Indications For Biopsy Research Articles

Between-hospital variation in biopsy indication for patients with newly diagnosed glioblastoma in the Dutch Quality Registry for Neurosurgery.

This registry-based study aims to examine the variation in biopsy and resection indications for glioblastoma patients across Dutch hospitals and to identify patient- and hospital-related factors associated with the surgical treatment. Data from all 7443 adults with first-time glioblastoma surgery at 12 hospitals were obtained from the prospective population-based Quality Registry Neurosurgery in the Netherlands between 2011 and 2021. Patients were stratified by either biopsy or resection. We analyzed variation in American Association of Anesthesiologist (ASA) classification, Karnofsky Performance Score (KPS), gender and age distribution between the different centers. Between-hospital variation in biopsy percentage was analyzed using a funnel plot. Logistic regression was used to identify associated patient- and hospital-related factors. In total, 32% of the newly diagnosed glioblastoma patients underwent a biopsy, with wide variations between the different centers (23-56%). Patients-related variables such as higher age or ASA classification and lower KPS were significantly associated with the indication for biopsy. After correction for these factors, between-hospital variation persisted, with two institutes performing more biopsies than expected and one less than expected. Median overall survival was 12.5months (95% CI 12.2-12.9) in the resection group and 5.6months (95% CI 5.1-6) in the biopsy group, with wide variations between the different centers. A substantial between-hospital variation in biopsy percentages was found. Patient factors (age, ASA classification and KPS) but also hospital factors (such as academic setting) impact surgical decisions. Variation persisted also after correction for potential confounders, indicating that other factors play a role in decision-making.

Kidney Biopsy-Proven Diabetic and Non-Diabetic Kidney Diseases and Outcomes in Patients With Type 2 Diabetes Receiving Dialysis: The REIN Registry.

Chronic kidney disease (CKD) in patients with diabetes does not always equate to diabetic kidney disease (DKD). This study aims to delineate and compare the clinical characteristics, survival rates, and access to kidney transplantation among patients with type 2 diabetes commencing dialysis, who were classified by kidney biopsy as having either DKD or non-diabetic kidney disease (non-DKD). We used the comprehensive French Renal Epidemiology and Information Network registry to analyze baseline clinical characteristics at dialysis inception and outcomes defined as death and access to kidney transplantation. We employed a multivariate Cox proportional hazards model and the Fine-Gray competing risk model to assess the probabilities of mortality and transplantation. Adults in the Renal Epidemiology and Information Network registry in France with a diagnosis of type 2 diabetes who initiated kidney replacement therapy from January 2009 to December 2015 and had a previous native kidney biopsy. We analyzed data from 2,869 patients with diabetes, 45% of whom had a biopsy-confirmed diagnosis of DKD. Among these patients, half presented additional histopathological findings indicative of nephroangiosclerosis and focal segmental glomerulosclerosis. The clinical profiles of patients with DKD and non-DKD were largely comparable. There were no significant differences in dialysis survival rates or kidney transplantation access between the groups, even after adjusting for confounding variables and considering competing risks. At the 6-year mark, the mortality rate was 60.3% (95% CI: 55.5-64.5) for the DKD group and 60.3% (95%CI: 55.9-64.3) for the non-DKD group. Multivariable Cox analysis revealed no significant difference in mortality risk between the DKD and non-DKD groups. The study limitations include potential residual confounders, lack of predialysis data, kidney biopsies possibly outdated, nonrandom biopsy indications, and survival bias because of analysis at dialysis inception. In patients with diabetes initiating dialysis, clinical characteristics and outcomes following dialysis initiation were similar in biopsy-proven DKD versus non-DKD. Our results suggest that the diabetic milieu has a more significant impact on outcomes in patients with diabetes treated with dialysis than the underlying pathological kidney diagnosis.

