 |
What is a “complete” sample? |
| |
A complete sample is one with cellular representation from all layers of the epithelium, penetrating down to the basement membrane. |
| |
|
|
How can I obtain a complete biopsy from a heavily keratinized lesion
(thick and white)? |
| |
Make sure to wet the brush before using it (preferably with the patient’s saliva or tap water); rotate the brush repeatedly in a drilling motion; a slight bend of the brush handle is a good indicator that sufficient pressure is being applied; the specimen should be obtained preferably from the periphery of the lesion; pinpoint bleeding or reddened tissue is evidence of good technique. |
| |
|
|
Are there locations in the oral cavity from which it is more difficult to
obtain a complete sample? |
| |
The surfaces of the hard palate and attached gingiva are keratinized. Therefore, extra rotations and firmer pressure are needed to ensure that a complete sample is obtained. |
| |
|
|
Are there precautions for lesions that are ulcerated and for those that readily bleed? |
| |
Since the surface of the ulceration lacks epithelium, only the periphery of an ulcerated lesion should be brushed. If the lesion starts to bleed, it is best to stop brushing, quickly transfer the material to the slide, and apply the fixative. |
| |
|
|
Should I use the circular end or the flat end of the brush when I obtain the specimen? |
| |
Depending upon the intraoral location and accessibility, either the circular border or the flat surface of the brush may be utilized. For example, the circular border may be used for oral lesions on the lateral tongue and gingiva, and the flat surface for lesions on the buccal mucosa. |
| |
|
|
The specimen was incomplete, but there was bleeding when I obtained the sample. Didn’t I obtain a sample that penetrated to the basement membrane? |
| |
Excessive blood can dilute the cells in the specimen you have obtained. Therefore, when rotating the brush, try to achieve pinpoint bleeding or pinkish red tissue only. |
| |
|
|
How can I obtain a complete sample from a lesion on the tongue or other mobile tissue? |
| |
A sterile 2 x 2 gauze can be utilized to immobilize the tongue. For buccal mucosal lesions, the free hand can be used to stabilize the outside of the cheek while pressure is applied to the buccal mucosa with the brush biopsy instrument. |
| |
|
|
I performed a brush biopsy, but I did not send it in to the lab right afterwards. Can I still submit the specimen at a later time? |
| |
As long as fixative was applied to the slide immediately after the brush biopsy sample was obtained, the specimen is preserved indefinitely. |
| |
|
|
Can I place the slide into the container even though it appears that the specimen is not fully dry? |
| |
After about 10 minutes the cells are completely fixed, and the slide can be placed into the container. |
| |
|
|
How do I transfer the cellular material from the brush to the glass slide? |
| |
Rub all sides of the brush firmly against the slide to create a visible layer of material on the slide. |
| |
|
