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PubMed1983

Primary bone tumors: percutaneous needle biopsy. Radiologic-pathologic study of 222 biopsies.

Findings of 222 needle biopsies were evaluated to determine the accuracy of the procedure in diagnosis, the role of the biopsy in limb-salvage procedures, the contribution of needle biopsy in the assessment of tumor effect in patients receiving chemotherapy or radiotherapy, and reasons for failure to obtain diagnostic tissue. The overall accuracy of needle biopsy in diagnosis of benign and malignant tumors was 78.6%. The major tumor categories included osteosarcoma (50 patients), giant-cell tumor (33 patients), Ewing sarcoma (22 patients), and spindle-cell sarcoma (15 patients). The accuracy of needle biopsy in diagnosis for these tumors was 78%, 88%, 95%, and 87%, respectively. The results of follow-up needle biopsy were encouraging, with roughly a 70% adequacy in the patients who had osteosarcoma and 50% in the patients who had Ewing sarcoma. The major reason for failure to obtain tissue for diagnosis in 17 of 35 patients was the presence of blastic tumors. The presence of cystic lesions and faulty technique were other reasons for failure. Percutaneous needle biopsy in patients who have primary bone tumors is a helpful diagnostic tool, forms an important part of the limb-salvage procedure, and contributes to the assessment of tumor effects in patients receiving chemotherapy or radiotherapy. To minimize failure in obtaining adequate tissue for diagnosis, biopsy specimens of blastic tumors should be obtained from their soft tissue components, lytic areas, or the least dense areas, while a smear of aspirate from cystic lesions should be prepared for cytologic examination and the clot embedded in paraffin for histologic study.

Biopsy, Needle↗

PubMed1998

Large-needle core biopsy: nonmalignant breast abnormalities evaluated with surgical excision or repeat core biopsy.

PURPOSE: To classify lesions initially considered nonmalignant at large-needle core biopsy that were subsequently surgically excised or sampled at repeat biopsy. MATERIALS AND METHODS: From August 1, 1991, to December 31, 1996, 1,032 breast abnormalities (214 malignant and 818 nonmalignant lesions) were sampled at large-needle core biopsy. Of the nonmalignant lesions, 112 (14%) abnormalities were studied. Twenty-four abnormalities were subsequently excised because of discordant imaging and pathologic findings; 41 may have been missed at biopsy (25 were surgically excised, and 16 were sampled at repeat biopsy); 40 were surgically excised as recommended by the pathologist; and seven were excised for other indications. RESULTS: None of 24 abnormalities excised because of discordant findings was malignant. Among the 41 possibly missed lesions, infiltrating ductal carcinoma was found in one lesion that was removed surgically and in one sampled at repeat biopsy. Among the 40 lesions recommended for excision by the pathologist, 16 malignancies were found (ductal carcinoma in situ, 11; infiltrating ductal carcinoma, three; phyllodes tumor, two). None of the remaining seven lesions was malignant. CONCLUSION: Correlation of the technical quality of the biopsy, imaging features, and pathologic findings resulted in 96 surgical excisions and 16 repeat biopsies of lesions initially considered nonmalignant. Eighteen additional malignancies were identified.

Biopsy, Needle↗

PubMed1980

Transbronchial lung biopsy in sarcoidosis. An approach to determine the optimal number of biopsies.

In order to determine if the diagnostic yield of the transbronchial lung biopsy in sarcoidosis is dependent upon the number of biopsies, a study was designed to examine individual specimens from 6 biopsies in patients with Stage II sarcoidosis. It was found that the probability of obtaining a positive specimen per biopsy was 46%, and this percentage remained constant for each biopsy. The diagnostic yield followed a logarithmic curve, gradually increasing from 1 through 4 biopsies until about 90% of true positive diagnoses were obtained, then approaching a plateau with successive biopsies. We therefore recommend that 4 transbronchial lung biopsies are sufficient to diagnose stage II sarcoidosis in the majority of patients with diffuse lung disease.

Adolescent↗

PubMed1989

Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen.

