Biopsy Cavity Research Articles

Sustained delivery of celecoxib from nanoparticles embedded in hydrogel injected into the biopsy cavity to prevent biopsy-induced breast cancer metastasis

PurposeWe have previously reported that protracted Cyclooxygenase-2 (COX-2) activity in bone marrow-derived cells (BMDCs) infiltrating into biopsy wounds adjacent to the biopsy cavity of breast tumors in mice promotes M2-shift of macrophages and pro-metastatic changes in cancer cells, effects which were suppressed by oral administration of COX-2 inhibitors. Thus, local control of COX-2 activity in the biopsy wound may mitigate biopsy-induced pro-metastatic changes.MethodsA combinatorial delivery system—thermosensitive biodegradable poly(lactic acid) hydrogel (PLA-gel) incorporating celecoxib-encapsulated poly(lactic-co-glycolic acid) nanoparticles (Cx-NP/PLA-gel)—was injected into the biopsy cavity of Py230 murine breast tumors to achieve local control of COX-2 activity in the wound stroma.ResultsA single intra-biopsy cavity injection of PLA-gel loaded with rhodamine-encapsulated nanoparticles (NPs) showed sustained local delivery of rhodamine preferentially to infiltrating BMDCs with minimal to no rhodamine uptake by the reticuloendothelial organs in mice. Moreover, significant reductions in M2-like macrophage density, cancer cell epithelial-to-mesenchymal transition, and blood vessel density were observed in response to a single intra-biopsy cavity injection of Cx-NP/PLA-gel compared to PLA-gel loaded with NPs containing no payload. Accordingly, intra-biopsy cavity injection of Cx-NP/PLA-gel led to significantly fewer metastatic cells in the lungs than control-treated mice.ConclusionThis study provides evidence for the feasibility of sustained, local delivery of payload preferential to BMDCs in the wound stroma adjacent to the biopsy cavity using a combinatorial delivery system to reduce localized inflammation and effectively mitigate breast cancer cell dissemination.

Impact of reactive changes on multigene testing: histopathologic analysis of low-grade breast cancers with high-risk 21-gene recurrence scores.

The 21-gene recurrence score (RS) assay predicts the recurrence risk and magnitude of chemotherapy benefit in patients with invasive breast cancer (BC). This study examined low-grade tumors yielding a high-risk RS and their outcomes.Kindly check the edit made in the article titleOk METHODS: We compared patients with grade 1 BC and a high-risk RS to those with low-risk RS. Histologic sections were reviewed and features reported to elevate the RS were noted, mainly biopsy cavity and reactive stromal changes (BXC). A total of 54 patients had high-risk RS (median RS of 28, range 26-36). On review, BXC were seen in all cases. Thirty BCs in this group also had low to negative PR. Treatment regimens included: chemoendocrine therapy (63%), endocrine therapy alone (31%) and no adjuvant therapy (6%). There were no additional breast cancer events over a median follow-up of 54.0 months (range 6.2 to 145.3). A total of 108 patients had low-risk RS (median RS of 7, range 0-9). BXC were seen in 47% of cases and none were PR negative. One patient had a recurrence at 64.8 months while the rest had no additional events over a median of 68.1 months (2.4 to 100). We provide further evidence that reactive stromal changes and/or low-PR scores enhance the elevation of the RS. A high-RS result in low grade, PR-positive BC may not reflect actual risk and any suspected discrepancies should be discussed with the management teams. Multigene testing results should be interpreted after correlation with pathologic findings to optimize patient care.

