Adequacy Of Tissue Samples Research Articles

Robotic CT guided biopsy to aid histological confirmation of recurrent lymphoma in cases where tissue sample is challenging to obtain through conventional percutaneous methods.

e18796 Background: Histological confirmation of recurrent lymphoma, suspected on clinical history or imaging, enables the determination of an optimal treatment regimen. Conventional percutaneous biopsy methods often involve computed tomography to plan ‘freehand’ needle paths that will often require multiple in procedure adjustments which increases the risk of collateral damage. In cases where suspected recurrent disease is challenging to access using conventional methods, such as lesions close to major structures or located within the retroperitoneum, histological diagnosis can be delayed. Robotic CT guided biopsy allows precise lesion targeting, minimizing the risk of collateral injury, enabling minimally invasive tissue diagnosis in difficult to access lymphoproliferative disease. The aims of this analysis were to assess the safety of robot assisted biopsy by analyzing the related complications and the effectiveness of robotic CT guided biopsy via the sufficiency of histological specimens obtained. Methods: Retrospective consecutive analysis of 11 patients who underwent robotic CT guided biopsy between the months of January and October 2022 in the context of suspected recurrent lymphoproliferative disease. The decision for robotic guided biopsy was based on a multidisciplinary team assessment of the radiology and proposed target sites. Tissue sample adequacy and histological diagnosis were recorded from local histopathology reports. Biopsy related complications were recorded within a 4-month follow-up period from clinical documentation. Results: 11 patients underwent robotic CT guided biopsy. Sufficient samples consisting of at least 2 cores were obtained in all patients. 9 patients were identified with a recurrent form of lymphoma. 1 patient was negative for recurrence. In 1 case an insufficient sample was obtained. No biopsy related immediate or late complications were recorded. Conclusions: We find that, with careful case selection, robotic CT guided biopsy is allowing us to safely obtain a histological diagnosis in suspected recurrent lymphoma where conventional methods are deemed challenging. In the single case where an insufficient sample was obtained significant patient agitation was documented, highlighting that a static target remains of importance with robotic CT guided biopsy. The targeting accuracy the technique provides is allowing optimal treatment planning in a higher proportion of cases.

Learning curves and association of pathologist’s performance with the diagnostic accuracy of linear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA): a cohort study in a tertiary care reference centre

ObjectivesWe aimed to assess the learning curves and the influence of the pathologist’s performance on the endobronchial ultrasound transbronchial needle aspiration’s (EBUS-TBNA’s) diagnostic accuracy in a real-world study.Design/settingCohort study conducted...

Surgical Pathology Diagnostic Pitfalls of Hepatoblastoma.

Hepatoblastoma (HB) is the most common malignancy within the rare cohort of pediatric primary liver tumors. It may arise sporadically or in association with germline mutations in specific genetic syndromes. Histogenesis recapitulates fetal hepatic development, however, this tumor can exhibit a markedly heterogeneous appearance both macroscopically and under the microscope. Histologic subtypes are classified based on morphologic appearance, with additional discrimination based on emerging molecular and immunohistochemical features. Numerous diagnostic pitfalls exist from clinical presentation through to ancillary testing; at all stages, the surgical pathologist must be discerning and open to collaboration with colleagues of different specialties. Problematic areas include the adequacy of tissue sampling, correlation of histology with radiologic appearance and alpha feto-protein (AFP) serology, forming a diagnostic consensus within the pediatric pathology community and choosing a shrewd immunohistochemical panel. This review discusses the sequence of events leading up to histologic assessment, and the nuances of microscopic evaluation. Along the way, pitfalls are highlighted, providing a tool for the surgical pathologists to support their individual approach.

Combined Oral Administration of Analgesia and Anxiolysis for Pain Associated with Bone Marrow Aspiration and Biopsy

▪BackgroundBone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors.AimsOur randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested.MethodsPatients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg plus oral midazolam 5 mg in addition to LIA (combo-group, 51,4%) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0-10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A telephone interview was performed 24 hours later. A total number of one-hundred-sixteen (n =116) were enrolled in the study. Nine (n = 9) patients did not meet inclusion criteria and were excluded. Fifty-two (n = 52) patients were randomized and assigned to standard group and fifty-five (n = 55) to combo group (Figure 1).ResultsAt T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower (p < 0.05) perception of pain in the patients who received sedoanalgesia (combo-group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures, thus confirming the effectiveness of this combination also in relieving anticipatory anxiety. Finally, the histological specimen was found to be high in quality, as defined by standards.ConclusionsAdministration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia. [Display omitted] DisclosuresPane:Novartis: Honoraria, Speakers Bureau.