We report the pathological accuracy of image-directed stereotactic brain biopsy in 30 patients who had mass lesions of the brain and subsequently underwent resection of the mass. The histological diagnosis at stereotactic biopsy was appropriate for direction of clinical management in 28 of 30 patients. Correlation between the stereotactic and resection diagnoses was exact in 19 of 30 cases. These included 11 of 12 nonastrocytic neoplasms and 8 of 13 astrocytic neoplasms. Correlation was imperfect in 9 of 30 cases, but not to the extent of having significant clinical impact. These included 2 cases of anaplastic astrocytoma that were upgraded to glioblastoma multiforme, 2 cases of astrocytoma that had a significant oligodendroglial component, and 5 non-neoplastic lesions that were reported on biopsy as showing nonspecific reactive changes. In 2 of 30 patients, the stereotactic biopsy was not accurate. This included one patient who had glioblastoma multiforme whose stereotactic biopsy showed only necrotic tissue. Serious diagnostic error that resulted in clinical mismanagement occurred in one patient who had a pineal germinoma that had large areas of granulomatous inflammation at which the stereotactic biopsy was directed. This study provides evidence that, with careful target placement, stereotactic biopsy can provide biopsy material that represents the entire lesion with an accuracy that is sufficient for clinical management.

Astrocytoma↗

PubMed1996

Image-guided percutaneous biopsy of musculoskeletal tumors: an algorithm for selection of specific biopsy techniques.

OBJECTIVE: The purpose of this study was to design and use an algorithm for selection of the most appropriate biopsy technique. MATERIALS AND METHODS: An algorithm was designed to maximize the tissue sampling and diagnostic accuracy of musculoskeletal tumor biopsy. We used fine-needle aspiration to sample small ( < 3 cm) soft-tissue masses, an 18-gauge automated Biopty Gun to sample large ( > 3 cm) soft-tissue masses, a bone-cutting core biopsy needle to sample sclerotic bone tumors, and a combination technique to sample lytic bone tumors with an intact bony shell. We reviewed the results of 46 consecutive biopsies obtained with this algorithm. RESULTS: The overall diagnostic accuracy was 96%, with one inadequate biopsy and one inaccurate biopsy. The diagnostic accuracies within subgroups of tumor types were: primary malignant tumors (n = 15), 93%; primary benign tumors (n = 9), 100%; secondary malignant tumors (n = 11), 100%; secondary benign tumors (n = 8), 88%; and infections (n = 3), 100%. CONCLUSION: This algorithm allows selection of the biopsy procedure most likely to safely provide adequate and accurate biopsy samples.

Adolescent↗

PubMed1999

Experience with breast biopsies using the Advanced Breast Biopsy Instrumentation system.

OBJECTIVE: A retrospective review of our experience with advanced breast biopsy instrumentation (ABBI) was undertaken to evaluate its efficacy for excisional breast biopsy of lesions detected on mammography. To our knowledge, experience with ABBI has not been previously reported in the radiology literature. MATERIALS AND METHODS: Biopsies using the ABBI system and an adapted dedicated table were performed in 53 patients who had 54 mammographically evident lesions. Samples were obtained with cannulas ranging in size between 5 and 20 mm. Indications for biopsy were calcifications (n = 22) and masses (n = 31). RESULTS: Forty-five specimens (44 patients) had benign results at pathology: 15 specimens were diagnosed as fibroadenoma, 15 as cystic breast disease, and four as reactive lymph nodes; the remaining 11 specimens had benign diagnoses of adenosis, fibrosis, and hyperplasia. The average specimen size was 4.8 cm in greatest longitudinal dimension. One patient had a nondiagnostic biopsy for calcifications later found to be dermal. Seven patients were diagnosed as having breast cancer; in six of these, the tumor involved the margins of the specimen. One patient had marked atypia that required reexcision for the diagnosis of intraductal carcinoma to be made. CONCLUSION: The ABBI procedure is a more invasive and less readily available procedure than core needle biopsy for sampling of benign breast lesions. In seven cases of malignancy diagnosed at breast biopsy, the ABBI technique completely excised only a single lesion. In our experience, the ABBI procedure offered no advantages over core needle biopsy for either benign or malignant lesions.

Biopsy, Needle↗

PubMed2000

Stereotactic breast biopsy: recumbent biopsy using add-on upright equipment.

OBJECTIVE: The purpose of the study was to show that stereotactic breast biopsy can be performed effectively and accurately using add-on stereotactic equipment when it is performed with the patient in a decubitus or recumbent position. MATERIALS AND METHODS: We retrospectively reviewed the results of 225 stereotactic core breast biopsies performed during a 42-month period. The biopsies were performed using a reclining mammography chair and add-on stereotactic equipment. Procedures were performed with the patient in the right or left lateral decubitus position or upright. Patients with benign biopsy results were followed up mammographically at 6 months initially, then yearly. RESULTS: Of the 225 lesions biopsied stereotactically, 205 lesions (91%) were biopsied with the patient in the decubitus (right or left) position and 20 (9%) biopsied with the patient upright. Pathology results were classified as abnormal in 45 lesions (20%) and normal in 180 lesions (80%). All but one of the abnormal lesions were followed up with surgical excision. One hundred thirty-four of the 180 benign lesions have been followed up with at least one 6-month mammogram (follow-up range, 6-40 months), and none of the lesions has been subsequently proven malignant. CONCLUSION: Stereotactic core biopsy can be performed effectively and accurately using standard add-on equipment when it is performed with the patient in the decubitus position. This approach obviates the use of dedicated prone stereotactic equipment.

