Adequate Tissue Sampling Research Articles

394 Gene expression based molecular test proves clinical validity as diagnostic aid for the differential diagnosis of psoriasis and eczema in formalin fixed and paraffin embedded tissue

Abstract Highly specific and efficient drugs have been developed to treat noncommunicable chronic inflammatory skin diseases (ncISD). Due to their specificity, these drugs require precise diagnostics to attribute the most efficient treatment to each patient. Diagnosis is complicated by the complex pathogenesis of ncISD and their clinical and histological overlap. Especially, precise diagnosis of psoriasis and atopic eczema is difficult in special cases, and molecular tools need to be developed to support gold standard diagnosis. Psoriasis and eczema are among the most prevalent skin diseases worldwide with a combined incidence rate of at least 2%. Although more than a dozen of immune-modulating therapies, particularly monoclonal antibodies targeting specific cytokines or their receptors, have become available over the last decade allowing highly effective treatment, the ultimate breakthrough would include accurate diagnostic tools. Diagnosis of both diseases largely depends on a subjective visual exam and histopathological examination. Due to phenotypical overlaps of both diseases, up to 50% of cases with a palmoplantar localization are misdiagnosed. To close this diagnostic gap, a gene expression-based classifier using NOS2 and CCL27 has been proposed and its clinical validity examined and proven in various patient cohorts. This study aims to develop a real-time based molecular classifier (MC) to distinguish psoriasis from atopic eczema in formalin-fixed, paraffin-embedded (FFPE)-fixed skin samples for diagnostic measures and to evaluate the potential of minimally invasive microbiopsies and noninvasive tape strips or sampling disks for molecular diagnosis. The FFPE, micro-(Ø1mm) and macrobiopsies (Ø4–6 mm), and tape strips were collected from psoriasis and eczema lesions and analysed by real-time polymerase chain reaction (PCR) for the expression of NOS2 and CCL27. A molecular classifier (MC) was established using a linear regression model. We transferred the RNAprotect-based molecular classifier to FFPE samples and were able to produce comparable results. Whereas the RNAprotect based MC distinguished psoriasis from eczema with a sensitivity and specificity for psoriasis of 97.7% and 100%, respectively, and an AUC of 0.99, the FFPE-based classifier determined probabilities for psoriasis with a sensitivity and specificity and of 92% and 100%, respectively, and an AUC of 0.97. To test if microbiopsies are also adequate tissue samples for the MC, we analysed gene expression in 83 pairs of macro- and microbiopsies by real-time quantitative-PCR. Delta-CT values showed no significant difference between macro- and microbiopsies. The MC led to reliable results in the vast majority of samples (91.57%) independent of biopsy size, with a small increase of misclassification (4.98%). The FFPE-based molecular classifier (MC) precisely separates eczema from psoriasis and efficiently identifies subtypes of both diseases. The reliability of the two markers NOS2 and CCL27 has been shown in FFPE tissue facilitating a possible implementation of this molecular diagnostic aid in routine clinical pathological practice. We further show that the gene expression profile of RNA later fixed microbiopsies is comparable to standard 4–6 mm biopsies and that microbiopsies are equally suited for the MC. We demonstrate the potential of tape strips of inflamed epidermis for molecular diagnostics of ncISD. Due to the minimally invasive sampling procedure, tape stripping may be particularly useful for the testing of visible and sensitive skin areas and in children as well as for repetitive sampling procedures necessary to monitor treatment responses over time. In summary, the MC discriminates psoriasis from eczema producing meaningful results in a broad range of skin tissue derived from invasive to minimally invasive sampling techniques. Further efforts are required to simplify and shorten the labor- and cost-intensive procedures of RNA isolation and real-time PCR. One possible solution is a fully automated and closed system, which would allow the integration of molecular diagnostics into the routine patient management at the point of care.

Quality of Tissue Samples Obtained by Endoscopic Ultrasound-Guided Liver Biopsy: A Randomized, Controlled Clinical Trial.

