Comparison of tissue artifacts in punch and scalpel biopsies of oral and maxillofacial lesions: A systematic review and meta-analysis

Safety of oral mucosal punch biopsy and other oral biospecimen collections in clinical research

OBJECTIVE

Oral punch biopsies are frequently used for analysis of lesions since they are minimally invasive, easily performed, and assist in diagnosis. Despite broad usage, recent changes in risk classification characterize oral punch biopsies as "greater than minimal risk" for institutional review board purposes. We performed a retrospective review of oral sampling in clinical trials to determine the safety of punch biopsies and other biospecimen collection methods in our oral cancer surveillance program.

STUDY DESIGN

Punch biopsies of 3- and 4-mm were collected following topical and local injection anesthetic. Hemostasis was achieved using pressure and silver nitrate cautery. Other specimens were collected according to standard collection guidelines. Safety and adverse events were determined through consultation with clinical investigator guidelines and were graded with the NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.

RESULTS

In total, 579 samples were collected, 339 of which were oral punch biopsies. There were no adverse events above NCI CTCAE grade 1 for any biospecimen collection.

CONCLUSIONS

These results support the safety profile of oral punch biopsies and saliva collection. Additionally, these results align with previous research on punch biopsy safety and demonstrate fewer bleeding events. Based on the results and prior research, we believe that punch biopsies should be considered a minimal-risk procedure.

Treatment Outcomes and Patterns of Disease Recurrence of Patients with Carcinoma of the Buccal Mucosa

Locally advanced buccal mucosa cancer is typically treated with surgery and adjuvant postoperative radiation therapy, which includes concurrent Cisplatin 100 mg/m2 on Day 1, plus 5-Fluorouracil 1000 mg/m2 from Day 1 to 4 every three weeks. Ipsilateral face radiotherapy is a de-escalated treatment that spares the opposite side of the face, enhancing post-treatment chewing function. The availability of electron beam radiotherapy for treating recurrences on the opposite side has increased the use of ipsilateral face radiotherapy. This retrospective study aimed to assess treatment outcomes and patterns of disease recurrence in patients with carcinoma of the buccal mucosa treated with different schedules. We retrospectively reviewed records of 54 patients with a pathological diagnosis of buccal mucosa cancers treated between 2018 and 2023. We extracted patients' demographic, disease, and treatment criteria. Indications for postoperative radiotherapy included a close margin of less than 3 mm and lymph node positivity. The primary tumor (face) and neck were considered separately for radiotherapy treatment. One patient who refused surgery, radiotherapy, and chemotherapy but regularly came for follow-up after receiving Ayurvedic treatment died of the disease after 2 years and 1 month. Fifty-three patients received concurrent chemoradiotherapy with Cisplatin 100 mg/m2 on Day 1, plus 5-Fluorouracil 1000 mg/m2 from Day 1 to 4 every three weeks for three cycles. Postoperative patients were treated with radiotherapy fields covering the face (bilateral or ipsilateral wedged fields) and the whole neck field with central shielding for the initial 44 Gy in 22 fractions over 4.5 weeks followed by a boost dose of 16 Gy to the primary tumor and involved neck. For radical radiotherapy, patients received a similar radiation field but the boost dose delivered was 26 Gy in 13 fractions over 2.5 weeks. For ipsilateral radiotherapy fields, the average face anterior field size was 6 W x 8 cm; the thick edge of the wedge laterally; depth 4 cm and lateral 8 W x 8 cm radiation field with a thick edge of the wedge anteriorly; depth 3 cm. The median dose to high-risk clinical target volume was 60 Gy/30 fractions in postoperative cases. Forty-eight patients received radical radiotherapy with a higher dose (66 Gy/33 fractions to 70 Gy/35 fractions); twenty-eight patients received radiotherapy fields of bilateral face and neck with a central spinal shield of 2 cm. Statistical analysis was conducted at the Community Medicine Department using SPSS software version 21.0. The Chi-square test and Fisher Exact test were applied to compare various groups. Fifty-four patients were analyzed. The median follow-up was 9 months. Surgery consisted of Composite Resection (Commando operation) plus Radical Neck dissection in three (5.5%) patients and non-composite resection surgeries (Wide excision of the lesion plus supra-omohyoid dissection) in nine (16.6%) cases, of which six (50%) cases had lymph node involvement but no patient with positive dissection had extracapsular extension. Tumor thickness by histopathology was found to be between 5 and 15 mm. Sixteen (28.1%) patients failed locally and 11 (20.3%) had lymph node recurrences. One patient (1.8%) with mucoepidermoid cancer had bony metastases at D9, L1, and the pelvis after 4 months of treatment. Death occurred in 12 (20.3%; one due to a non-oncologic cause) out of 54 patients during our study. The majority (88%) of patients in our study are male, aged less than 50 (55%). A KPS of 70/>70 was present in 83.3% of patients. The majority of patients in this study are T3 (37%) and T4a (29.6%). Nodal status of patients included 29.6% N0; 27.7% N1, and 35.1% N2. The majority of patients (57.4%) have well-differentiated carcinoma followed by moderately differentiated carcinoma in 38.8% of patients. The difference in death is non-significant when ipsilateral face + neck radiotherapy is compared to bilateral face + neck radiotherapy by Fisher Exact test (statistical value = 0.1246; p > 0.05, statistically not significant), and in other groups, it could not be compared due to the small number of patients. Our results show the non-inferiority of non-composite resection surgery + bilateral face + neck radiotherapy to non-operative radical radiotherapy (bilateral or ipsilateral face wedged radiotherapy + neck radiotherapy), so the majority of patients can be treated by these modalities of treatment. De-escalation of radiotherapy by the use of ipsilateral face wedged + neck radiotherapy is possible as there is no statistically significant difference in local and nodal relapse when compared to bilateral face + neck radiotherapy, and it results in sparing of the opposite side of the face. Buccal mucosa carcinoma in eastern Uttar Pradesh is a very aggressive disease, with 12 (20.3%; one due to a non-oncologic cause) out of 54 patients dying. Our results are different compared to historical data, possibly due to the use of concurrent Cisplatin + 5-Fluorouracil chemotherapy and the lower number of patients in the composite resection group as the majority of patients were frail and did not consent to composite resection.

