Adequate Biopsy Research Articles

The role of oesophageal physiological testing in the assessment of noncardiac chest pain.

Oesophageal physiology testing plays an important role in the diagnosis of noncardiac chest pain (NCCP) after cardiac, structural and mucosal abnormalities have been ruled out. Endoscopy can establish the presence of structural causes of chest pain such as cancer, oesophageal webs and diverticula. Even if macroscopically normal, eosinophilic oesophagitis is a common cause of chest pain and needs to be ruled out with an adequate biopsy regimen. In the remaining cases, diagnosis is focused on the identification of often subtle mechanisms that lead to NCCP. The most common oesophageal aetiologies for NCCP are gastro-oesophageal reflux disease (GORD), oesophageal dysmotility and functional chest pain. Ambulatory pH studies (with or without impedance or wireless measurements) can establish the presence of GORD, nonerosive reflux as well any association with symptoms of chest pain. High-resolution manometry, particularly with the inclusion of adjunctive testing, can rule out major motility disorders such as spasm, hypercontraction or achalasia. The EndoFLIP device can help define disorders with reduced distensibility, not easily appreciated with endoscopy or manometry. When all tests remain negative, a diagnosis of oesophageal hypersensitivity is normally made and therapy is shifted from targeting a disease to treating symptoms and patient affect.

Ultrasound-guided renal biopsy adequacy audit

Category: Biopsies and FNA

Pediatric Eosinophilic Esophagitis Is Associated With Increased Lamina Propria Immunoglobulin G4-Positive Plasma Cells.

Eosinophilic esophagitis (EoE) is considered a TH2-mediated food allergy disease that leads to submucosal esophageal fibrosis and strictures. Recent studies focused on adults with EoE identified a strong association with elevated esophageal IgG4 immunostaining. Our study aimed to determine the association of IgG4 with EoE in pediatric patients. Using our local EoE research registry, we identified 41 adequate biopsies from EoE patients. We used 10 age- and sex-matched patients with no diagnostic abnormalities at endoscopy or on biopsy. Using a monoclonal antibody to Immunoglobulin G4 (IgG4), we determined the maximum density of IgG4-positive plasma cells (IgG4-PC) per high-power field (hpf). Using a semi-quantitative assessment, we also graded the noncellular staining of the lamina propria and epithelium. Our EoE cohort consisted predominantly of boys with an average age of 5.9 years and 63% had a documented IgE-based food allergy. Median peak eosinophilia was 40 eosinophils/hpf and the median IgG4-PC density was 39/hpf in the active esophagitis patients, compared with a median of 0 IgG4-PC/hpf in the non-EoE patients (P = 0.0001). EoE patients with a food allergy showed a significantly higher IgG4-PC density (44.5/hpf) than those without a food allergy (8/hpf; P = 0.0385). There was no significant association between IgG4-PC density and peak eosinophilia (r = 0.0011). We demonstrate that active esophagitis in pediatric EoE patients is associated with elevated levels of IgG4-positive plasma cells, which was more significant in EoE patients with a documented food allergy. Our study also adds to the growing literature that EoE may involve more than just an exaggerated TH2 immune response.

Recent advancement in the early detection of melanoma using computerized tools: An image analysis perspective.

The paper reviews the advancement of tools and current technologies for the detection of melanoma. We discussed several computational strategies from pre- to postprocessing image operations, descriptors, and popular classifiers to diagnose a suspected skin lesion based on its virtual similarity to the malignant lesion with known histopathology. We reviewed the current state of smart phone-based apps as diagnostic tools for screening. A literature survey was conducted using a combination of keywords in the bibliographic databases: PubMed, AJCC, PH2, EDRA, and ISIC melanoma project. A number of melanoma detection apps were downloaded for two major mobile operating systems, iOS and Android; their important uses, key challenges, and various expert opinions were evaluated and also discussed. We have provided an overview of research on the computer-aided diagnosis methods to estimate melanoma risk and early screening. Dermoscopic images are the most viable option for the advent of new image processing technologies based on which many of the skin cancer detection apps are being developed recently. We have categorized and explored their potential uses, evaluation criteria, limitations, and other details. Such advancements are helpful in the sense they are raising awareness. Diagnostic accuracy is the major issue of smart phone-based apps and it cannot replace an adequate clinical experience and biopsy procedures.