Vacuum-assisted excision of small breast cancers under ultrasound guidance

PurposeThe purpose of this study was to evaluate if it is possible to completely remove small breast cancer tumours with vacuum-assisted excision (VAE) under ultrasound guidance. MethodsWomen ≥ 50 years old with a biopsy proven invasive cancer ≤ 10 mm were selected between October 2021 and November 2021 based on referrals and enrolled in this prospective study. The patients underwent VAE within six weeks following biopsy to remove the tumour. After the tumour was excised and the biopsy cavities margins were shaved, a radioactive seed was inserted into the biopsy cavity. The VAE excision cavity and surrounding tissue were surgically excised. Preliminary VAE results were evaluated after ten patients. For the study to proceed at least 80 % of the breast cancer tumours had to be completely removed by VAE. ResultsThe tumours median size in mammography was 8.5 mm (6–9 mm) and in ultrasound 6.5 mm (4–9 mm). The shape of the lesion was round in three (30 %), oval in two (20 %) and irregular in five (50 %) patients. None of the tumours were completely removed in the first VAE specimen, meaning that there was invasive cancer or ductal carcinoma in situ (DCIS) in the “shaved margins” and/or the surgical specimen. In five (50 %) cases, the surgical specimen was free of invasive cancer and DCIS. ConclusionsNone of the small invasive breast cancers were completely excised with VAE under ultrasound guidance, therefore it is not a reliable method to remove small breast cancers.

Use of breast MRI to distinguish treatment failure versus new primary tumor following single fraction breast intraoperative radiotherapy for breast cancer (SF-IORT).

e12534 Background: Single-fraction, intraoperative radiation therapy (SF-IORT) can replace whole breast radiotherapy (WBT) in select patients after lumpectomy for breast cancer. By combining histology review with co-registration of breast MRI at diagnosis and following an in-breast tumor recurrence, we sought to characterize IBTR as: missed on initial MRI, treatment failure, or new primary tumor. This has important implications for both breast MRI and understanding the effectiveness of SF-IORT. Methods: We reviewed our IORT database for patients with IBTR. Three radiologists recorded findings on DCE-MRI, mammograms and ultrasound, pathology at initial diagnosis and IBTR, and time to IBTR. Results: 90 women received SF-IORT between 12/6/2002 - 4/10/2019. There were 6 IBTRs (average age at recurrence 63, range 49-71 years). For these 6 patients, initial diagnostic mammograms showed fatty (1), scattered (4) or extremely dense (1) breasts with suspicious masses (4), calcifications (1), or asymmetry (1), average size 1.4 cm: range 0.3 - 2.0 cm. On MRI, background parenchymal enhancement was minimal (2), mild (2), moderate (1), or marked (1), showing a mass (4), mass/distortion (1), or post-biopsy marker/no abnormal enhancement (1). Initial pathology showed 2 IDC, 3 IDC/DCIS, and 1 DCIS, (average size 1.7 cm, range 1.1 - 2.4 cm) with 6/6 ER +, 5/6 PR + and 6 HER2 negative. IDC Ki-67 ranged from 5-25%. 5/6 patients had sentinel lymph node biopsy (SLNB) with 1/5 having a positive SLN. 4/6 received endocrine therapy. One patient declined follow-up mammography. After IORT, IBTR (average size 1.4 cm, range 0.7 - 3.6 cm) was diagnosed by mammography (3), palpable breast lump (2), or palpable axillary lymph node (LN) (1) shown as mass (4), mass/calcifications (1), or abnormal LN (1). IBTR occurred post-SF-IORT an average of 141.7 months, range 88.3 to 195.8 months. 2/6 IBTR occurred near the biopsy cavity. Subsequent surgery included mastectomy (3), re-excision lumpectomy/RT (2), or axillary LN dissection/RT (1) showing 4 IDC, 1 IDC/DCIS, and 1 IDC /ILC (6/6 ER +; 3/6 PR positive; 2 PR weakly positive; and 5 HER2 negative, 1 HER2 equivocal). Ki-67 ranged from 1-70%. Conclusions: 6/90 (6.6%) patients had an IBTR an average of 141.7 months post SF-IORT with 2/6 near the biopsy cavity. Breast MRI reliably screens patients for SF-IORT. Co-registration of imaging can help distinguish true recurrences from new primary tumors.

