Biopsy Request Research Articles

Epidemiological Features of 4777 Cysts and Odontogenic Tumors Based on the 2022 WHO Classification.

The epidemiology of cysts and odontogenic tumors is important for differential diagnosis and treatment strategies. We aimed to describe the epidemiological features of cysts and odontogenic tumors in the Chilean population using the current WHO classification. We reviewed 22,914 biopsy requests received between January 1984 and September 2023 at the oral pathology department, School of Dentistry, Universidad Mayor, Santiago, Chile. Patients diagnosed with cysts of the jaws and odontogenic tumors were selected and information regarding age, sex, and location was recorded. 4226 (18.4%) were cysts, and 551 (2.4%) were odontogenic tumors, ranging from 2 to 97 years old. Males represented 54.4% and females 45.7% of the total sample. The most prevalent cysts were radicular cysts (58.6%), dentigerous cysts (17.9%), and odontogenic keratocysts (13.3%). The most prevalent odontogenic tumors were odontomas (40.1%) and conventional ameloblastoma (17.6%). Our study was the first retrospective analysis to determine the epidemiological features of both cysts and odontogenic tumors together, based on the 2022 WHO classification. This is relevant as it offers a potential basis for comprehensive comparisons of the epidemiological features of these entities, which could contribute to an accurate differential diagnosis, therefore, leading to more effective therapeutic interventions.

Predictors of glomerular IgA immunostaining patterns and disease progression in IgA nephropathy patients; a 13-year study of clinical and morphological features of renal biopsies

Introduction: IgA nephropathy (IgAN) is a common primary glomerulonephritis with highly heterogeneous clinical and histopathological features. The MEST-C scoring system has been developed to improve prognostic assessment but lacks elements related to immunostaining study. Objectives: This study aimed to investigate the association between the immunofluorescence (IF) deposits’ patterns of IgA (mesangiocapillary versus pure mesangial) with demographic, clinical, biochemical, and morphological parameters of MEST-C classification in IgAN patients. Patients and Methods: This retrospective, cross-sectional study was conducted on 268 biopsy-proven cases of IgAN from July 2009 to July 2022 at a single laboratory in Isfahan in Iran. The demographic, clinical, and laboratory data including age, gender, serum creatinine, and proteinuria were collected from the biopsy request forms. The morphological parameters of MEST-C classification and IF study patterns were collected from the biopsy reports. Results: The average age of all patients was 37.7 ± 13.47 years, with 67% being males. The mean serum creatinine and proteinuria levels were 1.43 mg/dL and 1730.94 mg/day, respectively. MEST-C score analysis revealed that 171 patients (63.8%) had mesangial expansion (M1), while 105 patients (39.2%) exhibited endocapillary hypercellularity (E1). Additionally, segmental glomerulosclerosis (S1) and tubular atrophy/interstitial fibrosis (T1 and T2) was observed in 160 biopsy samples (59.7%). Moreover, crescent (C) formation was noted in 76 (28.4%) of biopsies. Data analysis using univariate logistic regression demonstrated that E, T, and C on morphology, complement C3, IgG, IgM deposits on IF, and the total MEST score were all associated with an increased risk for mesangiocapillary deposits of IgA. However, using the multivariate method, the results indicated that only the total MEST score (OR: 2.4), presence of crescent (OR: 3.22), presence of endocapillary hypercellularity (OR: 4.86), tubular atrophy/interstitial fibrosis grade II (OR: 34.4), and IgG deposition (OR: 3.37) were independent risk factors for mesangiocapillary deposits of IgA. Conclusion: The total MEST score is significantly higher in mesangiocapillary patterns. Furthermore, the presence of E1, T2, and C1-2 morphological parameters of the updated Oxford classification in renal biopsies are independent risk factors for IgA mesangiocapillary deposits. Hyperactivation of immunoglobulins and the complement system appears to contribute to mesangial-capillary proliferation.

Telecytology - remote rapid on-site evaluation for ultrasound-guided head and neck fine needle aspiration utilising a clinical imaging assistant with an extended practice role.