An investigation into the diagnostic adequacy of biopsies provided by the oral and maxillofacial department at St George’s NHS trust hospital

An investigation into the diagnostic adequacy of biopsies provided by the oral and maxillofacial department at St George’s NHS trust hospital

Manifestations ostéo-articulaires secondaires à une piqûre, griffure, morsure ou à germes inhabituels ou émergents

Osteoarticular manifestations after a sting, a bite or a scratch are rare but the diagnosis should not be neglected. Targeted antibiotic therapy is mandatory. Surgery might help the diagnosis with adequate biopsy and is sometimes essential for recovery. A detective work is needed to identify a history of wound. Pantoea agglomerans (P. agglomerans) and nocardiosis are seen after a telluric wound, Capnocytophaga canimorsus (C. canimorsus) and Pasteurella multocida (P. multocida) after a dog bite, Bartonella henselae (B. henselae) and P. multocida after a cat scratch, Erysipelothrix rhusopathiae (E. rhusopathiae) when the wound is caused by a pig bone or a fishbone. A contact with water soiled with rat urine during work or leisure activity could indicate infection with Streptobacillus moniliformis (S. moniliformis) Spirillum minus (S. minus), Leptospira interrogans (L. interrogans). Bacteriological documentation might be difficult but is often mandatory to ascertain diagnosis and to adapt antibiotics. A sting can be responsible for a non-infectious arthritis. Inflammation is directly mediated by foreign body and is called “thorn arthritis”. Foreign body is often not seen on conventional radiography, hardly seen in ultrasonography, and surgery is needed to extract it and sometimes to perform synovectomy. Atypical mycobacteria are seen in patients with immunodepression but not only. Contact with fish or fishing material brings Mycobacterium marinum (M. marinum) to mind and a history of joint injection evoke Mycobacterium kansasii (M. kansasii). Surgery is frequently needed for diagnosis and treatment of tenosynovitis or arthritis caused by atypical mycobacteria. Tick-borne arthritis are mainly caused by Borrelia burgdorferi but can also involve Babesia divergens or Rickettsia conorii. Among arthropod-borne viruses, chikungunya provides a model of infection-triggered inflammatory joint disease.

Evolving biopsy techniques for the diagnosis of neuroblastoma in children

Background/PurposeTo compare the adequacy and safety of percutaneous core needle biopsy and surgical wedge biopsy of neuroblastoma in children. MethodsA retrospective review of patients who underwent biopsy for intermediate- or high-risk neuroblastoma at our institution between 2011 and 2015 was performed (recent cohort). Procedure details and outcomes were collected and analyzed using descriptive statistics and Wilcoxon rank tests; P < 0.05 was considered significant. Published data from 2002 to 2010 were compared (historic cohort). ResultsSince 2011, percutaneous, ultrasound-guided, core needle biopsy has been more commonly utilized (47% (16/34) recent vs. 25% (7/28) historic; P = 0.07), and the number of core needle samples increased from median 7 (historic) to 25 (recent). Complications decreased (21% (7/34) recent vs. 64% (18/28) historic; P < 0.01). Biopsy adequacy in the recent cohort was similar (94% percutaneous vs. 89% surgical; P = 1.00), which is improved from the historic cohort (71% percutaneous vs. 100% surgical; P = 0.06). Larger tumors were more likely to have a percutaneous biopsy (82 ± 37 cm percutaneous vs. 47 ± 29 cm surgical; P = 0.04). ConclusionsWhen multiple cores are obtained, percutaneous core needle biopsy is adequate for complete tissue diagnosis of neuroblastoma and can be safely performed. This can be considered as an alternative to open surgical biopsy. Type of studyTreatment Study. Level of evidenceIII.

Needle guides enhance tissue adequacy and safety of ultrasound-guided renal biopsies.

