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At least 343 records · Page 19Linked to original sources

Impact of multiple biopsy cores on predicting final tumor volume in prostate cancer detected by a single microscopic focus of cancer on biopsy.

OBJECTIVES: To compare the impact that the number of biopsy cores have on final pathologic findings when minimal disease is detected at biopsy. Discordance has been noted between transrectal ultrasound-guided biopsy results and tumor volume even when minimal amounts of tumor are found on biopsy. METHODS: We identified patients who had undergone radical retropubic prostatectomy for a single microscopic focus of adenocarcinoma from a prospectively maintained surgical database. Patients were stratified into two groups: those with six biopsies or less and those with seven or more. The Gleason score, margin status, presence of extracapsular extension, and percentage of tumor volume were compared. RESULTS: A total of 102 patients in our database had a single microscopic focus of adenocarcinoma detected by needle biopsy. Of these patients, 65 underwent six or fewer biopsies and 37 underwent seven or more at transrectal ultrasonography. Of the 37 patients in group 2, 27 (73%) had a final tumor volume of less than 5% compared with 24 (37%) of 65 patients in group 1 (P = 0.002). Of the group 2 patients, 15 (75%) with Stage T1c had an estimated tumor volume of less than 5% compared with only 11 (34%) in group 1 (P = 0.01). No statistically significant difference was noted between the two groups for margin status, presence of extracapsular extension, or Gleason score. CONCLUSIONS: A single microscopic focus of cancer obtained after multiple cores predicts for a significantly lower tumor volume on final pathologic examination across clinical stages. In the context of greater tissue sampling, the minimal disease designation may carry more predictive value and be a useful parameter in stratifying patients with Stage T1c and other good-risk factors with regard to surgical outcome.

Adenocarcinoma↗

Upgrade rate of core biopsy-determined atypical ductal hyperplasia by open excisional biopsy.

BACKGROUND: Core biopsy finding of atypical ductal hyperplasia (ADH) are generally followed by open biopsy to avoid underestimation of malignant disease. METHODS: Retrospective examination of 11 gauge stereotactic-guided vacuum-assisted core biopsies was made with respect to ADH diagnosis, follow-up open biopsy, and upgrade rate. Readily available clinical, mammographic, and pathologic features potentially contributory to an upgrade were studied. RESULTS: This series of 1,313 patients had 43 ADH diagnoses. Thirty-two had open follow-up. There were 4 upgrades. Mammographic indication for biopsy, age, removal of calcifications, and the percentage of ADH in the specimen were not significant in predicting an upgrade with all probabilities over 0.10, odds ratios not different than 1, and 95% bounds all encompassing 1. CONCLUSIONS: These data indicate a high upgrade rate (13%) for ADH-positive core biopsies with no definitive predictive criteria for an upgrade. Our data support follow-up excision of ADH lesions diagnosed by core biopsy.

Biopsy↗

Transjugular liver biopsy: a review of 200 biopsies.

Transjugular liver biopsy was performed in 200 patients for whom percutaneous biopsy was contraindicated because of coagulation disorders (36%), ascites (32%) or for the work-up of portal hypertension (32%). An adequate biopsy allowing a histological diagnosis was obtained in 155 patients (77%). The biopsy was inadequate in 13 patients (6.5%). In 32 patients (16%) the biopsy failed. Complications occurred in 18 patients (9%). Twelve (6%) patients developed liver capsule perforations which were immediately embolized without complication. Inadvertent carotid artery puncture and supraventricular tachycardias occurred in three patients each. Transjugular liver biopsy is a valuable technique which provides information which would otherwise be unavailable in those patients for whom percutaneous biopsy is considered unsafe.

Ascites↗

Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps.

