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PubMed1983

Influence of biopsy on the prognosis of nasopharyngeal carcinoma--a critical study of biopsy from the nasopharynx and cervical lymph node of 649 patients.

Most of the nasopharyngeal carcinomas (NPC) are histopathologically either poorly differentiated or undifferentiated. After radiotherapy, hematogenous spread is the chief cause of failure for these patients. Biopsies taken from the nasopharynx or the enlarged neck nodes should be performed to establish diagnosis before radiotherapy. The present study was done to ascertain whether the biopsy procedure would affect the final outcome of this malignancy, and to establish certain criteria for clinicians as they endeavor to correctly diagnose and prepare the patients for treatment. Six hundred and forty-nine of 702 NPC patients treated in our hospital from March 1958 through 1972 were analyzed for this purpose and the results are as follows: For patients with fixed and partially fixed neck nodes, the interval between the first biopsy and radiotherapy, the number of times or frequency of biopsy either taken from the nasopharynx or the lymph node and the type of biopsy done on the lymph node did not influence the prognosis. For patients with or without only movable neck nodes, the interval between the first biopsy from the nasopharynx and radiotherapy influenced the final outcome. Patients who received radiotherapy within 14 days after biopsy had a five year survival of 61% (42/69), which is better than that of the patients who started their treatment beyond the 15th day (47.5%-58/122). This is statistically significant (p less than 0.05). The number of times or frequency of biopsy taken from the nasopharynx before radiotherapy did not influence the result of treatment. The interval, therefore, and not the frequency, is important in the biopsy from the nasopharynx. For patients with movable lymph nodes, partial excision of the node gave a poorer five year survival (22%-2/9) than that of patients on whom complete excision was done (50%-9/18). Therefore, complete excision of the node is advised for patients with movable neck node metastasis.

Biopsy, Needle↗

PubMed2006

Correlation between core biopsy and excisional biopsy in breast high-risk lesions.

BACKGROUND: The purpose of the current study was to compare the prevalence of invasive or in situ cancer at excisional biopsy in patients with image-guided core needle biopsy (CNB)-proven atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma-in-situ (LCIS). Factors affecting the upgrade rate to malignancy were also identified. METHODS: Patients diagnosed with ADH, ALH, or LCIS on image-guided CNB (stereotactic or ultrasound) from 1995 to 2005 were identified through radiologic and surgical databases. Patients who subsequently underwent excisional biopsy of their lesion were included in the study. The imaging, medical records, and pathology of these patients were reviewed. RESULTS: Ninety-six patients with either ADH (61/96, 63%), ALH (19/96, 20%), or LCIS (16/96, 17%) on image-guided CNB proceeded to excisional biopsy. Malignancy was detected on excisional biopsy in 31% of patients with ADH, 16% of patients with ALH, and 25% of patients with LCIS. There were no significant differences between the 2 groups in terms of age, parity, hormonal status, or previous benign breast biopsies. The presence of a mass on mammography was associated with an increased upgrade rate to malignancy, while biopsies performed using vacuum-assisted devices, larger gauge biopsy needles, and greater number of cores were associated with a lower upgrade rate. CONCLUSIONS: Our data suggest that excisional biopsy is warranted in all patients with CNB diagnoses of ADH, ALH, or LCIS to exclude the presence of cancer.

Adult↗

PubMed2006

Role of transurethral resection of the prostate and biopsy of the peripheral zone in the same session after repeated negative biopsies in the diagnosis of prostate cancer.