BackgroundNeedle guides have recently come into use for ultrasound-guided percutaneous renal biopsies; however, it is not yet clear if the use of needle guides leads to decreased post-biopsy complication rates and improved tissue yields. Thus, we conducted a retrospective single center study comparing biopsy yield, adequacy, and rates of complications before and after utilization of a needle guide device.MethodsA retrospective analysis was performed on all native kidney biopsies performed before and after June 2015 corresponding to the start of needle guide use. All biopsies in the latter period of the study were performed by a single operator. We compared clinical characteristics, indications, type of investigation, tissue yield, adequacy of procedure, and rates of major and minor complications.ResultsA total of 343 biopsies were analyzed, 140 in the pre-needle guide use period (Period I) and 203 in the needle guide use period (Period II). Biopsy yields were similar, irrespective of the use of needle guides. Tissue adequacy was better in Period II (93.7% vs. 84%, P < 0.001, with respect to pathologist-reported inconclusive biopsies. There were no differences in terms of major complications (1.7%) for the two periods; however, the rate of minor complications (8.4%) was significantly reduced in Period II (P = 0.006). According to multiple logistic regression analysis, not using a needle guide (odds ratio, 3.70; P < 0.001) along with low hemoglobin level, higher pre-dialysis serum creatinine level, and high urinary red blood cell count were significant predictors of biopsy complications.ConclusionUse of a needle guide improves biopsy adequacy and is associated with reduced rates of minor complications in native renal biopsies. Therefore, needle guides may be recommended in percutaneous renal biopsies, especially when transitioning to single-operator performed procedures.

The Spectrum of Glomerulopathies in Kashmir: A Tertiary Care Experience

Background: There is a paucity of data on the spectrum of renal diseases prevalent in the Jammu and Kashmir region. Objectives: To determine the spectrum of glomerulopathies in adult patients attending a tertiary care centre. Methods: Two hundred and twenty-one adequate biopsies from native kidneys of adult patients who presented with features suggestive of glomerular diseases at Sheri Kashmir Institute of medical sciences Srinagar Kashmir for the last 8 years were studied in a retrospective manner. Light and immunofluorescence (IF) microscopy were performed to evaluate these biopsies after obtaining well-informed consent from each patient. Results: Of the 221 biopsies carried out, 150 were performed on males and 71 on females with the mean age of 29 ± 13.5 years. The main presentation was the nephrotic syndrome in 177 (80%), hypertension in 60 (27%), renal insufficiency in 48 (21.7%), and abnormal urinary sediment in 42 (20.3%) of patients. The histopathology revealed minimal change disease (MCD) in 69 (31.2%), membranous glomerulonephritis (MGN) in 48 (21.7%), focal segmental glomerulsclerosis (FSG) in 49 (18%), and mesangioproliferative glomerulonephritis in 16 (7.2%). Patients with atypical presentation of diabetes mellitus showed diabetic nephropathy in 12 (5.4%) patients. Lupus nephritis was in 5 (2.2%) patients. Majority of the patients with MPGN had Immunoglobulin A deposits on IF. While evaluating the underlying cause of MGN, only 1 patient, a 62-year-old male, proved to have adenocarcinoma of the stomach. In the remaining patients, no secondary cause could be found. Thrombotic complications seen in our study were deep venous thrombosis, renal vein thrombosis and middle cerebral artery thrombosis. Conclusion: MCD and MGN were the most common primary glomerular diseases observed in our centre.

3:09 PM Abstract No. 92 Impact of rapid onsite pathology evaluation (ROSE) on biopsy adequacy: a retrospective review of 610 image-guided biopsies

