Biopsy Procedures In Patients Research Articles

The Effect of Relaxation and Respiratory Exercise on Anxiety in Thyroid Biopsy Patients

Objectives: It is known that high stress levels increase the risk of complications in invasive procedures. The aim of this study is to investigate the effect of the relaxation and respiratory exercise on the anxiety state specific to the thyroid biopsy procedure in patients. Methods: 100 randomly selected thyroid biopsy patients from 200 patients watched the Relaxation and Respiratory Exercise video (group 1) and did the instructions, and the rest 100 patients were control group (group 2) who did not watch it. The State-Trait Anxiety Inventory state scale (STAI-I) and trait anxiety scale (STAI-II) were administered to all patients before the procedure. Group 1 watched the video just before the biopsy procedure. After the biopsy procedure, all the 200 patients rested for 15 minutes, and the STAI- I scale was filled again. Results: When the STAI-II and pre-biopsy STAI-I questionnaire results of the patients were compared between two groups; study group (Group 1): Patients who were selected to watch the video, control group (Group 2): Patients who were not watching the video), no statistically significant difference was found (p>0,005). When the anxiety levels in the first STAI-I performed before the biopsy and the STAI-I tests performed after the procedure were compared, a statistically significant decrease was found in the anxiety levels of the SG (p<0,001). Anxiety levels of female patients were statistically significantly higher than male patients. Conclusions: Although thyroid biopsy is a minimally invasive procedure, it may cause anxiety in patients. Watching the video before the procedure resulted in a decrease in the anxiety levels of the patients.

Safety and Adequacy of Kidney Biopsy Procedure in Patients with Obesity.

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Safety and Adequacy of Kidney Biopsy Procedure in Patients With Obesity

Safety and Adequacy of Kidney Biopsy Procedure in Patients With Obesity

Effect of core needle biopsy number on intraductal carcinoma of the prostate (IDC-P) diagnosis in patients with metastatic hormone-sensitive prostate cancer

The number of core needle biopsies in metastatic prostate cancer cases are sometimes reduced to avoid various complications. We analyzed whether core needle biopsy number influence IDC-P detection rate in patients with metastatic castration-sensitive prostate cancer (mHSPC). We retrospectively evaluated data from 150 patients diagnosed with mHSPC. Subjects were allocated to three groups according to the number of core biopsies performed: ≤ 5, 6-9, and ≥ 10. The study endpoints were the cancer-specific survival (CSS) and overall survival (OS) rates. For patients who underwent ≥ 10 core biopsies, a significant difference on CSS was detected between with or without IDC-P (P = 0.016). On the other hand, the difference decreased as the number of core biopsies became smaller (6-9; P = 0.322 and ≤ 5; P = 0.815). A similar trend was identified for the OS outcome. A significant difference on OS was also found between with or without IDC-P in patients who underwent ≥ 10 and 6-9 core needle biopsies (P = 0.0002 and 0.017, respectively), but not in those who underwent ≤ 5 core biopsies (P = 0.341). IDC-P served as a stronger prognostic marker for CSS and OS than did the other factors included in the multivariate analysis for patients had ≥ 10 core biopsies (P = 0.016, and P = 0.0014, respectively). Given the IDC-P detection and its value as a prognostic marker, we propose the performance of ≥ 10 core biopsy procedures in patients diagnosed with mHSPC to minimize the sampling error of the IDC-P.

Effect of core needle biopsy number on intraductal carcinoma diagnosis in patients with metastatic castration-sensitive prostate cancer.