OBJECTIVE: To determine the role of the transurethral resection of the prostate (TURP) together with biopsies of the peripheral zone in the diagnosis of prostate cancer after repeated negative transrectal biopsies and increasing prostate-specific antigen (PSA) levels. METHODS: From 2003 to 2004, 43 patients, aged 53-69 yr, were seen for a history of at least two negative biopsies for prostate cancer. Thirty-five men had an increasing PSA level and underwent another set of biopsies. Seven patients had prostate cancer (20%); three were lost at follow-up and four had a Charlson comorbidity index >1. The remaining 21 were offered TURP and biopsy of the peripheral zone. Bladder outlet obstruction had no influence on decision-making. Fourteen men accepted. RESULTS: Eight patients (57%) had prostate cancer and underwent radical prostatectomy. Six cancers were detected only with TURP, one with TURP and biopsy, and one with biopsy alone. After a median of 9 mo of follow-up, two of six patients underwent rebiopsy for a rising PSA level, but no cancer was detected. CONCLUSIONS: TURP combined with a set of transrectal needle biopsies of the lateral portion of the gland is a safe procedure with a high diagnostic power after repeated negative biopsies in patients with persistently increasing PSA levels.

Aged↗

PubMed2004

Use of interphase fluorescence in situ hybridization in prostate needle biopsy specimens with isolated high-grade prostatic intraepithelial neoplasia as a predictor of prostate adenocarcinoma on follow-up biopsy.

Isolated high-grade prostatic intraepithelial neoplasia (HGPIN) on needle biopsy confers an increased risk of prostate carcinoma (CaP) on follow-up biopsy. The aim of this study is to determine whether paraffin-section fluorescence in situ hybridization (FISH) of specific chromosome/oncogene copy number abnormalities (CNAs) in biopsy specimens with isolated HGPIN increases the predictive value for CaP on repeat biopsy. Cases were divided into 3 groups: controls (n=8) and sextant biopsy specimens with isolated HGPIN without CaP (group A; n=11) and with CaP (group B; n=14) on follow-up biopsy. Dual-color FISH assessing c-myc, HER-2/neu, chromosome region 7q31 (D7S486), and corresponding chromosome centromeres was performed. An amplification ratio (AR) for each marker centromere was derived for each biopsy specimen, with AR ranges designated as no/low, low-intermediate, and high. Also calculated for each marker were the percentage of cells with marker amplification, hyperdiploidy, and monosomy. A composite score for each biopsy specimen was calculated based on these parameters, with a possible range of 0 to 15. The specific chromosomal oncogene CNAs were as follows: for chromosome 7/7q31, 2 of 11 (18%) in group A and 6 of 14 (43%) in group B; for chromosome 8/c-myc, 4 of 11 (36%) in group A and 9 of 13 (69%) in group B; and for chromosome 17/HER-2/neu, 10 of 10 (100%) in group A and 13 of 14 (93%) in group B. The mean composite score was 0 for controls, 2.5 for group A, and 4.7 for group B. Composite scores > or =4 for the 3 groups were 0 of 9 (0%) for controls, 1 of 11 (12%) for group A, and 8 of 14 (57%) for group B. These differences were statistically significant (P=0.015). One group A patient with a high composite score (6) had atypical small glands on follow-up biopsy at <1 year. Chromosome/oncogene CNAs are uncommon in control patients, occurring with increasing frequency and magnitude in patients with isolated HGPIN without and with follow-up CaP. Chromosome/oncogene CNAs in HGPIN are mostly of the low to intermediate level and display intercellular heterogeneity. HER-2/neu amplification is common in HGPIN with and without follow-up CaP. Chromosome 7 and 8 aneusomy and 7q31 and c-myc amplification are greater in HGPIN with follow-up CaP. Patients with isolated HGPIN and high composite score without follow-up CaP are uncommon; these patients may have a small, unsampled CaP. Although patients with HGPIN without CaP are more likely to have a low composite score, a subset of patients with follow-up CaP have low composite score, suggesting (1) mutational pathways independent of chromosomes 7, 8, and 17 and HER-2/neu, c-myc, and chromosome region 7q31 CNAs; (2) CaP derived from an independent, unsampled focus of HGPIN; or (3) CaP not derived from HGPIN.

Adenocarcinoma↗

PubMed2003

Voiding impairment after prostate biopsy: does tamsulosin treatment before biopsy decrease this morbidity?

