Tongue biopsy - Small <1cm

Biopsy

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No Fasting Required

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Histology of tongue lesion.

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Tongue Biopsy - Small (<1cm)

Why is it done?
- Diagnose oral malignancies including squamous cell carcinoma and other cancerous lesions of the tongue
- Evaluate suspicious lesions, ulcers, or abnormal tissue growths on the tongue that do not heal within 2-3 weeks
- Determine if benign conditions such as oral lichen planus, geographic tongue, or aphthous ulcers are present
- Assess for infectious processes including fungal infections (oral candidiasis) or viral lesions
- Evaluate lesions with unclear etiology or those requiring histopathological confirmation
- Perform punch or excisional biopsy typically during outpatient visits or clinical appointments when lesions are less than 1 cm in diameter
Normal Range
- Normal Result (Negative): Benign tissue with no malignant cells; normal stratified squamous epithelium with preserved architecture; absence of dysplasia, carcinoma, or significant inflammation
- Benign Findings: May show chronic inflammation, ulceration with granulation tissue, fungal organisms (candidiasis), or other non-malignant conditions
- Abnormal Result (Positive): Presence of malignant cells, dysplasia (mild, moderate, or severe), carcinoma in situ, or invasive carcinoma; abnormal cell morphology and increased nuclear-to-cytoplasmic ratio
- Interpretation Units: Histopathological classification using WHO standards and grading systems for oral dysplasia and malignancy
- Borderline/Atypical Findings: Tissue with mild dysplastic changes or features that may require clinical correlation and possible repeat biopsy or close monitoring
Interpretation
- Malignant Findings: Presence of invasive squamous cell carcinoma or other malignancies indicates cancer requiring immediate treatment planning, staging, and oncologic consultation. Carcinoma in situ represents high-grade dysplasia with risk of progression to invasive disease.
- Dysplastic Findings: Mild dysplasia indicates increased malignant potential requiring clinical surveillance and possible repeat biopsy every 6-12 months. Moderate to severe dysplasia represents significant risk and typically warrants excision or ablation therapy.
- Benign Inflammatory Findings: Chronic inflammation or reactive changes suggest non-malignant etiology; may require supportive care or treatment of underlying cause (e.g., antifungal therapy for candidiasis)
- Infectious Findings: Identification of fungal elements (Candida), viral cytopathic changes, or bacterial findings guides targeted antimicrobial or antiviral therapy
- Factors Affecting Interpretation: Tissue fixation quality, section thickness, staining technique, and adequate sampling depth affect diagnostic accuracy. Smoking, alcohol use, HPV infection, and immune status influence dysplasia severity and malignant progression risk.
- Clinical Significance: Results directly impact treatment decisions, prognosis, and surveillance strategies. Positive findings typically require multidisciplinary team management including oncology, maxillofacial surgery, and radiation oncology consultation.
Associated Organs
- Primary Organ System: Oral mucosa and tongue (part of the alimentary system); associated structures include oral cavity, pharynx, salivary glands, and regional lymph nodes
- Diseases Diagnosed: Oral squamous cell carcinoma (most common), adenocarcinoma, melanoma, verrucous carcinoma, and other malignancies of the oral cavity; benign conditions including oral lichen planus, aphthous ulcers, geographic tongue, traumatic ulcers, oral candidiasis, and herpes simplex virus infection
- Associated Complications: Malignant lesions may lead to lymph node metastasis (cervical lymphadenopathy), systemic cancer spread, airway compromise, dysphagia, and nutritional decline; untreated dysplasia can progress to invasive carcinoma with significant morbidity and mortality
- Biopsy-Related Risks: Minor bleeding at biopsy site, infection (rare), temporary discomfort or swelling, rarely nerve injury affecting tongue function; healing typically occurs within 1-2 weeks
- Risk Factors for Malignancy: Tobacco use, alcohol consumption, HPV infection, poor oral hygiene, ill-fitting dentures, chronic irritation, and immunosuppression increase malignant potential
Follow-up Tests
- If Malignancy Confirmed: Staging CT or MRI of head and neck to assess lesion extent and local spread; chest CT to screen for pulmonary metastases; PET-CT for systemic staging in advanced cases; HPV testing or p16 immunohistochemistry when indicated; complete head and neck examination for second primary lesions
- If Dysplasia Detected: Clinical follow-up examination at 2-4 weeks to assess response; repeat biopsy in 6-12 months or sooner if lesion changes; consider excision if moderate to severe dysplasia; increased surveillance of entire oral cavity for additional dysplastic lesions
- If Infectious Process Identified: Fungal culture and sensitivity testing for candidiasis; viral serologies or PCR for HSV if indicated; appropriate antimicrobial or antiviral therapy initiation; clinical re-evaluation at 1-2 weeks to assess treatment response
- If Benign Inflammatory Findings: Clinical observation for healing; supportive care measures; re-biopsy only if lesion persists beyond 3-4 weeks or shows concerning changes; address underlying irritants or causative factors
- If Non-Diagnostic or Atypical: Repeat biopsy at increased depth to ensure adequate tissue sampling; consider alternative imaging (ultrasound or MRI) for supplemental assessment; possible referral to oral pathology specialist for second opinion
- Long-term Surveillance: Malignancy patients require lifelong head and neck surveillance every 3-6 months initially, then annually; dysplasia patients need close clinical monitoring for 2-5 years minimum; patient self-examination education for early detection of recurrence or new lesions
Fasting Required?
- Fasting: No
- Patient Preparation: Fasting is not required. Patient may eat and drink normally before the procedure. Good oral hygiene recommended on day of biopsy but avoid vigorous rinsing. Arrive with clean mouth, free of food debris.
- Medications: Continue all regular medications unless otherwise instructed. Discontinue aspirin, NSAIDs, and anticoagulants (warfarin, DOACs) 3-5 days before biopsy to minimize bleeding risk; consult prescribing physician if on anticoagulation therapy. Continue prophylactic antibiotics if prescribed.
- Special Instructions: Wear comfortable, loose clothing; arrange transportation if local anesthesia used; bring identification and insurance information; inform physician of allergies (particularly to local anesthetics); avoid smoking and alcohol for 24 hours before biopsy if possible; prepare list of current medications and supplements.
- Post-Biopsy Care: Apply gentle pressure with gauze for 10-15 minutes if bleeding occurs; avoid hot foods and drinks for 24 hours; soft diet recommended for 3-5 days; rinse gently with warm salt water after 24 hours; avoid strenuous exercise for 2-3 days; take prescribed pain medication as needed; watch for excessive bleeding, fever, or signs of infection.

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