Biopsy Size Research Articles

Persistent melanocytic nevi: a review and analysis of 205 cases

Melanocytic nevi can recur or persist if not completely excised and are capable of mimicking malignant melanoma, both clinically and histologically. To characterize the impact of anatomic site, biopsy method, size, margin involvement and type of original melanocytic nevus on recurrence/persistence of melanocytic nevi. Secondarily, we sought to determine if the original type of melanocytic nevus could be determined solely from microscopic examination of the recurrent/persistent nevus. One hundred and eighty-five patients with 205 persistent nevi were identified. Of these, 108 cases had original biopsy specimens available for review. Location, original biopsy size, biopsy method, margins and interval to recurrence were recorded for each. A group of 232 non-persistent nevi was established as a control population. There was a female predominance in persistent nevi with the back being the most common site for persistence. Dysplastic melanocytic nevi were the most likely to persist. Accurate determination of the original type of melanocytic nevus from microscopic examination of the persistent nevus was possible in only 67% of the cases. Clinicians should take larger and deeper biopsies of clinically dysplastic and conventional melanocytic nevi on the back to prevent recurrences. Grading atypia of the persistent melanocytic nevi is unreliable.

Transient elastography: The bigger we are, the harder to scan

Transient elastography: The bigger we are, the harder to scan

35 The first 12 months of UK diagnostic services for EGFR gene mutations in NSCLC patients

were obtained by CT and 2 (3.3%) by bronchial biopsy (with no significant difference, p < 0.13 Fisher’s Exact test). There was also no statistically significant difference between needle size (18G/20G) and ability to obtain sufficient tissue to determine EGFR status (p < 0.14). Conclusions: The majority of samples obtained provided sufficient DNA mass for analysis. Neither modality of biopsy nor needle size were shown to significantly affect ability to obtain EGFR mutation status. We have only tested 36% of NSCLC cases this year for EGFR mutation status although our testing has increased to 53% since June in accordance with NICE guidance. We have identified 3 patients (2%) as positive with only one patient thus far receiving targeted therapy as a direct result.

Endovaginal magnetic resonance imaging of stage 1A/1B cervical cancer with A T2- and diffusion-weighted magnetic resonance technique: Effect of lesion size and previous cone biopsy on tumor detectability

Objective. To evaluate the effects of previous cone biopsy and lesion size on detectability of stage 1a/1b cervical cancer using endovaginal T2- and diffusion-weighted magnetic resonance imaging. Methods. One hundred and thirteen patients with cervical tumor were imaged using an endovaginal coil with T2-weighted (T2-W) and diffusion-weighted single-shot echo-planar sequences; 85 managed surgically (58 with prior cone biopsy/LLETZ) were evaluated. T2-W images and ADC maps viewed simultaneously were scored positive or negative for tumor and compared with histology at surgery. MRI tumor volumes, maximum radiological and histological dimensions were recorded. ROC analysis determined the MRI volume with optimal sensitivity/specificity for identifying tumor in those without and with prior cone biopsy/LLETZ and the maximum histological dimension for correctly identifying tumor with MRI. Mean apparent diffusion coefficients (ADCs) from tumor and adjacent normal epithelium were compared. Results. Sensitivity and specificity for detecting tumor in those without (100%; 100% respectively) and with (80%; 78.9% respectively) prior cone biopsy/LLETZ were significantly different ( p < 0.001). Following cone biopsy/LLETZ, MRI tumor volume of 83 mm 3 detected tumor with 80% sensitivity, 94.7% specificity; a 5.3 mm maximal histological dimension was detected on MRI with 100% sensitivity, 100% specificity. Tumor ADCs were significantly lower ( p < 0.001) than paired normal epithelial tissue (median, 988 × 10 −6 mm 2/s vs. 1564 × 10 −6 mm 2/s) but neither tumor nor epithelial ADCs differed significantly between patients with or without prior cone biopsy/LLETZ ( p = 0.48 and 0.15, respectively). Conclusions. Endovaginal MRI with T2- and diffusion-weighted sequences has significantly lower sensitivity and specificity for tumor detection following cone biopsy/LLETZ.

