Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 11, November, p. 1513–1517

doi: 10.17219/acem/104525

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Could the super-pulsed CO2 laser be used for oral excisional biopsies?

Gianluca Tenore1,A,B,C,D,E,F, Gaspare Palaia1,A,B,C,D,E,F, Ahmed Mohsen1,A,B,C,D,E,F, Simone Ambrogiano1,A,B,C,D,E,F, Cira Rosaria Tiziana Di Gioia2,A,B,C,D,E,F, Marzena Dominiak3,A,B,C,D,E,F, Umberto Romeo1,A,B,C,D,E,F

1 Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy

2 Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy

3 Department of Oral Surgery, Wroclaw Medical University, Poland

Abstract

Background. The main purpose of a biopsy is microscopic examination and diagnosis. Keeping the margins of specimens safe and readable is always fundamental to detecting marginal infiltrations or malignant transformation. Numerous options and tools have been introduced for biopsy procedures. Lasers are one of these options that provide many enhancements to clinical and surgical biopsy procedures in comparison to scalpels.
Objectives. The aim of the present study is to quantify the thermal artefacts in histological specimens obtained using a CO2 laser from different oral mucosal lesions and to evaluate if the resulting thermal effect hinders the histological examination. This aim is accomplished through quantitatively and qualitatively assessing the thermal effect in both the epithelium and connective tissue.
Material and Methods. A super-pulsed CO2 laser (10,600 nm) was used to obtain 10 excision biopsy samples. The parameters were a power of 4.2 W in focused mode and a frequency of 80 Hz in super-pulse mode. The histological analysis was performed with an optical microscope. Computerized imaging software was utilized to quantitatively evaluate the thermal effect in both the epithelium and connective tissue expressed in microns.
Results. The thermal effect of the CO2 laser was limited to the surgical resection margins in all the specimens and did not hinder the histological analysis. Thermal artefacts were observed in 3 specimens. The range of thermal effects in the epithelial tissue was between 184 μm and 2,292 μm, while in the connective tissue it was between 133 μm and 2,958 μm.
Conclusion. The resulting thermal effects of using a CO2 laser did not hamper the histological evaluation. Utilizing a laser in biopsy procedures should be tailored. Not only should laser parameters and safety margins be taken into consideration but also the working time, clinical accessibility, and the nature and water content of the tissue.

Key words

biopsy, artefacts, carbon dioxide laser (CO2)

References (31)