Rapid On-Site Evaluation (ROSE) of fine needle aspirations (FNA) is widely accepted as best practice, resulting in better outcomes and delivery of care for patients. However, it is not always practical for cytology laboratories to release staff. To increase the availability of ROSE, this study aimed to robustly test the effectiveness of Telecytology ROSE (TCROSE) utilising a clinical imaging assistant (CIA) to prepare the samples and operate the microscope. The study was divided into 3 phases. Phase 1, equipment testing, validation and in-house training for the CIA and the Consultant Biomedical Scientist (CBMS) performing TCROSE. Phase 2, Verifying TCROSE on the same site as the cytology laboratory and phase 3, TCROSE utilising a clinic at a peripheral site away from the cytology laboratory. 78/80 (97% sensitivity, 95% accuracy) of TCROSE cases matched the final report for assessment of adequacy and sufficient sampling, demonstrating 94% reliability with a 95% confidence value. An appropriately trained CIA effectively prepared the samples and operated the microscope for remote interpretation. The samples were triaged effectively, and biopsy requests were appropriate to reduce the need for repeat procedures and delays in treatment. This approach received positive feedback from patients. TCROSE utilising a CIA provides a highly effective alternative to conventional ROSE, minimising the resources required from cytopathology services and improving patient care and access to best practice. This study supports the validity of trained CIAs for a more involved role in the ultrasound-guided FNA service.

A Retrospective Analysis of Concordance Between Clinical and Histopathologic Diagnoses and Completeness of Oral Biopsy Forms at a Tertiary Dental Hospital in Eastern Nepal.

Introduction: Histopathological diagnosis remains the gold standard tool for the diagnosis, yet accurate and detailed clinical descriptions are necessary to facilitate the final diagnosis. Histopathologists believe that clinicians are unaware of how histopathology departments operate, partly because of the less information on requisition forms. The objective of the present study is to assess the concordance of clinical and histological diagnoses of all oral and maxillofacial biopsy samples, along with the completion of the requisition form provided with the biopsy sample. Methods: A retrospective study was conducted at the Department of Oral Pathology. The biopsy request forms of year 2018-2019 were retrieved from the archive of the department and were analyzed for clinicopathological concordance. Descriptive and analytical statistics were performed using SPSS. Results: Of 338 forms, 243 (71.89%) forms had total concordance between clinical and histopathologic diagnosis; 20 forms (5.92%) had concordance with the histopathological diagnosis, but only after the clinical diagnosis had been refined. Of all the forms analyzed, 36 (10.65%) forms lack habit history in cases suspected of oral cancer and oral potentially malignant disorder, and 24 (7.10%) cases lack radiographic details. The categories of clinicohistopathological concordance and the different clinical information groups showed a statistically significant relationship. We also found that the sign-out time for histopathological reports depend on the extent of clinical information provided which was statistically significant too. Conclusions: The current study concluded a sufficient level of concordance between clinical and histopathological diagnosis. A high completion rate of biopsy forms indicated that the clinicians/operating surgeons perceive the significance of clinical information in histopathological diagnosis. We also recommend, irrespective of the type of suspected oral lesions, submitted for biopsy, a detailed clinical information is the backbone for accurate and timely reporting of the histopathological diagnosis.

Inflammatory pseudotumor of frontal sinus mimicking an aggressive malignancy: a rare case with diagnostic challenge on fine needle aspiration

Abstract Introduction/Objective Inflammatory pseudotumor (IPT) of sinonasal tract is a rare disease that sometimes mimicks malignancy in radiographic findings. Diagnosis of IPT on fine needle aspiration (FNA) is challenging due to limited cellularity and lack of architectural evaluation. Methods/Case Report Patient is a 59-year-old female presented with left front head swelling, facial pain and pressure. Imaging demonstrated a 3.0 cm hypermetabolic frontal sinus mass with osseous erosion through the calvaria table and deviating the adjacent dura, suspicious for malignancy. Also, an incidental 6.8 cm renal mass was identified and was proven to be clear cell renal cell carcinoma. FNA from frontal sinus showed loosely cohesive atypical cells with prominent nucleoli and occasional mitotic activity mixed with lymphoplasmacytic inflammation and eosinophils. Extensive immunostains showed that the lesional cells were only weakly stained for CD10 and desmin. Because of prominent cytologic atypia and radiological concerning for malignancy, FNA was diagnosed as malignancy not further classified. The patient underwent frontal sinus resection and the surgical specimen showed spindle cell proliferation surrounded by reactive woven bone with plump osteoblasts in a myxocollagenous stroma containing mixed lymphoplasmacytic cells and eosinophils. The spindle cells are positive for actin and calponin, negative for ALK. The spindle cells and plump osteoblasts corresponded to the atypical cells observed on FNA. The overall finding is consistent with IPT, although inflammatory myofibroblastic tumor cannot be completely ruled out. During follow up, the patient developed metastatic renal cell carcinoma in lung. Her frontal sinus lesion was stable for 17 months after surgery. Results (if a Case Study enter NA) NA Conclusion IPT of sinonasal tract is a rare lesion that sometimes demonstrate aggressive radiologic features. FNA from IPT poses a diagnostic challenge and can be misinterpreted as malignancy due to prominent cytologic atypia. Being aware of this rare entity helps avoid misdiagnosis and triggers the request for core biopsy during onsite evaluation.

