The Efficacy of Punch Biopsies in Diagnosing Intra-Oral Lesions in OMFS

Research Article

J Dent & Oral Disord. 2023; 9(2): 1181.

The Efficacy of Punch Biopsies in Diagnosing Intra-Oral Lesions in OMFS

Joanne Rowe, Ravi Rathod*; Saffa Dean; N Nasser

Department of Oral & Maxillofacial Surgery, Barts Health Trust, United Kingdom

*Corresponding author: Ravi Rathod Department of Oral & Maxillofacial Surgery, Barts Health Trust, United Kingdom. Email: ravi.rathod@nhs.net

Received: November 17, 2023 Accepted: December 19, 2023 Published: December 26, 2023

Abstract

Intraoral biopsies are used, as an adjunct to clinical examination, to confirm the diagnosis of unknown pathology. Traditional biopsy techniques involved the sole use of a scalpel to obtain samples to determine histopathological diagnoses. This paper explores the efficacy of punch biopsies when sampling soft tissue pathologies.

A punch biopsy is a tool that is available in varying sizes that allows us to take accurate samples of intra-oral lesions to obtain histopathological diagnoses. Punch biopsies have an array of benefits; smaller sample sizes required, simple and quick procedures and leser operators sensitive.

66 punch biopsies of varying sizes and intra-oral sites were reviewed to assess their diagnostic quality. We reviewed the histopathology reports, noting any evidence of artifact as well as samples that were not diagnostically acceptable thus requiring a second biopsy.

Our findings showed that 98.5% of the punch biopsies taken were diagnostic, with only 1 out of the 66 samples reviewed requiring re-biopsy. We noted this was a 2mm biopsy, the smallest punch used in our sample size. This audit shows the benefit of appropriately sized punch biopsies when sampling intraoral lesions.

Clinicians are encouraged to use punch biopsies more often when sampling intraoral soft tissue lesions. Limitations of the initial cycle of this audit include the modest sample size. Successive cycles will look at more extensive data sets as well as compare traditional elliptical biopsies to punch biopsy techniques. This second cycle will allow us to discern the efficacy of modern punch biopsy techniques over traditional methods for sampling intraoral soft tissue lesions.

Introduction

The Oral & Maxillofacial outpatients department receives many patient referrals requiring management of intraoral soft tissue lesions. Many such lesions have clinically similar characteristics and therefore a diagnostic plan involves effective confirmation by histological diagnosis. The gold standard of reaching a diagnosis is by histological confirmation of the lesion [1]. This is in most cases carried out either excisional or as an incisional biopsy within the area of field change.

A biopsy is the removal of a small sample of tissue, which is then examined under a microscope, where cellular changes are noted, and a diagnosis is reached. Improper biopsy technique or inadequate tissue being provided can lead to an inconclusive result, requiring further biopsy. This not only delays the diagnosis and commencement of treatment but also results in increased anxiety for the patient and may also worsen the prognosis of neoplastic lesions, where a timely diagnosis is paramount.

Historically, an elliptical incisional biopsy has been advocated for most intraoral soft tissues lesions. Such biopsies are usually carried out by junior members of the team, who may not be entirely confident in their surgical skills. In the more recent years, punch biopsies have become a more popular choice amongst dermatologists. This technique can equally be applied when carrying out an intra-oral biopsy. There is a reduction of operative time, however some clinicians fear the sample is inadequate for diagnosis and representative samples may not be within the field of the lesion.

The purpose of this paper is to discuss the effectiveness of punch biopsies in diagnosis of lesions in the oral cavity.

Method & Results

A single cycle audit was completed collecting punch biopsy data for 58 patients with intra oral soft-tissue lesions. Data was collected from the electronic patient record system at Whipps Cross University Hospital between the dates of 01/09/2020 – 31/09/2021. We felt that the gold standard would be that 100% of cases should contain enough levels of tissue to provide histological diagnosis [1].

The electronic operation note & histopathology report were then studied to check the biopsy punch size, location of biopsy, and the resultant histological diagnosis. A note of any artefacts commented on the histopathology report on the sample was also made.

A total of 66 biopsies were collected from 58 patients. All biopsies were carried out by a dental core trainee, either unsupervised or with limited supervision in the outpatient setting under local anaesthetic.

A summary of the site of each intra oral biopsy is shown in the table below (Figure 1 & 2). The most common site was the tongue with 37.9% of all biopsies in this area. Over half (54.5%) of all tongue biopsies were taken from the lateral border (20.7%).