Blog – Page 7 – Dr. Bhuvan Nagpal

02Sep

Before Sending an Oral Biopsy

Plan the investigation before collecting tissue

A useful biopsy submission begins with a defined clinical question. The following checklist is intended to help clinical teams communicate that question clearly and preserve the information needed for interpretation.

Confirm identification and the exact site

Check the patient’s identifiers on the container and requisition before dispatch. Specify the anatomical site and side. If more than one site is sampled, label containers separately and describe what each contains. Record orientation markings where relevant.

Avoid a description such as “oral growth” when a precise site can be supplied. The specimen label and clinical record should make it possible to determine which tissue was examined.

Supply the clinical context

Include duration, symptoms, clinical appearance, relevant examination findings, the provisional diagnosis and reasonable differential diagnoses. Add earlier biopsy results and relevant treatment history.

For a jaw lesion, provide the available imaging and describe the relationship to teeth, vitality findings and previous procedures. For a changing mucosal lesion, a dated photograph with the site identified can help communicate what prompted sampling.

These are practical submission recommendations; the receiving laboratory’s current requisition and instructions should guide the final information set.

Use the appropriate handling pathway

Routine oral histopathology commonly uses 10% neutral-buffered formalin. Handle delicate tissue carefully because crush or thermal damage can distort morphology. Follow the laboratory’s instructions for the container, fixation and transport. [1,2]

Special investigations require advance planning. Direct immunofluorescence may need a separately collected sample in a medium such as Michel’s solution. Do not assume a specimen placed in routine formalin will meet every testing requirement. Contact the laboratory before collection when special studies are being considered. [3]

Make the handover traceable

Before dispatch, confirm that the container is secure, the paperwork matches and the referring clinician can be contacted. Keep a record of dispatch and a system for following up the result.

The diagnostic pathway should also include review of unexpected or discordant findings. If a report does not explain the clinical or radiographic picture, discuss the case with the pathologist rather than treating the report as an isolated answer.

Good submission practice supports interpretation, while active clinician–pathologist communication helps determine whether further assessment is needed.

Sources

[1] University of Florida Pathology Laboratories. Oral Pathology specimen requirements. https://pathlabs.ufl.edu/tests/test-directory-o/oral-pathology/

[2] University of Michigan School of Dentistry. Oral and Maxillofacial Pathology Biopsy Service, general specimen submission information. https://dent.umich.edu/patient-care/specialty-clinics/comprehensive-clinical-pathology-services/oral-and-maxillofacial

[3] University of California San Francisco. Oral Pathology Service, immunofluorescence testing. https://dermpath.ucsf.edu/oral-pathology

01Sep

Oral Pathology as a Career

admin Oral Pathology

Understand the work before choosing the label

Oral and maxillofacial pathology concerns the nature and diagnosis of disease affecting the mouth, jaws and related regions. Its professional description includes research and diagnosis using clinical, radiographic, microscopic and other examinations. [1]

Indian MDS course regulations describe Oral and Maxillofacial Pathology and Oral Microbiology in terms of disease causes, processes and effects and their clinical relationships. [2] For a student, this points towards a discipline that connects basic science with clinical interpretation.

Explore the daily responsibilities

Before choosing training, try to observe a diagnostic service. Ask how specimens are received, how cases are discussed and how reports are communicated. Speak to people working in different settings rather than relying on one account of the specialty.

Useful questions include: Do I enjoy explaining why a diagnosis fits? Am I comfortable revisiting an interpretation when new evidence appears? Do I like careful observation, written communication and sustained study?

Look for meaningful training exposure

My suggested programme questions concern the variety of cases, supervision, clinicopathological discussions, laboratory quality systems and access to ancillary investigations. Ask how trainees receive feedback and how uncertainty is handled.

Research and teaching opportunities are worth examining in the same practical way: what will you actually do, who will guide you and how will your work be evaluated?

Plan opportunities responsibly

Potential interests may include diagnostic practice, education, research and quality improvement. The ability to undertake a particular role depends on recognised qualifications, competence, applicable regulation and institutional requirements. A course title alone should not be read as permission for every activity.

Avoid choosing the specialty on a promise of a guaranteed income or a particular job. Seek current, local information about training and employment before making a major decision.

Build habits that remain useful

Keep a structured learning record, read primary literature and practise explaining findings clearly. Seek mentorship that encourages questions and careful reasoning.

Oral pathology offers a way to investigate disease in depth. The strongest career decision comes from understanding its real work and deciding whether that work matches your interests and abilities.

References

[1] American Academy of Oral and Maxillofacial Pathology. About AAOMP. Read source

[2] Dental Council of India. MDS Course Regulations, 2017, specialty description. Read source

01Sep

From Microscope to Clinical Decision

admin Oral Pathology

Diagnosis is a reasoned interpretation

Microscopy is central to tissue diagnosis, but the result is not simply the recognition of one familiar image. A pathology report brings together the examination of the specimen and relevant clinical information; additional studies may contribute when needed. [1]

For learners, it is helpful to think of the process as answering a series of questions while checking that the available material supports each answer.

Describe before naming

My suggested learning approach begins with an organised description. Identify what tissue is present, how it is arranged and which features seem most important. Then develop a short differential diagnosis and identify what would distinguish the possibilities.