OBJECTIVES: To evaluate the association of transrectal ultrasound (TRUS)-guided prostate biopsy with voiding impairment and to investigate whether tamsulosin treatment given before prostate biopsy could improve voiding impairment after the procedure. METHODS: The study included 66 consecutive patients who underwent TRUS-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 33 were treated with tamsulosin (0.4 mg daily) beginning the day before the biopsy procedure for 30 days. The remaining 33 patients underwent TRUS-guided prostate biopsy only with no tamsulosin treatment and served as the control group. The International Prostate Symptom Score (IPSS) and maximal flow rate (Qmax) were recorded in all patients before the procedure and on postbiopsy days 7 and 30. All patients were followed up and questioned about difficulty voiding and acute urinary retention after the procedure. RESULTS: No difference was found in the mean IPSS and Qmax before biopsy between the two groups (P >0.05). Acute urinary retention after the biopsy procedure developed in 1 patient in the tamsulosin group and 3 patients in the control group. The rate of voiding difficulty on postprocedure day 7 was significantly lower in the tamsulosin group (9.09%) than in the control group (42.42%), a statistically significant difference (P <0.001). In the tamsulosin group, the IPSS was significantly decreased on postbiopsy days 7 and 30 compared with the baseline value (P <0.05 and P <0.001, respectively), and Qmax was significantly elevated on postbiopsy day 30 (P <0.01). In the control group, the IPSS was significantly greater (P <0.05) and the Qmax was significantly lower (P <0.001) on postbiopsy day 7 compared with the baseline value. CONCLUSIONS: The results of our study show that TRUS-guided prostate biopsy leads to transient voiding impairment, and therefore, the alpha(1)-blocker tamsulosin before biopsy and for a brief interval afterward may decrease this morbidity.

Adrenergic alpha-Antagonists↗

PubMedDate not supplied

Comparison of endoscopic forceps biopsies and capsule biopsies in determining disaccharidase activity in the duodenum.

Endoscopic biopsy is an accepted technique for obtaining samples of small bowel mucosa for histological examination. In this study a comparison between endoscopic forceps biopsies and capsule biopsies in estimating disaccharidase enzyme activity in the small bowel was evaluated. Disaccharidase levels on 168 consecutive small bowel biopsies obtained by either endoscopic biopsy or capsule biopsy were reviewed retrospectively. There was no significant difference in enzyme activity in samples collected by either method. Another 18 patients had simultaneous endoscopic and capsule biopsies from the second part of the duodenum. Again, there was no difference in enzyme activity between samples collected by either technique at the same level in the duodenum. The disaccharidase activity in forceps biopsies taken from the second part of the duodenum is equivalent to those obtained by capsule biopsy.

Adult↗

PubMed2002

The procedure of transrectal ultrasound guided biopsy of the prostate: a survey of patient preparation and biopsy technique.

PURPOSE: We surveyed urologists in community and academic practice regarding their standard approach to patient preparation and their technique of transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: We mailed 110 surveys to community urologists in Florida and urological oncologists at academic centers across the United States. Responses were calculated per group. RESULTS: Of the 88 respondents 34% were at academic centers and 66% were community urologists. Overall 79% of respondents prescribe an enema in preparation for biopsy, 81% administer an oral fluoroquinolone before biopsy, 50% give some type of analgesia, usually an oral agent, 63% obtain 8 or more cores per biopsy session, 36% biopsy the lateral and midline locations, and 83% do not use prostate specific antigen density to plan the biopsy strategy. CONCLUSIONS: The majority of urologists who responded to our survey ask their patients to use an enema in preparation for a transrectal biopsy procedure, prescribe an oral antibiotic and administer some type of analgesia. Few urologists administer a periprostatic nerve block. The majority obtain at least 8 biopsies and only 17% perform sextant biopsy. Some of these practices are not consistent with the literature. This survey provides insight into the practice patterns of urologists in regard to one of the most commonly performed office procedures.

Anesthesia, Local↗

PubMed2000

[Repetition of ultrasonography-guided prostatic biopsy for the detection of cancer. Study of a series of 192 re-biopsied patients].