Refinement of Biomarker Pentosidine Methodology for use on Aging Birds

There is no reliable method for determining age for most species of long-lived birds. Recent success using the skin chemical pentosidine as a biomarker has shown promise as an aging tool for birds. Pentosidine levels have been determined only from the breast tissue of carcasses, and we sought to refine the procedure with respect to biopsy size and location for safe and effective use on living birds. We compared pentosidine concentrations in 4 skin-size samples (4, 6, 8, and 20-mm diameter biopsies) from the breast of black vulture (Coragyps atratus) carcasses. We also compared pentosidine levels from breast and patagial tissue to document potential differences among collection sites of deceased vultures (with unknown ages) and monk parakeets (Myiopsitta monachus; with actual, minimal, and unknown ages). Pentosidine concentrations (pmol pentosidine/mg collagen) were similar among the 4 sizes of vulture breast skin (P = 0.82). Pentosidine concentrations for the breast (0 = 8.9, SE = 0.55, n = 28) and patagium (0 = 8.9, SE = 0.51, n = 28) of vultures were similar, but in parakeets, pentosidine was higher in the breast (0 = 15.9, SE = 1.30, n = 105) than the patagium (0 = 11.5, SE = 1.10, n = 105). We made pentosidine-based age estimates for vultures and parakeets using a general age curve for wild birds. We also made vulture age estimates using plumage characteristics and a cormorant (Phalacrocorax auritus) age curve. Vulture pentosidine-based age estimates appear to correspond to plumage-based age estimates. Pentosidine-based age estimates for 88% of the known-aged parakeets (n = 17) were within 6 months of actual ages. Even though known ages were not available for all birds, we found a positive trend in pentosidine versus age for both species. We suggest that 6-mm diameter skin samples from the patagium of living vultures and other similar-sized birds will provide sufficient tissue for reliable age estimation and will not impair flight ability.

S93 Is Bcl-2 important in small cell lung cancer?

IntroductionBcl-2 is an anti-apoptotic protein that has previously been associated with increased cell survival in Small Cell Lung Cancer (SCLC) in vitro. However, several immunohistochemical studies of Bcl-2 expression and...

Safety of Blind Percutaneous Liver Biopsy in Obese Children A Retrospective Analysis

To determine the safety and adequacy of blind percutaneous liver biopsy (PLB) in obese children. PLB is an important diagnostic tool that, while invasive, enjoys a relatively low major complication rate. An ever increasing reason for pediatric liver biopsy is nonalcoholic fatty liver disease associated with obesity. There is a lack of data assessing the safety of liver biopsy in obese compared to nonobese children. A retrospective study of all children over 5 years of age having PLB was conducted. Data collected included age, gender, weight, height, BMI, reason for biopsy, number of passes, biopsy length, number of portal triads per biopsy, and complication rates. A total of 107 biopsies were reviewed. All biopsies were successful. Overall, major complications occurred in 1.3% and minor complications in 8.4%; there were no deaths. Comparison revealed no difference for number of passes (1.5±0.7 vs. 1.7±0.7), biopsy length (2.0±1.3 cm vs. 1.5±1.1 cm), number of portal tracts per biopsy (9.8±5.8 vs. 9.9±3.4), or complication rates (major: 0% vs. 1.3%; minor: 10.0% vs. 7.8%) between obese and nonobese children. Blind PLB can be safely carried out in obese children with no increase in complication rate compared with nonobese children. Similarly, there is no difference in number of passes, biopsy size, portal triads per biopsy, or biopsy success for obese children.