243 Background: The number of core needle biopsies performed to diagnose metastatic prostate cancer are sometimes reduced in daily clinical practice. Intraductal carcinoma of the prostate (IDC-P) is associated with adverse prognostic parameters and has recently received attention as a valuable indicator for the prediction of disease severity. Currently, the relationship between IDC-P diagnosis and the number of core prostate biopsies is unclear. In the present study, we analyzed the effect of core needle biopsy number on IDC-P diagnosis in patients with metastatic castration-sensitive prostate cancer. Methods: We retrospectively evaluated data from 150 patients diagnosed with metastatic prostate cancer at our hospital between 2002 and 2012. Percentage of the core involved with cancer and the maximum cancer occupancy were 100% in median of all the patients. Subjects were allocated to three groups according to the number of core biopsies performed: ≤5, 6–9, and ≥10. The study endpoints were the cancer-specific survival (CSS) and overall survival (OS) rates. Results: Twenty-seven (18%) patients had ≤5 core biopsies, 67 (45%) patients had 6–9 core biopsies, and 56 (37%) patients had ≥10 core biopsies. For patients who underwent ≥10 core biopsies, a significant difference on CSS was detected between with or without IDC-P ( p = 0.002). On the other hand, the difference decreased as the number of core biopsies became smaller (6–9; p = 0.322 and ≤5; p = 0.815). A similar trend was identified for the OS outcome. A significant difference on OS was also found between with or without IDC-P in patients who underwent ≥10 and 6–9 core needle biopsies ( p = 0.0002 and 0.015, respectively), but not in those who underwent ≤5 core biopsies ( p = 0.3407). IDC-P served as a stronger prognostic marker for CSS and OS than did the other factors included in the multivariate analysis. ( p = 0.0024, and p = 0.0014, respectively). Conclusions: Given the IDC-P detection and its value as a prognostic marker, we recommend the performance of ≥10 core biopsy procedures in patients diagnosed with metastatic prostate cancer. Sampling error effects the IDC-P value in smaller number of core needle biopsies.

PMD7 - Biopsy Procedures in Patients with Primary Lung Cancer

Biopsy is critical in diagnosis and staging of lung cancer. The study aims to assess the use of biopsy procedures, including the approaches, the frequency, and the associated costs, in the care pathway of diagnosis or monitoring of lung cancer. This study used Truven MarketScan® Database from 2013 to 2015. The 2014 data was used to identify baseline patients with primary diagnosis of lung cancer. We included patients who were ≥18 years old, had continuous enrollment of 12 months before and after the first recorded primary lung cancer diagnosis dated in 2014, and had ≥2 primary lung cancer diagnoses within two months. CPT, ICD-9-CM, and ICD-10-PCS codes were used to capture lung cancer diagnosis and biopsy procedures. The radiologic procedures (e.g. ultrasound, fluoroscopic, CT, or MR) for needle placement were excluded from biopsy enumeration. We identified three major biopsy approaches: surgical, percutaneous, and bronchoscopic. Descriptive statistics of frequency, duration and costs were performed for biopsies within a year before and after the primary diagnosis. Among 22,161 patients included in 2014, 14,280 (64.44%) patients had ≥1 biopsies within 1 year before or after the primary diagnosis; 17.59% surgical, 41.57% percutaneous, and 33.93% bronchoscopic. Specifically, 2,905 (13.11%) patients had 1 biopsy with an average procedure cost of $5,489 (standard deviation (SD): $22,593); 4,625 (20.87%) patients had 2 biopsies, with an average of 15.7 days from the first biopsy and an average procedure cost of $7,729 (SD: $4,664); and 6,750 (30.46%) patients had ≥3 biopsies with an average of 22.7 days between biopsies and an average procedure cost of $11,899 (SD: $15,438). All costs were significantly different (p<0.0001). More than 50% of patients with primary lung cancer had multiple biopsies with high costs in short time frame. Further research is needed to identify ways to reduce unnecessary biopsies.

Oral administration of cernitin pollen extract (Cernilton® ) for 30 days might be useful to avoid unnecessary biopsy in prostate biopsy candidates: A preliminary study.