PURPOSE: We reviewed the result of transrectal ultrasound (TRUS)-guided needle biopsies to find the re-biopsy criteria, emphasizing on the Focal Glandular Atypia (FGA) histological changes. MATERIAL AND METHOD: 192 cases were selected, from a total of 1957 patients older than 50, re-biopsied because of high PSA levels and/or abnormal DRE, or because of the histological findings on initial biopsies (high grade PIN and/or FGA). The results are related to the serum PSA levels and DRE characteristics. RESULTS: A 38.83% global positivity for cancer was obtained and 27.08% for re-biopsy. When the first biopsy was negative, the positivity of the re-biopsies was 19.37%; if it was negative for cancer but had high grade PIN and/or FGA changes, the positivity was 65.62%, being higher in FGA changes than in the PIN cases (68.00% vs. 57.14%). The abnormal DRE raised the positivity rate from 17.82% to, 35.75%. CONCLUSIONS: The positivity was especially related to abnormal DRE and/or PSA > or = 10 ng/ml. The tumor rate detected at second and third or successive biopsies was similar (19.28% vs 21.74%). The FGA changes (3.47% globally) had a cancer predictive value of 65.62%. We recommend re-biopsy in all patients with FGA changes.

Biopsy, Needle↗

PubMed2005

[How can the diagnostic value of head and neck biopsies be increased in Wegener's granulomatosis: a clinicopathologic study of 49 biopsies in 21 patients].

Head and neck biopsies usually have a low diagnostic value in Wegener's granulomatosis (WG). On the basis of 49 biopsies obtained from 21 WG patients at diagnosis from various sites, i.e. nose (29), paranasal sinus (7), oral cavity (4), larynx (4), conjunctiva (3) and external ear (2), we described the suggestive histological features and studied the diagnostic potential of the biopsy size, anaesthesia method (general (GA) or local (LA)), anatomic region of the biopsy, number of sections, and presenting macroscopic manifestations. Associated granulomatous inflammation (scattered giant cells, 28.5% of biopsies; poorly-formed granulomas, 28.5%), necrosis (neutrophilic microabscesses, 16.3%; geographic necrosis, 18.3%), angiitis (leukocytoclastic, 10%; necrotizing, 12%; and granulomatous, 6%) which confirmed the diagnosis were only present in 18.3% of the biopsies (28.5% of the patients). We think it is possible to propose a "WG-compatible" diagnosis when at least one of these histological features is present (24.5% of biopsies, 26% of patients in our study). We found that it was always better to perform biopsies targeted on macroscopic lesions. When there was no lesion, samples from paranasal sinuses obtained under GA had the highest diagnostic value in the head and neck region, whereas 90% of nasal systematic biopsies performed under LA were nonspecific. Moreover, we demonstrated that performing two further sections increased the sensitivity of histological examination by 7%.

Biopsy↗

PubMed1997

Stereotaxic needle-core biopsy and fine-needle aspiration biopsy in the diagnosis of nonpalpable breast lesions: controversies and future prospects.