Morphologic Characterization of Syndromic Gastric Polyps

The morphology of gastric hamartomatous polyps from patients with juvenile polyposis syndrome (JuvPS) and Peutz-Jeghers' Syndrome (PJS) is poorly characterized. We investigated the histologic features of gastric polyps in patients with established JuvPS or PJS to develop improved histologic criteria to distinguish these from gastric hyperplastic (HP) polyps. The patients with clinically confirmed hamartomatous polyposis syndromes were identified, including 26 patients with JuvPS (both familial and sporadic) and 17 patients with PJS. All gastric polyps (n=30) from these patients were intermixed with gastric HP polyps from nonsyndromic patients (n=26) and subsequently blindly reviewed by a panel of gastrointestinal pathologists. A consensus diagnosis was rendered. The panel then reviewed the slides in the context of clinical data and identified histologic features for distinguishing JuvPS, PJS, and HP gastric polyps based on epithelial changes, pit architecture, lamina propria features, and smooth muscle qualities. A sleeping period of 6 months lapsed before the same cases were renumbered and blindly rereviewed independently. Diagnoses were then rendered while adhering to the suggested criteria. Cases that the reviewers recalled were discarded from the study (n=8). On initial review, accuracy in diagnosis of gastric polyps in JuvPS was 50% and was 18% in PJS compared with 92% for HP gastric polyps. Adherence to the recommended histologic criteria resulted in diagnostic accuracy of 41% for JuvPS and 54% for PJS, compared with 73% for HP gastric polyps. Accuracy in diagnosis in antral mucosa was 66%, oxyntic mucosa 71%, and transitional-type mucosa (mixed antral and oxyntic) 32%. The diagnostic accuracy based on polyp size was 59% for polyps which were less than equal to 3 mm, 56% for those 4 to 9 mm, and 81% for polyps which were more than equal to 10 mm. The identification of gastric polyps from JuvPS and PJS patients without the context of clinical history of these syndromes remains poor, even with adherence to a set of morphologic criteria. Abiding by such criteria improved recognition of PJS polyps by more than double (P<0.19), but yielded an accuracy of only 54%. The accuracy did not improve when results were stratified for polyp location but did with biopsy size which were more than equal to10 mm. Whereas these syndromic polyps are readily diagnosed in the small bowel and colon, histologic features to distinguish gastric JuvPS and PJS from gastric HP polyps are unreliable.

Abstract 3746: Proteomic analysis of laser capture microdissected cells from basal, Her 2 positive and luminal A human breast tumors

Abstract The analysis of tissue is often confounded by the heterogenous nature, small size of biopsies, and focal presence of tumors. The use of laser capture microdissection (LCM) allows for isolation of nearly pure cell populations enhancing specificity of subsequent analyses. A method developed in our laboratory facilitating the removal of adhered cells utilizing SDS-PAGE followed by in-gel digestion and tandem mass spectrometry was applied to LCM-acquired cells from Basal, Her 2 positive and Luminal A breast tumor tissues. Cells were LCM-acquired from frozen tissue sections corresponding to Basal, Her 2 positive or Luminal A human breast tumor tissue. The sample set consisted of 3 tumors per subgroup with 3 caps per tumor, for a total of 27 caps each containing approximately 10,000 cells corresponding to 3-5 μg protein. The thermoplastic membranes containing the captured cells were peeled from the cap and suspended in SDS loading buffer and gently heated for 10 minutes. The solubilized proteins were electrophoresed 2 cm into a 10-20% Tricine gel followed by in-gel trypsin digestion and peptide extraction. Tryptic peptides were analyzed by reversed-phase (RP) liquid chromatography-tandem mass spectrometry (LC-MS-MS) on a Thermo Orbitrap instrument. Following LC/MS/MS analysis of the LCM digests, tandem spectra were searched against the human IPI database using the search algorithm, Myrimatch, and the search results filtered using IDPicker. A spectral counting approach was applied to the data-dependent data to compare quantitative differences of proteins identified. A total of 91646 spectra were confidently identified which corresponded to 1671 protein groups across all biological and technical replicates. An average of 545, 543, and 610 protein groups were identified in the basal, Her 2 positive, and Luminal A subtypes, respectively, from an equivalent of roughly 800 cells. Spectral count differences between datasets between normal and tumor samples were analyzed using both a Quasi-likelihood Poisson regression model, developed in-house, in addition to using the Limma package in Bioconductor. Using the criteria of a False Discovery Rate (FDR) &amp;lt; 0.05, a total of 90 proteins showed statistically significant differences in expression among the breast tumor subtypes. A hierarchical clustering of these proteins was performed, creating a heat map representing the gene expression patterns of these proteins. As expected, ERBB2 was identified in the Her 2 positive tumor tissue samples; however, this protein was not identified in either the Basal or Luminal A samples. The proteins identified which were found to distinguish each tissue subtype are currently being investigated for their biological relevance in breast cancer pathways and as possible prognostic and predictive biomarkers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3746.