To assess the effect of cernitin pollen extract on serum prostate-specific antigen level prostate biopsy candidates, and to develop an ideal protocol to avoid an unnecessary biopsy procedure. A total of 61 patients were administrated cernitin pollen extract tablets (two tablets t.i.d.) for 30 days, and then underwent a prostate biopsy with ≥12 systematic and targeted biopsy cores obtained. Serum prostate-specific antigen levels were examined before and after administration of the pollen extract, and the change in serum prostate-specific antigen and the rate of change were analyzed in relation to negative and positive biopsy results for cancer. The mean change in serum prostate-specific antigen and rate of change after administration of cernitin pollen extract in all patients were -0.6 ± 1.4 ng/mL and -7.6 ± 16.1%, respectively, which were significantly different from the baseline values (P = 0.0003 and P = 0.0005, respectively). When prostate-specific antigen change values and rates were compared between patients negative and positive for cancer, a significant difference between those groups was observed (P = 0.04 and P = 0.03, respectively). The present study is the first to show that an ideal protocol using cernitin pollen extract has the potential to avoid an unnecessary prostate biopsy procedure in patients with elevated prostate-specific antigen, possibly caused by inflammation. Additional studies with greater numbers of participants are required to confirm our findings and develop an ideal protocol.

Contaminação do trajeto de biópsia em sarcomas primários ósseos

ObjectiveDetermine the incidence of contamination of the biopsy pathway in patients with primary bone sarcomas, as well as the clinical characteristics that influenced this outcome. Materials and MethodsThe anatomopathological reports who were treated by the Orthopedic Oncology Sector of the Orthopedic and Traumatology Department of this institution were retrospectively evaluated. OutcomeOf the 148 patients included to evaluation on this study, only one presented contamination by neoplastic cells in their of biopsy pathway. ConclusionThe bone biopsy procedure in patients with primary bone sarcomas presents great safety regarding pathway contamination when performed in specialized centers that treat this type of pathology.

Can positron emission tomography/computed tomography be predictive of diagnostic success in endobronchial biopsies performed through a fiber-optic bronchoscopy in lung cancer?

PURPOSE:The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure.METHODS:Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). The SUVmax values of the two groups were compared with lesion characteristics of homogeneous, heterogeneous involvement/presence of necrotic component as shown by PET-CT. Group data were assessed by Chi-square test and Mann–Whitney U-test. In all tests, P < 0.05 was considered significant.FINDINGS:A total of 193 participants with a mean age of 61 ± 9.4 were included in the study. There were 128 (66.3%) cases in Group 1 and 65 (33.7%) cases in Group 2. The mean SUVmax value was 16.4 in Group 1 and 15.1 in Group 2. There was no statistically significant difference between the two groups (P = 0.329). Homogeneous involvement was present in 103 (80.3%) cases in Group 1 versus 42 (64.6%) cases in Group 2. In the presence of homogeneous PET-CT involvement, diagnosis rate by biopsy was significantly higher (P = 0.016).CONCLUSION:We concluded that the high SUVmax value of the mass lesion on PET-CT did not increase the diagnostic value of the biopsy procedure in patients prediagnosed with lung cancer and that the diagnostic success of FOB biopsy was poor in cases where PET-CT showed heterogeneous involvement of the mass lesion.

P3.01-001 Comparisons of Two Plasma EGFR Platforms (ddPCR and Cobas) in Patients with Radiological Metastatic Lung Cancer

The treatment for stage IV non-small cell lung cancer relies on molecular diagnosis on tumor DNA for guiding systemic therapy. Liquid biopsy provides a timely and non-invasive way of detecting potential therapeutic targets and spares the need of performing a confirmatory biopsy procedure in patients with a positive result. We report local experience on epidermal growth factor receptor (EGFR) mutations detected by two platforms (droplet digital polymerase chain reaction (ddPCR) technique and Cobas EGFR v2) on cell free tumor DNA from radiological stage IV lung cancer patients, guiding first- and second-generation EGFR tyrosine kinase inhibitor (TKI) therapy. All these patients who had either plasma EGFR platforms done from Nov 2015 to May 2017 are retrospectively identified and analyzed. 97 patients identified. 11 out of 39 (28.2%) and 16 out of 58 (27.6%) has detectable EGFR mutation in plasma by using ddPCR and Cobas techniques respectively. Much higher detection rate is noted in never smokers (23/46, 50.0%) compared with chronic/ever smokers (4/41, 9.8%) and is highly statistically significant for difference (p-value: <0.001). The types of EGFR mutations detected are as follows: ddPCR method: 4 (36.4%) del 19, 7 (63.6%) L858R. Cobas method: 5 (31.3%) del 19, 9 (56.3%) L858R, 2 (12.5%) G719X. 20 (74.1%) patients were eventually put on 1st or 2nd EGFR-TKI as first line treatment and, among those, 17 (85%) attained partial response as the best treatment response and the median PFS and OS of is not reached. Among the 56 patients who obtained tissue biopsy/cytology along the course of disease, 6 (10.7%) of which carries histology (3 squamous cell carcinoma, 1 peripheral nerve sheath tumor, and 1 small cell carcinoma and 1 large cell tumor neuroendocrine tumor) that's not normally sent for EGFR molecular testing, as well as 11 (19.6%) patients having NSCLC-NOS histology only. ddPCR and Cobas EGFR v2 platforms have similar detection rate and chance of avoiding the need of a confirmatory tissue biopsy. A simple clinical history of smoking status determines the yield of a positive result. Plasma liquid biopsy provides a non-invasive and promising way for treatment initiation in radiological lung cancer.