Optimizing molecular testing of lung cancer needle biopsy specimens: potential solutions from an interdisciplinary qualitative study

BackgroundMolecular testing can detect actionable genomic alterations and tumor cell surface proteins in patients with non–small cell lung cancer (NSCLC). However, utilization remains suboptimal, representing missed treatment opportunities. This study aimed to identify challenges and potential solutions to obtaining percutaneous lung needle biopsy specimens for successful molecular testing in patients with advanced NSCLC.MethodsThis interdisciplinary qualitative study included ten radiologists and four pathologists from academic and community settings across the United States who routinely perform and analyze percutaneous lung needle biopsies. Participants underwent semi-structured one-on-one interviews (Phase 1). Interview questionnaires were constructed based on a literature review of key lines of inquiry and conducted by professional market researchers using the theoretical domains framework. Primary barriers to molecular testing were identified using thematic analysis. Subsequently, multidisciplinary focus groups were convened to identify potential solutions (Phase 2).ResultsFour themes emerged as barriers to molecular testing and were matched to the clinical workflow: (1) biopsy request, (2) biopsy procedure, (3) specimen analysis, and (4) communication. The nineteen potential solutions included adding a “checkbox” to indicate molecular testing in the biopsy request, leveraging pre-procedural imaging to guide biopsies, conserving tissue through appropriate allocation strategies and next generation sequencing panels instead of sequential single-gene assays, instituting reflex-molecular testing upon NSCLC diagnosis, tracking and communicating biopsy outcomes at multidisciplinary tumor boards, and improving integration of radiologists and pathologists into oncology care teams.ConclusionsPotential solutions exist to increase successful molecular testing of lung needle biopsy specimens in patients with advanced NSCLC.

AMELOBLASTOMA WITH ADENOID STRUCTURES: A SURVEY OF 6 NEW CASES

<h3>Objectives</h3> The aim of the present study was to analyze the clinicopathologic profile of ameloblastomas with adenoid structures. <h3>Study Design</h3> This retrospective observational study consisted of cases diagnosed as ameloblastoma between 2014 and 2021 that were microscopically reviewed. The included cases were only those exhibiting focal (<50% of the tumor) or predominant (>50% of the tumor) duct-like spaces of variable size, lined by cuboidal to columnar cells containing mucoid material. Clinical data were collected from biopsy request forms and tabulated for descriptive analyses. <h3>Results</h3> There were 125 ameloblastomas (1.2%; ∼15 cases per year). Adenoid structures were observed in 6 samples (4.8%) from 5 males and 1 female, with a mean age of 41 years (range, 25 to 61). The posterior region of the mandible was most frequently affected (<i>n</i> = 5). The cases presented as asymptomatic unilocular (<i>n</i> = 1) or multilocular (<i>n</i> = 4) radiolucency. Three cases exhibited predominant adenoid structures, 1 of which exhibited exuberant dentinoid material. The other 3 cases of conventional ameloblastoma showed focal areas of adenoid features. <h3>Conclusions</h3> Adenoid structures in ameloblastoma appear to be an uncommon event of unknown clinical significance and may be associated with dentinoid material and should not be misinterpreted as an adenomatoid odontogenic tumor.

Non-Mammary Metastasis To Breast; A Diagnostic Challenge

Background: Non-mammary metastasis to the breast poses a diagnostic challenge for the pathologists especially when no prior history of non-mammary malignancy is provided. Since non-mammary metastasis is not a very common occurrence, there is a chance that it can be easily missed especially with overlapping morphology and unknown prior history of any malignancy.Methods: In total, 40 patients matching our inclusion criteria were identified through hospital information system in a 10-year period. Confirmatory stains were used to confirm the diagnosis.Results: The most common primary malignancy site was gastrointestinal tract comprising 35% of the metastasis. This was followed by small cell carcinomas (17.5%). In addition, in 72.5% of the patients, there was a known history of primary malignancy but only in 18 (45%) of the cases, the clinicians mentioned it on the biopsy request form. For the remaining cases (27.5%), the clinician was contacted after the verification of the report and was asked to evaluate the possibility of metastasis from the known primary site. Conclusion: Identifying the non-mammary metastasis is important at the time of initial diagnosis as it can prevent the patient from extensive surgery, which might not be needed, if it is not a primary breast tumor. Provision of prior history and use of immunohistochemical stains can aid in timely and accurate diagnosis.