Liver biopsy (LB) remains essential for the diagnosis and staging of parenchymal liver diseases. Endoscopic ultrasound-guided LB (EUS-LB) has emerged as an attractive alternative to percutaneous and transjugular routes. We aimed at comparing the adequacy of samples obtained by EUS-LB with percutaneous LB. A single-center, randomized, controlled clinical trial was designed. Patients undergoing LB were randomly assigned to EUS-LB or percutaneous LB groups. EUS-LB was performed with a 19-gauge Franseen core needle through a transduodenal and transgastric route. Percutaneous LB was performed with a 16-gauge Tru-Cut needle. The main outcome was the percentage of adequate samples obtained. Secondary outcomes were the percentage of accurate histologic diagnosis, number of complete portal tracts (CPT), total and longest specimen length (TSL and LSL), sample fragmentation, adverse events, and patients' satisfaction. An adequate specimen was defined as TSL ≥20 mm and including ≥11 CPT. Ninety patients were randomized (44 to EUS-LB and 46 to percutaneous LB) and included in the analysis. The percentage of adequate tissue samples was 32.6% and 70.4% for percutaneous LB and EUS-LB, respectively (P < 0.001). A final histologic diagnosis was provided in all cases but one. TSL was longer after EUS-LB (23.5 vs 17.5 mm, P = 0.01), whereas the number of CPT was similar in both groups. Sample fragmentation occurred more often after EUS-LB (P < 0.001). No differences in adverse events were found. Satisfaction reported with both procedures was high. EUS-LB is safe and accurate and may be considered an alternative to percutaneous LB for the evaluation of parenchymal liver diseases.

Robotic-assisted bronchoscopy for peripheral pulmonary lesions: A single-center experience of the Ion platform

Rationale: The diagnostic yield of electromagnetic navigational bronchoscopy to access lung lesions remains low. The multicenter NAVIGATE study showed the diagnostic yield to be 71% for lesions up to 3 cm and 67% for lesions up to 2 cm. The introduction of robotic-assisted navigational platforms may overcome some of the traditional barriers encountered with previous approaches. We aim to assess the navigational and diagnostic yield of the Ion™ endoluminal system (Intuitive Surgical, Inc., Sunnyvale, California) regarding pulmonary lesions that could not previously be biopsied using conventional white light bronchoscopy. Methods: We retrospectively reviewed and analyzed data from our first 76 consecutive robotic-assisted navigational bronchoscopy (RAB) cases performed by a single proceduralist at our single center between March 11, 2020, to November 25, 2020. Secondary endpoints included the safety of the platform, such as incidences of pneumothoraces and significant bleeding events. Results: The ability to localize the lesion using the shape sensing technology was 100% (n=76). Navigational success, as determined by lesion visualization using radial endobronchial ultrasound confirmation, was 76% (n=58) of the nodules. The additional use of 2D-fluoroscopy for needle-in-lesion guidance and Rapid Onsite Evaluation to assess for adequate tissue sampling resulted in a diagnostic yield of 92% (n=70). There was a 0% complication rate for pneumothorax and significant bleeding events in the postoperative phase. Conclusions: Our study supports the current literature regarding the safety and efficacy of the Ion™ RAB for use in obtaining biopsy of peripheral lung lesions. Depending on the definition of navigational success, based on our results, the Ion™ RAB is comparable to or better than flexible bronchoscopy. The diagnostic yield is comparable to or better than flexible bronchoscopy but slightly lower than the gold standard computed tomography-guided transthoracic biopsy (CTTB) for peripheral lung lesions. However, in contrast to CTTB, the Ion™ RAB has lower complication rates for pneumothoraces and major bleeding. Further studies are needed to directly compare the current two robotic systems with a third system, Galaxy System™ by Noah Medical that is pending FDA approval.

Endometrial biopsy: Indications, techniques and recommendations. An evidence-based guideline for clinical practice.

This practice guideline provides updated evidence for the gynecologist who performs endometrial biopsy (EB) in gynecologic clinical practice. An international committee of gynecology experts developed the recommendations according to AGREE Reporting Guideline. An adequate tissue sampling is mandatory when performing an EB. Blind methods should not be first choice in patients with suspected endometrial malignancy. Hysteroscopy is the targeted-biopsy method with highest diagnostic accuracy and cost-effectiveness. Blind suction techniques are not reliable for the diagnosis of endometrial polyps. In low resources settings, and in absence of the capacity to perform office hysteroscopy, blind techniques could be used for EB. Hysteroscopic punch biopsy allows to collect only limited amount of endometrial tissue. grasp biopsy technique should be considered first choice in reproductive aged women, bipolar electrode chip biopsy should be preferred with hypotrophic or atrophic endometrium. EB is required for the final diagnosis of chronic endometritis. There is no consensus regarding which endometrial thickness cut-off should be used for recommending EB in asymptomatic postmenopausal women. EB should be offered to young women with abnormal uterine bleeding and risk factors for endometrial carcinoma. Endometrial pathology should be excluded with EB in nonobese women with unopposed hyperestrogenism. Hysteroscopy with EB is useful in patients with abnormal bleeding even without sonographic evidence of pathology. EB has high sensitivity for detecting intrauterine pathologies. In postmenopausal women with uterine bleeding, EB is recommended. Women with sonographic endometrial thickness > 4mm using tamoxifen should undergo hysteroscopic EB.

