Protocols for Oral Biopsy Specimen Collection, Transportation and Analysis

What Makes a Biopsy Specimen Fit for Oral Pathology Examination?

We know that biopsy is one of the standard procedures that dentists and maxillofacial surgeons indicate to determine the type of specific oral disease or even cancer commonly, whether the benign or malignant tumors or the bacterial, viral, and fungal infections of the oral cavity. Several protocols need to be followed by your oral pathologist in performing and transporting the biopsy specimen and in studying the sample in the laboratory. Unless these protocols are strictly adhered to in the standard format, then the gold standard for diagnostic oral procedures cannot be met by conventional biopsy methods.

When a patient with a particular local oral lesion is seen, a list of differential diagnoses will be formulated. Hence, in clinically identifying what disease the patient is suffering from, a biopsy is useful in arriving at a confirmative diagnosis. Oral biopsy, hence, has always been the gold standard procedure for all oral diagnostic procedures or methods, though the drawback is that it can be an invasive procedure with some procedural drawbacks or limitations, having a psychological effect on the affected patients. However, according to maxillofacial surgery research, it is indeed true to note that the biopsy specimen obtained by the dentist and maxillofacial surgeon is a true representation of the entire lesion that is manifested in the oral cavity or the particular oral or head and neck region. A small tissue or sample biopsy specimen that is carefully selected from the local area tends to involve both the normal and the pathologic areas, which can make for a good diagnostic specimen and give a clear representation of the whole lesion.

What Are the Measures to be Taken in Oral Biopsy Collection and Specimen Analysis?

Let us now explore the dos and don'ts of biopsy collection orally and what protocols are to be followed by the examining oral pathologist:

1. Once the tissue specimen is obtained, you need to isolate the obtained specimen into a wide-mouth container ideally filled with 10 percent formalin, which should be at least nearly 20 times the volume of the surgical specimen.
2. Extreme care should be taken to ensure that the tissue is well preserved and does not get lodged on the container wall you have placed it in, above the formalin level, lest it get contaminated.
3. When performing an incisional biopsy specimen, the surgeon should ensure that the specimen area is taken from each area of the lesion to show different characteristics. This ensures that even if the lesion clinically may not be uniform, it gives detailed insight to the dentist or the maxillofacial surgeon. Trying cell types or disease patterns are scattered throughout the nonuniform surface of the lesions collected.
4. Multiple samples obtained for biopsy must always be adequately labeled and preserved. The tissue is never adapted into gauze, cotton, or paper, lest it lead to complete dehydration of the specimen.
5. If a blood culture is desired, then the biopsy material can be obtained for a bacteriologic study before the specimen is fixed. While the minimum size of the biopsy lesion should not be less than 5 mm in diameter, this rule is followed by all oral pathologists to ensure the slides are well-prepared for examination.
6. If the biopsy specimen is collected from a necrotic part or center of the tumor, the diagnosis that would be established by the oral pathologist can be only the "necrotic debris or tissue" that has no base to its true nature. Therefore, as a general rule, it is unwise to collect the biopsy specimen from the center of a lesion, which would probably be the lesser cellularly active parts. Instead, the lesion specimen should be collected from the periphery or through the nonuniform areas spread out - to study or analyze the nature of the lesion.
7. The cover of the test tube, once the sample is collected, should always be screwed on tightly, with the tube titled, to saturate the swab alongside the transport media for the specimen.
8. The fixative in the biopsy mailing container should never evaporate before the specimen examination. Usually, if this happens, it leaves behind a characteristic white powder residue, which cannot again be reconstituted with the addition of even water.
9. The oral pathologists should arrange all the necessary fixatives for the biopsy specimen well in advance so that a proper diagnosis can be established. The collecting surgeon should also never send an improper biopsy sample to establish a diagnosis. One of the common surgical errors during a biopsy is when the operating dentist or surgeon submits the biopsy sample or specimen in water or saline. This is a major error because this results in autolysis of the tissue cells.
10. In case of a quick sample collection, such as in an emergency, when 10 percent formalin cannot be obtained for the specimen, 70 percent alcohol may be used as a potent alternative. The histologist or the oral pathologists or technicians should then transfer the specimen to 10 percent formalin subsequently within 48 hours to prevent sample hardening because of the 70 percent alcohol used.

The most common fixing solutions are 10 percent formalin, Zenker's solution, and Carnoy's solution. Most oral pathologists prefer the 10 percent formalin solution for its ideal fixative properties.

Conclusion:

Only when all these protocols are followed strictly by the biopsy-operating dental or maxillofacial surgeon, along with the technician or the examining oral pathologists, a clear and accurate diagnosis be established as to the true nature of the lesions in affected patients. This comprehensive approach ensures that all aspects of the lesion are thoroughly evaluated, minimizing the risk of misdiagnosis. Dentists and maxillofacial surgeons can gain invaluable insight from the oral pathology reports, which should be cross-checked with the X-ray and clinical findings, providing a holistic view to arrive at a confirmed diagnosis regarding oral lesions. This is the reason why biopsy protocols hold utmost significance and cannot be overlooked, as even minor deviations or neglect in following these procedures can lead to diagnostic errors.