POS-101 AV fistula coiling post transjugular kidney biopsy

Nephrologists routinely request for renal biopsy to help understand the primary pathology of renal diseases. Nonetheless, this procedure comes with it complications. This case report describes one the complications post kidney biopsy that is AV fistula formation. This complication is rare post kidney biopsy it varies from 0.3-5%.

Concepts in Musculoskeletal Bone and Soft Tissue Biopsy.

Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.

Analyses of the Rationale and Implementation of Research Biopsies in Oncology Clinical Trials at a Tertiary Cancer Center.

Biomarkers in clinical trials have led to massive incorporation of research biopsies, with potentially risks and no direct benefit for patients. In 2018, the American Society of Clinical Oncology (ASCO) released an ethical framework to provide guidance on incorporating research biopsies in cancer clinical trials. We collected biopsy requirements of cancer clinical trials conducted at Institut Jules Bordet (IJB) between 2015 and 2019 to examine adherence with the ASCO Ethical Framework. We used logistic regression models to test the association between the request for biopsy, the request for tissue, and the adherence to the ASCO framework as well as some trial characteristics. Between January 2015 and December 2019, 178 oncological studies were conducted at IJB. Of these, 138 (78%) were sponsored by industry, 132 (74%) were phase II and III studies, and 141 (79%) concerned metastatic disease. Tissue was required for inclusion for 119 (67%) studies, among which 59 required at least one new biopsy. Adherence to ASCO's Ethical Framework was 67% for studies requiring tissue and went down to 39% for studies requiring at least one new biopsy. In multivariate analysis, requests for tissue or new biopsies increased in early-phase studies (p<.001, p<.001, respectively) and in studies investigating innovative treatments (immunotherapy or targeted therapies; p<.01, p=.02). Compliance to the ASCO framework significantly decreased with time (p<.001) and in early-phase studies (p<.001). Numerous studies required tissue or new biopsies for exploratory objectives of unknown clinical utility. Requests for tissue increased over the years, whereas compliance to ASCO's Ethical Framework decreased. In 2019, the American Society of Clinical Oncology (ASCO) developed an ethical framework to provide guidance on incorporating research biopsies in clinical trials. This study underlines the growing request for tissue in clinical trials with potentially no impact on drug development and no benefit to actual or future patients. Adherence to ASCO's Ethical Framework decreases through time. These results highlight the importance of improving the ethics of research biopsies. ASCO's Ethical Framework offers an opportunity to improve quality of care in clinical research by maximizing scientific utility and allowing for clinically meaningful correlative science and safe access to innovative treatments for a maximum number of patients.