Successful right lower bilobectomy for endobronchial carcinosarcoma rapidly occluding the trachea: a case report

Background: Endobronchial carcinosarcoma is an extremely rare type of pulmonary carcinosarcoma. It is defined by coexisting histologic elements of carcinomatous parenchyma and sarcomatous stroma and the most common finding was squamous cell carcinoma. Although it is also characterized by polypoid growth without invasion of the adjoining bronchial mucosa, because the polypoid often shows necrosis, it hampers prompt diagnosis by adequate tissue samples and treatment.

Extra-adrenal peripheral neuroblastic tumors: A clinicopathological study of 18 cases

Peripheral neuroblastic tumors arise from the sympathoadrenal lineage of the neural crest. They have been classified according to the International Neuroblastoma Pathology Committee (INPC) into Four categories according to International Neuroblastoma Pathology Committee (INPC): a) Neuroblastoma (NB) b) Ganglioneuroblastoma (GNB), nodular c) Ganglioneuroblastoma, intermixed, and d) Ganglioneuroma (GN). Because of the rarity of extra-adrenal peripheral neuroblastic tumors, limited information is available regarding the chemotherapy of NB and GNB. A few case reports or case series with a small number of patients have been documented in the literature. To describe the clinicopathological characteristics of extra-adrenal peripheral neuroblastic tumors. Materials and. Clinical, histopathological, and immunohistochemistry (IHC) findings of 18 cases were retrieved. Immunohistochemistry at the time of diagnosis was performed using Ventana Benchmark XT. The mean value was calculated using the Microsoft Office Excel 2019 software. The posterior mediastinum was the most commonly affected extra-adrenal site in our study. Neuroblastoma consisted of eight cases (six in children, two in adults), of which four cases were poorly differentiated and the other four cases were differentiating. Two cases had favorable histology. The bone marrow and cervical lymph node metastasis were documented. Of the four GNB cases, one patient developed bone metastasis. All patients of NB and GNB received combination chemotherapy. One out of six GN patients presented with a large retroperitoneal mass encasing the aorta and renal vessels, mimicking a sarcoma. Extra-adrenal peripheral neuroblastic tumors do not pose any diagnostic issue in adequate tissue sampling. In limited material, immunohistochemistry is needed. The chemotherapy regimen has not been standardized due to rarity. Further molecular testing and targeted therapy may be of help in the future.

Utility of 5‐aminolaevulinic acid fluorescence‐guided endoscopic biopsy for malignant mesothelioma in a cat and dog

Malignant mesothelioma (MM) is uncommon in cats and dogs and can be challenging to diagnose. Adequate tissue sampling is required for superior diagnostic accuracy. Protoporphyrin IX, a metabolite of 5-aminolaevulinic acid (5-ALA), is a photosensitiser for photodynamic diagnosis (PDD). To the best of our knowledge, no study has reported the use of 5-ALA-PDD to detect MM in veterinary medicine. The present study describes the use of 5-ALA-PDD for MM diagnosis in a cat and dog, as well as the effectiveness of intracavitary chemotherapy. We evaluated the use of PDD with 5-ALA hydrochloride (5-ALA-PDD) in two cases of MM. A 12-year-old cat presented with a 1-month history of respiratory distress, and a 9-year-old dog presented with a 3-month history of mild abdominal distention. We endoscopically biopsied lesions in both the cases using 5-ALA-PDD. Histopathological examination revealed mesothelioma, and immunohistochemical staining was positive for calretinin. Both patients were treated with carboplatin. The cat died of respiratory failure. Although, the dog's condition improved 21 days after the first chemotherapeutic drug administration, the dog died on day 684 owing to cardiac-related issues. 5-ALA-PDD is thus, safe and feasible for the diagnosis of MM in veterinary medicine.

Prospective registration study of diagnostic yield and sample size in forceps biopsy using a novel device under digital cholangioscopy guidance with macroscopic on-site evaluation.

