Biopsy Equipment Research Articles

Condom perforation during transrectal ultrasound guided (TRUS) prostate biopsies: a potential infection risk

Transrectal ultrasound (TRUS) guided prostate biopsies are amongst the most common outpatient diagnostic procedures performed in urology practice. Of concern appear to be recent reports of infectious complications following this procedure in which contamination of the biopsy equipment was the likely source. This study looks at the rate of condom perforation during prostate biopsy and we look to highlight the potential problems, which may arise as a result of inadequate cleansing of the equipment between cases during a busy prostate biopsy clinic All patients attending for prostate biopsies over a three-month period in our institution were included in the study. All condoms (latex) used were made by the same manufacturer and were checked prior to the procedure and found to have no leaks. The biopsy gun was inserted through an externally placed needle guide, as is standard practice in many departments in the UK. After the end of each procedure the condom was removed from the rectal probe and filled once again with water to assess for perforations. Two experienced surgeons carried out all the procedures. 10 out of 107 patients were found to have at least one perforation in the condom. In some of the condoms there were multiple perforations. We have demonstrated a significant condom perforation rate (9%) amongst patients undergoing prostate biopsies. This raises the serious issue of hygiene and cross infection, particularly with blood borne communicable diseases such as hepatitis and HIV unless strict disinfection and sterilization protocols are followed between patients. Perforation of the condoms used during TRUS guided prostate biopsy and hence faecal and blood contamination of the biopsy equipment could potentially have far-reaching implications for urologists and the infection control community. Although the risk of cross infection is probably small this serious issue needs addressing.

Outbreak of Pseudomonas aeruginosa Infections After Transrectal Ultrasound-Guided Prostate Biopsy

After the Georgia Department of Human Resources Division of Public Health was notified about 4 patients who were hospitalized with Pseudomonas aeruginosa infections after outpatient transrectal ultrasound-guided prostate biopsies in July 2005, we investigated the cause of, and risk factors for, the infections. We enhanced surveillance for additional cases, reviewed medical records, evaluated biopsy equipment and infection control practices, and collected environmental samples. Transrectal ultrasound-guided prostate biopsy procedures were discontinued during the investigation. A total of 4 cases were identified. All patients were men aged 57 to 71 years. All 4 recovered with antimicrobial therapy. P. aeruginosa was isolated from the narrow lumen of the steel biopsy needle guide that had been soaking in high-level disinfectant for several days. The needle guide isolate and three available clinical isolates were indistinguishable by pulsed-field gel electrophoresis. A review of the reprocessing procedures of the biopsy needle guide revealed that it was disinfected by submersion in high-level disinfectant rather than sterilization, the reprocessing procedure recommended by the manufacturer. Manual cleaning of the lumen was limited to flushing. After disinfection, the guide was rinsed with nonsterile tap water. The outbreak resulted from a contaminated needle guide. The needle guide reprocessing procedures were inadequate. Potential causes of P. aeruginosa contamination include the lack of adequate manual cleaning before disinfection, failure to sterilize the needle guide, and the use of a tap-water rinse after disinfection. Clinicians performing transrectal ultrasound-guided prostate biopsy procedures should follow the manufacturers' needle guide reprocessing recommendations or use disposable needle guides.

3D prostate model formation from non-parallel 2D ultrasound biopsy images

Biopsy of the prostate using 2D transrectal ultrasound (TRUS) guidance is the current gold standard for diagnosis of prostate cancer; however, the current procedure is limited by using 2D biopsy tools to target 3D biopsy locations. We propose a technique for patient-specific 3D prostate model reconstruction from a sparse collection of non-parallel 2D TRUS biopsy images. Our method conforms to the restrictions of current TRUS biopsy equipment and could be efficiently incorporated into current clinical biopsy procedures for needle guidance without the need for expensive hardware additions. In this paper, the model reconstruction technique is evaluated using simulated biopsy images from 3D TRUS prostate images of 10 biopsy patients. All reconstructed models are compared to their corresponding 3D manually segmented prostate models for evaluation of prostate volume accuracy and surface errors (both regional and global). The number of 2D TRUS biopsy images used for prostate modeling was varied to determine the optimal number of images necessary for accurate prostate surface estimation.