BACKGROUND: Monopolar hot biopsy forceps (HBF), bipolar HBF, and cold biopsy forceps (CBF) followed by bipolar electrocoagulation are used clinically to simultaneously perform a biopsy and coagulate diminutive colon polyps and angiomata. Our purpose was to conduct a randomized, controlled study to evaluate the safety of these different techniques in the canine right colon. METHODS: After right colotomy in 8 mongrel dogs, colonic mucosa was grasped en face, tented, and biopsy performed in randomized order. The dogs were sacrificed after nine days and the biopsy sites were identified and histologically examined. RESULTS: Monopolar HBF caused an overall mean rate of acute serosal whitening of 29% compared with 0% for bipolar HBF and CBF and 6% for CBF/bipolar probe. Histologically confirmed transmural injury 9 days after biopsy occurred in 44% of monopolar HBF compared with 5% of bipolar HBF, 0% of CBF, and 50% of CBF/bipolar probe. CONCLUSIONS: Monopolar HBF had significantly higher rates of acute serosal whitening and histologic transmural damage than bipolar HBF or cold biopsy alone. On the basis of these results, monopolar HBF should be avoided for coagulation of small or flat right colon lesions such as diminutive polyps or angiomata.

Animals↗

Repeat transrectal ultrasound-guided prostate biopsy: a strategy to improve the reliability of needle biopsy grading in patients with well-differentiated prostate cancer.

OBJECTIVES: Gleason grade from prostate needle biopsy (PNB) specimens is important in guiding therapeutic decision making in patients with localized prostate cancer. Recent data from our institution suggest a significant discordance between Gleason grading from PNB versus the actual pathologic grade at radical prostatectomy (RRP). Of most concern is that a substantial proportion of patients with Gleason score of 6 or less from PNB actually have Gleason score of 7 or more at RRP. Under classic measurement theory, one useful way to improve the reliability of an inherently unreliable test is to repeat it. We investigated this strategy in an effort to reduce undergrading errors. METHODS: The control group of patients (n = 51) from our neoadjuvant androgen deprivation protocol was used as the test (two-biopsy) group in this study. These patients underwent two separate PNBs before RRP. We used the highest Gleason score from the two biopsies in these patients and compared the error rates with a concurrent group of patients treated at our institution (n = 226) who had only one set (single-biopsy group) of prostate biopsies. All pathologic slides were reviewed at our institution. Any PNB grade of 6 or less that was scored as 7 or more on final pathology was considered significant. RESULTS: Mean age, prostate-specific antigen levels, and stage distribution were not significantly different between these two groups. In the single-biopsy group, 165 patients had PNB Gleason score of 6 or less. Of these patients, 63 (38%) had final pathologic grade of 7 or more. In the two-biopsy group, 37 patients had PNB Gleason score of 6 or less. Of these patients, only 7 (19%) had final pathologic grade of 7 or more (P = 0.04). CONCLUSIONS: Prostate rebiopsy minimizes the inherent unreliability of PNB derived grade and should be considered for patients in whom watchful waiting or nomogram-based therapy has been selected.

Biopsy, Needle↗

Audit of pleural biopsies: an argument for a pleural biopsy service.

We audited 203 consecutive pleural biopsies performed by medical and geriatric firms over a 3-yr period in our hospital (1987-9). For firms without a special respiratory interest only two to three biopsies per yr were performed, compared with 23 per yr for a respiratory team. Twenty percent of biopsies failed to obtain pleural tissue, 50% revealed normal or non-diagnostic pleural changes and 30% provided a diagnosis. For the respiratory team that performed a third (68) of the biopsies the failure rate for obtaining pleura was 9% compared with 27% for other teams. In view of this disparity a pleural biopsy service was offered by the respiratory team during routine bronchoscopy lists. A repeat audit (1990-2) following the introduction of this service revealed that 60% (84) of 141 biopsies were performed by the respiratory team with their failure rate for obtaining pleura being lower at 6% as compared to 16% for the general physicians. Thirty-one percent of biopsies provided a definitive diagnosis, being higher for those performed by the respiratory team (37%) as opposed to 23% for general physicians.

Biopsy, Needle↗

Transjugular liver biopsy: a prospective study in 43 patients with the Quick-Core biopsy needle.