Although the SpyGlass Direct Visualization System can be clinically useful for diagnosing indeterminate biliary stricture, it employs SpyBite forceps, which typically obtain only a small amount of tissue and have a low sampling rate. An improved forceps biopsy device for SpyGlass DS has recently been released (SpyBite MAX). The aim of this prospective registration study was to assess the diagnostic yield and efficacy of histological biopsy tissue obtained with SpyBite MAX forceps compared with SpyBite forceps in patients with indeterminate biliary stricture. The primary outcome of the study was the diagnostic accuracy of biopsy specimens obtained by SpyBite MAX forceps. The secondary outcomes were tissue size, number of forceps biopsies, rate of obtaining adequate tissue, and adverse events in the SpyBite MAX forceps group compared with the SpyBite group. Forceps biopsies using SpyBite MAX (n=47) and SpyBite (n=50) were performed successfully in all patients. The number of biopsies performed before visible core tissue was obtained was significantly lower in the SpyBite (mean, 1.5 ± 0.7) than in the SpyBite forceps group (mean, 2.3 ± 1.1 mm; P < .001). Tissue sample size was larger in the SpyBite MAX group (mean, 1.8 ± 1.6 mm2 ) than in the SpyBite group (mean, 1.0 ± 0.9 mm2 ; P=.004) but there was no significant difference in diagnostic accuracy. Improvements in dedicated forceps for biopsy in SpyGlass DS may contribute to improving the rates of adequate tissue and tissue sample size obtained, and to reducing the number of forceps biopsies required.

S2819 Endoscopic Full-Thickness Resection as a Means to Diagnose Hirschsprung Disease

Introduction: Hirschsprung Disease (HD) is the congenital absence of ganglionic cells in the rectum and often thought of as a disease of childhood. However, this disease may persist into adulthood and symptoms such as chronic constipation can negatively affect quality of life. Patients often require a multidisciplinary approach between geneticists, colorectal surgeons, endoscopists and gastrointestinal pathologists during initial evaluation. Confirming the diagnosis has historically required a suction or open rectal biopsy, which is considered the gold standard for diagnosis. This is an invasive procedure that is prone to complications. Potential biopsy modalities include open, punch, suction and endoscopic. Interestingly, endoscopic biopsy using an endoscopic full-thickness resection (EFTR) device is rarely reported. Case Description/Methods: Here we present a case of a 42-year-old female with a history of Hirschsprung disease diagnosed as a child. The patient had an extensive surgical history including colostomy, colostomy reversal, and closed loop obstruction. The patient had also been recently diagnosed with an enterocutaneous fistula. The patient was evaluated by a general surgeon who referred her to gastroenterology motility clinic. Gastrografin enema confirmed extensive stool burden without strictures. The patient underwent anorectal manometry, which found abnormal push, high sphincter pressure at rest, and absence in rectal inhibitory reflex, findings concerning for HD. A flexible sigmoidoscopy was performed to determine the extent of the disease. Full thickness endoscopic biopsy of the rectum using an EFTR device showed an absence of ganglionic cells. The patient underwent a takedown of enterocutaneous fistula as well with improvement in symptoms. (Figure) Discussion: Endoscopic biopsy of the rectum is a minimally invasive technique that can provide adequate tissue samples to confirm a diagnosis. There is a paucity of data regarding the comparison between endoscopic versus traditional techniques. Based on our experience, we suggest that endoscopic rectal biopsy may be a safe and effective method to diagnose Hirschsprung Disease in the adult population. EFTR devices are potentially able to resect the entire wall of the gastrointestinal tract. This technique could greatly simplify the diagnostic process in that it is safe and effective, and less invasive than surgical techniques. However, further studies are needed to better characterize the utility of this technique in this specific patient population.Figure 1.: A) H&E showing absence of myenteric ganglion cells B) Successful endoscopic full-thickness resection of tissue with Ovesco clip in place.

S1686 Primary Pancreatic Diffuse Large B Cell Lymphoma: A Rare and TreaTable Malignancy