Comparison of percutaneous liver aspiration biopsy and tru-cut biopsy results

Aims: The aim of this study was to compare the diagnostic rates, complications and histopathologic diagnoses of aspiration biopsy and tru-cut biopsy procedures in liver parenchyma and to reveal the differences between the technical methods. Methods: Patients who underwent liver parenchymal biopsy in our hospital were identified. While tru-cut biopsy needle was used in the radiology department, aspiration biopsy needle was used in the gastroenterology department. Patients who underwent parenchymal biopsy were included in the study, while lesion biopsies were excluded. Indications for biopsy, presence of hepatitis, type of biopsy needle, number of times, size of biopsy material, pathologic diagnosis and complications after biopsy were evaluated. Results: Of the 113 patients who underwent liver biopsy, 74 were male (mean age 40.38.±17.37 years) and 39 were female (mean age 45.49±15.85 years). Among the patients who underwent liver biopsy, tru-cut biopsy needle was used in 46 patients, while aspiration biopsy needle was used in 67 patients. The biopsy size and number of pieces were statistically significantly higher in aspiration biopsy compared to tru-cut biopsy. There was no difference between the two biopsies in terms of diagnosis rate, complication development, fibrosis staging and score. Conclusion: Percutaneous aspiration and tru-cut biopsies are reliable diagnostic methods with high diagnostic rates and low complication rates. The fact that biopsy is performed by experienced hands, under US guidance, and the number of biopsies is limited reduces the development of complications.

P0417 Impact of Cytomegalovirus infection on patients with Inflammatory Bowel Disease in the Southern Area of Gran Canaria: a case-control study

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic condition affecting the digestive tract. During refractory flare-ups, cytomegalovirus (CMV) infection should be ruled out. Objectives: To analyse the characteristics, risk factors, and subsequent outcomes of IBD associated with CMV infection. Methods A retrospective case-control study included 50 cases and 50 randomly selected controls with IBD flare-ups between January 2018 and December 2023. CMV infection was diagnosed using PCR on colonic mucosa samples. Epidemiological, clinical, and complication data were analysed. Results No differences were observed regarding sex or type of IBD. Significant differences (p<0.05) were found between cases and controls: age during the episode 51 vs 41 years; age at IBD diagnosis 47 vs 36 years; clinical presentation with bloody diarrhea 90% (45) vs 32% (16)); prior immunosuppressive therapy 30% (15) vs 16% (8); clinician-driven biopsy indication 70% (35) vs 60% (30); and hospital-based diagnosis 52% (26) vs 12% (6). The onset of IBD during the episode was less frequent in cases, 16% (8) vs 30% (15), and complete colonoscopy was performed less often, 24% (12) vs 72% (36). Multivariate analysis identified independent risk factors, including treatment with intravenous methylprednisolone, moderate-severe clinical presentation, and corticosteroid-refractory disease. Conclusion In our patients, CMV infection during IBD flare-ups was associated with (1) treatment with intravenous methylprednisolone, moderate-severe clinical severity, and corticosteroid refractory; (2) when the indication for a biopsy is based on clinical criteria; and (3) it does not lead to future therapeutic escalations, although it does higher rates of colectomy.

Asymptomatic HyperCKemia in the Pediatric Population: A Prospective Study Utilizing Next-Generation Sequencing and Ancillary Tests.

