A simple method to improve the efficiency of transrectal ultrasound guided prostate biopsy.

Abstract

It is estimated that 190,000 cases of prostate cancer will be diagnosed in 20021 and transrectal ultrasound biopsy is the current diagnostic gold standard.2 The cancer detection rate for transrectal ultrasound biopsy has been estimated at 25% to 35%,3– 6 implying that more than 500,000 biopsies are performed annually. Unless a patient specifically requests, it is usually performed under minimal, if any, anesthesia due to the short (7 to 10 minutes) duration of the procedure.7 However, many patients complain that the ultrasound probe is painful, and all of them want the procedure to be over as quickly as possible. Although the procedure takes only a few minutes, the majority of the time is spent removing the specimen and reloading the biopsy gun. We present a simple method that reduces the time needed to obtain 10 biopsies to 120 seconds. METHOD At our institution the most time consuming portion of the biopsy is removal of the specimen from the biopsy needle. The usual removal method requires the physician performing the biopsy to hand the biopsy gun (Radioplast AB Biotpy, Bromma Sweden) to the assistant who opens it, removes the biopsy needle and places the specimen into a designated container of formalin. The specimen often adheres to the biopsy needle, requiring the assistant to immerse the needle in the formalin, and in many cases use another device (the plastic sleeve included in the packaging of the biopsy needle is commonly used) to scrape the specimen off the biopsy needle. When this is complete, the biopsy needle must be rinsed in saline to remove the formalin, reloaded and handed back to the physician. In our experience this process takes at least 30 seconds and frequently results in broken specimens which may be more difficult for the pathologist to mount, section and interpret. All the while the patient lays with the probe uncomfortably in the rectum. RESULTS In our method when the physician hands the biopsy gun to the assistant, he recocks it and points the tip into the mouth of the specimen container but not in contact with the formalin. He fires the biopsy gun and the specimen is expelled into the container intact, without contaminating the needle and with no further manipulation needed. Should the needle touch the formalin, it can be rinsed in saline without removing it from the biopsy gun. By using this simple method and pre-labeled specimen containers we have reduced the time needed for the biopsy portion of the transrectal ultrasound (10 biopsies) to 120 seconds. CONCLUSIONS While patients still experience some discomfort, they are often surprised and uniformly grateful that the procedure is over so quickly. This simple modification makes a common procedure dramatically faster, has no deleterious effect on the accuracy of the test, reduces the chance for needle stick exposure and may actually improve specimen quality. REFERENCES