Introduction: Pancreatic lymphoma comprise less than 1 % of pancreatic malignancies. Most common location of diffuse large B cell lymphoma (DLBCL) are lymph nodes. Clinical symptoms and imaging studies have significant similarity resulting in delayed diagnosis or early initiation of comfort care measures. It is important to determine the histology of pancreatic tumor given the differences in management and prognosis. Here we report a rare case of primary DLBCL arising from pancreas. Case Description/Methods: 62-year-old female with history of HTN and DM presented with 30 lbs unintentional weight loss epigastric abdominal pain and early satiety. CT abdomen with IV and oral contrast demonstrated pancreatic mass. Core biopsy of pancreatic head mass demonstrated infiltration by large atypical lymphoid cells with high N/C ratio, round nuclear contour, fine chromatin and variably prominent nucleoli (Figure A). Atypical mitosis and apoptosis seen in background. Lymphoma cells positive for CD 19, CD 20 (Figure B). Final diagnosis Large B cell lymphoma germinal center type. FISH for BCL 2, C MYC were normal ruling out possibility of double or triple hit lymphoma. Cancer antigen 19-9 at the time of diagnosis was within normal limits. FDG PET/CT prior to initiation of treatment showed main foci of increased tracer activity appears to be in the proximal body of the pancreas just medial to the stomach, measures greater than 4 cm in diameter, and has a maximum SUV of 11.86 (Figure C). Rituximab- Cyclophosphamide HydrOxyadriamycin Prednisone (R-CHOP) every 3 weeks initiated. After one cycle of R-CHOP reported significant improvement in epigastric pain and started gaining weight. She completed 6 cycles of R-CHOP. Post treatment FDG PET/CT complete resolution of upper abdominal lymph node mass (Figure D). She remains in remission for the past 1 year. Discussion: Our case is an example of successful biopsy and treatment with aim to cure pancreatic malignancy. Despite radiological differences between pancreas adenocarcinoma and lymphoma, it is crucial to obtain adequate tissue sampling during from pancreas to establish histological diagnosis prior to discussion of prognosis and treatment plan. In general, DLBCL germinal center type has a 5-year survival of 70% with R-CHOP. Differential diagnosis of pancreatic mass that confer better prognosis than adenocarcinoma include neuroendocrine tumor, solid pseudopapillary tumor and lymphoma. Therefore, it is important to obtain biopsy and direct therapy based on histology.Figure 1.: A: Core biopsy of pancreatic head mass demonstrated infiltration by large atypical lymphoid cells with high N/C ratio, round nuclear contour, fine chromatin and variably prominent nucleoli. B: Lymphoma cells positive for CD 19, CD 20. C: FDG PET/CT prior to initiation of treatment showed main foci of increased tracer activity appears to be in the proximal body of the pancreas just medial to the stomach, measures greater than 4 cm in diameter, and has a maximum SUV of 11.86. D: Post treatment FDG PET/CT complete resolution of upper abdominal lymph node mass.

Malignancy of the Lymph Node: How General Practitioners and Pathologists can achieve a Definitive Diagnosis

The lymph node plays an important role in the lymphatic spread of abnormal antigens from exogenous or endogenous sources, including infectious agents, foreign bodies, self-antigens, and malignant cells, by harboring various immune cells that react to abnormal antigens and their sources. This often leads to enlargement of the lymph node, also known as “lymphadenopathy.” In this review article, malignancy of the lymph node is the main focus, especially regarding how general practitioners and pathologists can achieve a definitive diagnosis. The basic principle relies on the normal structure, cellular components, and functions of the lymph node as well as the types of malignancy found. Careful clinical history taking of any possible cause of lymphadenopathy warrants exclusion of any mimics of malignancy of the lymph node, including drug reactions and immunodeficiency states. An adequate cell or tissue sample allows pathologists to work efficiently by mastering the multimodality approach under good clinical collaboration. Effective communication between pathologists and physicians regarding relevant laboratory investigations should make it easier to diagnose a specific type of malignancy. This review article also focuses on how general pathologists handle cell or tissue samples by conventional morphologic evaluation and panels of immunohistochemistry so that general practitioners understand the diagnostic process and understand how to diagnose malignancy of the lymph node.

Kidney biopsy during pregnancy: a difficult decision. A case series reporting on 20 patients from Mexico.

Kidney biopsy is a routine procedure in the diagnosis of kidney disease, but during pregnancy it carries potential adverse effects for both mother and child, aside from the challenges of obtaining adequate tissue samples. Nevertheless, a precise diagnosis is necessary when specific and potentially toxic treatments are to be used during pregnancy. The present report presents our experience with regard to the usefulness and safety of kidney biopsies during pregnancy. Retrospective analysis of clinical indications, complications, histopathological diagnoses, and treatment of patients who had kidney biopsies done at a single academic center during gestation weeks 11-30 between January 2015 and January 2019. Kidney biopsies were carried out in 20 pregnant patients with nephrotic proteinuria. Biopsy was adequate in all patients. The histological diagnoses included focal segmental glomerulosclerosis (collapsing, tip and perihiliar varieties), membranous lupus nephropathy, diabetic nephropathy, and IgA nephropathy. Treatment was associated with reduction of proteinuria in 17 patients and reduction of serum creatinine in 9 out of 11 patients who had serum creatinine ≥ 1mg/dl at the time of biopsy. There was one major bleeding complication that required transfusion of one unit of blood. There was a high incidence of preeclampsia, preterm delivery, and low birth weight despite appropriate kidney disease therapy. Kidney biopsy may be done during pregnancy when therapeutic decisions depend on a precise pathologic diagnosis.