PURPOSE: To evaluate the efficacy and complication rate of the Quick-Core biopsy needle system compared with traditional transjugular biopsy needle systems. MATERIALS AND METHODS: Between January 1994 and April 1995, 43 patients underwent transjugular liver biopsy with the Quick-Core system; 18-, 19-, and 20-gauge needles were used in 28, 13, and two patients, respectively. Histologic diagnoses, specimen dimensions, and adequacy of the biopsy sample were determined. Immediate and delayed complications were recorded. RESULTS: A total of 118 biopsy specimens were obtained with an average of 2.7 passes per patient. Biopsy was successful in 42 of 43 patients (98%); one specimen contained renal parenchyma. Of the specimens that contained liver tissue, 100% were adequate. Mean maximum sample lengths were 1.1 and 1.5 cm with the 18- and 19-gauge needles, respectively. The procedural complication rate of 2% was due to puncture of the liver capsule in one patient, but no clinical manifestations occurred. No delayed complications occurred in any patient. CONCLUSION: The Quick-Core biopsy system produces consistently satisfactory, reproducible specimen cores with a very low complication rate.

Biopsy, Needle↗

Diagnostic value of ultrasound-guided fine-needle aspiration biopsy, core-needle biopsy, and evaluation of combined use in the diagnosis of breast lesions.

BACKGROUND: To investigate whether ultrasound-guided core-needle biopsy (US-CNB) has more diagnostic value for breast tumors than ultrasound-guided fine-needle aspiration biopsy (US-FNAB) and to evaluate their combined use in patients with breast tumors. STUDY DESIGN: US-FNAB was carried out in 233 patients with breast tumors (254 lesions); both US-FNAB and US-CNB (combined biopsy) were performed in 81 of these patients (82 lesions). The diagnosis obtained by US-FNAB and US-CNB was compared with the surgical findings and the diagnostic value of US-CNB and combined biopsy were retrospectively evaluated. RESULTS: The sensitivity of US-FNAB was 86.9%, the specificity was 78.6%, and the accuracy was 84%. In contrast, the sensitivity of US-CNB was 86.2%, the specificity was 95.8%, and the accuracy was 89%. The specificity of US-CNB was significantly higher than that of US-FNAB and the inadequate biopsy rate of US-CNB was significantly lower than that of US-FNAB. For combined biopsy, the sensitivity, specificity, and accuracy were all 100%. The sensitivity, specificity, and accuracy of combined biopsy were significantly higher than those of US-FNAB. CONCLUSIONS: These findings suggest that US-CNB is more useful than US-FNAB, and that a combination of US-CNB and US-FNAB can markedly improve the preoperative diagnosis of breast cancer.

Adult↗

Medical thoracoscopic lung biopsy in interstitial lung disease: a prospective study of biopsy quality.

The aim of this study was to analyse the quality and diagnostic value of lung biopsies for the diagnosis of interstitial lung disease (ILD), taken with diathermy coagulation cup forceps during medical thoracoscopy. Patients with ILD, not specified after thorough clinical assessment, high-resolution CT (HRCT), bronchoalveolar lavage and transbronchial biopsy, were studied. Medical thoracoscopy was performed in an endoscopy suite under neuroleptic anaesthesia with spontaneous ventilation. Biopsy specimens were analysed prospectively by one lung pathologist blinded to the clinical findings. Over 2 yrs, 118 samples were analysed from 24 consecutive patients. A good quality biopsy was obtained in 23 patients, and 78% of the samples were of good quality. Biopsy findings plus clinical and HRCT data revealed a relevant diagnosis in 18 patients and some diagnostic clues in four patients, for whom further examinations were needed. No major complications occurred. Chest tube drainage averaged 5.3+/-4.7 days, and was related to the total lung capacity (p=0.008), which mirrors the severity of ILD. Separate sampling of biopsies from different lobes proved to be useful in one third of the cases. In conclusion, lung biopsy sampling can be performed safely by interventional pulmonary endoscopists and has a good diagnostic yield in interstitial lung disease of unknown origin.

Adult↗

[CT-guided percutaneous biopsies for the classification of focal liver lesions: a comparison between 14 G and 18 G puncture biopsy needles].

