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Biopsy Kits

Routine Formalin Fixed Tissue

POMPL provides biopsy kits upon request. Each biopsy kit consists of a formalin-filled plastic container, a history sheet and a business reply label addressed to our laboratory. You can also request a FedEx shipping prepaid labels.

Specimen Handling for Direct Immunofluorescence (DIF)

In order to help us process and diagnose your tissue samples, we offer the following guidelines.

  • Specimens taken for DIF of bullous/desquamative lesions must be accompanied by another specimen for routine histopathology.
  • Either two biopsies can be taken, or a single elliptical wedge can be procured and then hemisected.
  • One specimen should go into formalin, the other into special DIF transport media supplied on request from our lab.

The diagnosis of bullous/desquamative lesions requires an assessment of where the epithelium is splitting. Clinically, obtaining these biopsies can be problematical due to the tendency for the epithelial layer to slough. It is best to seek a site in the anterior portion of the mouth and take care not to grasp the specimen with forceps. Eight-millimeter punch biopsies work quite well, and one should always biopsy the edge of the lesion to include both pathologic and normal-appearing tissues.

How does DIF Work?

Immunoglobulins from rabbits, goats or mice are used as reagents. These immunoglobulins are directed to antigens in the host tissue, and many of these antigens are immunoglobulins or autoantibodies (i.e. an antibody to an antibody). Many antigens are damaged by formalin fixation and tissue processing; therefore a special media is used and the sections are cut from frozen tissue samples.

The anti-human immunoglobulins are tagged with a fluorescent dye that can only be visualized with an ultraviolet light source (fluorescent) microscope.

How are results interpreted?

  • Localization of fluorescent antibodies
  • Basement membrane fibrinogen: lichen planus, lichenoid lesions
  • Basement membrane C-3, IgG, IgM and/or IgA: mucous membrane pemphigoid
  • Basement membrane IgM: lupus erythematosus
  • Intercellular (desmosomal region) C-3, IgG, IgM and/or IgA: Pemphigus vulgaris
  • Vascular wall C-3 and IgG: Erythema multiform

For the most part DIF is a useful adjunct for erosive diseases such as lichen planus, pemphigoid, pemphigus and erythema multiforme.

Due to limited storage times, please request DIF media only when you are ready to obtain a specimen for direct immunofluorescence. DIF tissue samples cannot be placed in formalin, since fixation damages the protein structure of many antigens and obfuscates the staining reaction. The transport media that we supply has a shelf life of about three months and can be refrigerated. It is advisable that media designated for direct immunofluorescent studies be refrigerated until use, but it can be transported at room temperature to the laboratory. For optimal results, please transport the specimen as soon as it is harvested in the designated container and send to the lab via FedEx.

Ordering

To order specimen packages, call 415.929.6560.

Please provide the requesting doctor's:

  • First and last name
  • Street address
  • City, state and zip code
  • Phone number in case of questions

Let us know how many you'd like and if you're new to our service.

Shipping Instructions

Free Return Shipping Instructions

  1. Pack the biopsy bottles in the same manner as you receive them.
  2. Wrap the biopsy bottle in a portion of paper towel and place it inside the plastic ziplock bag.
  3. Place the completed patient history sheet along with the sealed ziplock bag containing the biopsy bottle into our regular mailing can (for FedEx) or padded envelope (for U.S. Postal Service).

U. S. Postal Service:

A business reply label is provided on the padded envelope for your convenience. Just drop in any mailbox.

FedEx:

If you've had trouble with losses through the mail we offer return shipping by FedEx at no cost to you. Our packaging has been quality tested by the FedEx testing lab and is certified with FedEx #9001119506.

Just follow these instructions exactly:

  1. Call your local FedEx office to obtain FedEx Diagnostic Specimen Envelopes. You may request as many as you like. They will be delivered to you the next day. If you have any questions, call 1.800.GO.FEDEX (1.800.463.3339))
  2. Pack the biopsy bottles in the mailing cans as previously described.
  3. Place the mailing can(s) inside the FedEx Diagnostic Specimen Envelope and seal it according to the instructions on the envelope. You do not need additional absorbent material or outer packaging. The envelope can hold up to 10 cans.
  4. Affix the FedEx Billable Stamp Receipt provided with this mailing onto the envelope. Additional billable stamp receipts will be sent with new biopsy containers or upon request.

Biopsy Procurement Guidelines

The following guidelines are intended to guide medical professionals in properly preparing biopsies for sending to our lab.

Types of Biopsies

  • Incisional biopsy: Sampling a portion of the lesion with a scalpel wedge incision or a punch.
  • Excisional biopsy: Surgical removal of the entire lesion.
  • Cytology smear for fungal stain ( must be fixed with alcohol and dried prior to sending)

Selecting a site

  • For red, white and pigmented lesions, a biopsy can be taken anywhere within the lesional area.
  • For bullous/erosive lesions, take an elliptical wedge incisional biopsy to include the lesion and a portion of normal adjacent tissue.
  • Large masses: Take an incisional biopsy by obtaining a deep wedge, about a centimeter deep.
  • Small masses: Excise the entire mass.
  • Mucoceles: Include underlying glands to avoid recurrence.
  • Gingival masses: Excise and perform thorough root planning.
  • Ulcers: Small ones can be excised, Large ulcers should have an elliptical incision into the ulcer bed with inclusion of adjacent normal tissue.

Margins

Orient the specimen for anterior (or superior), posterior (or inferior), left margin, right margin. Place a short suture in the anterior (or superior) margin and a long suture in the right margin (or use one gut and one silk).

Do not use laser or cautery on epithelial lesions where dysplasia is expected. The artifactual changes can be severe and no diagnosis can be given. Use scalpel or punch, and after the tissue is removed, laser or cautery to the wound site can be applied for hemostasis.