OBJECTIVE: To determine the advantages and limitations of a combined stereotaxic fine-needle aspiration biopsy and needle-core biopsy in the diagnosis of 353 nonpalpable breast lesions with special attention given to the collection of follow-up data. METHODS AND MATERIAL: 353 nonpalpable breast lesions underwent 'one pass' stereotaxic fine-needle aspiration (21 gauge needle) and needle-core biopsy (18 gauge needle) at our institution from January 1990 to October 1993. Stereotaxic biopsies were carried out by means of an 'add-on unit'. Surgical biopsy was usually recommended for highly suspicious radiologic patterns and/or needle biopsy reports classified as atypical or malignant. In all other cases mammographic follow-up was advised at 6 months and then annually for 3 years. The data were collected retrospectively during September 1995 (theoretical average follow-up of greater than 3 years). RESULTS: Following the combined needle biopsy technique procedure, surgery was recommended for 83 lesions. Fifty-four cancers were associated to these suspicious lesions. Because of changing radiological or clinical pattern during follow-up (mean follow-up: 22 months), 11 cancers were detected among the 270 lesions initially considered not to need surgery. Forty-three percent of the 65 malignant lesions were initially read as having less than highly suspicious mammographic features. There was no significant difference between the sensitivity and the specificity of one pass fine-needle aspiration biopsy (57% and 96% respectively) and needle-core biopsy (60% and 97% respectively), but noncontributive samples were not included in the false negative diagnoses and atypical samples were included in the true positive diagnoses. Of the 11 missed cancers, nine were manifested initially by clusters of calcifications. Our diagnostic approach was significantly less sensitive (P = 0.006) and less specific (P = 0.032) in cases of clusters of calcifications (31% false negative diagnoses) than in cases of soft-tissue masses (5.5% false negative diagnoses). In this study, an average delay in diagnoses of 22 months was responsible for a significantly increased percentage of axillary node positive invasive cancer (P < 0.001) and six of the 11 missed cancers were palpable at the time of the delayed diagnosis. For the nine cancers initially manifested by calcifications, the 22 months delay in diagnosis was responsible for a nonsignificant increase of microinvasive type at the expense of carcinoma in situ. CONCLUSION: Our enthusiasm with the sensitivity of this double stereotaxic needle sampling has been tempered by the results of this reanalysis in the light of a mean theoretical follow-up of three years. Our diagnostic approach was adequate in the presence of soft-tissue masses but not valid in the presence of clustered calcifications. When dealing with calcifications, multiple samplings must be done in order to improve the sensitivity of the diagnosis. Furthermore, this study does not favour the theory that the majority of mammographically detected cancers are indolent and highlights the poor sensitivity of the mammographic follow-up of nonpalpable lesions.

Biopsy, Needle↗

PubMed2001

Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a preliminary study.

BACKGROUND: The diagnostic advantage of methylene blue (MB) chromoendoscopy in Barrett's esophagus is unclear. METHODS: Patients with columnar-lined esophagus (CLE) were enrolled into a prospective, randomized crossover trial of MB-directed biopsy versus conventional biopsy. RESULTS: Forty-seven patients (19 long-segment CLE; 28 short-segment CLE) were enrolled and underwent MB-directed biopsy. Sensitivity and specificity of MB for specialized intestinal metaplasia were 53% and 51%, respectively. Sensitivity and specificity of MB for dysplasia were 51% and 48%, respectively. Thirty-five patients (15 long-segment CLE; 20 short-segment CLE) completed the crossover trial. Relative frequencies for specialized intestinal metaplasia were 73% and 71% from MB-directed and conventional biopsy specimens, respectively (p = 0.73). Relative frequencies for dysplasia were 20% and 18% from MB-directed and conventional biopsy specimens, respectively (p = 0.65). In patients with long-segment CLE, dysplasia was diagnosed in 10 patients with MB and 7 patients with conventional biopsy methods (p = 0.25). The number of biopsy specimens per EGD was greater with MB, which may have influenced the diagnosis. Histologically, the grade of dysplasia was indefinite/low in nearly all of the dysplastic specimens. CONCLUSIONS: Results of MB-directed biopsy were similar to conventional biopsy in detecting specialized intestinal metaplasia and indefinite/low-grade dysplasia. MB was not useful in short-segment Barrett's esophagus.

Barrett Esophagus↗

PubMed2002

Patient-perceived cosmesis and satisfaction after breast biopsy: comparison of stereotactic incisional, excisional, and wire-localized biopsy techniques.