Customized Low-Cost Model for Hands-on Training in Intraoperative Ultrasound for Neurosurgeons: Our Experience and Review of Literature

Practical ultrasound (US) training is essential to overcome operator dependence and optimize image acquisition. For intraoperative neurosurgical application, in addition to hand-eye coordination, ultrasound training should incorporate training for visuomotor and visuospatial skills, as well as 3-dimensional depth orientation. Our agar-based, low-cost model has been developed keeping these skill sets in mind. We have described preparation of an agar-based, low-cost customizable model using commonly available echogenic objects as targets, which allows the clinician to perform various training tasks like depth insonation, target localization, and biopsy and resection cavity insonation. This low-cost model was implemented for internal training and validated at an international training course. The cost of the model was 4 USD, and its preparation time was <1 hour. It can be used for performing multiple US training tasks and provides realistic images and good tactile feedback. However, the model is perishable and artifacts are occasionally visible. Feedback survey results showed that >80% of participants felt the model was useful for US training. Our customizable low-cost US training model is an effective and efficient tool for US training with high acceptance by neurosurgeons. It faithfully mimics various intraoperative tasks and helps clinicians gain confidence to use intraoperative ultrasound as an adjunct during the procedures. This model can be used by individual surgeons/departments for ongoing training, as well as for larger training courses and workshops.

Subsequent Marking under Ultrasound Guidance of Vacuum-Assisted Breast Biopsy Areas after Receipt of Histology: A Feasibility Study of a New Technique

Purpose: The aim of this study was to evaluate the feasibility and the accuracy of a secondary, metachronous ultrasound (US)-guided marking of the stereotactic vacuum-assisted breast biopsy (ST-VABB) area. Materials and Methods: The institutional ethics committee approved the study. The retrospective study included 98 patients. In ST-VABB of 45 women, no tissue markers were deployed at the biopsy site, even if no residual calcifications remained. After histology proved the necessity for a subsequent operation, the biopsy site was marked under US guidance using a coil marker. All interventions were technically successful. No complications occurred. Mammography was done to visualize the coil deployment. The distances from the center of the lesion and the biopsy cavity to the coil location were measured in both planes to evaluate the accuracy of the marking procedure. Results: In 24 of the 46 cases, the whole lesion was biopsied without residual elements. The mean time between ST-VABB and sonographic marking of the lesion was 9.7 days (median 6.5). The biopsy cavity could be detected in 40 (87%) cases and thus marked exactly. The mean time of US-guided marking was 12.5 min. The mean distance between the coil and the target lesion was 0.6 ± 1.5 cm in the craniocaudal (cc) view and 0.5 ± 1.5 cm in the mediolateral (ml) view for all markings. The mean delta value from the distance nipple–original lesion and from the distance nipple–coil was 0.85 ± 1.2 cm (median 0.5) in the cc view and 0.88 ± 1.2 cm (median 0.6) in the ml view for all cases. Clip migration was not observed. Conclusion: Our study demonstrates the feasibility and the technical success of secondary metachronous coil marking of the biopsy site under US guidance after receipt of histology. This approach seems to be a cost-effective alternative to the standard procedure of the primary coil marking especially in all completely removed lesions. It may offer advantages for allergic patients.

Hybrid trajectory/force control strategy for the in vivo robot during stomach biopsy

Traditional endoscopy involves limited surgery called biopsy and abdominal cavity exploration. Limitations like reduced dexterity and limited visualization, because of reduced access to the surgical field, limit the surgeon's perception and increases his strain. This results in error while performing surgery. To reduce this deficiency, the involvement of robotic assistance to surgery is one of the greatest milestones crossed so far in the history of medical science. Many researches have been carried out in this particular domain so far, and the research is still in its infancy stage. Several attempts have been made to diminish the limitations in conventional endoscopes used for biopsy, and new design and control strategies have been proposed. This paper presents a hybrid force/trajectory control strategy of such hyper-redundant robot when the robot interacts with the tissues. The force control is of interest here to avoid the damage of healthy tissues when robot interacts with them. To illustrate the methodology, an example of three-link redundant robot has been considered.

Tissue marker migration after MRI-guided breast biopsy: Migration frequency and associated factors.