FDA, CDC Cite Contaminated Biopsy Equipment

FDA, CDC Cite Contaminated Biopsy Equipment

35 A novel method for transplanting a reproducible volume of xenograft tumour beneath the renal capsule using automated biopsy equipment and an epidural needle

Introduction: The growth of human tumours under the renal capsule in animal models has been performed successfully for many years. However, the use of modern surgical equipment has not always been translated into the animal laboratory. We report on a novel method for human renal tumour transplants using an automated biopsy gun to obtain tumour tissue and an epidural needle with introducer to easily deploy the grafts under the renal capsule.Methods: Nude mice had human xenografted tumours grown subcutaneously after implantation of cells from culture. Tumours were then biopsied using a 16 gauge automated biopsy gun. Digital callipers were used to measure a 2 mm segment of the biopsy core that was cut and placed inside a hollow needle (epidural needle). The needle was placed under the renal capsule and the trochar introduced to deploy the graft beneath the capsule with minimal trauma.Results: Tumour grafts were be established in ninety percent of grafted kidneys in this renal subcapsular model. Grafts were confirmed by direct observation and histology.Conclusion: Modern surgical equipment may be utilised to allow tumour transplantation to be undertaken in a more precise fashion than has previously been possible, with the volume of deployed tumour able to be identified and reliably reproduced. Surgical researchers and laboratory‐based scientists need to embrace new techniques and utilise them where appropriate in order to allow for a more objective comparison of results of xenograft transplantation.

Radiation risk and cost-benefit analysis of a paediatric radiology procedure: results from a national study

A national study was performed to investigate radiation doses and associated risks to patients during X-ray fluoroscopy-guided small intestinal biopsies in the investigation of coeliac disease. Thermoluminescent dosemeters (TLD) and questionnaires were sent to 42 of the 43 paediatric departments in Sweden performing these biopsies. During the study period (2 x 3 weeks) 257 biopsies were recorded, representing about 10% of annually performed paediatric investigations. The results show that the absorbed dose during biopsy ranged from 0.04 mGy to 23.8 mGy (mean 1.87 mGy). The fluoroscopy time ranged from 2 s to 663 s (mean 60 s). The collective dose from the procedure amounts to 4.7 manSv year(-1). Thus, the annual excess cancer mortality, including severe hereditary effects, can be estimated at 0.6-0.7 cases per year. However, significant dose saving can be obtained by proper choice of sedation and biopsy equipment.

Lung Biopsy

There are many techniques that can be used to arrive at a diagnosis in dogs and cats with signs referable to the pulmonary system. Biopsy of the pulmonary parenchyma remains the technique of choice when a diagnosis is absolutely required; it is also the technique with the greatest potential for serious complications during and after the procedure. This potential caused most veterinarians to refrain from performing biopsy in the majority of their respiratory cases. Nevertheless, newer, sophisticated biopsy equipment and techniques are now available, with lower complication rates. As more veterinarians become comfortable with this technology, pulmonary biopsy will become more commonplace, and more definitive diagnosis will be obtained. This will benefit the client, the patient, the practitioner, and the profession.

Multiple 14G Stereotactic Core Biopsies in the Diagnosis of Mammographically Detected Stellate Lesions of the Breast

AIM: The aim of this retrospective study was to measure the accuracy of stereotactic guided 14 gauge core biopsy in distinguishing between benign and malignant causes of a mammographically detected stellate breast lesion and to assess the impact of the number of core samples taken on the sensitivity for detection of malignancyMATERIALS AND METHODS: Seventy-two patients with mammographically detected stellate lesions of the breast formed the study group. All patients in the study group underwent multiple 14 gauge core biopsies using prone stereotactic breast biopsy equipment. The diagnostic accuracy of the technique was measured by retrospectively comparing the outcome with the core biopsy results. The result of each core sample was separately recorded to allow analysis of the effect of increasing the number of samples on accuracy.RESULTS: Nine of 72 (12%) did not have surgery. Forty of 72 (56%) had a benign surgical outcome and 23/72 (32%) a malignant surgical outcome [7/72 (10%) non-invasive, 16/72 (22%) invasive carcinoma]. The absolute sensitivity for multiple stereotactic guided core biopsies of stellate lesions for the detection of malignancy was 78% with a complete sensitivity of 100%. The sensitivity for the detection of invasive carcinoma was 94% (15 out of 16 patients). No statistically significant improvement in sensitivity was shown for multiple samples vs one sample, but in two patients, malignant tissue was only found in core samples 6–9, the first five cores showing atypia only.CONCLUSION: Multiple stereotactic guided 14 gauge core biopsies accurately distinguish malignant from benign causes of stellate breast lesions. When core biopsy histology is malignant, therapeutic surgery can be planned. When the core biopsy shows typical features of a benign radial scar, diagnostic surgical excision may not be required to confirm the diagnosis.Kirwan, S. E., (2000). Clinical Radiology55, 763–766.