Ulcerated, tender nodules of the lower extremities

Ulcerated, tender nodules of the lower extremities

Franseen Needles May Be Promising for Improving the Sampling Adequacy of EUS-FNA for Subepithelial Lesions.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful in diagnosing subepithelial lesions (SELs), and adequate tissue sampling is necessary to differentiate between benign and malignant diseases to determine therapeutic strategies. This study aimed to evaluate sampling adequacy and diagnostic performance of EUS-FNA for SELs with Franseen needles. This retrospective study enrolled 130 patients who underwent EUS-FNA with a 22-gauge needle for SELs from January 2010 to March 2021. We compared sampling adequacy and predictive factors influencing the sampling adequacy of EUS-FNA for SELs between Franseen and conventional needles. The sampling adequacy rates were 95.0% (38/40) with Franseen needles and 76.7% (69/90) with conventional needles (p = 0.011). The mean number of punctures with Franseen needles (2.80) was significantly less than that with conventional needles (3.42) (p < 0.001). In the multivariate analysis, the use of Franseen needles (p = 0.029; odds ratio [OR], 5.37; 95% confidence interval [CI], 1.18–23.36) was an independent factor influencing the sampling adequacy. Compared to conventional needles, the Franseen needle could play a vital role in accurately diagnosing SELs by yielding better sampling adequacy and reducing the number of passes.

P-076 Standard IV cannula aspiration of testicular sperm: A novel, efficient and minimally invasive aspiration technique

Abstract Study question Can we aspirate enough testicular tissue for sperm retrieval in non-obstructive azoospermia (NOA), using a wide bore 14-G Standard IV cannula in comparison to micro-TESE? Summary answer Standard IV cannula Aspiration (SIVCA) can yield an ample amount of testicular tissue sufficient for sperm retrieval through a single puncture site on the scrotum. What is known already The current conventional method of testicular sperm aspiration is fine needle aspiration (FNA). FNA has the advantage of being a cost-effective and minimally invasive procedure compared to open testicular sperm extraction (TESE). But FNA with its conventional 23-G needle may not always yield enough testicular tissue for sperm retrieval. Furthermore, FNA may require multiple punctures on the scrotum to retrieve enough tissues from different areas of the testis. Study design, size, duration A 24 months prospective cohort study conducted at a specialized IVF center. A total of 130 men aged from 22 to 53 years old (35.03 +/- 9.04) with NOA and normal testicular volume (≥ 12ml) were enrolled in the study. The men had testicular biopsies taken at the day of their partners’ ovum pick-up. On each patient, the testes were randomized to undergo SIVCA on one testis followed by micro-TESE on the contralateral testis. Participants/materials, setting, methods After local anesthesia, a wide bore 14-G standard IV cannula was introduced near the lower pole of the testis. The needle was withdrawn and the catheter introduced into the testicular tissue. A 20-ml syringe was secured to the catheter and constant negative pressure applied and secured with a clamp. Back and forth motions were performed covering as many areas of the testis as possible. Micro-TESE was then performed on the contralateral testis. Main results and the role of chance Sperm retrieval rates (SRR) were compared between the two techniques using McNemar χ2 test. A P-value of less than 0.05 was considered to be statistically significant. Out of a total of 130 cases, an adequate tissue sample could successfully be aspirated using SIVCA in 122 cases, showing a 0.93 probability of success. In those 8 cases where SIVCA had not yielded sufficient tissue and were reverted to micro-TESE, 2 cases were positive for sperm retrieval. Whenever tissue aspiration was successful with both methods, both SIVCA and micro-TESE showed similar success rate with respect to SRR (56.2 vs 57.3%; McNemar P = 1.000). Limitations, reasons for caution Both FNA and SIVCA are not easy to perform on small sized testes. Moreover if testicular tissue is fibrotic or sclerotic, it may be difficult to aspirate and micro-TESE would be the ideal choice to yield enough testicular tissue. Further blinded randomized control studies with larger datasets are recommended. Wider implications of the findings The use of a peripheral IV wide bore cannula is suitable for the aspiration of adequate amounts of testicular tissue for sperm searching whilst requiring only a single puncture on the scrotum. We recommend routinely starting off with SIVCA to search for sperm before reverting to micro-TESE. Trial registration number Unique Protocol ID: SIVCA Protocol registration Records number will be made available to the public through the ClinicalTrials.gov web site within 2 to 5 days of today 31/1/2022

A Case of Hepatic Immunoglobulin G4-Related Disease Presenting as an Inflammatory Pseudotumor and Sclerosing Cholangitis.