Persistent elevation of serum creatine kinase levels (hyperCKemia) as an isolated manifestation presents a diagnostic challenge. Genetic myopathies are frequently involved; however, studies using next-generation sequencing (NGS) in pediatric patients are lacking, and the significance of genetic aberrations remains poorly understood. This study, therefore, aimed to investigate the relevance of NGS and the support of contemporary diagnostic tools in the diagnosis of pediatric asymptomatic hyperCKemia. This was a prospective cohort study enrolling pediatric (0-18 years old) patients meeting the predefined criteria for asymptomatic/paucisymptomatic hyperCKemia, excluding DMD gene deletion/duplication, recruited from a referral center. NGS, muscle MRI, EMG, and muscle biopsies with immunolabeling and inflammatory markers were performed according to a prespecified protocol. Data analysis was performed using descriptive/univariate statistics and Bayesian logistic regression. The series comprised 65 patients (78% male). NGS diagnosis was achieved in 55% of the cohort, with 70% of the pathogenic variants involving 7 genes (DMD, CAPN3, ANO5, DYSF, RYR1, GAA, and CAV3). The diagnostic rate was similar across all age groups; however, the gene profiles varied between the childhood and juvenile groups. EMG yielded myopathic features in 48% of the investigated cases, being predictive for diagnosis (p < 0.05; odds ratio [OR] 13.484, 95% CI 1.358-705.297). MRI showed normal (64%), focal fatty change (26%), or short-tau inversion recovery hyperintensity (10%) profiles, which were not predictive of diagnosis but supported muscle biopsy indications. Muscle biopsy provided a significant diagnostic effect (p < 0.05; OR 0.028, 95% CI 0.001-0.238), contributing to myopathologic features clarifying the variant pathogenicity and identifying inflammatory myopathies. The diagnoses remained inconclusive and unresolved in 14% and 29% of the cohorts, respectively. The diagnostic rate for patients with CK levels below the threshold of 3× was 42%. In multivariate analysis, NGS was the only variable achieving a significant diagnostic effect (β = 9.85, 95% CI 4.65-16.09). NGS, as the primary diagnostic tool for investigating hyperCKemia in the pediatric population, yielded a higher diagnostic rate. However, muscle biopsies are necessary to define variants of uncertain pathogenicity and aid in identifying inflammatory myopathies. EMG and MRI may play a role in hyperCKemia characterization, guiding the decision to perform muscle biopsy. The primary limitation of this study was that not all ancillary tests were performed in all recruited patients owing to ethical restrictions, which lowered the power of the predictive analysis.

Possible Threats of IgA Vasculitis in Children: One Center Experience

Introduction: Immunoglobulin A vasculitis (IgAV) is the most common vasculitis in children. Although typically self-limiting, IgAV may result in serious complications. Our objective was to evaluate the incidence, clinical features, laboratory predictors and outcomes of IgA vasculitis with gastrointestinal (GI) and kidney involvement.Methods: Medical records of patients &lt;18 years of age with newly diagnosed IgAV between 2013 and 2021 in a single center were analyzed. Demographic, clinical, laboratory data, and incidence of GI and kidney involvement data were analyzed. As laboratory predictors, neutrophil, lymphocyte, platelets count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) were calculated.Results: 240 patients with IgAV were included. GI involvement was in 104 patients (43.3%), whereas kidney involvment in 21 patients (8.8%). Age was the only variable associated with increased odds of kidney involvement (OR 3.5, 95% confidence interval 1.39–8.56, p=0.009). None of the laboratory predictors or other tested variables was associated with kidney involvement in univariable logistic regression. The neutrophil and lymphocyte count, NLR and PLR levels were found to be significantly higher in children with GI involvement. There were no bad outcomes: lethal outcome or chronic kidney disease for the patients with GI and kidney involvement in recent study. During two years of surveillance after IgAV diagnosis, 11 cases (4.6%) had indications for kidney biopsy and were diagnosed with IgAV nephritis.Conclusions: Older children were more likely to have kidney disease. Easy obtained laboratory parameters such as NLP, PLR could help to predict GI involvement in early disease stage, but had no value for predicting kidney involvement.

Epidemiology of kidney biopsy from regional referral center in Romania: 10-year review.

To provide epidemiologic data on kidney biopsy from Romania. Retrospective observational study of kidney biopsy records for adult patients from a referral center in the north-western part of Romania, reported for 2014-2023. 556 biopsies were performed, corresponding to an incidence of 12 biopsies/m person-year with over 50% increase over the last reported year. Optimal core for optic microscopy was available in 81.4%, immunofluorescence was performed in 86.3%, and electron microscopy in 35.2% of patients. The mean age at biopsy was 47.12 years, and 53.8% were males. Indications for kidney biopsy were nephrotic syndrome in 63.1% of patients, nephritic in 25.9% of patients, asymptomatic urinary abnormalities in 2.9%, acute kidney injury/rapid progressive renal failure in 3.6%, and chronic kidney disease in 1.4%. The most frequent diagnostic categories were membranous nephritis (14.7%), IgA nephropathy (13.9%), focal segmental glomerulosclerosis (11,1%), minimal change disease (12,2%), lupus nephritis (10,9%), vasculitis (7.6%), and membranoproliferative glomerulonephritis (8%). The age of diagnosis increased for IgA Nephropathy over time while it decreased for membranous nephritis. Our study adds data for the completion of the kidney biopsy map in our region.