Biopsy, Needle↗

PubMed1982

Endoscopic duodenal biopsy compared with biopsy with the Watson capsule from the upper jejunum in patients with dermatitis herpetiformis.

Forty-eight patients with dermatitis herpetiformis were investigated with duodenoscopy, endoscopic biopsy, and conventional upper jejunal biopsy. Three endoscopic biopsy specimens were obtained from the duodenal bulb, three to six specimens from the second part of the duodenum, and one suction biopsy from the upper jejunum. In 60%, 71%, and 65% of the patients subtotal or partial villous atrophy was found in biopsies from the three levels, respectively. In eight patients (17%) mucosal abnormalities were confined to the duodenal biopsies and in two patients to the jejunal biopsies. The technique of endoscopic biopsy is advocated because multiple visually selected duodenal specimens may be obtained and because this technique also enables a complete evaluation of the stomach.

Adult↗

PubMed1999

Automated stereotactic core needle biopsy of microcalcifications with correlation to surgical biopsy.

PURPOSE: To compare pathologic findings from stereotactic core and excisional biopsies in patients with microcalcifications in the breast. MATERIAL AND METHODS: Stereotactic core needle biopsies of 101 lesions with mammographic evidence of microcalcifications were performed with long-throw (2.2 cm) automated core biopsy devices fitted with 2.1-mm needles. The core specimens were placed on microscope slides and radiographed. The pathologic features of core and excisional specimens were compared. RESULTS: In 100 of the 101 breast lesions, a correct choice for an additional diagnostic procedure or definitive treatment could have been made upon histopathologic findings of the core needle biopsy. CONCLUSION: Stereotactic core needle biopsy is a reliable alternative to surgical biopsy of breast lesions with microcalcifications provided that specimen radiography has been performed to ensure that appropriate tissue has been obtained. Excisional biopsy may be avoided if microcalcifications are visible in radiographs of core biopsy specimen with benign histology.

Biopsy, Needle↗

PubMed1992

Percutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps.

To obtain a histopathologic diagnosis at the site of a biliary obstruction, we recently have performed 24 cases of biliary biopsy using gastrofiberscopic biopsy forceps (Olympus, Tokyo, Japan) via transhepatic tracts provided in the course of the procedure of percutaneous biliary drainage. Histopathologic diagnosis was successfully made at the first attempt of biopsy procedure but a second trial was made a week later in 6 cases who were negative for malignant cells on the first attempt. The histological results from the biopsy specimens were 18 adenocarcinomas, 5 chronic inflammations and one normal epithelium. Of 6 cases who were negative for malignant cells on forceps biopsy specimen, three cases were confirmed as adenocarcinoma of the ampulla of Vater, adenocarcinoma of the pancreas and chronic pancreatitis by surgical biopsy. The latter was a true negative result, which was diagnosed as chronic inflammation on forceps biopsy and verified as chronic pancreatitis by surgery. The remaining two cases were diagnosed as malignant obstructive jaundice by clinical and radiological follow-up findings. Major complications (bile peritonitis, bleeding, and hemopneumothorax) occurred in 3 patients, which mainly arose in the earlier period of study. This procedure can be performed at the same time as percutaneous transhepatic biliary drainage with low morbidity or mortality, and although the potential for perforation of bile ducts and injury to adjacent blood vessels is considered it is a useful addition to existing biopsy techniques for yielding material sufficient for histologic analysis.

Adult↗

PubMed2005

Follow-up of the transrectal ultrasonographic features of the prostate after biopsy: does any ultrasonographically detectable lesion form secondary to the first biopsy?