Endobronchial ultrasound needles: does size matter?

Endobronchial ultrasound guided sampling is a commonly performed endoscopy procedure. Despite its widespread use, the technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration, including the selection of needle size, have not been standardized among operators or institutions. Furthermore, professional guidelines are vague regarding their recommendations in choosing a needle size for optimal sampling. Various factors such as operator training, type of needle, use of suction, needle-tissue interaction, sample handling, processing, and presence of rapid on-site cytopathologic evaluation may impact the diagnostic yield. This review focuses on the various needle sizes used in endobronchial ultrasound-guided transbronchial needle aspiration, specifically comparing diagnostic accuracy and adequacy of tissue sampling, with a focus on use in lung malignancy, sarcoidosis, and lymphoproliferative disorders. Additionally, the advantages and limitations of different needle sizes will be addressed.

Adequacy of Tissue Sampling in Breast Specimen

Abstract Objectives Due to inadequate sampling concerns, pathologists frequently request additional tissue sections (ie, more tissue sections in addition to initial representative sections) in breast specimens. This study explores the effectiveness of the additional tissue sections in the breast specimens. Methods Breast specimens received in our institution on which additional tissue sections were requested were included in the study. Pathology reports and glass slides for these specimens were reviewed. Additional tissue sections were considered effective if they changed the final diagnosis altogether, changed a benign entity to borderline or malignant category, changed pathologic tumor stage, changed margin status, changed tumor focality, or if lymphovascular invasion was identified. Results A total of 325 specimens were identified. Of these, 98 (30.1%) were benign while 224 (68.9%) were malignant. Among malignant cases, 53 (23.7%) had neoadjuvant therapy. Overall mean initial representative sections submitted were 15.1 ± 8.7 while additional tissue sections were 10.7 ± 8.0. There was no difference in additional sections submitted for benign versus malignant cases (9.8 ± 7.7 vs 11.2 ± 8.0; P = .96). Also there was no difference in additional sections submitted for cases with neoadjuvant therapy versus those without any therapy (10.4 ± 6.9 vs 11.6 ± 8.4; P = .36). Twenty-five (7.7%) specimens benefited from submission of additional tissue sections. All 25 cases were malignant; 7 had neoadjuvant therapy while 18 did not. No tumor was identified in initial representative sections in 6 cases, pathologic tumor stage was changed in 12 cases, margin status changed in 2 cases, tumor focality changed in 4 cases, and an extra positive lymph node was identified in 1 case. Conclusion Additional tissue sections contributed to final diagnosis in 7.7% cases. Surgical pathology breast specimens require specialized handling and thorough sampling for accurate diagnosis and staging.

PF733 COMBINED ORAL ANALGESIA AND ANXIOLYSIS FOR PAIN ASSOCIATED WITH BONE MARROW ASPIRATION AND BIOPSY

Background:Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors.Aims:Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested.Methods:Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo‐group, 51,4%) during BMAB. Pre‐procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0–10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group.Results:At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower (p &lt; 0.05) perception of pain in the patients who received sedoanalgesia (combo‐group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures.Summary/Conclusion:Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.

Combined oral administration of analgesia and anxiolysis for pain associated with bone marrow aspiration and biopsy.

e18313 Background: Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors. Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested. Methods: Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo-group, 51,4%) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0-10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group. Results: At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower ( p&lt; 0.05) perception of pain in the patients who received sedoanalgesia (combo-group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures. Conclusions: Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.

Endoscopic techniques for full thickness intestinal biopsy.

Accurate diagnosis of gastrointestinal neuromuscular diseases requires full thickness biopsy for adequate histologic evaluation of the enteric neuromuscular and ancillary cells. Historically, this has been achieved by surgical approaches. An overview of procedure evolution and current techniques of endoscopic full thickness biopsy (EFTB) for diagnosis of gastrointestinal neuromuscular disorders will be presented. Emergence and advancement of endoscopic full thickness resection techniques has offered a less invasive, nevertheless an effective modality of tissue acquirement. Recently, clip-assisted close-then-cut EFTB has been utilized in clinical practice under research protocol. Early experience has shown that this technique provides an adequate full-thickness specimen including the myenteric plexus and ganglia cells, with acceptable safety profiles. EFTB is a promising means in diagnosing the nature of the disease and guiding therapy. Available animal and human studies have shown the noninferiority of endoscopic methods to surgical ones in term of adequacy of tissue samples, while potentially decreasing the risk and occurrence of complications. Further large prospective studies are needed to assess its efficacy, safety and impacts on patient's outcomes.