Research biopsies in gynecologic oncology: patients’ perspective

Objectives: The aim of this study was to assess the impact of research biopsies on quality of life of patients (pts) with gynecologic malignancies, and determine which factors are associated with the pts willingness to undergo future biopsies. Methods: We conducted a prospective study on pts with gynecologic malignancies undergoing research biopsies between 2015 and 2020 at a tertiary Canadian cancer centre. Eligible pts were ≥18 years old and had an ECOG status of ≤2. Pts completed the questionnaires prior to the biopsy (Q1) and 1 week after the biopsy (Q2). Q1 collected general information, perceived risks and the modified Hospital Anxiety and Depression Scale (HADS; range 0-21, normal Results: 129 pts were enrolled, 88 were evaluable and completed Q1/Q2. The site of biopsy was abdomen/pelvis 78%, liver 16%, other 6%. Pts had predominantly recurrent disease (99%), 91% had ovarian and 9% endometrial cancer. Median age was 61.5 years (32-80). Ethnicity was White in 79%, Asian 15%, and others in 6% of pts. 92% of pts were involved in interventional clinical trials. Mean time from biopsy request to biopsy was 10.4 days (standard deviation [sd] 13.9). The mean HADS score was within normal ranges in Q1 and Q2, with a significant decline in the total score after the biopsy (Q1 5.3 [sd 4.7] and Q2 3.7 [sd 4.5]; p=0.005). Figure 1 describes the pts reported post-biopsy symptoms and perceptions in Q2. At Q2, 83% of pts reported that they would definitely or likely consent for another research biopsy. We then correlated each of the factors with pts willingness to undergo future research biopsies. There was no significant difference according to ECOG status (p=0.74), site of biopsy (p=0.99), age (p=0.56). None of the post-biopsy reported symptoms showed a significant impact in pts willingness to undergo future biopsies, including feverish feeling (OR:0.33, p=0.12), nausea/vomiting (OR:0.51, p=0.3), pain in biopsy area (OR:0.4, p=0.19), flu-like symptoms (OR:0.3, p=0.06). In terms of biopsy related perceptions, we did not detect a significant correlation with pain during procedure (OR:0.3 p=0.23). Whereas, pts with higher HADS scores in Q2 (OR:0.83, p=0.005), those who felt physically uncomfortable (OR:0.1, p=0.02), felt embarrassed (OR:0.03, p=0.005), or felt loss of dignity during the biopsy (OR:0.05, p=0.015) were less likely to consent for future research biopsies. Download : Download high-res image (244KB) Download : Download full-size image Conclusions: Research biopsies were generally well accepted in pts that underwent a biopsy, and 83% of pts reported willingness to undergo subsequent research biopsies. The mean HADS level was within normal ranges before the biopsy and decreased significantly post-procedure. Higher HADS scores, embarrassment, loss of dignity and physical discomfort during the procedure significantly influenced the likelihood of obtaining serial biopsies. A better understanding of the impact of research biopsies in pts is vital to improve their experience.

Endosonography-Guided Biopsy as a First Test in the Diagnosis of Lymphoma

To evaluate the diagnostic accuracy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) in the diagnosis of lymphoma. A retrospective analysis of patients with suspected mediastinal lymphoproliferative disorders who underwent EBUS-TBNA, EUS-FNA or combined procedures from 2009 to 2019 was conducted using a prospectively maintained interventional thoracic endoscopy database. Demographic data, imaging, needle size, surgical biopsy, complications rate and pathology reports were reviewed. Over a 10-year period, a total of 444 patients were investigated with endosonography as the first diagnostic procedure for mediastinal adenopathy suspicious for lymphoma. Lymphoma was diagnosed in 77 patients (17.3%). In total, 68 patients (88.3%) were diagnosed using endosonographic mediastinal tissue sampling. Four patients had both lymphoproliferative disorders and lung cancer. Nine patients (11.7%) required a surgical biopsy to confirm the lymphoma diagnosis (6 non-diagnostic; 3 inadequate samples from endosonographic biopsies). In patients with adequate biopsies via endosonography, the sensitivity for the diagnosis of lymphoma, was 91.9% (n=68/74). The histopathologic subtype of lymphoma was determined by endosonographic biopsies in 61 patients (89.7%) with an increased sensitivity (92.6%) for low grade Non-Hodgkin lymphoma (NHL). No acute complication related to endosonography was observed. Endosonographic biopsy (EBUS and/or EUS) of mediastinal adenopathy in patients with suspected lymphoma is a highly sensitive and safe diagnostic test. Endosonography should be the first test in the diagnosis of suspicious mediastinal lymphoma and should be followed by surgical biopsy in cases of insufficient sampling or indefinite diagnosis.

Effect of smoking status and programmed death-ligand 1 expression on the microenvironment and malignant transformation of oral leukoplakia: A retrospective cohort study.