Outpatient photodynamic-guided diagnosis of carcinoma in situ with flexible cystoscopy: an alternative to conventional inpatient photodynamic-guided bladder biopsies in the operating theatre?

Objective: The aim of this prospective open comparative study was to establish whether conventional photodynamic-guided bladder biopsies using general anaesthesia and rigid resectoscopes (inpatient) can be replaced with less traumatic flexible cystoscopy in non-sedated patients (outpatient), without compromising the diagnosis of carcinoma in situ (CIS).Materials and methods: Thirty-one patients were included. After BCG instillation for CIS, bladder biopsies were obtained using photodynamic-guided flexible cystoscopy. Two weeks later, patients underwent the conventional inpatient procedure. An external pathologist reviewed the biopsy samples. Pain and quality of life (QoL) symptom score were recorded.Results: Post-BCG biopsies showed only CIS in 10 patients; high-grade Ta or T1 tumour in three patients, who were referred for cystectomy; and normal or low-grade tumour tissue in 18 patients. There was a high agreement of identification of high-grade disease in biopsies and cytology using the two methods (κ = 0.93, 95% confidence interval 0.8–1.0). The outpatient procedure identified four high-grade patients diagnosed as ‘normal/low-grade’ in the inpatient procedure. The opposite was observed in two patients. Quality of biopsies did not differ between the two procedures. Pain scores for outpatients were low, and median QoL symptom score was significantly lower than for inpatients (24 vs 33, p = 0.02). Hospital length of stay was significantly longer for inpatients.Conclusions: Outpatient photodynamic-guided flexible cystoscopy is less traumatic than the conventional inpatient procedure in the diagnosis of CIS. It is safe and cost-effective, and may be an alternative to conventional inpatient biopsy procedures in patients with malignant urine cytology and normal white-light cystoscopy.

Probabilistic issues with sentinel lymph nodes in malignant melanoma.

To address issues of probability for sentinel lymph node results in melanoma and provide details about the probabilistic nature of the numbers of sentinel nodes as well as to address how these issues relate to tumor thickness and patient outcomes. Analysis of the probability of observing sentinel node metastases uses the discrete exponential probability distribution to address the number of observed positive sentinel nodes. In addition, mathematical functions derived from survival analysis are used. Data are then chosen from the literature to illustrate the approach and to derive results. Observations about the numbers of positive and negative sentinel nodes closely follow discrete exponential probability distributions, and the relationship between the probability of a positive sentinel node and tumor thickness follows closely a function derived from survival analysis. Sentinel node results relate to tumor thickness as well as to the total number of nodes harvested but fall short of identifying all those who eventually develop metastatic melanoma. Probability analyses provide useful insight into the success and failure of the sentinel node biopsy procedure in patients with melanoma.