PTU-019 Nasal or standard endoscopy (nose) for diagnosis of Barrett's oesophagus – efficacy and patient tolerance: Abstract PTU-019

Introduction In order to detect all cases of Barrett9s oesophagus (BE) in the population, with the aim of reducing adenocarcinoma associated mortality, screening needs to be considered. Unsedated transnasal endoscopy (TNE) can potentially offer a safer and less expensive alternative to conventional sedated endoscopy (CE) for detecting BE. Aims (1) To evaluate the sensitivity and specificity of TNE in diagnosing BE compared with CE. (2) To assess patient acceptability of TNE for a future multicentre screening trial. Methods Patients with known BE under surveillance and those referred for routine endoscopy for other reasons underwent both TNE and CE in a randomised cross-over design. TNE findings of endoscopic BE, biopsy size and presence of intestinal metaplasia (IM) were compared against CE, which was used as gold standard. Pre and post endoscopy short-form spielberger state-trait questionnaires (SF6), a visual analogue scale and a single question addressing preference for endoscopy type were used to measure patient acceptability of the procedures. Results Of 57 patients randomised, 50 completed the study. All 22 BE cases with columnar lined epithelium (CLE) on CE were correctly diagnosed by TNE. Although the biopsy size of TNE was significantly smaller compared to CE (mean size 2.59 vs 4.74 p Conclusion TNE is accurate in diagnosing BE and detecting IM. Despite the smaller biopsy size, it detected an equal number of IM cases and showed potential to detect dysplasia. It was well tolerated and preferred by patients and may be an efficient screening method for BE.

908 EVALUATION OF ADEQUACY OF PATHOLOGIC SPECIMENS USING A NOVEL BACKLOADING URETEROSCOPIC BIOPSY FORCEPS

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010908 EVALUATION OF ADEQUACY OF PATHOLOGIC SPECIMENS USING A NOVEL BACKLOADING URETEROSCOPIC BIOPSY FORCEPS Shaun Wason, Alan Schned, John Seigne, and Vernon Pais Shaun WasonShaun Wason More articles by this author , Alan SchnedAlan Schned More articles by this author , John SeigneJohn Seigne More articles by this author , and Vernon PaisVernon Pais More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Quality of ureteroscopic biopsies may be limited by the small specimen size. Dictated by the working channel of the ureteroscope, biopsy forceps of 3fr have less than 1mm3 of biopsy head volume. Utilizing a backloading design, the BIGopsy™ ureteroscopic biopsy forceps has a biopsy head larger than the working channel of the ureteroscope. Recognizing that small biopsied tissue volume may preclude adequate pathologic evaluation, we sought to assess the adequacy of surgical specimens obtained utilizing the BIGopsy™ forceps. METHODS In accordance with our IRB, patients undergoing nephroureterectomy for suspected upper tract TCC were recruited. Surgical specimens, immediately after extirpation were examined. The most clinically suspicious region to gross examination was alternatively biopsied with a 3fr Piranha® followed by the BIGopsy™ biopsy forceps. These specimens were fixed, stained and evaluated by a single pathologist. Biopsy size and qualitative assessment of specimen adequacy were recorded. Pathologic diagnosis of the biopsy specimens were compared to the final pathologic diagnosis. RESULTS Three nephroureterectomy specimens were evaluated. A total of 6 biopsies were obtained from the Piranha® and 5 biopsies from the BIGopsy™. Biopsy size from the Piranha® ranged from 1 to 8mm2, while those from the BIGopsy™ ranged from 6 to 80mm2. Average biopsy size from the Piranha® was 3.5 +/- 2.8mm2 while the average biopsy size from the BIGopsy™ was 31.2 +/-34.6mm2. In 2 of 3 nephroureterectomy specimens, final diagnosis was high grade papillary urothelial carcinoma in accordance with both the Piranha® and BIGopsy™ specimens. In the third specimen, the final diagnosis was benign polypoid/papillary pyelitis consistent with only the BIGopsy™ specimen, while the Piranha® specimen was suspicious for a low grade papillary lesion. Subjectively, the BIGopsy™ specimens revealed less distortion and fragmentation and were easier to interpret by the pathologist. Smooth muscle was contained in 1 of 3 BIGopsy™ specimens and in none of the Piranha® specimens. CONCLUSIONS The BIGopsy™ backloading biopsy forceps allows removal of ureteral and renal pelvic tissue larger than the standard 3fr biopsy forceps. In all 3 cases, the diagnosis based upon the BIGopsy™ biopsy agreed with the final pathologic report, one of which was pathologically misassigned as malignant by the smaller 3fr Piranha® biopsy forceps specimen. Improved biopsy quality may translate into improved ability to diagnose ureteral and renal pelvic mucosal lesions endoscopically. Lebanon, NH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e354-e355 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shaun Wason More articles by this author Alan Schned More articles by this author John Seigne More articles by this author Vernon Pais More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The reliability of pre-transplant donor renal biopsies (PTDB) in predicting the kidney state. A comparative single-centre study on 154 untransplanted kidneys