Tobacco smoking is associated with an increased risk of oral leukoplakia and head and neck cancer. Although it has recently been reported that the establishment of an immunosuppressive microenvironment in oral potentially malignant disorders may lead to malignant transformation, it is unclear whether the microenvironments of oral potentially malignant disorders differ according to smoking status. We examined differences in programmed death-ligand 1 (PD-L1) expression and subepithelial CD163+ TAM and CD8+ cell/lymphocyte counts in the microenvironment of oral leukoplakia of smoking and non-smoking patients and investigated their associations with malignant transformation. Pathology reports and original biopsy request forms from 1995–2015 were retrospectively reviewed. Lesions clinically characterized as white plaques/lesions of the oral mucosa and pathologically diagnosed as oral epithelial dysplasia were included. Immunohistochemistry was performed to evaluate PD-L1 expression and subepithelial CD163+/CD8+ cell counts. The significance of prognostic factors in predicting malignant transformation was determined using Cox regression analysis. Statistical significance was defined as P<0.05. In total, 200 patients with oral leukoplakia were selected. The mean age at diagnosis was higher in non-smoking patients (n = 141; 66.9 years) than in smoking patients (n = 59; 60.5 years). The 5-year cumulative malignant transformation rate was higher in non-smoking patients than in smoking patients (9.3% vs. 3.0%, respectively). Oral leukoplakia was associated with significantly higher PD-L1 expression and increased numbers of subepithelial CD163+ cells in the non-smoking group compared with the smoking group. Non-smoking-related oral leukoplakia with positive PD-L1 expression was associated with a 6.97-fold (95% confidence interval: 2.14–22.7) increased risk of malignant transformation. The microenvironment of oral leukoplakia differed according to smoking status. A combination of smoking status and PD-L1 expression may predict malignant transformation in oral leukoplakia patients. This study highlights the importance of understanding the interaction between smoking and the microenvironment in oral leukoplakia.

POS-818 ESTABLISHING AN EFFECTIVE CLINICAL DATA COLLECTING TOOL FOR PROPER EVALUATION OF RENAL BIOPSY

The renal biopsy is currently being used to achieve optimal patient care in the era of personalized and precision medicine. Indeed, clinicopathological correlation is mandatory to establish an accurate diagnosis of kidney diseases. Otherwise, the final pathology report would only be describing patterns of injury which will not help the treating physician to decide the appropriate therapy. Clinical information oriented to the kidney diseases such as history, physical examination, investigation and management plan, is not always accessible for renal pathologists. With the advances in technology, our aim is to create a quality-improved, standardized, uniform, electronic, efficient, and environmentally friendly clinical data collecting form to be completed for each renal biopsy request. Thirty-three renal pathologists with various levels of experience in Canadian health care institutions, all of them members of the Canadian Society of Pathology, Renal Pathology Working Group, were invited individually by e-mail to respond to a survey. The survey comprised two parts: native and transplant renal biopsies. The questions in the survey pertained to the necessity of inclusion of specific elements of clinical information in the categories of history, physical examination, investigations and management plan. Based on the responses to the survey and comments, the pilot preliminary form was modified. Upon our institutional Quality Improvement Review Committee (QIRC) review, a formal waiver of the requirement for REB (Research Ethics Board) approval was obtained. PDF files of the clinical data collecting form were distributed to more than 80 nephrologists by e-mail. These forms could only be completed electronically, and no handwriting was permitted. The nephrologists were encouraged to complete these forms for hypothetically patients or real patient data. Estimated time for completing the form was recorded. Nephrologists also made some comments on the form itself. Simultaneously, a further short survey to measure the satisfaction of all users was sent. Twenty renal pathologists representing 14 different academic centers, completed the survey. The rate of agreement on the survey questions ranged from 38.89% to 100.00%. On the other hand, 21 nephrologists and their assistants have responded. Average time needed to complete a PDF form is 11.11 minutes (ranges between 6 and 20 minutes). Few nephrologists considered it too long and they have no enough time to complete it. Overall, the suggestions were to modify it and make it more clinically relevant. Among survey respondents, 50% were satisfied with using these forms and the same percentage of those clinicians would recommend it to their colleagues. Clinical data is important for an accurate diagnosis in renal pathology. An electronic, efficient, and environmentally friendly clinical data collecting form was developed through consensus by renal pathologists in Canada. We have tested the form by sending it to the nephrologists to be used with each renal biopsy request. This innovation would help with the flow, workload and turnaround time making our service more accurate and efficient.

Ultrasound-Guided Core Biopsy for Tissue Diagnosis in Pediatric Oncology: 16-Year Experience With 597 Biopsies.