OBJECTIVE: The purpose of this study was to evaluate the transrectal ultrasonographic features of the prostate after biopsy and to find out whether any ultrasonographically detectable lesion forms secondary to biopsy. METHODS: Prebiopsy transrectal ultrasonographic findings in 60 consecutive patients who underwent repeated biopsies were evaluated. Detected lesions that were not defined before the first biopsy were considered postbiopsy-formed lesions and were sampled during the second biopsy. All transrectal ultrasonographically detected lesions were correlated with histopathologic results in the same locations. RESULTS: There were 7 (11.6%) patients with new hypoechoic lesions formed after the first biopsy. Histopathologic analysis of postbiopsy-detected lesions showed that 38.5% were cancer; 62.5% of the detected benign lesions were prostatitis foci. CONCLUSIONS: Prostate biopsy does not give rise to formation of fibrotic scar tissue in the peripheral zone. Most postbiopsy-detected lesions are prostatitis foci, but all hypoechoic lesions must be sampled during repeated prostate biopsies because of the 38.5% cancer detection rate.

Aged↗

PubMed2006

Sonographically guided percutaneous muscle biopsy in diagnosis of neuromuscular disease: a useful alternative to open surgical biopsy.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of sonographically guided percutaneous muscle biopsy in the investigation of neuromuscular disorders. METHODS: Sonographically guided percutaneous needle biopsy of skeletal muscle was performed with a 14-gauge core biopsy system in 40 patients over a 24-month period. Patients were referred from the Department of Neurology under investigation for neuromuscular disorders. Sonography was used to find suitable tissue and to avoid major vascular structures. A local anesthetic was applied below skin only. A 3- to 4-mm incision was made. Three 14-gauge samples were obtained from each patient. All samples were placed on saline-dampened gauze and sent for neuropathologic analysis. As a control, we retrospectively assessed results of the 40 most recent muscle samples acquired via open surgical biopsy. RESULTS: With the use of sonography, 32 (80%) of 40 patients had a histologic diagnosis made via percutaneous needle biopsy. This included 26 (93%) of 28 patients with acute muscular disease and 6 (50%) of 12 patients with chronic disease. In the surgical group (all acute disease), 38 (95%) of 40 patients had diagnostic tissue attained. CONCLUSIONS: Sonographically guided percutaneous 14-gauge core skeletal muscle biopsy is a useful procedure, facilitating diagnosis in acute muscular disease. It provides results comparable with those of open surgical biopsy in acute muscular disease. It may also be used in chronic muscular disease but repeated or open biopsy may be needed.

Adult↗

PubMed1999

Sentinel lymph node biopsy for breast cancer: the role of previous biopsy on patient eligibility.

Several reports have demonstrated the accurate prediction of axillary nodal status with radiolocalization and selective resection of sentinel lymph nodes (SLNs) in patients with breast cancer (BC). Because of concerns over lymphatic disruption, several authors have proposed that prior excisional breast biopsy is a contraindication for SLN biopsy. Clear unfiltered 99mtechnetium-sulfur colloid (1.0 mCi) was injected around the perimeter of the breast lesion (palpable and nonpalpable) or prior biopsy site. Resection of the radiolocalized SLN was then performed. Axillary lymph node dissection was performed immediately after SLN biopsy in the first 57 patients. Eighty-two BC patients underwent SLN biopsy. The SLN was localized in 98 per cent (80 of 82). The type of previously performed diagnostic biopsy or the location of the primary lesion did not influence the ability to localize the sentinel lymph node. In the 57 patients who had axillary lymph node dissection, metastatic disease was identified in 23 per cent (13 of 57). Axillary nodal status was accurately predicted in 98 per cent (56 of 57). Early experience with radiolocalization and selective resection of SLN in BC remains promising. By demonstrating the effective localization of the SLN regardless of the extent of prior biopsy, these data support expanding the number of patients potentially eligible for SLN biopsy.

Axilla↗

PubMed1975

Gastroscopic biopsy: reliability of histological diagnosis with special reference to the single biopsy.

For three years (1970-72) endoscopic gastric biopsies from 883 lesions in 862 patients were histologically examined, every single biopsy (4088) separately. In 38% of the cases, namely 142 malignant and 194 benign lesions, the diagnoses could be verified. If the criterion for a positive examination was that one of the biopsies showed unambigous carcinoma, the sensitivity of the examination was 76%, the specificity 99%, the PVpos 98%, and the PVneg 85% for the first examination, using the terms of Vecchio. If the biopsy diagnoses carcinoma with some uncertaincy and precancerous biopsies were considered positive too, and if all examinations prior to verification were included, the corresponding figures were 88%, 98%, 97%, and 91%. The most common number of biopsies used in an examination for diagnosing carcinoma was 4 (range 1-11). Fewer biopsies were used if the carcinomas were localized to the whole stomach, were protruded or had a largest diameter of more than 7 cm. The characteristic 'protruded' was the only tumour criterion which significantly was found most common among positive examinations. Ulcer-like carcinomas were common among the false negative. On the basis of pathoanatomy no special number of biopsies to be taken per examination could be recommended.