The purpose of this study was to determine the frequency and associated risk factors contributing to immediate tissue marker migration in patients undergoing MRI-guided breast biopsy and to evaluate how often tissue marker migration altered clinical management. Between July 2010 and May 2015, we retrospectively reviewed all MRI-guided breast biopsies at our institution for tissue marker migration. Migration was defined as final position of the tissue marker >10mm from the target site based on the expected location of the MRI finding on postprocedure mammogram. Factors associated with migration were analyzed using Fisher's exact test and Chi-squared test, with P<.05 considered statistically significant. A total of 278 patients underwent 298 MRI-guided biopsies. Migration occurred in 42/298 biopsies (14%). Almost entirely fat fibroglandular tissue was identified as an independent risk factor for tissue marker migration, occurring in 6/16 (38%), compared to 36/262 (14%) for the other fibroglandular tissue categories (P=.03). Biopsy target size was significantly associated with clip migration, occurring in 25/114 (22%) lesions <10mm in size vs 17/184 (9%) for larger lesions (P=.003). Clinical management was affected by clip migration in 6/42 cases (14%) with one requiring ultrasound-guided biopsy cavity marker placement and five requiring biopsy cavity wire localization. Radiologists must be vigilant in assessing for clip migration as it is not an infrequent complication. Given migration may change clinical management and require altered procedures for localization of the biopsy cavity, the possibility of clip migration should be included in informed consent.

Multifocal/Multicentric Ipsilateral Invasive Breast Carcinomas with Similar Histology: Is Multigene Testing of All Individual Foci Necessary?

Multiple synchronous ipsilateral invasive breast carcinomas (BCs) with similar histology usually have concordant receptor status. It is unknown whether individual foci with similar histology also share molecular and biological similarities or are heterogenous. This study examined the concordance of the 21-gene recurrence score (RS) in multiple synchronous morphologically similar ipsilateral BCs. We identified patients with multiple ipsilateral BCs and available RS treated at our institution from 1/2014 to 6/2018. BCs were divided into three groups based on RS: (1) RS in same risk category, (2) RS in different risk categories but within 2-unit difference (e.g., RS 17 and RS 19), and (3) RS in different risk categories and a change of > 2 units. BCs in groups 1 and 2 were considered as concordant (no significant clinical impact) and BCs in group 3 as discordant (variation affects management). A total of 53 patients met the study criteria. RS was concordant in 46 (87%) cases. Seven (13%) cases were discordant (group 3). Of these, three (43%, 3/7) had biopsy cavity changes (BXC) adjacent to the BC with highest RS. In two cases the focus with higher RS had a lower percentage of progesterone receptor-positive tumor cells. In two cases, extensive ductal carcinoma in situ was associated with the BC focus with lower RS. Morphologically similar multifocal ipsilateral BCs have concordant RS in 87% (46/53) of cases. Our results suggest that, in cases of morphologically similar multifocal BCs, testing of a single focus provides accurate prognostic and predictive information.

Comparison of the effect of different disinfectants on endoscopic disinfection and durability

Objective To explore the effect of different disinfectants on endoscopic disinfection and durability. Methods A total of 428 endoscopes were selected from the endoscopic center of our hospital from January 2016 to September 2016, and they were randomly divided into control group and observation group, each group in 214cases.The control group was treated with glutaraldehyde.The observation group used o-phthalaldehyde treatment disinfection.The sampling site was the endoscopic biopsy cavity surface, sterile syringe was used to extract 10ml containing neutralizer buffer, into the endoscopic biopsy to be tested, and then 15mL sterile test tube from the biopsy outlet collection, was checked within 2h.The sterilization pass rate was evaluated, the disinfectant disinfection endoscopic cavity and the number of surface colonies, disinfectant endoscopic durability in the two groups were compared. Results The disinfection rate was 89.25% in the control group and 97.20% in the observation group, the difference of the qualified rate of endoscopic disinfection between the two groups was statistically significant (χ2=10.69, P=0.001). The endoscopic cavity and the number of surface colonies of the observation group were lower than those of the control group (t=3.17, P=0.00; t=26.76, P=0.00). The numbers of disinfection per cycle and per day in the observation group were higher than those in the control group, the differences were statistically significant (t=94.44, P=0.00; t=23.94, P=0.00). Conclusion The use of o-phthalaldehyde for endoscopic disinfection is better, more durable, suitable for endoscopic room to promote the use. Key words: Disinfectant; Endoscopic; Disinfection qualified rate; Durability

Margin-free excision of small solid breast carcinomas using the Intact Breast Lesion Excision System®: is it feasible?