BACKGROUND: Several options exist for obtaining tissue for pathologic diagnosis of nonpalpable breast lesions. They are generally divided into traditional, open wire-localized biopsy through a 3- to 5-cm incision, stereotactic-guided excisional biopsy through a 1- to 2.5-cm incision, and stereotactic-guided incisional biopsy through a puncture wound a few millimeters long. Because all 3 techniques are reliable, cosmesis has been suggested to be a critical issue driving procedure choice. However, no study has surveyed breast biopsy patients themselves as to the importance of this issue. METHODS: We conducted telephone interviews with 59 women who underwent wire-localized biopsy (WL), stereotactic incisional biopsy with the Mammotome device (Mammo), or stereotactic excisional biopsy with the ABBI device (ABBI). All patients had benign diagnoses, were at least 2 years after procedure, and were matched to age and race. The questions were (1) How would you rate your scar? (2) Were you satisfied or dissatisfied with your biopsy experience? (3) Which is more important to you-complete removal of the abnormality or scar appearance? (4) Do you have any additional comments? RESULTS: Eighty percent of patients ranked complete removal of the abnormality more important than cosmesis. Ninety-five percent of the ABBI and Mammo patients rated their scar as excellent, whereas only 25% of WL did (P =.02). Ninety percent of WL patients, 80% of Mammo patients, and 75% of ABBI patients were satisfied with their experience (P = not significant). Many of the reasons for dissatisfaction were related to service quality rather than medical quality. CONCLUSIONS: Complete removal of the mammographic abnormality may be the priority for patients undergoing breast biopsy. There did not seem to be patient-perceived difference in cosmetic result between the Mammo and ABBI patients. Patient satisfaction is multifactorial, and attention must be paid to these issues generally ignored by physicians.

Adult↗

PubMed2002

The advantages of frameless stereotactic biopsy over frame-based biopsy.

A comparison study is presented, which examines the outcome, complications and cost of stereotactic brain biopsy performed with a frameless versus a frame-based method. The technique of frameless stereotactic biopsy has been shown previously, in both laboratory and in vivo studies, to achieve a level of accuracy at least equal to frame-based biopsy. The investigators have validated the technique in a large clinical series. The frameless and frame-based series were concurrent, comprising 76 and 79 cases, respectively. The frameless stereotactic technique involved standard needle biopsy, targeted by an image-guidance system and directed by a novel rigid adjustable instrument-holder. Frame-based biopsies were performed with the CRW and Leksell systems. There were no significant differences in the demographics, lesion site, size and pathologies between the groups. Operating theatre occupancy and anaesthetic time were both significantly shorter for the frameless series than the frame-based series (p < 0.0001). In addition, the complication rate in the frameless biopsy series was significantly lower than in the frame-based series (p = 0.018). This resulted in lower ITU bed occupancy (p = 0.02), shorter mean hospital stay (p = 0.0013) and significant cost savings (p = 0.0022) for the frameless stereotactic biopsy group, despite the greater use of more expensive MRI in these cases. This comparison study demonstrates that the superior imaging, target visualization and flexibility of the technique of frameless stereotactic biopsy translates into tangible advantages for safety, time and cost when compared with the current gold-standard of frame-based biopsy. The principles are discussed and the authors propose a definition for the term 'frameless stereotaxy'.

Adolescent↗

PubMed1998

Frequency of renal diseases and clinical indications for renal biopsy in children (report of the Italian National Registry of Renal Biopsies in Children). Group of Renal Immunopathology of the Italian Society of Pediatric Nephrology and Group of Renal Immunopathology of the Italian Society of Nephrology.