An inflammatory pseudotumor is a benign disease characterized by tumor-like lesions consisting of inflammatory cells including plasma cells and fibrous tissue. Recently, some inflammatory pseudotumor cases proved to be a form of Immunoglobulin G4-related disease (IgG4-RD). This novel clinical entity, recognized as a fibroinflammatory condition, is characterized by lymphoplasmacytic infiltration with a predominance of IgG4-positive plasma cells, storiform fibrosis, and often elevated serum IgG4 concentrations. We report a case of IgG4-RD in the form of an inflammatory pseudotumor in the liver with combined sclerosing cholangitis. We recommend that for diagnosing IgG4-RD accurately, it is important to obtain adequate tissue samples and follow-up the lesion in clinical practice.

Detecting anaplastic lymphoma kinase (ALK) gene rearrangements with next-generation sequencing remains a reliable approach in patients with non-small-cell lung cancer.

Next-generation sequencing (NGS) is rapidly becoming routine in clinical oncology practice to identify therapeutic biomarkers, including gene rearrangements in anaplastic lymphoma kinase (ALK). Our study investigated the concordance of ALK positivity evaluated by DNA-based NGS with orthogonal ALK testing methods such as fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and RNA-based NGS (RNA-NGS). Thirty-eight patients with lung adenocarcinoma who were detected with ALK rearrangements using DNA-NGS and also had adequate tissue samples submitted for FISH, IHC, and RNA-NGS, were included in this study. Of the 38 patients, RNA samples from 3 patients failed quality control for RNA-NGS. The concordance of ALK positivity was calculated relative to DNA-NGS results. The concordance rates were 97.1% (34/35) for RNA-NGS, 94.7% (36/38) for IHC, and 97.4% (37/38) for FISH. DNA-NGS detected single ALK rearrangements in 14 (35.0%) patients and complex ALK rearrangements in 26 (65.0%). RNA-NGS detected only single transcripts of the primary ALK fusions. A novel LANCL1-ALK (L7:A20) detected using DNA-NGS was detected as EML4-ALK (E13:A20) transcripts using RNA-NGS. Interestingly, patients with single ALK rearrangements were more likely to be detected with atypical isolated red signals (p < 0.001), while patients with complex ALK rearrangements were more likely to be detected with atypical split red and green signals less than 2 signal diameters apart (p < 0.001). Our study highlights the reliability of NGS in the accurate detection of specific ALK fusion variants and concomitant mutations that are crucial for individualized treatment decisions in patients with lung cancer.

MP32-14 IN VITRO TESTING OF UNTETHERED THERMAL-ACTUATED MICROGRIPPERS AS A NOVEL DIAGNOSTIC TOOL FOR UROTHELIAL TISSUE

You have accessJournal of UrologyCME1 May 2022MP32-14 IN VITRO TESTING OF UNTETHERED THERMAL-ACTUATED MICROGRIPPERS AS A NOVEL DIAGNOSTIC TOOL FOR UROTHELIAL TISSUE Ridwan Alam, Wangqu Liu, Ezra Baraban, Brian Matlaga, Andres Matoso, David Gracias, and Jared Winoker Ridwan AlamRidwan Alam More articles by this author , Wangqu LiuWangqu Liu More articles by this author , Ezra BarabanEzra Baraban More articles by this author , Brian MatlagaBrian Matlaga More articles by this author , Andres MatosoAndres Matoso More articles by this author , David GraciasDavid Gracias More articles by this author , and Jared WinokerJared Winoker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002581.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gold standard for diagnosis of a suspicious upper tract mass is ureteroscopic biopsy. However, due to the microscopic caliber of the ureter, the development of tools to obtain an adequate tissue sample for analysis has proven challenging. All tools to date have required tethering to the ureteroscope, which severely restrict the size of the biopsy instrument and range of motion. As a result, up to 65% of upper tract malignancies are inaccurately staged. Therefore, we propose the development of untethered submillimeter tools called microgrippers to obtain tissue samples from the upper urinary tract using an in vitro model of porcine urothelium. METHODS: Microgrippers are microsurgical tools measuring 1 mm in the open configuration (Figure 1A). These devices are fabricated using materials safe for use within the human body. A thermosensitive layer keeps the microgrippers in the open configuration at 4°C but softens at 37°C, allowing the microgrippers to close (Figure 1B). The closing motion allows the device to capture contents within its phalanges. Experiments were conducted by placing microgrippers on a sample of porcine urothelial tissue. The microgrippers were retrieved using a magnet and centrifuged to separate the microgrippers from tissue. Tissue samples were analyzed using standard histopathological techniques. RESULTS: Urothelial tissue was successfully obtained when tested on 10 separate samples of porcine ureteral and renal pelvic tissue. Histological analysis confirmed the presence of urothelial tissue without excessive damage or artifact. CONCLUSIONS: Untethered thermal-actuated microgrippers demonstrate the ability to adequately sample urothelial tissue in vitro for analysis by pathologists. There is potential for this revolutionary technology to establish a new standard for biopsy of the upper urinary tract. Ongoing studies are focused on ex vivo and in vivo experimentation for biopsy and drug delivery mechanisms. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e537 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ridwan Alam More articles by this author Wangqu Liu More articles by this author Ezra Baraban More articles by this author Brian Matlaga More articles by this author Andres Matoso More articles by this author David Gracias More articles by this author Jared Winoker More articles by this author Expand All Advertisement PDF DownloadLoading ...