OBJECTIVE. Percutaneous imaging-guided core needle biopsies (CNBs) for cancer diagnosis in pediatric patients are gaining interest because of their availability, lower rate of complications, and high diagnostic power compared with traditional surgical biopsies. Nevertheless, their precise role in the diagnostic algorithm of pediatric oncology is still unknown. The purpose of this study was to report our accumulated 16-year experience with CNB; discuss the availability, safety, and diagnostic accuracy of the procedure and the adequacy of ancillary testing; and compare our findings with the available literature. MATERIALS AND METHODS. Pediatric ultrasound-guided CNBs performed in our hospital between November 2003 and December 2019 were retrospectively studied. Data collection included demographics, clinical and procedural parameters, complications, and final diagnosis. RESULTS. A total of 597 biopsies were performed in 531 patients (132 performed in known oncologic patients and 465 performed to establish diagnosis). The median time between the biopsy request and the procedure was 1 day. Of 432 biopsies performed in patients with malignancies, 12 (2.8%) had false-negative results. In 165 cases of benign pathologic findings, all had true-negative results. Ancillary testing was adequate in all malignant cases. Overall sensitivity, specificity, and accuracy rates were 97.2%, 100%, and 98.0%, respectively. Five biopsies (0.8%) resulted in complications, including one major bleed and one track seeding. CONCLUSION. Our experience shows that ultrasound-guided CNB for suspected malignancy in pediatric patients has a high safety profile, availability, and accuracy rate compared with surgical biopsy. Our fast-track strategy enables early initiation of designated therapy and has the potential to become the procedure of choice.

DEMOGRAPHIC AND CLINICAL PROFILE OF DEVELOPMENTAL ODONTOGENIC CYSTS IN A BRAZILIAN POPULATION

Odontogenic cysts (OCs) are the most frequent lesions of gnathic bones and present with unique clinical findings and diverse biological behavior. Objective: To describe the demographic and clinical characteristics of developmental OCs diagnosed in a pathologic anatomy service. Study design: Through retrospective and descriptive analyses, data referring to age, sex, size, location, and radiographic characteristics were obtained from the biopsy request forms in the period 2002-2018. Results: A total of 135 cases of developmental OC were identified, of which 48% (n = 65) were odontogenic keratocyst (OKC), 36% (n = 49) dentigerous cyst (DC), 9% (n = 12) calcifying odontogenic cyst (COC), 3% (n = 4) gingival cyst of adult, and 1.48% (n = 2) glandular odontogenic cyst (GOC). Lateral periodontal cyst (LPC), botryoid odontogenic cyst (BOC), and orthokeratinized odontogenic cyst (OOC), were 1% (n = 1) each. Mean age of the patients was 30.6 years, with no predilection for sex. OKC, COC, and GOC showed the largest sizes, with averages of 2.92 cm, 2.67 cm, and 4.0 cm, respectively. The posterior mandible was affected more often (59%; n = 80). Radiographically, 41.5% exhibited a unilocular radiolucent appearance. Conclusion: DC and OKC were more frequent in this study. Developmental OCs predominated in the posterior mandible and the most aggressive lesions were large in sizes. Odontogenic cysts (OCs) are the most frequent lesions of gnathic bones and present with unique clinical findings and diverse biological behavior. Objective: To describe the demographic and clinical characteristics of developmental OCs diagnosed in a pathologic anatomy service. Study design: Through retrospective and descriptive analyses, data referring to age, sex, size, location, and radiographic characteristics were obtained from the biopsy request forms in the period 2002-2018. Results: A total of 135 cases of developmental OC were identified, of which 48% (n = 65) were odontogenic keratocyst (OKC), 36% (n = 49) dentigerous cyst (DC), 9% (n = 12) calcifying odontogenic cyst (COC), 3% (n = 4) gingival cyst of adult, and 1.48% (n = 2) glandular odontogenic cyst (GOC). Lateral periodontal cyst (LPC), botryoid odontogenic cyst (BOC), and orthokeratinized odontogenic cyst (OOC), were 1% (n = 1) each. Mean age of the patients was 30.6 years, with no predilection for sex. OKC, COC, and GOC showed the largest sizes, with averages of 2.92 cm, 2.67 cm, and 4.0 cm, respectively. The posterior mandible was affected more often (59%; n = 80). Radiographically, 41.5% exhibited a unilocular radiolucent appearance. Conclusion: DC and OKC were more frequent in this study. Developmental OCs predominated in the posterior mandible and the most aggressive lesions were large in sizes.