Can Broadening the Kidney Biopsy Criteria Reduce Misleading Diagnoses in Young Patients with End-Stage Renal Diseases? A Survey on the Sicilian Registry of Nephrology, Dialysis, and Transplantation.

Audits allow analysis of the delivery of care and the prevalence of diseases. This study investigated kidney diseases' impact on end-stage renal disease (ERSD) in patients younger than 30 years. Methods: This analysis is retrospectively conducted on young dialysis-dependent patients included in the Sicilian Registry of Nephrology, Dialysis and Transplantation Participants. It evaluated patients who started dialysis before the age of 30 retrieved in the mentioned registry. The sample was divided into two groups, according to the presence or absence of a specific diagnosis. Baseline features were reported as mean ± sd, median [IQR] and n (%). A Student T-test, Mann-Whitney test or Pearson Chi-Square test was performed. Logistic regression analysis detected the association between the variables and the unknown diagnosis, and variables with a p-value < 0.2 were added to the multivariate model. ROC curves were drawn including this multivariate prediction. Results: In total, 145 patients started dialysis before the age of 30 years. Between patients with and without a diagnosis, the intake of renin-angiotensin-aldosteron system inhibitors (RAASIs) and blood pressure differed enough to be considered as possibly confounding. Logistic regression showed that blood pressure and RAASIs seemed to be related to the unknown diagnosis. ROC curves adjusted for RAASIs and blood pressure provided an AUC = 0.689. Conclusions: Although Kidney Disease Improving Global Outcomes (KDIGO) did not include hypertension among biopsy indications, our data suggest that performing renal biopsy in young patients with hypertension and worsening renal function could improve kidney diagnosis management.

Donor-derived cell-free DNA monitoring for early diagnosis of antibody-mediated rejection after kidney transplantation: a randomized trial.

Donor-derived cell-free DNA (dd-cfDNA) shows good diagnostic performance for the detection of antibody-mediated rejection (AMR) in kidney transplant recipients (KTR). However, the clinical benefits of dd-cfDNA monitoring need to be established. Early diagnosis of AMR at potentially reversible stages may be increasingly important due to emerging treatment options for AMR.We hypothesized that monitoring dd-cfDNA in KTR with de novo donor-specific anti-HLA antibodies (dnDSA) and performing kidney biopsy in case of increased dd-cfDNA may reduce time to AMR diagnosis in comparison to clinical indication biopsy. In this diagnostic, single-center, open-label, randomized clinical trial, we assigned 40 KTR with prevalent dnDSA and estimated glomerular filtration rate ≥20mL/min/1.73m2, but without previous biopsy-proven AMR, to either dd-cfDNA-guided biopsy (intervention group) or clinician-guided biopsy (control group) over a 12-months period. In both groups, dd-cfDNA was assessed at inclusion and 1, 3, 6, 9, and 12 months. In the intervention group, dd-cfDNA>50cp/mL indicated a biopsy. Biopsies for clinical indication could be performed at any point during the study period in both groups. A protocol biopsy was scheduled after 12 months for patients without dd-cfDNA-guided biopsy or clinical indication biopsy until study completion. The primary endpoint was time from study inclusion to diagnosis of active or chronic active AMR. 39/40 patients had functioning grafts at study completion. From these, 26 patients underwent biopsy, 13 in each group. AMR was diagnosed earlier in the intervention group than in the control group (median 2.8 months, IQR 1.7-5.3vs. median 14.5 months, IQR 13.3-16.7, p=0.003). Longitudinal dd-cfDNA monitoring had 77% positive predictive value and 85% negative predictive value for AMR. Dd-cfDNA-guided biopsy in KTR with prevalent dnDSA can reduce the time to AMR diagnosis and hereby expedite therapy initiation. (NCT04897438).