Marked safety and high diagnostic yield of freehand ultrasound-guided core-needle biopsies performed by pulmonologists.

BackgroundAdequate tissue sampling is fundamental for establishing a definitive diagnosis, assessing prognosis and tailoring therapy. Each of the methods for obtaining tissue (e.g., endoscopic, image guidance and surgical biopsies) results in a different diagnostic yield and complication rate profile.ObjectivesPresent feasibility, and assess safety and efficacy of freehand transthoracic ultrasound‐guided core‐needle biopsies (USGNB) of thoracic lesions performed by pulmonologist.MethodsA retrospective analysis study of ultrasound‐guided core‐needle biopsies of thoracic lesions performed at the Pulmonary Institute of Rabin Medical Center was conducted from September 2020 to October 2021. All core‐needle biopsies were performed under local anesthesia with guidance of Mindray TE7 2019 US system. Procedural variables including complications and pathological diagnostic yield were the primary end point. IRB 0671‐21‐RMC.ResultsIn total 91 biopsy procedures were analyzed in38 females and 53 males, average age 71.1 years. Twenty‐three (25.3%) cases were lung lesions, 7 (7.7%) – mediastinal, 13 (14.3%) – chest wall, 27 (29.7%) – pleural, and 21 (23.1%) supraclavicular lesions. Average lesion size was 51.6 mm, the largest in the mediastinum and the smallest in supraclavicular locations (97.7mm and 28.0 mm, respectively). Overall pathological diagnostic yield was 90%, highest success in chest wall (100%) and lowest in mediastinal biopsies (71.4%). We had only one complication –hemothorax resolved by chest tube drainage‐ accounting for only 1.1% complication rate.ConclusionSafety and efficacy were demonstrated in freehand US‐guided core‐needle biopsy of thoracic lesions performed by pulmonologists. We suggest thoracic ultrasound and USG‐CNB be part of training and clinical practice in interventional pulmonology.

Clinical impact of a novel device delivery system in the diagnosis of bile duct lesions: A single-center experience.

Pathological evaluation is essential for the diagnosis of biliary tract diseases. However, existing evaluation methods have various challenges in terms of operability and diagnostic performance. The present study aimed to evaluate the feasibility, utility, and safety of a novel device delivery system for bile duct biopsy. This study was conducted as a retrospective, descriptive analysis at a single center. Overall, 25 examinations in 14 consecutive patients who underwent transpapillary biopsies for biliary lesions using the novel device delivery system from July to November 2020 were reviewed. Number and time of biopsy, technical success rate, adequate tissue sampling rate, adverse events, and diagnostic performance of bile duct biopsies using the novel device were evaluated. Moreover, negative surgical margins were assessed in patients who underwent surgical resection after mapping biopsy. The median number of biopsy samples was five (range: 2-13), with a median biopsy time of 11.6min. The technical success rate was 100% (140/140), with an adequate sampling rate of 82.9% (116/140). These rates did not differ depending on the biopsy site or purpose. There were no serious adverse events related to the procedures. The diagnostic sensitivity, specificity, and accuracy of biliary stricture were 90%, 100%, and 92.3%, respectively. Negative surgical margins were confirmed in all patients undergoing surgical resection, including one patient with a surgical procedure changed based on the results of mapping biopsy. The novel device delivery system has potentials in diagnosing biliary tract diseases and determining appropriate treatment strategies.