This method helps avoid forcing every feature into the first diagnosis that comes to mind. It also makes a discussion with a supervisor more informative than presenting only a label.

Bring the clinical question back into view

Oral and maxillofacial pathology draws on clinical, radiographic and microscopic investigation. [2] Ask whether the proposed interpretation explains the lesion’s location and the findings supplied by the clinician.

If important information is missing, request it. If the tissue and clinical findings do not fit, identify the mismatch and discuss how to resolve it.

Use additional tests purposefully

Before requesting another investigation, state the question it should answer. After receiving the result, reassess the whole interpretation rather than simply adding another line to the report.

Communicate uncertainty with appropriate specificity. Explain whether the limitation concerns the sample, the information supplied or the ability to distinguish particular possibilities.

Make the report useful to the next decision

The treating clinician needs to understand what has been established and what, if anything, remains unresolved. Patients need a plain-language explanation of how the result affects their plan.

A good educational exercise is to ask: “What can the treating team reasonably do with this report?” That question encourages precise diagnosis, clear limitations and direct communication. The value of microscopy is realised when its findings contribute to an appropriate clinical decision.

References

[1] National Cancer Institute. Surgical Pathology Reports. Read source[2] American Academy of Oral and Maxillofacial Pathology. About AAOMP. Read source

01Sep

Reading an Oral Pathology Research Paper Critically

admin Oral Pathology

Begin with the question

Before reading the conclusion, write down what the study is trying to establish. Is it describing morphology, measuring diagnostic accuracy, testing a treatment or exploring an association? Different questions need different designs and appraisal methods.

CASP provides study-specific critical appraisal tools, including a diagnostic study checklist. [1] A structured approach helps readers inspect methods rather than decide from the title alone.

Examine who and what was studied

For a diagnostic study, identify how participants or samples were selected, the test being assessed and the reference standard. Ask whether the material resembles the cases in which the test would actually be used.

STARD reporting guidance addresses these elements, along with thresholds, missing or indeterminate results, participant flow and estimates of accuracy with uncertainty. [2]

Read beyond a headline percentage

Ask which errors matter clinically. Could a test miss a malignant lesion, or could a false positive lead to unnecessary investigation? Look for the underlying numbers and the uncertainty around estimates.

In an image-based study, a useful additional question is whether multiple images from the same patient were kept together when datasets were divided. Also ask whether performance was assessed on an independent population. These questions help examine how closely the evaluation matches the proposed use.

Separate reporting from validity

A well-reported study is easier to appraise, but complete reporting does not prove that the design is unbiased. Conversely, an omitted detail may prevent confident judgment. Record what is known and what cannot be assessed.

Read the limitations, funding and conflicts disclosures with the methods and results. Check whether the authors’ conclusion stays within what the study actually tested.

Finish with a practical note

My suggested reading record has four entries: the question, the main finding, the principal limitation and the decision it might inform. Add whether the paper should change practice now, prompt further reading or simply raise a hypothesis.

Critical reading makes research more useful by connecting the strength of the evidence to the decision being considered.

References

[1] Critical Appraisal Skills Programme. Diagnostic Study Checklist. Read source[2] EQUATOR Network. STARD 2015, diagnostic accuracy study reporting guidance. Read source

01Sep

Understanding Laboratory Accreditation

admin Oral Pathology

Ask what has been assessed

NABL accredits medical testing laboratories against ISO 15189 requirements for quality and competence. Accreditation relates to a defined scope, which describes the activities or tests covered. [1,2]

The useful question is therefore more specific than “Is this laboratory accredited?” Ask whether the relevant location and investigation are included in its current scope.

A certificate and its scope belong together

Check the laboratory’s identity, certificate details, status and associated scope through the appropriate official information. A familiar name or logo on a collection centre is not enough to answer which facility performs a particular examination and whether that activity is covered.

For a specialised investigation, ask whether it is performed locally or referred to another laboratory and how the report identifies the testing service.

Quality is a continuing process

WHO laboratory quality guidance describes quality as involving the full laboratory system, including personnel, equipment, processes, information and improvement. [3] In day-to-day practice, this means patients and clinicians should be able to ask about preparation, specimen handling, reporting and resolving unexpected findings.

Accreditation should not be described as a promise that every result will be free from error. Nor does it replace the need to interpret a result in the patient’s clinical context.

Questions worth asking

For patients: Where will my sample be tested? What preparation is required? When should I expect the report? Whom should I contact if the result needs clarification?

For clinicians: Is this test within scope at the performing site? What specimen limitations apply? How are urgent results communicated? How can the case be discussed with the appropriate laboratory professional?

Keep the claim precise

Laboratory teams should describe accreditation in terms that match the certificate and scope rather than imply broader approval. Keep public information current when locations, methods or services change.

Accreditation provides useful evidence about a laboratory’s assessed system and competence. Its meaning becomes clearer when the exact service and scope are understood.

References

[1] National Accreditation Board for Testing and Calibration Laboratories. Accreditation Process and Scope. Read source

[2] NABL. NABL 100B, Accreditation Process and Procedure. Read source

[3] World Health Organization. Laboratory Quality Management System Handbook. Read source

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