CT-Guided Biopsy Produces High Quality Specimens For Diagnosis: A Retrospective Analysis Of 64 Consecutive Cases Using a Powered Biopsy Device At a Community Based Hospital

IntroductionFor decades, the standard methods of performing bone marrow and bone biopsy procedures in patients with varying bone densities have remained unchanged; despite the fact that the manual method of performing these biopsies has significant limitations; including patient discomfort, needle-related adverse events, and operator physical ability. As a consequence, interventional radiologists are often asked to perform these procedures for patients with difficult-to-reach biopsy targets. In 2010, a new battery/rotary powered biopsy device was introduced, initially for bone marrow sampling; then for examination of focal lesions of bones; procedures often performed by interventional radiologists using image guidance. In a retrospective study sponsored by Vidacare Corporation, an examination of one radiology and one pathology groups' initial experience using the device at a single center was conducted to determine the performance characteristics of the new biopsy device. MethodsMedical records at Holy Family Hospital from March 2010 to July 2012 were examined, and data for patients who had undergone biopsy procedures using the powered device (OnControl, Vidacare Corp, Shavano Park, TX) were compiled. Data included patient demographics, biopsy type, imaging type, analgesia/anesthesia type, anatomical location, number of passes, room time, procedure time, and complications. Pathology data included specimen dimensions, grading for crush and thermal artifact, presence of hemorrhage, overall quality, and ability to provide a definitive or descriptive diagnosis. Results64 patients had biopsy procedures using the powered device by 11 clinicians. Mean patient age was 63.5±15.6; 61% were female. Eleven patients received bone marrow aspiration and biopsy (BMAB) to diagnose/rule out hematological disorders. For the bone marrow biopsy procedures, pathology examination revealed the mean specimen length was 14.8±6.8mm; mean specimen volume was 87.9±64.2mm3 (vs. mean length of 11.0±5.5mm and mean volume of 20.4±9.0mm3 reported for patients receiving manual biopies in a separate study*) Of those specimens, 54.5% were intact, 91.9% were graded excellent or good (compared to 80% rated excellent or good for patients receiving manual biopsies in a separate study*), and the pathologist was able to provide either definitive or descriptive diagnosis for 100% of the cases. For the remaining cases, patients received bone biopsy procedures for focal lesions. Procedures were performed on vertebrae and the ilium in 39% and 38% of the cases, respectively. Other bones included the sacrum, femur, pubis, humerus, rib, and tibia. For all procedures, the mean number of passes was 1.3±0.7, and mean procedure time was 17.8±9.8 minutes. There were no complications. ConclusionsFor random marrow sampling and focal lesions, the powered system yielded outstanding specimens, particularly with respect to volume. Use of the powered device resulted in increased yield rates and higher quality specimens compared to manual devices; as well as easier and faster performance of biopsies, a broader spectrum of potential users (due to the decreased physical requirements for the biopsy), and reduced radiation exposure to patients and operators. The powered devices were especially useful when sampling hard bones and difficult-to-reach bone lesions. Shorter procedure time and diminished physician effort using the new system vastly improved operator ergonomics. The system also transformed previously inaccessible focal lesions into viable biopsy targets.*Berenson JR, Yellin O, Blumenstein B, Bojanower D, Croopnick J, Aboulafia D, et al. Using a powered bone marrow biopsy system results in shorter procedures, causes less residual pain to adult patients, and yields larger specimens. Diagnostic Pathology 2011;6:23 [Display omitted] Disclosures:Symington:Vidacare Corporation: Consultancy, Honoraria, Research Funding. Off Label Use: Not really off-label but could be interpreted as off-label. The study device has a specific indication to be used to biopsy bone marrow, bones of the iliac crest and vertebra and a general indication for bone lesions. Some specific bones other than iliac crest and vertebra were treated, studied and mentioned in this abstract, which could be interpreted as off-label use. Martinez:Vidacare Corporation: Research Funding. Cohen:Vidacare Corporation: Research Funding. Miller:Vidacare Corporation: Co-inventor of study device, Co-inventor of study device Patents & Royalties, Employment. Philbeck:Vidacare Corporation: Employment.