PURPOSE: Analysis and comparison of CT-guided 14- and 18-gauge cutting needle biopsies to accurately assess focal liver disease. METHODS: The data of 272 CT-guided biopsies in 268 patients were evaluated retrospectively with regard to sensitivity, specificity and complication rate of the chosen needle caliber in differentiating between benign and malignant disease as well as in the ability to determine specific cell types in the various disorders. A 14-gauge (G) needle was used in 101 (37.1%) cases, an 18-g needle biopsy was performed in 171 (62.9%) cases. The Fisher exact test was employed for statistical analysis. RESULTS: Cutting needle biopsy yielded sufficient histologic material in 267 of 272 (98.2%) cases. Correct diagnosis of malignancy was established in 178 of 191 (93.2%) lesions, 73 of 76 (96.1%) disorders were accurately defined as benign, resulting in an overall value of 94.0% (251 of 267). Of these 251 biopsies a definite histological diagnosis could be determined in 90.6% of the cases employing a 14 G needle and in 90.3% using an 18-g needle. The sensitivity, specificity and rate of complications were 94.8%, 92.0%, 3.0% for the 14-g needle and 92.7%, 97.6%, 0.6% for the 18-g needle, respectively. There were no statistically significant differences with regard to the needle size. CONCLUSIONS: CT-guided biopsy of hepatic lesions with the 18-g biopsy needle is of equivalent diagnostic accuracy when compared with the 14-g needle.

Adult↗

Endosonography-guided fine-needle biopsy of indurated pancreatic lesions using an automated biopsy device.

BACKGROUND AND STUDY AIMS: We have designed and evaluated a prototype automated spring-loaded biopsy needle for endoscopic ultrasonography (EUS)-guided tissue sampling of indurated lesions in which sampling using conventional aspiration needles has failed. PATIENTS AND METHODS: EUS-guided fine-needle biopsy using the new device was performed in four patients (two men, two women, mean age 65 years) with indurated pancreatic lesions that could not be penetrated with a conventional manually operated aspiration needle. The lesions were located in the head of the pancreas in two patients, in the genu in one, and in the body in one. RESULTS: The automatic biopsy needle allowed penetration of the pancreatic lesions in all cases. The biopsy route was transduodenal in two patients, and transgastric in the other two. The biopsies provided a core specimen for histological and cytological diagnosis in all cases. No complications occurred. CONCLUSION: The spring-loaded biopsy needle allows tissue sampling of indurated pancreatic lesions that cannot be penetrated with conventional aspiration needles. Further studies are warranted to determine whether this device can improve the results of EUS-guided fine-needle aspiration biopsy.

Adenocarcinoma↗

Magnetic resonance-guided biopsy of suspicious breast lesions with a handheld vacuum biopsy device.

PURPOSE: To evaluate a handheld vacuum-assisted device system for magnetic resonance image (MRI)-guided breast lesion biopsy. MATERIAL AND METHODS: In 32 patients, a total of 42 suspicious breast lesions (mean diameter 7.5 mm for mass lesions, 11.6 mm for non-masslike diffuse lesions) seen with MRI (no suspicious changes in breast ultrasound or mammography) were biopsied (27 lateral, 15 medial) using a 10G vacuum-assisted breast biopsy device under MR guidance. Histology of biopsy specimens was compared with final histology after surgery or follow-up in benign lesions. RESULTS: In all biopsies, technical success was achieved. Histology revealed 11 lesions with ductal carcinoma in situ (DCIS) or invasive cancer, three with intermediate lesions (LCIS) and 28 with benign breast lesions (adenosis, infected hematoma). In one patient with discordant results of MRI and histology, surgical excision revealed medullary cancer. In the follow-up (mean 18 months) of the histological benign lesions, no breast cancer development was observed. Besides minor complications (hematoma, n = 6), with no further therapeutic interventions, no complications occurred. CONCLUSION: MRI-guided breast lesion biopsy using a handheld vacuum-assisted device is a safe and effective method for the work-up of suspicious lesions seen with breast MRI without changes in mammography or ultrasound. In the case of discordant histology of vacuum biopsy and breast MRI appearance, surgical excision is recommended.

Adult↗

Apoptosis of mononuclear cell infiltrates in cardiac allograft biopsy specimens questions studies of biopsy-cultured cells.