Rapid onsite evaluation (ROSE) for percutaneous biopsy is a system in which a cytopathologist is available at the time of procedure to evaluate sample adequacy. The aim of our study is to evaluate sample adequacy rates at two academic hospitals staffed by the same group of interventional radiologists, one which uses ROSE and one which does not. We hypothesize ROSE improves the rate of diagnostic specimens obtained and decreases both the number of needle passes and the need for repeat biopsy. IRB approval was obtained at center 1 (with ROSE) and waived at center 2 (without ROSE) for this retrospective review of 610 liver, lung and thyroid biopsies. Center 1 included 96 thyroid, 110 liver, and 114 lung biopsies; center 2 included 117 thyroid, 60 liver, and 112 lung biopsies. The two groups were compared using the t-test and ANOVA for age and sex, respectively. Comparisons of the number of needle passes were done using least squares regression, adjusting for age, sex, and target site. Comparison of whether a specimen was diagnostic was done using a multivariate logistic regression model. After performing multivariate analysis adjusting for age, sex, and tissue type, the odds of having a diagnostic specimen were almost 4 times greater at center 1 than at center 2 (OR 3.97, p<0.01). The rebiopsy rate was significantly lower at center 1 when compared to center 2 (p<0.01). There was no significant difference in the number of needle passes taken per biopsy site when compared between the two centers. ROSE improves the diagnostic yield of image-guided liver, lung, and thyroid biopsies. Our large study presents evidence that on-site cytopathology is a valuable resource; it improves the time to diagnosis by increasing the diagnostic yield at the time of procedure, and it decreases the need for rebiopsy. Thus, centers that utilize image-guided percutaneous biopsy should allocate resources to cover on-site cytopathologic evaluation.

Abstract No. 691 Safety and diagnostic utility of percutaneous transcaval retroperitoneal biopsies

Percutaneous biopsy of retroperitoneal lesions via a transcaval approach has historically not been a preferred means of access secondary to concern for bleeding complications. The purpose of this study is to examine the safety and diagnostic adequacy of transcaval biopsies. 31 patients with clinical follow up underwent percutaneous transcaval biopsy of a retroperitoneal node using coaxial technique. Biopsies were performed with 22G fine needle aspiration (31/31) with or without additional 20G core biopsy (5/31). Clinical, imaging, and laboratory variables were analyzed, including position of guide needle with respect to the cava. Technical success was achieved in 100% of cases. Biopsies were diagnostic in 25/31 patients (80%). 24 (77%) cases were performed with FNA only and with pre-caval guide position, and 7 (23%) were performed with post-caval guide position (through both walls of the cava). There was no significant difference between pre- and post-caval guide positions on rate of diagnostic success (p=0.9) or change in hemoglobin levels (p=1.0). Flow cytometry was able to be performed in 4/7 (57%) cases in patients with history of non-Hodgkin's Lymphoma. There was 1 complication (3%) of post-biopsy retroperitoneal hemorrhage without hemodynamic changes in the pre-caval group which was managed conservatively. Percutaneous transcaval coaxial biopsy of retroperitoneal lesions is a safe and effective diagnostic technique with a low rate of post-procedural complications and a high rate of diagnostic adequacy of samples gathered. Position of guide needle in coaxial technique affects neither success of biopsy nor complication rate.

In vitro Comparison of Ethanol Metabolism in Precision Cut Liver Slices from C57Bl/6, Balb/c, DBA/2J and 129S1/SvlmJ Mice

Percutaneous biopsy is a key diagnostic tool for both native and allograft kidney diseases. Adequacy criteria vary, but at a minimum, a biopsy should allow the pathologist to reach a diagnosis and provide prognostic information such as the degree of interstitial fibrosis and tubular atrophy (IF/TA) and percentage of glomerulosclerosis. Whereas most studies use glomerular counts as a surrogate for biopsy adequacy, the amount and preservation of tubulointerstitium is equally important, considering IF/TA is a major prognostic parameter for most medical renal diseases. Many studies have compared the diagnostic adequacy of different gauge needles; however few have investigated performance differences between same gauge needles. In this study, we retrospectively analyzed 235 renal biopsies performed at a single center in Canada over 2 years to compare the utilization, safety, diagnostic and prognostic performance of two 18-gauge needles in native and allograft kidney biopsies. We found no significant difference in needle utilization between native and allograft kidneys, or between trainees and staff radiologists. The total tissue yielded area, glomerular counts, percentage of inadequate biopsies and number of passes were similar; however the number of cases in which IF/TA evaluation was deemed not possible was higher for biopsies using disposable instrument needles (4.3% vs. 0%; p = 0.01). These also showed greater number of tissue fragments (median 4 for reusable vs 3 for disposable; p = 0.04). We postulate that the increased tissue fragmentation might have impaired the pathologists ability to accurately assess interstitial fibrosis and tubular atrophy in biopsies obtained with the disposable instrument needles.