BACKGROUND: Children's renal biopsy data were gathered for 3 consecutive years (1992-1994) by the Group of Renal Immunopathology of the Italian Society of Pediatric Nephrology, which opened a paediatric section of the Italian Registry of Renal Biopsies. MATERIALS: The Registry recorded the histological diagnosis and the clinical data at renal biopsy of 432 children < or = 15 years old (mean age 8.96 +/- 3.7 years). RESULTS: The most common glomerulonephritis (GN) at renal biopsy was idiopathic IgAGN (18.8%) and the most frequent secondary GN was Henoch-Schönlein purpura (HSP) nephritis (11.6%). Minimal-change disease (MCD) accounted for 11.6%, focal and segmental sclerosis (FSG) 8.5%, mesangial proliferative GN (MPGN) 9.5%, membranoproliferative GN 5.5%, and thin-membrane disease 5%. Lupus nephritis was diagnosed in 5% and Alport's GN in 3.9% of the cases. The annual incidence of primary GN in Italian children was 11.1 cases per million children population (p.m.c.p.), IgAN accounting for 3.1 cases, MCD 2.3, and HSP nephritis 1.9 cases p.m.c.p. respectively. Italian children underwent renal biopsy because of isolated microscopic haematuria in 19.3% of the cases, non-nephrotic proteinuria with or without microscopic haematuria in 31.2%, and nephrotic-range proteinuria in 34.2%, less frequently (15.3%) because of acute or chronic renal failure. Children with persistent isolated microscopic haematuria had most frequently IgAN (34.9%) or thin-membrane disease (25.3%), while those with non-nephrotic proteinuria had IgAN (30.4%) and HSP nephritis (23%). In cases with nephrotic proteinuria renal biopsy showed MCD in 34.5% of the cases, FSG in 16.9%, and MPGN in 12.2%. When renal biopsy was performed in chronic renal failure, chronic interstitial renal disease was detected in 62.5% of the cases. CONCLUSIONS: This National Registry provides data on the indications for performing renal biopsy in Italian children and on the frequency and annual incidence of histological lesions detected. IgAN, primary or related to HSP, was the most common nephritis in Italian children undergoing renal biopsy.

Adolescent↗

PubMed1995

Double contrast upper gastrointestinal barium examination with biopsy versus endoscopy with biopsy in dyspeptic patients.

RATIONALE AND OBJECTIVES: The financial restrictions of the managed care environment require reconsideration of the barium upper gastrointestinal examination as a diagnostic tool for gastritis patients. However, a greater sensitivity and specificity for gastritis is needed. A prospective study was performed comparing barium examinations with gastric biopsies to endoscopy with biopsy. METHODS: Forty adult patients underwent upper gastrointestinal barium examination with gastric biopsies obtained under fluoroscopy through a nasogastric tube. Twenty-seven patients gave consent for subsequent endoscopy with biopsy. Both sets of biopsies were compared, as were the interpretations of the radiographs and visual appearances. RESULTS: For barium examinations with gastric biopsies, sensitivity for gastritis was 94% and specificity was 100%, using endoscopic biopsies as the gold standard. CONCLUSIONS: In addition to endoscopy with biopsy, the upper gastrointestinal barium examination with biopsy is another option of sufficient sensitivity and specificity for consideration by clinicians in their workup of patients with gastritis.

Adult↗

PubMed2004

Preoperative model for predicting prostate specific antigen recurrence after radical prostatectomy using percent of biopsy tissue with cancer, biopsy Gleason grade and serum prostate specific antigen.

PURPOSE: We developed a preoperative model to risk stratify patients for prostate specific antigen (PSA) failure following radical prostatectomy (RP) and identify those at high risk who would be potential candidates for neoadjuvant clinical trials. MATERIALS AND METHODS: A retrospective survey of 459 patients from the SEARCH Database treated with RP between 1990 and 2002 was done. Multivariate analysis was used to compare the preoperative variables of patient age, race, PSA, biopsy Gleason score, clinical stage and percent of prostate needle biopsy tissue with cancer for the ability to predict time to PSA recurrence following RP. Significant independent predictors were combined to create a novel risk grouping model. RESULTS: On multivariate analysis biopsy Gleason score (p < 0.001), percent of biopsy tissue with cancer (p < 0.001) and serum PSA (p = 0.001) were the only significant independent predictors of PSA failure. Combining these 3 significant predictors of PSA failure using previously published cutoff points for each variable generated a 4 tier preoperative model for predicting biochemical failure following RP (HR 1.91 for each 1 risk category increase, CI 1.62 to 2.26, p < 0.001). The model further stratified patients who were already stratified into low, intermediate and high risk groups based on a previously described model using PSA, biopsy Gleason score and clinical stage. A simplified table was developed to predict the risk of biochemical recurrence within 2 years following surgery, as stratified by percent of tissue with cancer, PSA and biopsy Gleason score. CONCLUSIONS: A combination of serum PSA, biopsy Gleason score and percent of prostate biopsy tissue with cancer define a new preoperative model for predicting PSA failure following RP. This model further stratified patients who were already stratified based on PSA, biopsy Gleason score and clinical stage, and it can be used preoperatively to identify patients at high risk who would be candidates for neoadjuvant clinical trials. Using this model an easy to use table was developed to predict preoperatively the 2-year risk of PSA recurrence following RP.