PTU-028 Peroral cholangioscopy – experience with conscious sedation

<h3>Introduction</h3> Per-oral Cholangioscopy (POC) offers the facility for direct visualisation of bile ducts, targeted biopsy and interventional techniques including Electro Hydro lithotripsy (EHL). Procedure completion time is often longer than conventional Endoscopic Retrograde Cholangio-Pancreatography (ERCP), patients often require high doses of standard sedation or general anaesthesia. We present our data where POC is performed under conscious sedation. <h3>Method</h3> Retrospective analysis was performed for all POC cases between January 2013 –December 2014. Definitions and endpoints were as used by Kalaitzakis <i><i>et al</i></i>.¹Procedural success was defined as direct visualisation of the lesion enabling tissue sampling. Adequacy of tissue samples were analysed against the final Multidisciplinary meeting (MDM) decision-detailing both benign and malignant diagnosis. <h3>Results</h3> 47 cases of POC were performed in 43 patients. Median age was 63 years (IQR 22–86 years). 31 cases were performed for non stone-related disease (28 for indeterminate lesions 3 for other reasons). 16 patients underwent POC for choledocholithiasis, 9 of which had EHL. All patients had conscious sedation during POC. Median midazolam dose was 7 mg (IQR 5–11 mg), fentanyl 150 mcg (IQR 50–225 mcg). Buscopan was used in 42 cases (range 20–60 mg) and glucagon (1 mg) in 6 cases. Lowest oxygen saturations recorded were 95% (range 95–99%). Where a score of 1 represented maximum discomfort and 5 least, worst comfort score recorded was 3 for a single case. There were 4 failed procedures, 1 due to patient related factors and 3 due to equipment failure. Median procedure time was 86 min (IQR 34–114 min) for non-EHL and 92 min (IQR 76–132 min) for EHL cases. Procedural success was established in in 42 (89%) cases with positive visualisation of the target lesion. For non-stone related disease, 27 were successful (87%). For suspected malignancy, POC performance was again comparable with published data (sensitivity 70%, specificity 93%, positive predictive value 88%, negative predictive value 81%), when compared against the final MDT decision. Overall complication rate was comparable with other published data (6.3%). Over sedation requiring reversal was not encountered in the study. <h3>Conclusion</h3> Diagnostic results and complication rates, in our study, were comparable with published UK outcomes. Our practice demonstrates that POC can be performed under conscious sedation without compromising patient safety, test tolerance or efficacy. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Kalaitzakis E, Webster GJ, Oppong KW, Kallis Y, Vlavianos P, Huggett M, <i>et al</i>. Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones. Eur J Gastroenterol Hepatol. 2012;24(6):656–64

Tissue Sample Adequacy for Mutational Analysis by Endbronchial Ultrasound and Electromagnetic Navigation Bronchoscopy

Tissue Sample Adequacy for Mutational Analysis by Endbronchial Ultrasound and Electromagnetic Navigation Bronchoscopy

Tissue Sample Adequacy for Mutational Analysis by Endbronchial Ultrasound and Electromagnetic Navigation Bronchoscopy

Tissue Sample Adequacy for Mutational Analysis by Endbronchial Ultrasound and Electromagnetic Navigation Bronchoscopy

Rapid on‐site evaluation of EUS–FNA by cytopathologist: An experience of a tertiary hospital

Endoscopic ultrasound-guided-fine-needle aspiration (EUS-FNA) is the preferred modality nowadays for the cytological diagnosis of various mediastinal and gastrointestinal lesions. Onsite cytopathology interpretation is not available in most centers. The objective of this study is to assess whether rapid on-site evaluation (ROSE) by cytopathologist of the tissue samples improves the diagnostic accuracy of EUS-FNA. This study is a retrospective review of all 646 patients undergoing EUS-FNA between January 2009 and October 2012 in our hospital. Patients in group I had cytology slides prepared by an endoscopy nurse. Patients in group II had cytology slides prepared, stained and assessed for adequacy of tissue sampling by a cytopathologist onsite. The adequacy of the samples and the final cytopathological diagnosis (definitely positive, definitely negative, inconclusive, or inadequate) was compared between the two groups. A total of 425 EUS-FNA procedures were performed in 375 patients in group I and 271 EUS-FNA procedures in 271 patients in group II. The mean of needle passes in group I was 3.12 passes per patient and 3.24 passes in group II. The difference in the number of needle passes was not statistically significant (P = 0.30). The final diagnosis was definite in 64.8% in group I compared with 97.7 % in group II (P = 0.001). The percentage of inconclusive and inadequate diagnoses was 5.6% and 29.3%, respectively in group I and 0% and 2.3% in group II (P = 0.001). In conclusion, ROSE by cytopathologist and interpretation significantly improves the diagnostic yield of EUS-FNA.