Autopsy↗

PubMed2002

[Repeat prostate biopsy in patients with previous negative biopsies].

We retrospectively analyzed the results of 104 patients who underwent a second prostate needle biopsy. Between January 1993 and September 2000, 654 needle biopsies were performed and cancer was found in 239 patients. Among the other 415 patients, 104 patients underwent a second biopsy. The average prostate specific antigen (PSA) value was 9.6 ng/ml (2.0-30.9) (Tandem R conversion value). Cancer was detected in 16 out of 104 cases (15%) at the second biopsy, 4 out of 39 (10%) at the third biopsy, and 3 out of 10 (30%) at the fourth biopsy. The age, PSA value, digital examination, echography, and magnetic resonance imaging (MRI) were not helpful in distinguishing the patients with prostate cancer and atypical histological findings at the previous biopsy were the most important information. Among the 9 patients who showed atypical findings at the previous biopsy, 6 (67%) had cancer.

Aged↗

PubMed2005

The evolution of untreated borderline and subclinical rejections at first month kidney allograft biopsy in comparison with histological changes at 6 months protocol biopsies.

Our study sought to identify the possible implications of histological findings of borderline and subclinical rejections as well as histological markers of chronic allograft nephropathy (CAN) in protocol biopsies at 1 and 6 months after living-related kidney transplantation. Twenty-eight paired allograft biopsies were blindly reviewed using Banff '97 criteria, among which only 10.7% (6/56) showed no histopathological lesions. BR was found in 9/28 (32.1%) and 6/28 (21.4%), and SR in 3/28 (10.7%) and 10/28 (35.7%) of the patients, in the 1 and 6 month biopsies, respectively. The mean CAN score (sum of histological markers for chronicity) increased significantly at 6 months biopsy, 1.57 +/- 1.36 vs. 4.36 +/- 2.32 (p < 0.01). When compared according to chronicity index (CI < 5 >), the high CI group had a mean CAN score of 2.36 +/- 1.15 at 1 month, which increased to 5.14 +/- 1.99 at 6 months biopsy (188.9%). The proportion of these changes in low CI group were also increased from 0.79 +/- 1.12 to 3.57 +/- 2.38 (451.9%). In conclusion, a protocol 1 month biopsy may uncover a high prevalence of BR or SR in stable allografts. The presence of an untreated BR or SR in biopsies with low chronicity index showed greater susceptibility to histological deterioration on the 6 month biopsy, associated with rapid impairment of graft function and chronic allograft nephropathy.

Adult↗

PubMed1988

[Bone biopsy of uncertain bone lesions using a new biopsy cannula measuring 1.4 mm].

Bone biopsy for the clarification of ambiguous lesions has until now been the last resort in diagnostic procedures because obtaining the material for histological evaluation has involved very traumatizing methods (biopsy by surgical intervention, percutaneous biopsy with high-caliber needles). A new bone-biopsy apparatus has now been developed that is provided with a cannula not much larger than a fine needle (1,4 mm); it can be used to obtain histologically evaluable biopsy material from almost all regions of the skeletal system. As the procedure can be carried out under local anesthesia, there is no undue stress to the patient. The complication risk is no higher than when using conventional fine-needle biopsy. Despite the small diameter of this needle it is possible to obtain biopsy specimens not only of osteolytic but also of osteoplastic lesions. An electric motor (20 rotations/min) is the power source for apparatus. The value of bone biopsy in diagnostic procedures has increased considerably.

Biopsy↗

PubMed1986

A low voltage diathermy loop for taking cervical biopsies: a qualitative comparison with punch biopsy forceps.

Twenty patients attending a colposcopy clinic because of a cytological suspicion of dyskaryosis were entered into a 'paired' biopsy study. A low voltage diathermy loop biopsy and a punch biopsy were taken from the cervix of each patient. In a second 'unpaired' study loop biopsies taken from 20 patients were compared with punch biopsies taken from 20 different patients. The length and depth of the loop biopsies were greater than those of the punch biopsies. There was no difference in the amount of artefactual damage. These findings held for both the paired and the unpaired studies. We conclude that biopsies taken with the low voltage diathermy loop are more likely to reveal microinvasive disease.

Biopsy↗