Diagnosis and kidney-sparing treatments for upper tract urothelial carcinoma: state of the art.

Conservative management of upper tract urothelial cancer (UTUC) is becoming increasingly popular: the key to success is correct selection of patients with low-risk UTUC based on size (≤2 cm), focality (single lesion), stage (< T2), and grade (low grade). Despite the recent growing interest in the conservative approach to UTUC, the diagnostic process is still a challenge, and kidney-sparing surgery (KSS) is traditionally reserved for patients with contraindications to radical nephroureterectomy. In order to explore the "state of the art" in the diagnosis and conservative treatment of UTUC, a systematic review of the literature was performed. A PubMed, Scopus, and Cochrane search for peer-reviewed studies was performed using the keywords "upper tract urothelial carcinoma" OR "UTUC" OR "upper urinary tract" AND "biopsy" OR "diagnosis" OR "endomicroscopy" OR "imaging" AND "URS" OR "ureteroscopy" OR "kidney-sparing surgery" OR "laser ablation" OR "ureterectomy". We considered as relevant comparative prospective studies (randomized, quasi-randomized, no randomized), retrospective studies, meta-analyses, systematic reviews, and case report series written in the English language. Letters to the editor and contributions written in languages other than English were not considered of value for this review. Eligible articles were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Two hundred and sixty-three (263) records were identified using the above-mentioned keywords. Overall, 30 studies were considered relevant for the purpose of this systematic review and for the evidence evaluation process during qualitative synthesis. The outcomes evaluated in this review were the current diagnostic methods and the KSS approaches in UTUC. Furthermore, we included in the review the emerging technology for distinguishing between normal tissue, low-grade UTUC, and high-grade UTUC. Conclusive diagnosis is fundamental to the decision-making process in patients who could benefit from conservative treatment of UTUC. The most relevant diagnostic modalities are computed tomography urography, local urine cytology, and ureteroscopy with acquisition of an adequate biopsy sample for histology. KSS includes the endourological approach and segmental ureterectomy. Promising technology in the endourological management of UTUC helps in providing intraoperative information on UTUC grading and staging, with a high accuracy. Patients treated conservatively have to undergo stringent postoperative follow-up in order to detect and, if necessary, treat any recurrence promptly. Further larger and multicenter studies are needed to confirm these findings.

Safety and adequacy of percutaneous kidney biopsy performed by nephrology trainees

BackgroundRecently there has been a progressive loss of specialty related skills for nephrologists. Among the skills we find the kidney biopsy that has a central role in diagnosis of renal parenchymal disease. One of the causes might be the belief that the kidney biopsy should be performed only in larger Centers which can rely on the presence of a renal pathologist and on nephrologists with a large experience. This trend may increase in the short term procedural safety but may limit the chance of in training nephrologists to become confident with the technique.MethodsWe evaluated renal biopsies performed from May 2002 to October 2016 in our Hospital, a mid-sized facility to determine whether the occurrence of complications would be comparable to those reported in literature and whether the increase in the number of biopsy performing physicians including nephrology fellows which took place since January 2012, after our Nephrology Unit became academic, would be associated to an increase of complications or a reduction of diagnostic power of renal biopsies. Three hundred thirty seven biopsies were evaluated. Patients underwent ultrasound guided percutaneous renal biopsy using a 14 G core needle loaded on a biopsy gun. Observation lasted for 24 h, we evaluated hemoglobin levels 6 and 24 h and kidney ultrasound 24 h after the biopsy.ResultsComplications occurred in 18.7% of patients, of these only 1,2% were major complications. Complications were more common in female (28%) compared to male patients (14,8%) (p = 0.004). We found no correlation between diagnosis, kidney function and complication rates; hypertension was not associated to a higher risk in complications. The increase of biopsy performing personnel was not associated to an increase in complication rates (18,7% both pre and post 2012) or with an increase of major complications (1.2% vs 1,2%).ConclusionsKidney biopsy can be safely performed in mid-sized hospitals. Safety and adequacy are guaranteed even if the procedure is performed by a larger number of less experienced nephrologists as long as under tutor supervision, thus kidney biopsy should become an integral part of a nephrology fellow training allowing more widespread diffusion of this technique.