Biopsy↗

PubMed2004

A comparison of extended biopsy and sextant biopsy schemes for predicting the pathological stage of prostate cancer.

PURPOSE: We compared the performance of the extended multisite directed biopsy strategy to the sextant component of this strategy for predicting the pathological stage and Gleason score of the radical prostatectomy specimen. MATERIALS AND METHODS: We studied 157 men in whom prostate cancer was diagnosed by extended multisite directed biopsy and who underwent radical retropubic prostatectomy. The pretreatment variables of serum prostate specific antigen, prostate specific antigen density, biopsy specimen Gleason score, the location, number and percent of cancer containing cores, greatest tumor length in a single core and greatest percent of tumor in a single core were determined and compared with the pathological features of prostate cancer in the radical prostatectomy specimens. A comparison of the information obtained from sextant component cores of the extended biopsy strategy with that from all cores of the extended biopsy strategy was performed using chi-square statistics and ROC curve analysis. RESULTS: When comparing the areas under the ROC curves, the extended multisite directed biopsy strategy was found to have greater predictive power for extraprostatic extension than the sextant core component of this biopsy scheme, although the difference was not significantly different. The sextant component was equivalent to the extended biopsy strategy for predicting the prostatectomy specimen Gleason score. CONCLUSIONS: The extended biopsy strategy has better performance in the upper sensitivity ranges compared to the sextant technique for predicting extraprostatic extension.

Biopsy↗

PubMed2006

Application of a single needle type for all image-guided biopsies: results of 100 consecutive core biopsies in various organs using a novel tri-axial, end-cut needle.

PURPOSE: To assess feasibility, results and complications in image-guided biopsies using a single needle design in various organs. MATERIALS AND METHODS: 100 consecutive percutaneous biopsies were performed in 54 females and 46 males aged 24-87 years (mean age/standard deviation: 64.5 +/- 12 years) using a full-core end-cut tri-axial full-automatic biopsy needle (18 gauge BioPince, InterV-MDTech, Gainesville, Florida) under CT (n = 45) or ultrasound (n = 55) guidance. In 63 biopsies a coaxial technique was used. RESULTS: Biopsies were obtained of liver (n = 32), lymph nodes (n = 17), thyroid (n = 11), lung (n = 9), adrenal (n = 9), pelvis (n = 6), chest wall/pleura (n = 6), mediastinum (n = 4), lytic bone lesions (n = 2), retroperitoneum (n = 1), muscle (n = 1), pancreas (n = 1), peritoneum (n = 1). Between 1 and 6 (mean/SD 2.83 +/- 0.92) needle passes were performed. In 77 cases a malignant (40 metastases, 37 primary tumours) and in 23 a benign lesion was diagnosed. Of the 23 benign lesions a specific diagnosis was possible in 22. In one case necrosis and haemorrhage was diagnosed. In this patient surgery and autopsy both revealed a mediastinal haematoma of unknown origin. Eight minor complications (mild pain/local haematoma requiring no therapy) and three major complications (three pneumothoraces in nine lung biopsies requiring two aspirations and one drainage) were observed. There was no mortality. CONCLUSION: Percutaneous image-guided biopsy using the described full-core end-cut needle resulted in a specific diagnosis in 99/100 consecutive biopsies in various organs with a low complication rate. We use this needle type for all CT- or US-guided biopsies in all organs except for solid bone.

Adult↗