Short Communication: Analysis of the Spectrum of Glomerular Diseases in Chronic Filariasis Diagnosed in a Tertiary Care Hospital in India.

Introduction: The study presents renal manifestations in chronic filariasis, a substantial health concern in the eastern and north-eastern regions of India. Materials and Methods: The study is a retrospective analysis of a renal biopsy series of patients with chronic filariasis from a tertiary care hospital in Odisha. It involves eight cases of chronic filariasis. Results: Common indications of biopsy were nephrotic syndrome, chyluria, and unexplained renal failure. The mean duration from the diagnosis of filariasis to the onset of glomerular diseases was 15.75 years, SD ± 4.2 years. Patients were followed up for a minimum of 6 months. Renal histopathology revealed various patterns, including membranous nephropathy, minimal change disease, IGA nephropathy, and membranoproliferative glomerulonephritis. Conclusion: The study fills a critical gap in the literature by elucidating renal biopsy findings in chronic filariasis. The multifaceted nature of this disease underscores the need for continued research to understand kidney diseases due to filariasis, especially in endemic regions.

Evaluation and randomised controlled trial of home urinalysis testing in patients with SLE at elevated risk for developing lupus nephritis: a study protocol

IntroductionLupus nephritis (LN) is a frequent complication of SLE, occurring in up to 60% of adult patients and ultimately progressing from acute inflammation to chronicity with fibrosis and end-stage kidney...

HPB SO50 - A comprehensive review of clinical practice guidelines for managing hepatic adenoma

Abstract Background Hepatic adenoma(HCA) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of Hepatic adenomas. Practice guidelines are needed, because of the many variation, diagnostic tools, and conservative and invasive management protocols. Therefore, our aim was to systematically search for available clinical practice guidelines on hepatic adenoma, critically appraise them, and compare management recommendations. Method Systematic literature search was performed by two investigators using appropriate prespecified search terms within the bibliographic databases of MEDLINE, EMBASE, and PubMed. All HCA guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on HCA were analysed, compared, and critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) 2020 checklist. Results The literature search yielded unique 199 papers, 187 were excluded after screening of title/abstract, and 9 after full-text screening. Guidelines included were: (EASL; 2016, (ACG; 2014), (SBH; 2015),). There were no set standards in the assessment methods for grading and gravity of recommendations between guidelines. Observed differences were: (1) indications for biopsy; (2) advices on contraceptive pills and follow-up; (3) use of an lesion centred approach to HCA; (4) lack of adequate treatment recommendations of HCA in male population ; and (5) approach to HCA depending on subtype varaition on magnetic resonance imaging. Conclusion Recognising differences in recommendations can assist in formulating practice standards and identify needs for research.

Practical use of S-Detect Thyroid artificial intelligence-based program for automatic detection and characterization of thyroid nodules

In order to assess the practical efficacy of the S-Detect Thyroid artificial intelligence-based program for automatic detection and analysis of thyroid lesions, the prospective assessment of 84 focal thyroid lesions was carried out. he risk of malignancy was stratified according to the EU-TIRADS at the same time. A fine-needle aspiration biopsy was performed for all detected nodules of EU-TIRADS 3–5 category and a diameter ≥10 mm. Cytological examination was performed using the Bethesda classification. According to the cytology data, all patients were divided into two groups: 73 patients with benign thyroid nodules (Bethesda II) and 11 patients with malignant nodules (Bethesda V). Patients with “uncertain” Bethesda categories “I”, “III”, and “IV” were excluded from the study. The results of the study showed that the use of the S-Detect program based on artificial intelligence allows for differential diagnostics of benign (Bethesda II) and malignant (Bethesda V) thyroid nodules with a sensitivity of 90.9%, specificity of 94.5%, positive and negative predictive value of 71.4% and 98.6%, accuracy of 94%, and AUC 0.941. In our opinion, the best results of all program settings show the S-Detect “High Accuracy” mode, which we recommend for practical use. In some cases, there was disagreement between the S-Detect and the doctor's opinion in characterizing the nodule structure and echogenicity, as well as in determining the presence of macro- and microcalcifications. In our opinion, the use of the S-Detect benign/malignant criteria as indications for needle aspiration biopsy would avoid obviously unnecessary diagnostic interventions in some patients with thyroid nodules classified as EU TIRADS 3–5. However, the S-Detect artificial intelligence program cannot currently fully replace the doctor's intellect, erudition, and experience.