Mesenchymal Mandibular Chondrosarcoma: A Case Report and Review of Literature

Introduction: Chondrosarcomas (CS) are malignant cartilaginous tumors of rare maxillary localization. Their evolution is generally slow in time. They have a high tendency for locoregional recurrence after surgical treatment. Their prognosis depends on their degree of differentiation and the quality of resection. The authors report a clinical case of mesenchymal mandibular chondrosarcoma (MC), which is considered to be a subtype of CS, and specify the epidemiological, diagnostic, therapeutic and evolutionary features of this tumor. Case Report: A 73-year-old woman reported in February 2018 in our department complained of a slowly enlarging mass involving the right part of the lower jaw for the last 18 months. On examination a firm multilobular painful mass was palpated with cortical expansion, occupying the right side. A CT scan with 3D reconstruction was achieved and showed osteolysis lesions and cortical thickening. The mass biopsy for histological examination found a grade I well-differentiated bone chon-drosarcoma. We performed a hemi-mandibulectomy with complete resection of the tumor. The anatomopathologic examination of the resection specimen was in favour of a grade II mesenchymal chondrosarcoma. No radiotherapy was needed. The patient’s follow up was uneventful. Discussion: CS grading is the key to its management. Low grade CS (grades I and II) of the facial skeleton are luckily the most common, they are best treated with a local resection using 1.5 cm margins for bone and soft tissue. According to published literature, CS was historically considered as a radio resistant tumor. Radiotherapy and chemotherapy were therefore mainly reserved for high-grade tumors and for non-operable lesions. However, radical local surgery appears to be the treatment of choice for low grade chondrosarcoma. Conclusion: CS’s definitive diagnosis depends on appropriate radiographic evaluation along with adequate biopsy with meticulous histopathological examination and adjunctive immunohistochimical analysis. Neither chemotherapy nor radiotherapy is indicated as primary treatment. A long period follow-up should be advised as recurrence and metastasis are very frequent.

C4d-negative antibody-mediated rejection: A pathologist's perspective and clinical outcome.

Banff'13 update included C4d-antibody-mediated rejection (ABMR) as a separate entity responsible for graft dysfunction with limited clinical/prognostic implications. We present a retrospective study to determine the incidence and outcome of C4d-negative ABMR. A total of 987 renal allograft (RA) biopsies obtained from 987 RA recipients were studied from January 2013 to January 2016. All samples were subjected to light microscopy using standard stains and C4d immunohistochemistry on paraffin sections and reported according to modified Banff's criteria. Adequate biopsies with immunological injuries were categorized as Group 1: pure ABMR, Group 2: combined ABMR with concurrent T-cell-mediated rejection (TCR), and Group 3: pure TCR. Groups 1 and 2 were further subgrouped as C4d positive (Group 1a and 2a) or C4d negative (Group 1b and 2b). Graft function was measured by serum creatinine (SCr) level (mg/dL). Of the 987 biopsies, 43.3% (404) biopsies revealed immunological injury. Of these, 27.7% of the biopsies revealed pure ABMR (Group 1), 60.6% revealed combined ABMR with TCR (Group 2), and 11.3% revealed pure TCR (Group 3). The overall incidence of ABMR (pure ABMR + ABMR with TCR) was 36.27%, of which C4d-negative rejections were 18.48% and 18.7% in Group 1 and Group 2, respectively. The mean SCr at the end of three years follow-up in patients with C4d-negative rejections was comparatively higher. C4d-negative ABMR, recently included in Banff'13, has a low incidence, usually presents early after transplantation but carries better outcome than C4d-positive ABMR. However, further long-term studies are still required for knowing the clinical course over years.