Nomogramy w postępowaniu terapeutycznym u chorych na raka piersi ze zmianami przerzutowymi w węźle wartowniku — przyczyny powstania, rodzaje systemów punktowych oraz ocena ich wartości klinicznej

Sentinel lymph node (SLN) biopsy procedure in patients with non-advanced breast cancer made it possible to considerably reduce the intensity of unfavourable after-eff ects connected with classical axillary lymphadenectomy. The presence of metastatic changes in SLN coexists in some patients with metastases to non-SLN. Depending on the size of the metastases detected in SLN, the above mentioned clinical situation may aff ect from 10–41% of cases. Therefore in about 3/5ths of patients with diagnosed SLN metastasis, histopathologi cal examination of removed axillary lymph nodes — within the radicalization of surgical treatment, will not reveal further changes. Presently available calculation devices (nomograms) for measuring the likelihood of metastases in non-SLN of the armpit make it possible to accurately determine the probability of their occurrence. They therefore simplify further therapeutic decisions.

Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study

The optimum timing of sentinel-lymph-node biopsy for breast cancer patients treated with neoadjuvant chemotherapy is uncertain. The SENTINA (SENTinel NeoAdjuvant) study was designed to evaluate a specific algorithm for timing of a standardised sentinel-lymph-node biopsy procedure in patients who undergo neoadjuvant chemotherapy. SENTINA is a four-arm, prospective, multicentre cohort study undertaken at 103 institutions in Germany and Austria. Women with breast cancer who were scheduled for neoadjuvant chemotherapy were enrolled into the study. Patients with clinically node-negative disease (cN0) underwent sentinel-lymph-node biopsy before neoadjuvant chemotherapy (arm A). If the sentinel node was positive (pN1), a second sentinel-lymph-node biopsy procedure was done after neoadjuvant chemotherapy (arm B). Women with clinically node-positive disease (cN+) received neoadjuvant chemotherapy. Those who converted to clinically node-negative disease after chemotherapy (ycN0; arm C) were treated with sentinel-lymph-node biopsy and axillary dissection. Only patients whose clinical nodal status remained positive (ycN1) underwent axillary dissection without sentinel-lymph-node biopsy (arm D). The primary endpoint was accuracy (false-negative rate) of sentinel-lymph-node biopsy after neoadjuvant chemotherapy for patients who converted from cN1 to ycN0 disease during neoadjuvant chemotherapy (arm C). Secondary endpoints included comparison of the detection rate of sentinel-lymph-node biopsy before and after neoadjuvant chemotherapy, and also the false-negative rate and detection rate of sentinel-lymph-node biopsy after removal of the sentinel lymph node. Analyses were done according to treatment received (per protocol). Of 1737 patients who received treatment, 1022 women underwent sentinel-lymph-node biopsy before neoadjuvant chemotherapy (arms A and B), with a detection rate of 99.1% (95% CI 98.3-99.6; 1013 of 1022). In patients who converted after neoadjuvant chemotherapy from cN+ to ycN0 (arm C), the detection rate was 80.1% (95% CI 76.6-83.2; 474 of 592) and false-negative rate was 14.2% (95% CI 9.9-19.4; 32 of 226). The false-negative rate was 24.3% (17 of 70) for women who had one node removed and 18.5% (10 of 54) for those who had two sentinel nodes removed (arm C). In patients who had a second sentinel-lymph-node biopsy procedure after neoadjuvant chemotherapy (arm B), the detection rate was 60.8% (95% CI 55.6-65.9; 219 of 360) and the false-negative rate was 51.6% (95% CI 38.7-64.2; 33 of 64). Sentinel-lymph-node biopsy is a reliable diagnostic method before neoadjuvant chemotherapy. After systemic treatment or early sentinel-lymph-node biopsy, the procedure has a lower detection rate and a higher false-negative rate compared with sentinel-lymph-node biopsy done before neoadjuvant chemotherapy. These limitations should be considered if biopsy is planned after neoadjuvant chemotherapy. Brustkrebs Deutschland, German Society for Senology, German Breast Group.