  1. Bernstein ML. Biopsy technique: The pathological considerations. J Am Dent Assoc. 1978;96(3):438–443.
  2. Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4th ed. Philadelphia, PA: W.B. Saunders Company; 1983.
  3. Palaia G, Del Vecchio A, Impellizzeri A, et al. Histological ex vivo evaluation of peri-incisional thermal effect created by a new-generation CO2 superpulsed laser. ScientificWorldJournal. 2014;2014:345685.
  4. Romeo U, Palaia G, Del Vecchio A, et al. Effects of KTP laser on oral soft tissues: An in vitro study. Lasers Med Sci. 2010;25(4):539–543.
  5. Spector N, Spector J, Ellis DL, Reinisch L. Reduction in lateral thermal damage using heat-conducting templates: A comparison of continuous wave and pulsed CO2 lasers. Lasers Surg Med. 2003;32(2):94–100.
  6. Margarone JE, Natiella JR, Vaughan CD. Artifacts in oral biopsy specimens. J Oral Maxillofac Surg. 1985;43(3):163–172.
  7. Tuncer I, Ozçakir-Tomruk C, Sencift K, Cöloğlu S. Comparison of conventional surgery and CO2 laser on intraoral soft tissue pathologies and evaluation of the collateral thermal damage. Photomed Laser Surg. 2010;28(1):75–79.
  8. Pick RM, Colvard MD. Current status of lasers in soft tissue dental surgery. J Periodontol. 1993;64(7):589–602.
  9. Cercadillo-Ibarguren I, España-Tost A, Arnabat-Domínguez J, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Histologic evaluation of thermal damage produced on soft tissues by CO2, Er,Cr:YSGG and diode lasers. Med Oral Patol Oral Cir Bucal. 2010;15(6):e912–918.
  10. Romeo U, Del Vecchio A, Ripari F, Palaia G. Effects of different laser devices on oral soft tissues: An in vitro experience. J Laser Appl. 2007;7(3):155–159.
  11. Vescovi P, Corcione L, Meleti M, et al. Nd:YAG laser versus traditional scalpel: A preliminary histological analysis of specimens from the human oral mucosa. Lasers Med Sci. 2010;25(5):685–691.
  12. Romeo U, Palaia G, Tenore G, Del Vecchio A, Nammour S. Excision of oral mucocele by different wavelength lasers. Indian J Dent Res. 2013;24(2):211–215.
  13. Romeo U, Palaia G, Galanakis A, et al. Granular cell tumour of the tongue: Two clinical cases treated with laser. Italian Oral ­Surgery. 2012;11(5):s90–95.
  14. Vescovi P, Del Vecchio A, Manfredi M, Fornaini C, Tenore G, Romeo U. The use of laser for treatment of oral mucosal diseases [in Italian]. Dental Cadmos. 2009;77(10):i–xvii.
  15. Romeo U, Libotte F, Palaia G, et al. Histological in vitro evaluation of the effects of Er:YAG laser on oral soft tissues. Lasers Med Sci. 2012;27(4):749–753.
  16. Yagüe-García J, España-Tost AJ, Berini-Aytés L, Gay-Escoda C. Treatment of oral mucocele-scalpel versus CO2 laser. Med Oral Patol Oral Cir Bucal. 2009;14(9):e469–474.
  17. Bornstein MM, Winzap-Kälin C, Cochran DL, Buser D. The CO2 laser for excisional biopsies of oral lesions: A case series study. Int J Periodontics Restorative Dent. 2005;25(3):221–229.
  18. Huang IY, Chen CM, Kao YH, Worthington P. Treatment of mucocele of the lower lip with carbon dioxide laser. J Oral Maxillofac Surg. 2007;65(5):855–858.
  19. Suter VG, Altermatt HJ, Sendi P, Mettraux G, Bornstein MM. CO2 and diode laser for excisional biopsies of oral mucosal lesions: A pilot study evaluating clinical and histopathological parameters. Schweiz Monatsschr Zahnmed. 2010;120(8):664–671.
  20. White JM, Chaudhry SI, Kudler JJ, Sekandari N, Schoelch ML, Silverman S Jr. Nd:YAG and CO2 laser therapy of oral mucosal lesions. J Clin Laser Med Surg. 1998;16(6):299–304.
  21. Seoane J, Caballero TG, Urizar JM, Almagro M, Mosquera AG, Varela-Centelles P. Pseudodysplastic epithelial artefacts associated with oral mucosa CO2 laser excision: An assessment of margin status. Int J Oral Maxillofac Surg. 2010;39(8):783–787.
  22. Matsumoto K, Suzuki H, Usami Y, Hattori M, Komoro T. Histological evaluation of artifacts in tongue tissue produced by the CO2 laser and the electrotome. Photomed Laser Surg. 2008;26(6):573–577.
  23. Convissar RA. Laser biopsy artifact. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(5):458.
  24. Merigo E, Clini F, Fornaini C, et al. Laser-assisted surgery with different wavelengths: A preliminary ex vivo study on thermal increase and histological evaluation. Lasers Med Sci. 2013;28(2):497–504.
  25. Suter VG, Altermatt HJ, Dietrich T, Warnakulasuriya S, Bornstein MM. Pulsed versus continuous wave CO2 laser excisions of 100 oral fibrous hyperplasias: A randomized controlled clinical and histopathological study. Lasers Surg Med. 2014;46(5):396–404.
  26. Lanzafame RJ, Naim JO, Rogers DW, Hinshaw JR. Comparison of continuous-wave, chop-wave and super pulse laser wounds. Lasers Surg Med. 1988;8(2):119–124.
  27. Walsh JT, Flotte TJ, Anderson RR, Deutsch TF. Pulsed CO2 laser tissue ablation: Effect of tissue type and pulse duration on thermal damage. Lasers Surg Med. 1988;8(2):108–118.
  28. Sanders DL, Reinisch L. Wound healing and collagen thermal damage in 7.5-microsec pulsed CO2 laser skin incisions. Lasers Surg Med. 2000;26(1):22–32.
  29. Frame JW. Removal of oral soft tissue pathology with the CO2 laser. J Oral Maxillofac Surg. 1985;43(11):850–855.
  30. Azevedo LH, Galletta VC, De Paula Eduardo C, De Sousa SO, Migliari DA. Treatment of oral verrucous carcinoma with carbon dioxide laser. J Oral Maxillofac Surg. 2007;65(11):2361–2366.
  31. Jerjes W, Upile T, Hamdoon Z, Mosse CA, Akram S, Hopper C. Prospective evaluation of outcome after transoral CO2 laser resection of T1/T2 oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(2):180–187.
© Wroclaw Medical University