During acute rejection, CD4 and CD8 T cells infiltrate the myocardium and cause myocyte death and dropout. CD4 and CD8 cells use a number of cytotoxic mechanisms, including fas-fas ligand interactions, which lead to apoptotic death. Since fas is expressed on myocytes, we investigated endomyocardial biopsy specimens from cardiac transplant patients to determine whether apoptosis is one of the mechanisms of cell death in acute rejection. Serial sections of individual endomyocardial biopsy specimens from patients histologically diagnosed as having grade 3A rejection (n=22 biopsy specimens), biopsy specimens showing a typical "Quilty effect" (n=10), and specimens with concurrent grade 3A rejection and the Quilty effect (n=6) were evaluated using the C-terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) technique for frequency of apoptosis in myocytes and mononuclear cell infiltrates. None of the examined sections showed detectable evidence of apoptotic myocytes, even within regions clearly showing myocyte damage. Of interest was our consistent finding that 85-98% of mononuclear cell infiltrates within biopsy specimens scored as having grade 3A rejection had undergone apoptosis. In marked contrast, 9 of the 10 specimens with Quilty lesions showed <5% apoptotic mononuclear cells in the endomyocardial infiltrates. Of further interest was our finding of 85-98% apoptotic mononuclear cell infiltrates within Quilty lesions associated with biopsy specimens scored as having grade 3A rejection. The frequency of apoptotic cells determined by the TUNEL technique was confirmed by histological examination of the morphology of the cells and with a technique that involves detection of c-jun. These results prompt a note of caution in the interpretation of data on the phenotype, cytokine profile, Vbeta T cell receptor repertoire, and donor specificity of mononuclear cells cultured and propagated from such cardiac biopsy specimens. The possible reasons for apoptosis of graft-infiltrating mononuclear cells are discussed.

Adult↗

Intraoperative ultrasonographically guided excisional biopsy or vacuum-assisted core needle biopsy for nonpalpable breast lesions.

OBJECTIVE: To compare duration and rates of underestimation and complete excision for nonpalpable breast lesions using either intraoperative ultrasonographically guided excisioned biopsy (IUGE) or directional vacuum-assisted biopsy (DVAB). SUMMARY BACKGROUND DATA: Percutaneous ultrasonography-guided core needle biopsy is preferable to stereotactic biopsy for treatment of nonpalpable breast lesions; however, underestimation and false-negative results can occur, and rebiopsy may be required. To date, however, there has been no comparison of these two procedures in terms of diagnostic accuracy and duration. METHODS: For 4 consecutive years, IUGE was performed for 104 nonpalpable breast lesions and DVAB for 128 lesions at Chang Gung Memorial Hospital. Of the DVAB cases, the handheld mammotome was used for 53 procedures, with all lesions removed as completely as possible. The duration of the two procedures was calculated from initial skin incision until completion of wound closure. Most of the patients with benign pathology underwent ultrasonographic examination at 3 months after surgery, with a follow-up examination at 1 year. Surgery was performed subsequently for all of the malignancy cases. RESULTS: The average ages and mean tumor sizes for patients undergoing IUGE or DVAB were 46 and 47 years and 1.1 and 1.0 cm, respectively. The average IUGE and DVAB surgery durations for 88 benign tumors and 117 benign lesions were 44.3 and 21.5 minutes, respectively (P < 0.001), and 43.5 and 20.6 minutes for the malignant tumors (n = 16 and n = 11), respectively (P = 0.036). The IUGE and DVAB surgery durations for tumors <1 cm in diameter were 43.5 and 20.6 minutes, respectively, and 44.2 and 23.6 minutes for tumors over that size (P < 0.001). An older-model mammotome was used for 75 patients, with an average duration of 24 minutes in comparison to 18 minutes for the handheld variant (P < 0.001). No false-negative results were noted and, except in the case of the malignant tumors, there was no need for reexcisional biopsy. Further, there were no underestimates of the disease for the 4 cases of atypical ductal hyperplasia and the 12 of noninvasive carcinoma. No further ultrasonographic evidence of tumors was noted for 95% of the benign pathologies, with no residual abnormality detected for 13 of the 27 malignant tumors after IUGE or DVAB. CONCLUSIONS: For treatment of nonpalpable breast lesions, both IUGE and DVAB eliminate false-negative results, underestimates, and the requirement for reexcisional biopsies. In comparison to IUGE, DVAB is more convenient and time efficient for excisional biopsy of nonpalpable breast lesions.

Biopsy, Needle↗

Transjugular liver biopsy: comparison with percutaneous liver biopsy.