Is bigger better? A retrospective analysis of native renal biopsies with 16 Gauge versus 18 Gauge automatic needles

Percutaneous renal biopsy (PRB) remains the gold standard for the diagnosis of renal disease; however, the tissue yield which relates to the optimal needle size used for native-kidney biopsies has not been clearly established. Our study compares the sample adequacy and complication rates using 16 gauge (G) and 18 gauge (G) automatic needles on native kidney PRB. A retrospective analysis was performed of native-kidney biopsies at two centres, one exclusively using 16G and the other exclusively using 18G needles. All samples were assessed by a single centralized pathology service. We compared patient characteristics, indications, diagnoses, adequacy of tissue samples, and complications. A total of 934 native-kidney biopsies were performed with real time ultrasound guidance: 753 with Bard Max Core 16G × 16 cm needles, and 181 with Bard Magnum 18G × 20 cm needles. The median (range) of total glomeruli count per biopsy was higher in the 16G group compared with the 18G group (19 (0-66) vs. 12 (0-35), P < 0.001), despite having fewer cores per biopsy (2 (0-4) vs. 3 (1-4), P < 0.001). The 16G group provided a greater proportion of adequate biopsy samples (94.7% vs. 89.4%, P = 0.001). There was no significant difference in the frequency of total complications between the 16G and 18G groups (3.7% vs. 2.2%, P = 0.49). This retrospective study demonstrates 16G needles provide more glomeruli, more diagnostically adequate renal tissue, with fewer cores without a significant increase in complications compared with 18G needles. Based on these observations, 16G needles should be considered as the first line option in native-kidney PRB.

How to Find an Isoechoic Lesion with Breast US

Breast ultrasonography (US) is recognized as a useful diagnostic tool for palpable or nonpalpable breast masses, but isoechoic lesions surrounded by fat can be a challenge for radiologists and can result in false-negative interpretations and a delayed diagnosis of breast cancer. Identifying isoechoic lesions surrounded with fat by using breast US requires meticulous evaluation with B-mode US in correlation with mammography. For correlation between mammography and US, the location, surrounding tissue, and lesion characteristics, including size, shape, and internal contents, must be considered. Complementary tools to B-mode US in the evaluation of isoechoic breast lesions include spatial compound imaging, tissue harmonic imaging, US elastography, color or power Doppler imaging, power Doppler vocal fremitus imaging, and contrast agent enhancement. Specimen radiography after breast biopsy can be helpful in evaluating the adequacy of tissue sampling and the appropriateness of lesion targeting and localization, evaluations that increase confidence in the findings from tissue acquisition.

Does Onsite Cytotechnology Evaluation Improve the Accuracy of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy?

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the preferred modality for the cytological diagnosis of various cancers. Onsite cytopathology interpretation is not available in most centres. To assess whether the the adequacy of tissue sampling assessed by an onsite cytotechnologist improves the diagnostic accuracy of EUS-FNA. The present study is a retrospective review of all patients undergoing solid mass EUS-FNA between September 2005 and August 2007. Patients in group I (September 2005 to August 2006) had cytology slides prepared by an endoscopy nurse. Patients in group II (September 2006 to August 2007) had cytology slides prepared, stained and assessed for adequacy of tissue sampling by a cytotechnologist in the endoscopy suite. The final cytopathological diagnosis (definitely positive, definitely negative or inconclusive) was compared between the two groups. A total of 49 EUS-FNA procedures were performed in 47 patients in group I and 60 EUS-FNA procedures in 55 patients in group II. Pancreatic masses were the most common target site in both groups. The total number of needle passes was 105 in group I (mean 2.14 passes per patient; range one to five needle passes) and 158 in group II (mean 2.63 passes per patient; range one to four needle passes). The difference in the number of needle passes was not statistically significant between groups. The final diagnosis was definite in 53% in group I compared with 77% in group II (P=0.01). The percentage of inconclusive diagnoses was 47% in group I and 23% in group II (P=0.001). Onsite cytotechnologist interpretation of adequacy of tissue sampling significantly improves the diagnostic yield of EUS-FNA. This appears to be independent of the total number of needle passes undertaken for tissue sampling.