P0114BENEFITS AND CHALLENGES OF A RENAL BIOPSY REGISTRY AND NETWORK - FCGG EXPERIENCE

Abstract Background and Aims End December 2016, a renal biopsy network in the Flemish region (Belgium) was founded as a collaboration between the renal pathologists and nephrologists. This FCGG network introduced a uniform renal biopsy request form, a well-structured report form of the renal pathology examination and a comprehensive list of renal pathology diagnoses. Method Following informed consent [99.5%] and in compliance with GDPR, the registration of the renal biopsies consists of basic categorical renal data, structured renal pathology information and the final clinical renal disease. Results In 2017 and 2018, 1385 renal biopsies were registered – 10.5 per million inhabitants per year; in addition, 28 patients had a repeat biopsy in the same time frame (2%). Of the pediatric patients ( age &amp;lt; 18 years; N=92; 6.6%), 23 had IgA nephropathy, 20 a minimal change disease and 15 another type of glomerulonephritis. The biopsy was reported as normal or non-diagnostic in 15 patients (16%) – the majority was clinically considered as glomerulonephritis. The spectrum of the adult population was quite similar across gender and age groups: 56% glomerulonephritis [= IgA nephropathy [19%] + FSGS [8%] + pauci-immune glomerulonephritis [7%] + other GN [22%] ), 10% tubulo-interstitial nephritis, 7% acute tubular necrosis [ATN], 7% diabetes mellitus, and 7% nephroangiosclerosis. Exceptions are pauci-immune glomerulonephritis as the most important renal disease in women aged 65 years and older, and lupus nephritis as the second most important glomerulonephritis in women aged 18-44 years. Only a small percentage of adult renal biopsies yielded no result (7%), clinically interpreted as glomerulonephritis in 50% of the cases. Conclusion The FCGG network has provided a more intense collaboration between renal pathologists and nephrologists mainly by standardizing the renal biopsy reading and reporting across all centers. More precise estimates of the prevalent renal diseases were provided for the first time; however, in order to get full information, renal diseases diagnosed by other techniques ( serology, genetic analysis ) should also be collected in the future. Efforts will be done to coordinate the clinical care of renal diseases, particularly the more rare renal diseases, and to offer access to new therapeutic molecules or new schemes, through this super-regional network.

A study to evaluate the indications for performing skin biopsies

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The skin biopsy is an invaluable tool done for the confirmation of several skin disorders. Skin biopsy serves as an indispensable tool in the diagnosis of skin disorders especially for the clinical presentation which has several differential diagnoses or diagnostic difficulties. The studies to determine the indications for which skin biopsy is routinely performed are few. Hence, we conducted this study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We assessed the biopsy request forms of two consecutive years (from January 2017 to December 2018) to evaluate the indications for which the biopsies were performed. The statistical data were expressed as number and percentage.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In the present study, 320 consecutive skin biopsy request forms were evaluated for the indications for performing skin biopsy. In the present study, the skin biopsy was done predominantly for the spongiotic disorders followed by granulomatous and psoriasiform disorders. Among the granulomatous disorders, skin biopsy was done commonly in case of Hansen’s disease. In our study incisional biopsy was the technique often used followed by excisional and punch biopsy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The common indications for which the skin biopsies were performed was determined in this study. This study bridges the gap since the studies performed in this aspect are lacking.&lt;/p&gt;

Pearls and Pitfalls for Soft-Tissue and Bone Biopsies: A Cross-Institutional Review.

Management of soft-tissue and bone neoplasms depends on a definitive histologic diagnosis. Percutaneous image-guided biopsy of bone and soft-tissue tumors is a cost-effective and accurate method to obtain a histopathologic diagnosis. Biopsy requests must be approached thoughtfully to avoid numerous potential pitfalls. Hasty biopsy planning places the patient at increased risk for misdiagnosis, delayed therapy, repeated invasive procedures, and substantial morbidity. Biopsy planning begins with a thorough review of the relevant clinical history and pertinent imaging. The biopsy route must be planned in concert with the referring orthopedic oncologist to preserve limb-sparing options. Carefully selecting the most appropriate imaging modality to guide the biopsy increases the chances of reaching a definitive diagnosis. It is also critical to identify and target with expertise the part of the lesion that is most likely to yield an accurate diagnosis. Percutaneous biopsy is a safe procedure, and familiarity with preprocedural laboratory testing parameters, anticoagulation guidelines, and commonly used sedation medications minimizes the risk of complications while ensuring patient comfort. Nondiagnostic biopsy results are not infrequent and may still have value in guiding patient treatment. Awareness of the imaging manifestations of tumor recurrence is also important. The aim of this article is to provide a comprehensive review of pertinent preprocedural, periprocedural, and postprocedural considerations for bone and soft-tissue musculoskeletal biopsies.The online slide presentation from the RSNA Annual Meeting is available for this article.©RSNA, 2020.