Electrosurgical Biopsy

Abstract

Cancer of the oral structures is a potentially fatal disease, but if it is diagnosed early enough and treated properly a complete, permanent cure can be achieved. Biopsy is the key to successful cancer therapy. It establishes an accurate differential diagnosis of the pathologic condition and reveals the specific type of malignant cells that are present, and whether the condition is localized or in an active state of metastasis. This information dictates the type of treatment to institute, and how extensive and radical the treatment should be. Biopsy, being a potentially life-saving procedure, is the most important service a dentist can render, and thus biopsy is the most important dental treatment. It is therefore imperative that the biopsy be performed properly. The advantages of electrosurgical biopsy over manual steel scalpel excision, especially the hemostasis provided by fully rectified cutting current, eliminate the dangers of causing surgical or mechanical metastasis during biopsy, which are ever-present hazards with manual steel scalpel biopsy excisions. Hemostasis produced by fully rectified cutting current seals off the cut ends of the blood and lymph capillaries, and thus prevents surgical metastasis. Fulguration of the bed from which the tissue has been removed provides added insurance against surgical metastasis even if the tumor is actively metastasizing. Tissue must be taut to be incised and excised efficiently. Bunching and manipulative tissue kneading to create enough tautness to force a steel scalpel blade into the tissues to incise and excise a biopsy specimen can cause clumps of tumor cells to break off and invade into the adjacent normal tissue. The capability of an electrosurgical procedure to incise and excise tissue precisely without pressure minimizes the need to manipulate the tissues to create tissue tautness. Engaging the tissues lightly with a tissue hook or ophthalmic tissue forceps and lifting gently creates sufficient tautness to excise precisely and effortlessly by electrosection, eliminating the danger of causing mechanical metastasis. Electrosurgery, by eliminating both dangers, eliminates the main reason why many dentists are reluctant to perform biopsies despite their life-saving potential. Electrosection provides another useful clinical advantage; electrosurgical wounds can heal with normal, supple, scar-free repair tissue by secondary granulation repair as well as by primary intention. Thus, loop-excised wounds can heal without suturing, without fear of tissue distortions from scar tissue adhesions or contractions. Techniques are presented for electrosurgical biopsy of small and large masses by incisional and loop excisions. Clinical biopsies performed by both methods at six typical oral sites are presented. The clinical cases confirm the effectiveness of the hemostasis provided by fully rectified cutting current, the safety of using this current even against bone, and the fact that tissue repair by primary and secondary intention is rapid, scar-free, and normal in all respects.