The Breast Lesion Excision System® (BLES®) is a stereotactic vacuum-assisted breast biopsy device that utilizes radiofrequency in order to excise non-palpable mammographic lesions for pathologic diagnosis. The purpose of this study was to evaluate the efficacy of BLES® in performing complete, margin-free excisions of small solid carcinomas. Our retrospective study of prospectively enrolled patients included 50 cases of non-palpable, BIRADS≥4, solid by means of mammography and sonography, lesions. All these patients underwent a BLES® breast biopsy procedure from June 2010 to June 2014 and had a malignant diagnosis. According to each patient's pathologic diagnosis, appropriate surgical treatment was recommended. Postoperatively, surgical specimens were histologically analyzed, aiming to determine whether residual malignant disease was present in the specimen cavity formatted by BLES®. Ductal carcinoma in situ (DCIS) was diagnosed in 5 patients and invasive carcinoma (IC) in 45 patients, at primary BLES® pathology report. Tumor-free resection margins (<0.5 and<1mm) were accomplished in only 8/24 subcentimeter cases (33.3%). Absence of residual disease upon surgical excision was confirmed in 23/24 subcentimeter cases (95.8%) and 2/26 of the cases measuring>1cm (7.69%). Statistical analysis revealed that mammographic size was the only significant prognostic factor for complete excision (i.e., with no residual disease in the biopsy cavity) of a malignant lesion. Our results indicate that it is possible, when using the BLES® device, to completely excise small (≤10mm) breast carcinomas that appear radiologically as solid lesions. This subset of patients should be investigated regarding the therapeutic potential of this method.

Stereotactic core needle breast biopsy marker migration: An analysis of factors contributing to immediate marker migration.

To evaluate breast biopsy marker migration in stereotactic core needle biopsy procedures and identify contributing factors. This retrospective study analyzed 268 stereotactic biopsy markers placed in 263 consecutive patients undergoing stereotactic biopsies using 9G vacuum-assisted devices from August 2010-July 2013. Mammograms were reviewed and factors contributing to marker migration were evaluated. Basic descriptive statistics were calculated and comparisons were performed based on radiographically-confirmed marker migration. Of the 268 placed stereotactic biopsy markers, 35 (13.1%) migrated ≥1 cm from their biopsy cavity. Range: 1-6 cm; mean (± SD): 2.35 ± 1.22 cm. Of the 35 migrated biopsy markers, 9 (25.7%) migrated ≥3.5 cm. Patient age, biopsy pathology, number of cores, and left versus right breast were not associated with migration status (P> 0.10). Global fatty breast density (P= 0.025) and biopsy in the inner region of breast (P = 0.031) were associated with marker migration. Superior biopsy approach (P= 0.025), locally heterogeneous breast density, and t-shaped biopsy markers (P= 0.035) were significant for no marker migration. Multiple factors were found to influence marker migration. An overall migration rate of 13% supports endeavors of research groups actively developing new biopsy marker designs for improved resistance to migration. • Breast biopsy marker migration is documented in 13% of 268 procedures. • Marker migration is affected by physical, biological, and pathological factors. • Breast density, marker shape, needle approach etc. affect migration. • Study demonstrates marker migration prevalence; marker design improvements are needed.

Effect of Mammography on Marker Clip Migration After Stereotactic-Guided Core Needle Breast Biopsy

To determine whether the type of projection used-same as or orthogonal to the projection used during a stereotactic-guided core needle biopsy procedure-to obtain the first view on a 2-view postbiopsy mammogram affects biopsy marker clip migration. We prospectively recruited women scheduled to undergo stereotactic-guided core needle breast biopsy with marker clip deployment and categorized the women randomly into one of the following 2 groups: first view on the postbiopsy mammogram obtained in the same projection as that used during the biopsy procedure (group 1), or first view on the postbiopsy mammogram obtained orthogonally to the projection used during the biopsy procedure (group 2). Masks of the prebiopsy and postbiopsy mammograms were used to determine whether and how far the biopsy marker clip moved from the biopsy cavity. Sixty-two biopsies were performed in 60 patients (mean age = 56 years; range: 30-78 years); 30 women (32 lesions) were randomized to group 1 and 30 women (30 lesions) were randomized to group 2. Marker clip migration occurred in 10 cases in group 1 (20%, <1cm; 30%, 1-3cm; and 60%, >3cm) and 8 cases in group 2 (0%, <1cm; 75%, 1-3cm; and 25%, >3cm). The mean displacement distance was 0.84cm in group 1 and 0.67cm in group 2 (P = 0.83). The mean displacement distance difference was -0.17cm with a 95% bootstrap confidence interval from -0.87 to 0.57cm. The type of projection used to obtain the first view on the postbiopsy mammogram, relative to that used during the stereotactic biopsy procedure, did not affect biopsy marker clip migration.