A transjugular liver biopsy was performed on 60 patients. Specimens were successfully obtained from 57 (95%) patients. Specimens obtained from cirrhotic patients were frequently small-sized/fragmented. The wedge hepatic venous pressure and hepatic venous pressure gradient were higher in patients with small-sized/fragmented specimens than those with non-fragmented specimens (16.3 +/- 6.4 vs 12.3 +/- 4.9 and 10.9 +/- 6.2 vs 7.3 +/- 3.4 mmHg, P < 0.05, respectively). During the same period of time, percutaneous liver biopsies were consecutively performed on 277 patients. The liver specimens by transjugular method were generally smaller (0.63 +/- 0.58 vs 1.50 +/- 0.86 cm, P < 0.001) and more fragmented (63% vs 16%, P < 0.01) than those obtained by percutaneous method. Biopsy specimens obtained for diagnosis by the former method were inadequate from 6 (10%) patients and by the latter route were inadequate from 7 (2%) patients. Subcapsular haematoma in one patient was associated with the transjugular liver biopsy. Minor complications occurred in three patients: neck haematoma in two and paroxysmal supraventricular tachycardia during the procedure in one. In comparison, percutaneous liver biopsy was followed by minor complications in 20 patients and major complications in four patients. It is concluded that transjugular liver biopsy is a safe, valuable and alternative procedure to obtain liver specimens, especially in patients who were contraindicated for percutaneous liver biopsy.

Adult↗

Comparison of the Tru-cut biopsy needle with the Abrams punch for pleural biopsy.

In a prospective study pleural biopsy specimens obtained with a Tru-cut needle were compared with those obtained with an Abrams pleural biopsy punch from 36 patients in Zimbabwe judged to have an effusion of at least 1.5 litres; one patient had two biopsies. Both instruments were used on each patient, the Abrams punch being followed by the Tru-cut needle. There were no serious complications. The diagnoses determined by biopsy were: tuberculosis (11); carcinoma (12); chronic inflammation (9); and pleural fibrosis (4); one biopsy showed nothing abnormal. In 23 (62%) patients both biopsy needles produced adequate diagnostic material; in eight the Tru-cut needle alone produced diagnostic material and in six the Abrams punch alone. Thus diagnostic material was obtained in 31 patients from the Tru-cut needle and in 29 from the Abrams punch. The Tru-cut needle was useful and safe for pleural biopsy in this series and appeared to be particularly useful when the pleura was thickened.

Adolescent↗

Transjugular liver biopsy: a review of 461 biopsies.

Transjugular liver biopsy was performed in a large series of patients for whom routine percutaneous biopsy was contraindicated; most of the patients had severe liver disease associated with coagulopathies or massive ascites. Of the 461 biopsies performed over a 7-year period, adequate specimens for histologic diagnosis were obtained in 425; in 14 (3.3%), the biopsy provided a false-negative result. Minor complications such as neck pain, hematoma at the puncture site, or pyrexia occurred in 79 patients (17.1%). Serious complications were encountered in six patients (1.3%) (two with cardiac arrhythmias; four with intraperitoneal hemorrhage following capsular perforation), with an overall mortality rate for the series of 0.22%. Modification of the technique--taking the biopsy with the catheter positioned centrally rather than wedged peripherally--has reduced the occurrence of capsular perforation without affecting the success rate. Transjugular liver biopsy is a valuable technique that provides diagnostic information in a high proportion of cases in which conventional percutaneous biopsy is contraindicated.

Adolescent↗

Biopsy of the pancreas with a biopsy gun.

Cutting-needle biopsy under ultrasonic guidance was performed in 47 patients with suspected pancreatic carcinoma. The final diagnosis as revealed by autopsy, surgery, or radiologic/clinical follow-up was pancreatic malignancy in 39 patients and benign disease in eight. A correct diagnosis with the aid of biopsy findings was obtained in 44 of the 47 patients (94%). In three patients with carcinoma of the pancreas, the correct diagnosis was not obtained with use of results from the first biopsy. In two of these three patients, simultaneous biopsy of a liver metastasis revealed the presence of a malignant tumor growth. After the biopsy, two patients had a vasovagal reaction, and two experienced mild pain. No case of biopsy-induced pancreatitis occurred, although in one patient a transient rise in the serum amylase level was seen. The present results show that cut biopsy of the pancreas is a useful, reliable, and nontraumatic method in the diagnosis of pancreatic malignancy.

Adenoma, Islet Cell↗