by immersing the biopsy specimen
immediately after biopsy either in liquid nitrogen or cold solid
carbon dioxide or in a hexane bath. The quick frozen biopsy is
then mounted in tissue embedding compound and sectioned in
a cryostat. Tissue substrates for DIF techniques are processed
similarly. Because rapid freezing of specimens require special
supplies and keeping them frozen during transportation is a
packaging challenge, an excellent alternative is to place the
specimen in a room temperature transportation medium that
permits convenient transport to the laboratory for processing.
At present, immunofluorescence can be performed with biopsy
specimens handled for several days at ambient temperature
in a preservative liquid medium, as described by Michel et al.
Michel’s medium is now commercially available.[28]
Fresh frozen tissue [Table 3] is also required where cases
are intended for genetic testing and flow cytometry[5] (e.g.,
in cases of lymphoma). Also, in suspected cases of fungal,
mycobacterial, bacterial or viral infections, a small portion
of fresh specimen should be sent separately without fixation
for culture.[5] The other main situation where fresh tissue is
processed is when frozen sections are used to examine surgical
margins perioperatively. In cases of electron microscopic
studies, specimens should be fixed in gluteraldehyde.[13]
INFORMATION TO PATHOLOGIST
To diagnose a specimen properly, the oral pathologist may
need to review the clinical history and the setting in which
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Table 4: Details required in pathology form
• Patient data
• Clinical details of lesion
• Any medical history with details of medication
• Oral habits - all forms of tobacco and alcohol consumption
• Investigations done, if any
• Site and biopsy type
• Clinical diagnosis with differential diagnosis
• Previous biopsy done, if any, with details.
the patient’s condition manifested. Therefore, the clinician
should submit a biopsy data sheet with pertinent thorough
history and radiograph as appropriate. Adequate clinical
history and description should be provided so that it enables
the pathologist to provide a useful and meaningful diagnosis.
A labeled diagram on the pathology form may be very useful,
showing the area biopsied and size of the lesion indicating
where the specimen was taken from. Most of the labs have
their own prescribed requisition form that can be collected
from the laboratory [Table 4].
CONCLUSION
For entities of uncertain significance or etiology, a biopsy
provides the simplest and most speedy means of obtaining
the perfect diagnosis. In the concern of patient’s welfare,
correct diagnosis is of extreme importance. A carefully selected,
performed and interpreted biopsy is critical in rendering an
accurate diagnosis. When considering biopsy, a little forward
planning and thought can greatly improve the diagnostic
value obtained. Careful handling of the tissue and prompt
appropriate fixation will enable a confident histological
diagnosis to be reached. Inadequate care at any stage could
result in a nondiagnostic biopsy and may necessitate the
patient having a repeat procedure with its ensuing physical
and psychological morbidity.
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Cite this article as: Kumaraswamy KL, Vidhya M, Rao PK, Mukunda A.
Oral biopsy: Oral pathologist's perspective. J Can Res Ther 2012;8:192-8.
Source of Support: Nil, Conflict of Interest: None declared.

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198 Journal of Cancer Research and Therapeutics - April-June 2012 - Volume 8 - Issue 2