Radial Scar at Percutaneous Breast Biopsy That Does Not Require Surgery

Surgical excision is currently recommended after pathologic radial scar is found on breast core needle biopsy because surgical upgrade to carcinoma is not uncommon. The goal of our study was to identify the true pathologic upgrade rate for a "pure" radial scar, those without associated proliferative lesion, based on indication for biopsy, biopsy type, and needle size. The pathology database of Continuum Health Partners was searched for the terms radial scar and radial sclerosing lesion, from January 2007 to December 2015. From review of 1,513 pathology reports, 292 cases of core biopsies without malignancy were identified. Age, indication for biopsy, type of biopsy, and excisional pathology were obtained. Data were then analyzed using SPSS. Two hundred nineteen (75%) of the 292 core biopsies showed pure radial scar without associated proliferative lesion, and 161 (74%) of these patients had surgical excision. Only 1 of these patients had disease that was upgraded to ductal carcinoma in situ-a 2-mm focus located 5 mm away from the radial scar biopsy cavity. This patient also had residual calcifications on mammography after the stereotactic biopsy. Six additional malignant upgrades were found in patients who had radial scar associated with atypical ductal hyperplasia (n= 5) or lobular neoplasia (n= 1) on needle biopsy. Surgical excision is unnecessary when radial scar is found at percutaneous needle biopsy without an associated proliferative lesion. Surgical excision is still indicated when radial scar is associated with atypical ductal hyperplasia or lobular neoplasia.

Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap.

The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4–4.43 cm) in the x, 1.07 cm (range, 0.05–5.67 cm) in the y, and 1.12 cm (range, 0–3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction.

A prospective comparative study to evaluate the displacement of four commercially available breast biopsy markers

Radiopaque markers are commonly deployed following breast biopsies to indicate the location of the targeted lesion. A frequently encountered complication is the displacement of these markers. This study compared the degree of displacement among four newer generation markers after stereotactic core needle biopsy. 80 consecutive biopsies were performed at three breast centre sites. The markers included: HydroMARK(®) (Mammotome, Cincinnati, OH), MammoMARK™ (Mammotome, Cincinnati, OH), MammoStar™ (Mammotome, Cincinnati, OH) and SecurMark(®) (Hologic, Bedford, MA). Each marker was composed of a radiopaque core with a unique polymeric encasing component. Post-procedure mammograms were obtained and the degree of marker displacement was measured. MammoMARK™ exhibited the greatest mean net displacement, followed by HydroMARK(®), SecurMark(®) and MammoStar™ (13.9, 7.7, 5.8 and 4.7 mm, respectively), although these differences did not reach statistical significance (p = 0.398). 73% of the markers did not displace at all. However, in the 19 of 22 markers in which displacement occurred, the distance from the biopsy cavity was >10 mm. No statistically significant contributing factors to predict displacement were found. Newer generation biopsy markers perform comparably with one another. However, clinically significant and unpredictable marker displacement persists. Compared with multiple similar studies of older generation bare metallic markers, the overall displacement rate of newer generation markers seems to be lower, possibly owing to the use of polymeric embedding agents that self-expand within the biopsy cavity. This article compares the post-procedure displacement of breast biopsy markers, which have not been evaluated or discussed in detail since markers with polymeric embedding agents gained widespread use.

