Diagnostic accuracy of punch biopsy in subtyping basal cell carcinoma

Abstract

Punch biopsy has serious pitfalls in differentiating aggressive and non-aggressive BCC subtypes. Dermatologists should consider the possibility of aggressive components within non-aggressive BCCs reported using punch biopsy.

Hyperspectral imaging system in the delineation of Ill‐defined basal cell carcinomas: a pilot study

“…In 27–43% of cases, a combination of different patterns – i.e. a mixed histology – exists . The histological subtype affects the clinical choice of treatment and the prognosis .…”

“…The accuracy of a punch biopsy in the interpretation of a mixed histology is 37% . Moreover, in 39.1% of aggressive BBCs, the punch biopsy fails to identify the subtype correctly compared to the following excision, and 11–14.1% of any type of BCC shows an unsuspected aggressive component in the excision compared to the preceding punch biopsy …”

Key characteristics of basal cell carcinoma with large subclinical extension

“…However, since components are often subclinical in nature, clinicians should be aware that their biopsy may not provide adequate sampling of the lesion, and therefore not capture its more distant, subclinical extensions. In fact, studies have shown an 18‐38% discordance rate between the BCC subtype in the biopsy specimen and in the subsequent excision, with up to 40% of those cases having a more histologically aggressive subtype that was not sampled on the initial biopsy . One study showed the most commonly missed subtypes on biopsy to be nodular, micronodular and infiltrative, which we found to have greater LSE …”

Acurácia da biópsia incisional por trépano de 2 mm nos tumores palpebrais: estudo comparativo entre um e dois sítios

“…Por isso, no planejamento da excisão tumoral e posterior reconstrução do defeito, é importante que o cirurgião saiba o diagnóstico histológico da lesão. (20,21,42,43,46) Em alguns casos, de acordo com tamanho e localização, a biópsia excisional é praticável. Em outros, inicialmente, é necessária a biópsia incisional.…”

“…Os pacientes foram divididos em 2 grupos de forma aleatória (43) O exame anatomopatológico das peças (tanto na biópsia incisional por trépano quanto no padrão-ouro) foi realizado por um mesmo médico patologista no Departamento de Patologia do HC-FMUSP. Os resultados discordantes foram revisados por um segundo patologista.…”