Trends in Biopsy-Based Diagnosis of Kidney Disease: A Population Study.

Background:Kidney biopsy is considered the gold standard for diagnosis of renal disease. It is increasingly performed in cases of diagnostic uncertainty, including in patients with coexistent diabetes and hypertension, for which a presumptive clinical diagnosis can be made. Little is known about the incidence and distribution of biopsy-proven kidney diseases. Changes in the distribution of biopsy diagnoses over time may have significant implications for resource allocation and future research.Objective:We studied the relative frequency of kidney diseases in Southern Alberta over the past 30 years, to determine whether the population-standardized annual biopsy rate and incidence of selected diagnostic categories have changed. We hypothesized an increasing incidence of renal biopsies and a growing proportion of nonglomerular diseases (eg, tubulointerstitial disorders) likely due to evolving indications for biopsy. Given the rise in obesity, diabetes, and aging population with chronic kidney disease (CKD), we anticipated a rise in nephroangiosclerosis and diabetic nephropathy over time.Design:Retrospective population-based cohort study using the Biobank for the Molecular Classification of Kidney Disease (BMCKD).Setting:Southern Alberta, Canada.Patients:All patients who underwent renal biopsy between 1985 and 2015 in our database.Measurements:We used descriptive and quantitative analysis to characterize demographics and biopsy-based diagnoses.Methods:We conducted a retrospective population-based cohort study to analyze all consecutive patients who underwent at least one kidney biopsy over a 30-year period in Southern Alberta (1985-2015). We considered the first adequate biopsy. We described the annual standardized incidence of biopsy-proven kidney diseases over time and summarized associated patient characteristics. We assumed a Poisson distribution for biopsy counts and used provincial demographic information to standardize rates.Results:During the study period, 6434 people (58% male; mean age: 47.9 years) underwent a kidney biopsy. The population-standardized annual biopsy rate increased from 10.8 biopsies per 100 000 person-years in the first 5 years of the study (1985-1989) to 18.2 biopsies per 100 000 person-years in the last 5 years (2010-2014). The mean age at the time of biopsy increased from 42.5 years (1985-1989) to 51.4 years (2010-2014). Glomerular diseases remained the most prevalent histopathological group, with a growing representation of diabetic kidney disease from 3.69% to 16.18%, and a relative decrease in the proportion of other glomerular diseases from 72.32% to 62.92% of glomerular diagnoses. Tubulointerstitial diseases increased from 5.87% to 7.36% of total diagnoses.Limitations:Classification schemes have changed over time, so recently recognized conditions may have been misclassified in earlier data. There was a changing group of pathologists and nephrologists over this period. Variations in interpretation and application of biopsy indications by physician may influence recorded prevalence of certain diagnoses. We do not yet have complete information on indications or patient outcomes linked to the database.Conclusions:In Southern Alberta, kidney biopsy is being utilized more frequently and in older people. Diabetic nephropathy is increasingly diagnosed, which may reflect either or both changes in the prevalence of causative factors and local biopsy practices.

Does cryoprobe biopsy increase the diagnostic yield in endobronchial tumor lesions?

Background Lung cancer is considered to be one of the most common causes of death among patients with confirmed cancer all over the world. Bronchoscopic diagnosis with ordinary forceps biopsy (FB) is applied primarily for those with endobronchial mass or with suspected visible abnormalities. The small-sized sample is the main limitation for the diagnostic yield by this procedure. Cryoprobe that is mainly used for the cryotherapy purpose has been involved and used nowadays for adequate diagnostic biopsy in patients with suspected endobronchial tumors or lesions. Aim The aim was to compare the flexible cryoprobe with conventional FB regarding diagnostic yield, and to show the feasibility, safety, and possible complications in patients with endobronchial tumor lesions. Patients and methods A total of 40 patients with endoscopically visible lesions were randomized into two groups: group I included 20 patients in whom biopsies were carried out using FB (two samples) and group II included 20 patients in whom biopsies were carried out using cryobiopsy (CB) (one sample). Results There was higher significant diagnostic yield of CB as regards the diameter size, finally diagnosed type of lung cancer and that was diagnosed from the first time bronchoscopy or after redobrochoscopy than FB. Bleeding was the only detected complication during both procedures, but there were no statistically significant difference among both techniques as regards bleeding during procedure, need for hamostatics during the procedure, hemoptysis postprocedure or need for hemostatics postprocedure. Conclusion Endobronchial CB is a safe, successful, and confident technique with superior diagnostic yield compared with ordinary conventional FB mainly because of the larger size and better quality of the obtained specimens’ excellent tissue preservation than that can be used during conventional fiberoptic FB.