Questioning the Correlation Between Incidence of Hirschsprung Disease and Indications for Rectal Biopsy.

Aim: To review the indications for rectal mucosal/submucosal biopsy (RMSBx) used for diagnosing Hirschsprung's disease (HD) in pediatric patients. Methods: The medical records of all children between 1 and 15 years old assessed for chronic constipation between 2012 and 2022 were reviewed. Until the end of 2018, enema usage (E+) was a major indication for RMSBx. In 2019, laxative use for 3 months irrespective of enema use was added as an indication (L+). To determine the relevance of enema usage, L+ was subdivided by enema usage into (L+E+) and (L+E-) groups. The effect of changing the indications for RMSBx on the incidence of HD was investigated. Results: Of 562 eligible subjects, E+ = 410, L+ = 152; demographics are similar. RMSBx rate in E+ (E+RMSBx) was 36/410 (8.8%) and in L+ (L+RMSBx) was 42/152 (27.6%;) (P < .05). For L+RMSBx, 15/42 were L+E+ and 27/42 were L+E-. HD incidence in E+RMSBx was 8/36 (22.2%; E+HD) and in L+RMSBx was 13/42 (31.0%; L+HD) (p = ns). In L+RMSBx, HD incidence in L+E+ was 5/15 (33.3%; L+E+HD) and in L+E- was 8/27 (29.6%; L+E-HD) (P = ns). Differences in daily bowel motion frequency 6 months postoperatively were not statistically significant; E+HD (1.75/d) versus L+HD (2.03/d) and L+E+HD (1.60/day) versus L+E-HD (2.31/day). Unassisted voluntary defecation was confirmed 12 months postoperatively in 7/8 (87.5%) E+HD, 11/13 (84.6%) L+HD, 4/5 (80.0%) L+E+HD, and 7/8 (87.5%) L-E-HD; differences were not significant. Laxatives were still required in 2/8 (25.0%) E+HD, 3/13 (23.1%) L+HD, in 1/5 (20.0%) in L+E+HD, and 2/8 (25.0%) L+E-HD; differences were not significant. Conclusion: Incidence of HD was higher in L+HD, but not significantly different suggesting that indications for RMSBx have potential to influence incidence of HD and hint that the incidence of HD could actually be higher. Further assessment of additional indications is warranted to diagnose HD with greater accuracy.

Clinicopathological characteristics and outcomes of adult patients with idiopathic membranoproliferative glomerulonephritis according toan immunofluorescence-based classification.

The classification of membranoproliferative glomerulonephritis (MPGN) into immune complex-mediated MPGN and complement-mediated MPGN on immunofluorescence has provided insights into two distinct disease processes. There are limited data available on renal outcomes of MPGN from developing countries. A retrospective analysis was conducted on biopsy-proven MPGN cases diagnosed between 1998 and 2018 at the Sindh Institute of Urology and Transplantation (SIUT). Secondary causes were excluded. Patients were reclassified as immune complex-mediated-MPGN and complement-mediated-MPGN based on immunofluorescence results. The clinicopathological findings and outcomes of the two groups were compared. In total, 213 patients with idiopathic MPGN were identified. Among these, 163 (76.5%) were reclassified as immune complex-mediated-MPGN and 50 (23.4%) as complement-mediated-MPGN. No significant differences were found between the two groups regarding age, gender, clinical characteristics, biopsy indications, biopsy findings, and renal function at presentation. Overall, 63 subjects (38.7%) with immune complex-mediated-MPGN and 27 (54%) with complement-mediated-MPGN received immunosuppressive agents (p = 0.08). Complete and partial remission rates were higher in immune complex-mediated-MPGN than in complement-mediated-MPGN (76% vs 58%, p < 0.05). At two years, median estimated glomerualr filtration rate (eGFR) tended to be higher in patients with immune complex-mediated-MPGN 91.2 (45.4-113.7) vs 83.45(34.6-102.50)ml/min/1.73 m2, p = 0.22) with significantly better renal survival (76% vs 58%, p = 0.03). Comparatively, more patients progressed to end-stage kidney disease (ESKD) in the complement-mediated-MPGN group (32% vs 19.6%, p = 0.06), with increased overall mortality (5 (10%) vs 7 (4.3%), p = 0.12). The clinicopathological features at presentation of complement-mediated-MPGN are similar to those of immune complex-mediated-MPGN. However, it is less frequent and overall prognosis is less favorable.