Pre-transplant donor biopsy (PTDB) is a common practice in marginal donors, taking for granted that it represents the whole kidney state, but its reliability has not yet been thoroughly investigated. This prompted us to carry out a comparative study on a needle biopsy group (NBG) and a wedge biopsy group (WBG) and their corresponding untransplanted kidneys. One hundred and fifty-four biopsies and matched kidneys were scored for four morphologic indexes, i.e. tubular atrophy, interstitial fibrosis, vascular damage and global glomerulosclerosis. Categorical indexes were statistically evaluated for concordance with the k index, and the percentage of sclerotic glomeruli with correlation and linear regression analysis. Agreement between biopsies and kidneys was similar in both NBG and WBG with high scores for vascular damage (k 0.74 and 0.75) and intermediate ones for tubular atrophy (k 0.54 and 0.50). Agreement as to fibrosis and glomerular sclerosis was intermediate in the WBG (k 0.56 and 0.55) and poor in the NBG (k 0. 34 and 0.18). Vascular damage was underscored and glomerulosclerosis overscored in both groups, whereas interstitial fibrosis was underscored in the NBG and overscored in WBG. The agreement for the total score, i.e. the sum of the single indexes, was high in the NBG (k 0.73) and intermediate in WBG (k 0.57). Agreement for glomerulosclerosis and total score rose consistently in both groups along with the increasing number of biopsy glomeruli. There was an agreement as to biopsy and kidney evaluation for fitness for transplantation in 85% of NBG and 81% of WBG. PTDB supplies reliable data on the actual kidney state, with better results for needle biopsy. Although the biopsy size plays a role, samples with over 10 glomeruli suffice for clinical purposes. Vascular damage is the most faithful single parameter, whereas global glomerulosclerosis estimation requires some caution.

Prospective Controlled Animal Study on Biopsy Sampling with New Flexible Cryoprobes versus Forceps: Evaluation of Biopsy Size, Histological Quality and Bleeding Risk

Background: Cryoextraction is a procedure used for the recanalization of obstructed airways caused by visible exophytic endobronchial tumor. Biopsy samples obtained by this technique have been shown to be useful for histological assessment. Objectives: The aim of the present animal study was to systematically evaluate biopsy size, histological quality and bleeding risk after cryobiopsy with new, flexible cryoprobes in comparison with forceps biopsy, serving as the gold standard. Methods: Biopsies were obtained from anesthetized pigs with the flexible bronchoscopy technique, and evaluated histologically with respect to their size and quality. Bleeding frequency, bleeding duration and histological changes in the biopsy bed were also recorded. Results: Cryobiopsies were significantly larger than forceps biopsies. The size of cryobiopsies was dependent on the freezing time. The histological quality of the cryobiopsy specimenswas not impaired by the freezing process, whereas forceps biopsies showed typical crush artifacts. Despite the larger defects left in the tracheobronchial system after cryobiopsy, bleeding frequency and duration were not higher compared to forceps biopsy. Conclusions: Since cryobiopsy sampling is not associated with a higher bleeding risk compared with forceps biopsy, this new biopsy technique offers – in addition to a good specimen quality – a safe and valuable tool with the potential of improving the outcome of diagnostic endoscopy.