Need for appropriate specimen for microbiology diagnosis of chronic osteomyelitis.

INTRODUCTION:Chronic osteomyelitis (COM) is a common infection, especially in developing countries. An adequate bone biopsy specimen processed with appropriate microbiology culture methods for isolation and identification of the causative organisms is considered as the gold standard for the diagnosis of osteomyelitis.MATERIALS AND METHODS:The present study is a retrospective microbiology analysis of the specimen from 219 clinically diagnosed cases of COM between January 2013 and April 2016.RESULTS:The overall culture positivity was 111/219 (50. 6%), colonization was seen in 22/219 (10.5%), while the rest 86/219 (39.3%) were culture-negative specimen; culture positivity was highest from tissue specimen (71/113, 62.8%). Among the swabs, 40/106 (37.7%) were culture positive. About 28/40 (70%) culture-positive swabs showed significant growth of Gram-positive organisms. Colonization with skin flora such as diphtheroids and Coagulase-negative Staphylococci was seen in 22/106 (20.7%) of the swabs. Sterile cultures (44/106, 41.6%) were high among the swab specimen. Gram-positives were most common (75/111, 67.56%). Staphylococcus aureus was the predominant organism isolated in 70/111 (63%) cases. Gram-negative bacilli showed a high level of antibiotic resistance.CONCLUSION:As per our data, the culture yield from wound swabs was low or contaminated with normal skin flora, as compared to the biopsy or tissue specimen. Hence, an appropriate sampling of the infected bone using recommended protocols is highly essential for improving microbiological yield and the outcome of COM.

Characteristics of percutaneous core biopsies adequate for next generation genomic sequencing.

PurposeDetermine the characteristics of percutaneous core biopsies that are adequate for a next generation sequencing (NGS) genomic panel.Materials and methodsAll patients undergoing percutaneous core biopsies in interventional radiology (IR) with samples evaluated for a 46-gene NGS panel during 1-year were included in this retrospective study. Patient and procedure variables were collected. An imaging-based likelihood of adequacy score incorporating targeting and sampling factors was assigned to each biopsied lesion. Univariate and multivariate logistic regression was performed.Results153 patients were included (58.2% female, average age 59.5 years). The most common malignancy was lung cancer (40.5%), most common biopsied site was lung (36%), and average size of biopsied lesions was 3.8 cm (+/- 2.7). Adequacy for NGS was 69.9%. Univariate analysis showed higher likelihood of adequacy score (p = 0.004), primary malignancy type (p = 0.03), and absence of prior systemic therapy (p = 0.018) were associated with adequacy for NGS. Multivariate analysis showed higher adequacy for lesions with likelihood of adequacy scored 3 (high) versus lesions scored 1 (low) (OR, 7.82; p = 0.002). Melanoma lesions had higher adequacy for NGS versus breast cancer lesions (OR 9.5; p = 0.01). Absence of prior systemic therapy (OR, 6.1; p = 0.02) and systemic therapy </ = 3 months (OR 3.24; p = 0.01) compared to systemic therapy >3 months before biopsy yielded greater adequacy for NGS. Lesions <3 cm had greater adequacy for NGS than larger lesions (OR 2.72, p = 0.02).ConclusionAs targeted therapy becomes standard for more cancers, percutaneous biopsy specimens adequate for NGS genomic testing will be needed. An imaging-based likelihood of adequacy score assigned by IR physicians and other pre-procedure variables can help predict the likelihood of biopsy adequacy for NGS.