TISSUE SITE MARKERS FOR IN VIVO IMAGING

The invention is directed biopsy site markers and methods of marking a biopsy site, so that the location of the biopsy cavity is readily visible by conventional imaging methods, particularly by ultrasonic imaging. The biopsy site markers of the invention have high ultrasound reflectivity, presenting a substantial acoustic signature from a small marker, so as to avoid obscuring diagnostic tissue features in subsequent imaging studies, and can be readily distinguished from biological features. The several disclosed embodiments of the biopsy site marker of the invention have a high contrast of acoustic impedance as placed in a tissue site, so as to efficiently reflect and scatter ultrasonic energy, and preferably include gas-filled internal pores. The markers may have a non-uniform surface contour to enhance the acoustic signature. The markers have a characteristic form which is recognizably artificial during medical imaging. The biopsy site marker may be accurately fixed to the biopsy site so as to resist migration from the biopsy cavity when a placement instrument is withdrawn, and when the marked tissue is subsequently moved or manipulated.

Uso de los cianoacrilatos en el sellado de las biopsias renales en la cirugía de procuración del trasplante renal

Introduction and objectiveCyanoacrylate surgical glues have been widely used for sealing and hemostasis in distinct surgical specialties and interventions. In urology, these glues are highly useful in sealing surgical sutures to prevent bleeding and urinary extravasation in urinary tract surgery. We describe a new application of cyanoacrylate surgical glue: sealing renal graft biopsy during bench surgery in renal transplantation. MethodsWe applied several drops of Glubran ®2 surgical glue (N-butyl-2-cyano-acrylate and methacryloxysulfolane) over the orifice of the graft biopsy at bench surgery. The glue was left to set for 90s until completely polymerized, leaving the biopsy cavity completely sealed. ResultsWe have used this procedure successfully since 2010. Cyanoacrylate polymerizes rapidly on contact with the renal tissue and is therefore ideal to reduce cold ischemia time. Among the 194 kidney transplantations performed, there was no active bleeding at the biopsy site on graft reperfusion, nor in any of the subsequent Doppler ultrasound follow-up examinations. ConclusionsRenal biopsies are usually closed using a cruciate suture pattern. In our center, we prefer sealing with cyanoacrylate adhesive. This method avoids parenchymal laceration and bleeding after reperfusion. In our experience, this alternative is safe and effective.

Forward kinematic analysis of in-vivo robot for stomach biopsy.

The introduction of robotic medical assistance in biopsy and stomach cavity exploration is one of the most important milestones in the field of medical science. The research is still in its infancy and many issues like limitations in dexterity, control, and abdominal cavity vision are the main concerns of many researchers around the globe. This paper presents the design aspects and the kinematic analysis of a 4 degrees of freedom (DOF) hyper-redundant in-vivo robot for stomach biopsy. The proposed robot will be inserted through the tool channel of a conventional 4-DOF endoscope and this will increase the dexterity and ease in reaching the furthest parts of the stomach beyond the duodenum. Unlike the traditional biopsy tool, the present design will enhance dexterity due to its 4 DOF in addition to the endoscope's DOF. The endoscope will be positioned at the entrance to the stomach in the esophagus and the robot will move to the desired position inside the stomach for biopsy and exploration. The current robot is wire-actuated and possesses better maneuverability. The forward kinematic analysis of the proposed robot is presented in this paper.

Japanese Multi-Institutional Feasibility Study of APBI Using Interstitial Brachytherapy

device was used for both preand post-implant planning. Stranded seeds were created and intraoperatively placed in real time using the INSTANT (tm) device. A total dose of 25 Gy was delivered to the biopsy cavity with 1.0cm margin over the life of the isotope. The patients wore a shielded bra for six weeks after the procedure. Pre-planning utilized ultrasound and CT while post planning utilized CT only at one week. A second CT was performed 6 weeks after the seed implant to verify seed stability. Results: Cosmetic results were excellent with no evidence of needle marks by 6 weeks post procedure. Patient tolerance was exceptional, returning to work within 3 days of the procedure with minimal to no breast discomfort. No acute erythema and no radiation mysositis observed over the first 3 months after the procedure. Conclusions: Permanent Pd seed implantation as boost therapy appears to be safe. It is inexpensive and is well tolerated. A similar technique has been described by Pignol, et al for the sole local mangement of early stage breast cancer and the technique described in this paper could easily by adjusted to provide the sole local management for early stage breast cancer as well.