Oral Mucosal Biopsy: Comparison of Surgical Artifacts in Incisional and Punch Oral Mucosal Biopsy

Background: Artifact is an artificial structure or tissue alteration on a prepared microscopic slide, as a result of an extraneous factor. It makes diagnosis difficult. Punch&Incisional biopsy commonly used for diagnosis of oral lesions often present with artefacts.

Aims&Objective: To study the artefacts arising in specimens during incisional&punch biopsy and to compare their occurrence in punch&incisional biopsy cases.

Methodology: The study was carried out at Department of Oral Pathology and Microbiology between March 2007 to May 2008. Study design was cross sectional&study unit comprised of subjects with oral lesions, having indications for incisional&punch biopsy. Incisional biopsy and punch biopsy specimens were taken from 25 cases each having oral lesions needing biopsy for diagnosis after informed consent. Specimens were compared for artefacts like curling, crush, haemorrhage, splits&fragmentation, stretch, pseudo cyst etc. Chi-square test was used to determine any significant difference between the two biopsy techniques.

Results: Artefacts were more frequent in Incisional biopsy group compared to punch biopsy group except for stretch artefact which was significantly higher in punch biopsy group. No statistically significant difference in proportion of artefacts was observed for artifact induced by improper surgical removal, by surgical suction instruments, curling, crush and injection artifacts. A statistically significant difference was found between Incisional&punch biopsy cases for haemorrhage and split&fragmentation artifact, both of which were lesser in punch biopsy group.

Conclusions: Punch biopsy technique produces much less artefacts in biopsy specimens compared to Incisional biopsy. It is rapid, safe and can reduce potential diagnostic problems and misdiagnosis