Breast and axillary marking in the neoadjuvant setting: survey results from experts of the Brazilian society of mastology.

The precise location of the tumor site is essential for the success of surgical treatment. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor and node localization. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached. This was an online survey conducted between June and December 2022. All 1,742 active mastologists affiliated to the SBM were invited anonymously. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program version 26.0. Post hoc analysis was performed when appropriate and the significance level was set at p < 0.05. Polychoric regression analyses were conducted using `VGAM` package. In total, 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%). Most professionals were board-certified (84,8%). The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree). However, there was consensus that the clinical and imaging evaluation was insufficient for staging the axilla as N1 (71.6%). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. When <3 lymph nodes were retrieved 41.0% of mastologists performed axillary lymphadenectomy. Among the 28 questions, consensus was reached on only 11 (39.3%). The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking.

Ultrasonographic scores and parotid histopathology in Sjögren's disease: challenges in lymphoma identification.

The role of major salivary gland ultrasound (SGUS) in evaluating Sjögren's disease (SjD) continues to be debated. This study aims to assess the effectiveness of two SGUS scores (OMERACT and Hocevar et al.) in identifying lymphoma in SjD patients. A secondary aim is to explore the correlation between SGUS findings and histological characteristics of the parotid salivary glands. Consecutive adult SjD patients with a clinical indication for parotid gland biopsy between September 2018 and October 2023 were included. Ultrasound images were anonymised and assessed according to the OMERACT and Hocevar et al. scores. The histological assessment performed by the pathologist included the evaluation of lymphoma presence, focus score (FS), lymphoepithelial lesions (LELs), germinal centres (GCs), multiple focal lymphocytic sialadenitis/lymphoepithelial sialadenitis (MESA/LESA), and features of non-specific sialadenitis. Among the 57 patients included in the study, 24 (42%) were diagnosed with lymphoma. Neither the OMERACT nor the Hocevar et al. score were effective in identifying lymphoma (OMERACT score: odds ratio 1.10, 95% CI: 0.91-1.34; p=0.305; Hocevar et al. score: odds ratio 1.03, 95% CI: 0.97-1.10; p=0.300). In the remaining 33 patients without lymphoma diagnosis but at higher risk of lymphoma development, regression analysis showed significant associations between ultrasound scores and histopathological features. LELs were linked to higher OMERACT (β=3.57, 95% CI:1.53-5.61; p=0.001) and Hocevar et al. scores (β=8.16, 95% CI: 1.45-14.87; p=0.019). Additionally, the FS was correlated with both OMERACT (β=0.26, 95% CI: 0.09-0.43; p=0.004) and Hocevar et al. scores (β=0.57, 95% CI: 0.03-1.12; p=0.040). The current SGUS scores seem not to allow identifying lymphoma in SjD patients with high clinical suspicion. However, the correlation between advanced histological lesions and SGUS scores raises the opportunity of developing new SGUS scores with a prognostic rather than diagnostic or classificatory significance.

