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Biopsy And brush cytology of oral Lesions

Removal of  tissue from living beings for macroscopic examination ,microscopic analysis, bacterial analysis  & combination of above is called  “BIOPSY”.

Indications for Biopsy

1. Any lesion that persists for more than 2 weeks with no apparent cause

2. Any inflammatory lesion that does not respond to local treatment after 10-14 days (after removing local irritant)

3. Persistent hyperkeratotic changes in surface tissues

4. Any persistent tumescence, either visible or palpable beneath relatively normal tissue


5.  Inflammatory changes of unknown cause that persist for long periods

6. Lesions that interfere with local function (e.g. fibroma)

7. Bone lesions not specifically identified by clinical and radiographic findings

8. Any lesion that has the characteristics of malignancy.

9. Any tissue expelled from the body orifice

10. Research purpose and to know the progress of lesions.

Characteristics of Lesions that Raise Suspicion of Malignancy

1. Erythroplasia

2. Ulceration

3. Duration more than 2 weeks

4. Rapid growth rate

5. Bleeding lesion on manipulation

6. Induration

7. Fixation

Oral Brush Cytology

1. Sensitivity > 96%”

2. Uses a special brush to collect epithelial cells

3. Brush is placed in contact with oral epithelium and rotated with firm pressure 5-10 times

4. Brush collects cells from all 3 layers of the epithelium: (1) the basal, (2) intermediate, and (3) superficial layers

5. Cellular material on brush is transferred to a glass slide and flooded with fixative


6. Dry slide sent to pathologist to view with computer assisted analysis

7. Results: negative, positive, atypical

8. “Positive” and “atypical” results require scalpel biopsy to characterize the lesion completely

9. May be a good tool for “monitoring” patients with chronic mucosal changes, such as leukoplakia, lichen planus, post-irradiation, and patients with a history of oral cancer who require long-term surveillance of their ongoing mucosal changes

10. Serves as a trigger for, and not a substitute for traditional scalpel biopsy and histology. This is because brush cytology specimens are disaggregated and architectural information to stage and grade the lesion is absent