Renal Biopsy in Chronic Kidney Disease: Lessons from a Large Italian Registry

Background: Renal biopsy procedure in patients with chronic renal failure (CRF) may represent a valid tool to help clinicians in clinical practice. However, the use of this invasive method in CRF is variable and it reflects the hospital biopsy policy. Methods: To better define the CRF-related histological patterns and to assess the clinical utility of this procedure in this extensive group, we analyzed biopsy records of 1,185 CRF patients living in a large area of north-east Italy from 1998 to 2010. Results: Data analysis showed that, although the biopsy incidence rate and the histological features were unchanged, the mean age of our CRF patients increased during the study period (R² = 0.42, p < 0.01). Primary and secondary glomerulonephritis (SGNs) were the main histological presentations (53.9 and 23%, respectively). SGNs were over-diagnosed in females. Leading histological types were immunoglobulin A nephropathy (22%), focal segmental glomerulosclerosis (12.4%), membranous glomerulonephritis (MGN, 7.5%) and nephroangiosclerosis (7.3%). These forms were also highly frequent in CRF patients with elevated proteinuria and moderate/severe renal damage. Elderly patients were primarily affected by MGN. After biopsy, 49.5% of CRF patients with and 34.1% without nephrotic syndrome received immunosuppression therapy. Conclusions: This study demonstrated that renal biopsy in CRF patients, regardless of age and glomerular filtration rates, is safe and essential to achieve a correct diagnosis and to commence the correct therapy. Additionally, it revealed that, even in patients with severe renal damage, it is possible to perform an accurate histological diagnosis and, interestingly, end-stage kidney disease seems not to be the primary form.

Impact of Ultrasound-Guided Kidney Biopsy Simulation on Trainee Confidence and Biopsy Outcomes

Background/Aims: To improve procedural skill competence in real-time ultrasound-guided renal biopsy, we have developed an inexpensive simulation tool (a porcine kidney inserted under a turkey breast) that mimics biopsy conditions in human patients in terms of kidney size, depth, echogenicity and overall structural characteristics. This study investigated the utility of this simulation tool for improving trainees’ confidence in performing renal biopsy and biop- sy-associated bleeding complications. Methods: We have quantitatively assessed the confidence level of renal fellows before and after their initial renal biopsy simulation training. Subsequently, we determined the effect of this simulation training on trainees’ procedural competence by comparing outcomes of clinical renal biopsies performed by fellows that did versus those who did not participate in the simulation training. Results: We show that renal biopsy simulation has improved the confidence level of trainees (23.4 presimulation to 70.3 postsimulation on a 0–100 scale; p = 0.001; η² = 0.69). The improvement in trainees’ confidence did not vary across their prior experience performing renal biopsies (η² = 0.23; p = 0.060). Additionally, fellows who participated in the simulation training demonstrated improved competence in performing the renal biopsy procedure in patients. Successful retrieval of renal tissue per pass was 94% (vs. 73% in fellows who did not participate in this simulation training; p = 0.002) and procedure-related blood loss was reduced as indicated by smaller postbiopsy versus prebiopsy hematocrit decline (1.18 vs. 2.68; p = 0.049). Conclusion: Renal biopsy simulation training may improve trainees’ confidence and reduce the severity of biopsy-associated bleeding complications in patients.

Portal and Sinusoidal Fibrosis are Common on Liver Biopsy After Fontan Surgery

Hepatic fibrosis is an important complication after Fontan surgery in patients with single-ventricle congenital heart disease. Few reports of hepatic histology in these patients exist, and sinusoidal fibrosis has been described. We aimed to characterize fibrosis at liver biopsy procedure in patients with previous Fontan surgery and to identify patient variables associated with the degree of fibrosis. All patients who had previous Fontan surgery and who subsequently underwent liver biopsy at our institution between January 1990 and July 2010 were identified. For each biopsy specimen, portal and sinusoidal fibrosis were graded and medical records reviewed. Biopsy specimens from 13 patients were examined; the median time from Fontan surgery to liver biopsy procedure was 16.9 years (range 6.9-25). At the most recent biopsy procedure, 12 patients (92 %) had evidence of portal fibrosis, including 1 patient with portal-based cirrhosis. Thirteen patients (100 %) had at least some degree of sinusoidal fibrosis, including 1 patient with centrilobular-based cirrhosis. Lower platelet count was associated with greater degree of portal fibrosis by ordinal regression (odds ratio 0.84, P = 0.04), and patients with no or mild portal fibrosis had significantly higher platelet counts compared with those with moderate or severe portal disease (278 ± 78 K vs. 160 ± 46 K, P = 0.005). Four patients underwent serial biopsy procedures; portal fibrosis was progressed in 3 patients, and sinusoidal fibrosis was progressed in 3 patients. After Fontan surgery, portal and sinusoidal fibrosis are common at liver biopsy and can progress over time. Lower platelet count may represent a marker of portal-based disease in these patients.