EFFECTS OF LIVE ANIMAL SAMPLING PROCEDURES AND SAMPLE STORAGE ON THE GLYCOLYTIC POTENTIAL OF PORCINE LONGISSIMUS MUSCLE SAMPLES

ABSTRACT Eight hybrid gilts of Hampshire descent were selected at 110 kg live weight, grouped together in one pen and given a one‐week adaption period prior to sampling. Longissimus samples (approximately 0.5 g) were taken using spring‐loaded biopsy equipment with animals either unrestrained and free to move in the pen or, 3 h later, restrained with a nose snare for two minutes prior to sampling. There was no difference among the two handling approaches for glycolytic potential (P > 0.05). Animals were slaughtered and four longissimus samples (0.5 g) were taken from each carcass immediately following exsangination to evaluate four sample storage methods. Two viable storage methods, freezing in liquid nitrogen followed by freeze drying or immediate homogenization in perchloric acid, yielded relatively high and similar values for muscle glycolytic potential.

ULTRASOUND LOCALIZATION AND GUIDANCE FOR RENAL BIOPSY IN THE HORSE

Real‐time ultrasonography was used to assist percutaneous renal biopsies in seven normal horses. Ultrasound (US) guidance and blind biopsy following US localization were compared. Ten biopsies (seven right kidney and three left kidney) were performed. A transverse approach to the lateral border of the right kidney through the 17th intercostal space was favored, with the needle angle being approximately perpendicular to the body wall. Both biopsy techniques were effective, but blind biopsy following US localization was favored as it was easily performed by one operator without the need for specialized biopsy equipment. The spleen had a variable location and its penetration with the biopsy needle was necessary to obtain two left kidney biopsies. Macroscopic and microscopic hematuria was observed postbiopsy in one and four horses, respectively, out of six horses examined. Perirenal hemorrhage was a prominent finding on necropsy in five of six horses euthanized.

Contact hysteroscopy.

In 1907 innovations in optics and illumination made by Maximilian Nitze were applied to hysteroscopy by Charles David, who wrote a treatise of hysteroscopy. David improved illumination by placing an electric incandescent bulb at the intrauterine end of his endoscope and also sealed the distal end of the tube with a piece of glass. The history of the contact endoscope that the authors personally used is connected to the invention by Vulmiere (1952) of a revolutionary illumination process in endoscopy--the "cold light" process. The components of cold light consist of a powerful external light source that is transmitted via a special optical guide into the endometrial cavity. The 1st application of his principle (1963) was an optical trochar contained in a metallic sheath. This simple endoscope was perfected, and in 1973 Barbot and Parent, in France, began to use it to examine the uterine cavity. Discussion focuses on methods, instrumentation, method for examination (grasping the instrument, setup, light source, anesthesia, dilatation, technique, and normal endometrium); cervical neoplasia; nonneoplastic lesions of the endometrium (endometrial polyp, submucous myoma, endometrial hyperplasia); intrauterine device localization; neoplastic lesions of the endometrium; precursors (adenocarcinoma); hysteroscopy in pregnancy (embryoscopy, hydatidiform mole, postpartum hemorrhage, incomplete abortion, spontaneous abortion, induced abortions, and amnioscopy); and examinations of children and infants. The contact endoscope must make light contact with the structure to be viewed. The principles of contact endoscopy depend on an interpretation of color, contour, vascular pattern, and a sense of touch. These are computed together and a diagnosis is made on the basis of previously learned clinical pathologic correlations. The contact endoscope is composed of 3 parts: an optical guide; a cylindric chamber that collects and traps ambient light; and a magnifying eyepiece. The phase of the menstrual cycle may be identified on the basis of the endometrial pattern. This pattern diagnosis is dependent on color, contour, and physical adhesiveness of the tissue. Cervical intraepithelial neoplasia (CIN) is the most common neoplastic lesion of the cervix. When atypical epithelium extends into the cervical canal beyond the view of the colposcope, the 6 mm contact hysteroscope has been helpful in determining the extent and severity of the lesion as well as to direct biopsy equipment to the site of the pathologic condition.