Biopsy Specimens Obtained With Small-Caliber Endoscopes Have Comparable Diagnostic Performances Than Those Obtained With Conventional Endoscopes

Esophagogastroduodenoscopy (EGD) can be routinely performed via a nasal route in adults by using small-caliber endoscopes. The aim of this study was to evaluate the adequacy of biopsy specimens obtained with small forceps for histologic diagnosis. From January to April 2007, we prospectively compared all biopsy specimens obtained, during conventional EGD (8.8-mm-diameter endoscope), with (CS-EGD) or without sedation (C-EGD), and transnasal or transoral-EGD (4.9-mm-diameter endoscope) without sedation (T-EGD). All biopsy specimens were blindly evaluated by a pathologist. For each specimen, were recorded: site, biopsy size and thickness, type of lesion (focal or diffuse), and in case of focal abnormalities described by the endoscopist, presence of the histologic lesions in the targeted biopsies. One thousand and thirty-five biopsy specimens were obtained from 300 procedures (109 T-EGD, 48 C-EGD, and 143 CS-EGD): 983 biopsy specimens were untargeted (esophagus and cardia in 21%, stomach in 85% and duodenum in 84%) and 352 biopsy specimens were targeted to focal lesions (esophagus and cardia in 79%, stomach in 15%, and duodenum in 16%). The mean size of specimens was 1.8, 2, 2.2 mm diameter, in T-EGD, C-EGD, and CS-EGD groups, respectively (P<0.001). The whole thickness of mucosa was present in 68%, 84%, 71% of the cases among T-EGD, C-EGD, and CS-EGD groups, respectively (P=0.9). There was no significant difference in the rate of definitive histologic diagnosis from targeted or nontargeted biopsies according to the endoscopic procedure. Biopsy specimens obtained during EGD with small forceps are as effective for diagnosis as those obtained with standard forceps.

Comparison of histopathological and gene expression-based typing of cancer of unknown primary

For the clinical diagnosis and appropriate therapy of patients with cancer of unknown primary (CUP), biopsies of the tumor metastases are generally examined histopathologically and by immunohistochemistry (IHC). Gene expression profiling (GEP) is a new diagnostic technique that might further contribute to tumor specification. Biopsies of 43 CUP cases underwent a retrospective central histopathological and immunohistochemical review and centrally performed GEP using CupPrint(TM). Two samples could not be evaluated by IHC due to small biopsy size or loss of immunoreactivity. One of these and 17 other samples were not suited for GEP due to RNA degradation. In 13 out of the remaining 24 cases (54%), the same primary was proposed by IHC and GEP and was supported by the clinical findings, furthermore leading to the doubtless identification of the primary in four out of these. In seven cases, there was discordance between IHC and GEP, with the clinical picture being more in line with IHC in three and with GEP in four cases. Four cases had to remain undecided because the primary tumors suggested by IHC and GEP were not supported. In conclusion, overlap between IHC and GEP results and the clinical presentation was noted in the majority of those true CUP cases that were evaluable with both techniques. Therefore, GEP can be a complementary diagnostic technique assisting immunohistochemical profiling of cancer biopsies with unknown primary.

Pluripotent Stem Cells Derived From Adult Human Testes

Recent reports have demonstrated that adult tissue cells can be induced to pluripotency, the iPS cells, mostly with the addition of genes delivered using viruses. Also, several publications both in mouse and in human have demonstrated that spermatogonial stem cells (SSCs) from testes can convert back to embryonic stem (ES)-like cells without the addition of genes. Furthermore, these pluripotent ES-like cells can differentiate into all three germ layers and organ lineages. Thus, SSCs have great potential for cell-based, autologous organ regeneration therapy for various diseases. We obtained testes from organ donors and using 1 g pieces of tissue (biopsy size) we demonstrate that testis germ cells (putative SSCs and/or their progenitors) reprogram to pluripotency when removed from their stem cell niche and when appropriate growth factors and reagents in embryonic stem cell medium are added. In addition, our method of obtaining pluripotent ES-like cells from germ cells is simpler than the described methods and may be more suitable if this procedure is developed for the clinic to obtain pluripotent cells to cure disease.