To Evaluate the Efficacy of Diagnostic Periocular Punch Biopsy: Using a 4-mm Dermatology Punch

PURPOSE

The dermatological punch biopsy is a minimally invasive procedure that provides conclusive diagnosis when managing periocular lesions. It aids with establishing histological diagnosis and subtype thereby facilitating management planning and eliminates the risk of unnecessary tissue sacrifice. The present literature provides limited evidence evaluating the value of punch biopsy in diagnosing periocular lesions.

METHODS

A retrospective case note analysis of 400 consecutive 4-mm periocular punch biopsies performed between 2005 and 2016, from 353 patients was undertaken at a single institution. Three hundred fifty-nine lesions had an initial definite clinical diagnosis of malignancy (group A) and the remaining 41 lesions had an uncertain clinical diagnosis with enough suspicion to merit a biopsy (group B).

RESULTS

In group A, 75.5% (n = 271) of the biopsies verified the clinical diagnosis of malignancy and 24.5% (n = 88) were benign. In group B, 70.7% (n = 29) of the lesions were benign and 29.3% (n = 12) were malignant and were subsequently treated as group A. Only 4, group A biopsies, which underwent formal excision, did not initially diagnose a malignancy (punch biopsy was repeated) providing a sensitivity of 98.6% and a specificity of 100%. One hundred seventeen were found to be benign avoiding unnecessary tissue sacrifice in 29.25% of cases.

CONCLUSION

Our study provides the largest sample size in the literature that evaluates a 4-mm diagnostic periocular punch biopsy in managing eyelid lesions. In 29.5% of punch biopsies, unnecessary tissue sacrifice was avoided as they were histologically benign. The authors found that punch biopsies for lesions <7 mm carry a risk of inadvertent excision of lesion.

Biopsy of the oral mucosa: Does size matter?

AIM

To analyze the relation between biopsy specimen's size and the definitive diagnosis. In addition, other variables including oral mucosa region, type of disease and general versus specialist practitioner were also assessed.

METHODS

Data from specimens submitted to histopathological examination between 2007 and 2017 were retrospectively analysed.

RESULTS

We analysed data on 792 patients. Out of 1089 archived reports, 81 (7.4%) had no definitive diagnosis. Multivariate analysis rendered biopsy length as the factor influencing the possibility to reach a definitive diagnosis.

CONCLUSION

The size of the specimen is an important parameter to achieve a correct histopathological diagnosis of the oral lesions investigated. According to our results, it seems that a 10 mm length is adequate to optimize the biopsy outcome. No statistically differences were observed between GPDs and oral surgery specialists, probably because biopsies were performed by experienced general practitioners, although not formally trained.

Application of optical coherence tomography to study the structural features of oral mucosa in biopsy tissues of oral dysplasia and carcinomas

OBJECTIVE

This study aims to examine the ability of optical coherence tomography (OCT) to differentiate ex vivo epithelial structure of benign disorders, dysplastic, and oral squamous cell carcinoma (OSCC) in comparison with the structure of normal marginal mucosa of oral biopsies. As a secondary objective, we examined the inter- and intra-observer variations of OCT measurements of two calibrated assessors.

MATERIALS AND METHODS

Oral biopsies (n = 44) were scanned using the swept source OCT (SSOCT) and grouped by pathology diagnosis to benign, dysplasia or carcinoma. Two trained and calibrated assessors scored on the five OCT variables: thickness of keratin layer (KL), epithelial layer (EL), homogeneity of lamina propria (LP), basement membrane integrity (BMI), and the degree of reflection of the epithelial layer (Ep Re). Chi-square tests and Fischer's exact method were used to compare the data.

RESULTS

The OCT images showed breached BM status in all the OSCC samples (100%). Epithelial reflection was noted to be hyper-reflective in all the OSCC and oral dysplasia samples (100%). An increase in KL in 66.67% of the OSCC and 100% of the oral dysplasia samples was found. EL was increased in all the OSCC samples (100%) and 85.72% of the oral dysplasias. Kappa values showed that there was very good agreement (over 0.7) when scoring individual parameters between the two assessors.

CONCLUSION

The study showed that the BM status was a key parameter in the detection of SCC and for differentiating SCC from oral dysplasia or benign disorders.

CLINICAL RELEVANCE

OCT is a non-invasive and non-radioactive adjunct diagnostic tool that can provide immediate results on the structure of oral mucosa. The BM status measured ex vivo was a key parameter in the detection of SCC and for differentiating SCC from oral dysplasia or benign disorders.