Evaluation of the quality of the sentinel lymph node biopsy procedure in patients with breast cancer

The Sentinel Lymph Node Biopsy (SLNB) has been demonstrated to be a safe alternative to axillary lymph node dissection in breast cancer staging. The multidisciplinary team must do it with rigor and demonstrate that they have fulfilled some essential criteria. Objective To evaluate the quality of the procedure in the Breast Pathology Unit of Hospital Puerta del Mar, using the self-evaluation guidelines of the Spanish Society of Senology and Breast Pathology. Material and method These guidelines establish some objective and measurable evaluation criteria related to the aspects that intervene in the SLNB. Each criterion is associated to 4 levels of quality standards. There are 3 essential criteria of mandatory fulfillment to implement SLNB in the clinical practice. They evaluate care experience (6 criteria), operative aspects (18 criteria, 3 essential) and scientific activity (8 indicators). The initial validation phase included 50 patients and the application phase 120 patients (February 2009). Results Three essential criteria related to the detection of the sentinel node (98%), accredited sensitivity (90%), and mean number of axillary sentinel nodes (2.1) were fulfilled. The application of self-evaluation guidelines in our Unit obtained a global score of 39 out of 71 points, quality level II being the most prevalent. Conclusion During the validation phase, our unit fulfilled the criteria established to implement the procedure. Following that, the use of this guideline accredits the good practice of the SLNB procedure and makes it possible to identify the areas of improvement, in our case, those related to the scientific and training activities.

Relationship between biopsy-proven parenteralnutrition-associated liver fibrosis and biochemical cholestasis in children with short bowel syndrome

Purpose The aim of the study was to determine the frequency of biochemical cholestasis (direct bilirubin [DB] ≥2 mg/dL) in children with short bowel syndrome and biopsy-proven parenteral nutrition (PN)-associated liver disease and to define predictive factors for the occurrence and degree of hepatic fibrosis. Methods After institutional review board approval, a retrospective review was conducted of patients followed by 2 multidisciplinary intestinal rehabilitation programs between January 1, 2000, and September 30, 2008. Inclusion criteria were exposure to PN (>30 days) and having undergone a liver biopsy. Liver biopsy specimens were graded from 0 to 3 based upon degree of fibrosis in the pathology report. The most recent DB within 10 days before biopsy was recorded. Results A total of 66 children underwent 83 liver biopsy procedures. The most common diagnoses included necrotizing enterocolitis (NEC) (36.4%), gastroschisis (22.7%), and intestinal atresia (15.1%). Median age at biopsy was 6.1 months with a median duration of PN of 4.7 months. Of the patients, 70.3% had a history of exposure to parenteral ω-3 lipid emulsion. Of the liver biopsy specimens, 89% (74/83) demonstrated some degree of fibrosis (fibrosis scale 1-3), including 9.6% (8/83) with evidence of cirrhosis. 83% of biopsies without fibrosis and 55% of biopsies with fibrosis were obtained in patients without evidence of biochemical cholestasis ( P = .20). Three (37%) of the 8 patients with cirrhosis on liver biopsy had no evidence of biochemical cholestasis. Univariate analysis identified only gestational age (GA) at birth as significantly associated with the degree of liver fibrosis ( P = .03). A multivariate logistic regression model accounting for multiple biopsy procedures in patients revealed that GA was a predictor of fibrosis only in patients with a diagnosis other than NEC ( P < .01). Conclusions In children with short bowel syndrome, biochemical cholestasis does not reflect the presence or degree of histologically confirmed PN-associated liver fibrosis. Careful follow-up, combined with further refinement of diagnostic and hepatoprotective strategies, may be warranted in this patient population.