Indications and Histological Outcomes of Liver Biopsies in Sokoto, Northwestern Nigeria

Background: Various liver disorders require histological assessment for proper diagnosis, staging, treatment, or follow-up. We determine indications and histological outcomes of liver biopsy samples. Materials and Methods: Sixty-two patients were consecutively recruited from four health centers within Sokoto metropolis over a five-year period (March 2019 to February 2023). Fifty one subjects that consented had a liver biopsy done for various indications. The tissues obtained were taken for histopathologic evaluations. Results: In the majority of the subjects, 39 (76.5%) the clinical indications for liver biopsy was Chronic viral Hepatitis infections (CVHI) while 7(13.7%) and 5(9.8) of the subjects had clinical indications of unexplained liver mass and fatty liver disease respectively. In all, fifty one subjects had liver biopsy. Histological outcomes were: Chronic Hepatitis 37 (72.5%), followed by HCC with 6 (11.8%), steatohepatitis 4(7.8%) then one subjects each for steatosis and secondary metastasis to the liver. Among the subjects with histological findings of Chronic Hepatitis majority of them either having mild necroinflammation 13(35.1%) or moderate necroinflammation 14(40.5%). Significant fibrosis was found in over 40% of the patients, with 2(5.6%) had histological conclusion of liver cirrhosis. The degree of inflammation and fibrosis from chronic hepatitis was not statistically significant between genders. Conclusions: Despite advancements made in available facilities in diagnosing liver diseases, tissue still plays a significant role in diagnosis. This is particularly so in regions with hyper- endemicity for CHBVI and low socio-economic standards.

To biopsy or not to biopsy a teenager with typical idiopathic nephrotic syndrome? Start steroids first.

It is well known that minimal change disease (MCD) and focal segmental glomerulosclerosis are the most common histopathology findings in children with idiopathic nephrotic syndrome. Moreover, several studies demonstrated that MCD is associated with high steroid-responsiveness and a low incidence of kidney failure, suggesting that routine kidney biopsy is not warranted. Over time, the indications for performing a kidney biopsy have become increasingly stringent, aiming to limit unnecessary invasive procedures in the paediatric population. The most recent guidelines state that a kidney biopsy is not usually necessary at disease onset. Still, it should be performed in case of atypical features suggestive of systemic diseases or glomerulonephritis and in case of steroid-resistance, to assess the different differential diagnoses, regardless of patient age. Moreover, it has been shown that the best prognostic marker in childhood nephrotic syndrome is response to treatment and that kidney histology is not accurate in predicting prognosis. Furthermore, a kidney biopsy is not necessary to predict the relapsing course. Notably, kidney biopsy is an invasive procedure and may lead to significant complications. Finally, novel non-invasive biomarkers have been validated or are in the process of being approved to guide differential diagnoses and thus limit the need for kidney biopsies in patients with typical nephrotic syndrome. In the following sections, we aim to explain why initiating steroid treatment as the initial approach in teenagers with typical nephrotic syndrome is a reasonable strategy. Additionally, we explore how kidney biopsy indications may be alleviated in this population.

Management of acute myocarditis: a systematic review of clinical practice guidelines and recommendations.

The management of acute myocarditis (AM) is addressed in multiple clinical guidelines. We systematically reviewed current guidelines developed by national and international medical organizations on the management of AM to aid clinical practice. Publications in MEDLINE, EMBASE and Cochrane were identified between 1 January 2013 and 12 April 2024. Additionally, the websites of relevant organizations and the Guidelines International Network, Guideline Central, and NHS knowledge and library hub were reviewed. Two reviewers independently screened titles and abstracts, two reviewers assessed the rigour of guideline development, and one reviewer extracted the recommendations. Two of the three guidelines identified showed good rigour of development. Those rigorously developed agreed on the definition of AM, sampling serum troponin as part of the workflow for AM, testing for B-type natriuretic peptides in heart failure, key diagnostic imaging in the form of cardiovascular magnetic resonance, coronary angiography to exclude significant coronary disease, indications for endomyocardial biopsy (EMB), and indications for immunosuppression and advanced treatment options. Discrepancies exist in sampling creatine kinase-myocardial bound as a marker of myocardial injury, indications for EMB, and indications for immunosuppression and treatment of uncomplicated AM. Evidence is lacking for the use of 18F-Fluorodeoxyglucose Positron Emission Tomography for myocardial imaging, exercise restriction, follow-up measures, and genetic testing, and there are few high-quality randomized trials to support treatment recommendations. Recommendations for management of AM in the guidelines have largely been developed from expert opinion rather than trial data.