Frozen Section Diagnosis and Indications in Ophthalmic Pathology

Frozen sections for ophthalmic tissues require very precise indications. To describe indications and procedures for frozen sections in ophthalmic pathology based on review of my experience and reports in the literature. Frozen sections received by the ophthalmic pathology service at The Methodist Hospital from 1996 to 2004 were reviewed. A review of the literature also was performed. Of the 277 specimens received, most were eyelid lesions (138, 49.8%), followed by orbital (106, 38.3%), temporal artery (17, 6.1%), optic nerve (9, 3.2%), and conjunctival (7, 2.5%) lesions. A review of appropriate indications for intraoperative diagnosis is presented and a description of tissue handling and procedures to obtain better results in ophthalmic pathologic lesion cases is discussed. The most frequent indications for frozen sections in ophthalmic abnormalities are for margin control in eyelid and orbital lesions. At my institution, the second most frequent indications for ophthalmic frozen sections are the evaluation of adequacy of tissue sampling and triaging for flow cytometry and molecular techniques, especially in childhood malignancies.

Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration

Objectives Endoscopic ultrasound-guided fine needle aspiration (EUS-guided FNA) is becoming a preferred modality for diagnosing and staging GI and mediastinal malignancies. Although experts advocate on-site cytopathology assessment for tissue sample adequacy, there are few data to support this claim. Our goal was to determine whether on-site cytopathology interpretation improves the diagnostic yield of EUS-guided FNA. Methods EUS-guided FNA results from two university hospital centers were reviewed and compared. At center 1, where EUS-guided FNA was performed with a cytopathologist on site, the results of 108 consecutive patients were evaluated. At center 2, where a cytopathologist is unavailable, the results of 87 consecutive patients were reviewed. One endoscopist performed all procedures at both institutions. Cytologic diagnoses were categorized as positive or negative for malignancy, suspicious for malignancy, atypical/indeterminate, or unsatisfactory. The number of repeat procedures, needle passes, medication use, target site, age, and sex were compared between the two sites. Results Patients at center 2 were older ( p = 0.04) and predominantly female ( p = 0.03). Pancreas was the most common target site at center 2, whereas thoraco-abdominal nodes were the most common at center 1 ( p = 0.0001). Patients at center 1 had a diagnosis of positive or negative for malignancy more frequently ( p = 0.001) and were less likely to have an unsatisfactory specimen ( p = 0.035) or repeat procedure, although the latter was not significant ( p = 0.156) Conclusion On-site cytopathology interpretation improves the diagnostic yield of EUS-guided FNA. EUS centers should allocate resources to cover for on-site cytopathology evaluation.

Interventional musculoskeletal procedures performed by using MR imaging guidance with a vertically open MR unit: assessment of techniques and applicability.

To evaluate the safety of and time required for a broad range of musculoskeletal interventional procedures performed by using magnetic resonance (MR) imaging guidance with a vertically open 0.5-T unit. Sixty-three MR imaging-guided procedures were performed. A vertically open MR unit equipped with in-room display monitors allowed interactive freehand MR guidance predominantly with fast spin-echo and gradient-echo sequences. Each procedure was classified in terms of the anatomic location, procedure type, and tissue type involved. The procedures were evaluated for success of needle placement, adequacy of tissue sampling, total procedural time, needle time, number of needle passes, and complications. Procedures consisted of tissue sampling with core-needle (n = 6) or fine-needle aspiration (n = 20) biopsy, corticosteroid or contrast agent injection (n = 19), joint cyst aspiration (n = 7), and drainage (n = 11). Successful needle placement was achieved in all 63 cases. Cytologic and histologic tissue samples were sufficient for pathologic diagnosis in 24 of 26 cases. In two cases, complications occurred: transient local bleeding and a brief vasovagal episode. The mean total procedural time was 64.8 minutes; the mean needle time, 26.2 minutes; and the mean number of needle passes per patient, 1.6. With use of a vertically open MR unit, MR-guided interventional procedures involving bone, soft tissue, intervertebral disks, and joints are safe and sufficiently rapid for use in clinical practice.

Transvenous liver biopsy in critically ill patients: adequacy of tissue samples.

In a consecutive series of 33 patients (38 biopsies), the authors analyzed the pathologic specimens obtained with their relatively new transvenous biopsy method. From the point of view of establishing a useful pathologic diagnosis, the method proved worthwhile in the series of predominantly critically ill patients. A specific diagnosis or a later confirmatory tissue diagnosis was achieved in 18 patients, and a strong clinical correlation was achieved in 10 more. There were no complications from this repeatable, technically relatively simple, and safe procedure.