Human-in-mouse modeling of primary head and neck squamous cell carcinoma

To develop a reliable modeling system for head and neck squamous cell carcinoma (HNSCC). Laboratory-based translational study. HNSCC tissue was obtained from patients at biopsy/resection, cultured, and implanted into mice. In vivo, tumor growth, and survival was monitored by bioluminescence imaging. Histology and immunohistochemistry (IHC) were used to confirm HNSCC and human origin. Short-term culture techniques were optimized allowing survival of primary HNSCC cells more than 7 days in 76% of tumors. The size of the tumor biopsy collected did not correlate with the success of short-term culture or xenograft establishment. Xenograft modeling was attempted in primary HNSCCs from 12 patients with a success rate of 92%. Immunostaining confirmed human origin of epithelial tumor cells within the modeled tumor. Bioluminescence and Ki67 IHC suggested tumor proliferation within the model. Luciferase expression was maintained for as long as 100 days in modeled tumors. The techniques developed for short-term primary tumor culture followed by xenograft modeling provide a low-cost and tractable model for evaluation of HNSCC response to standard and novel therapies. The high success rate of human-in-mouse tumor formation from primary HNSCC suggests that selection pressures for tumor growth in this model may be less than those observed for establishment of cell lines. Bioluminescent imaging provides a useful tool for evaluating tumor growth and could be expanded to measure response of the modeled tumor to therapy. This model could be adapted for xenograft modeled growth of other primary tumor types.

The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth

Treatment decisions for renal malignancies depend largely on qualitative data, including a description of tumor anatomy and the experience of the treating surgeon. Currently characterization of renal tumor anatomical elements is descriptive and lacks standardization. Surgical decision making and data set comparisons would be significantly enhanced by a consistent, reproducible system that quantitates the pertinent characteristics of localized renal lesions. We have developed and propose a standardized nephrometry scoring system (R.E.N.A.L. Nephrometry Score) to quantify the anatomical characteristics of renal masses on computerized tomography/magnetic resonance imaging. The nephrometry score is based on 5 critical and reproducible anatomical features of solid renal masses. Of the 5 components 4 are scored on a 1, 2 or 3-point scale with the 5th indicating the anterior or posterior location of the mass relative to the coronal plane of the kidney. We applied the R.E.N.A.L. Nephrometry Score to 50 consecutive masses resected at Fox Chase Cancer Center. The R.E.N.A.L. Nephrometry Score consists of (R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of the tumor, (N)earness of tumor deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line. The suffix h (hilar) is assigned to tumors that abut the main renal artery or vein. The nephrometry scoring system accurately classified the complexity of 50 consecutive tumors undergoing excision at our institution. Standardized reporting of renal tumor size, location and depth is essential for decision making and effective comparisons. The R.E.N.A.L. Nephrometry Score is a reproducible standardized classification system that quantitates the salient anatomy of renal masses. This novel approach for the systematic characterization of renal tumors provides a tool for meaningful comparisons of renal masses in clinical practice and in the urological literature.

Experimental Study on Biopsy Sampling Using New Flexible Cryoprobes: Influence of Activation Time, Probe Size, Tissue Consistency, and Contact Pressure of the Probe on the Size of the Biopsy Specimen

Cryoextraction is a procedure for recanalization of obstructed airways caused by exophytic growing tumors. Biopsy samples obtained with this method can be used for histological diagnosis. The objective of this study was to evaluate the parameters influencing the size of cryobiopsies in an in vitro animal model. New flexible cryoprobes with different diameters were used to extract biopsies from lung tissue. These biopsies were compared with forceps biopsy (gold standard) in terms of the biopsy size. Tissue dependency of the biopsy size was analyzed by comparing biopsies taken from the lung, the liver, and gastric mucosa. The effect of contact pressure exerted by the tip of the cryoprobe on the tissue was analyzed on liver tissue separately. Biopsy size was estimated by measuring the weight and the diameter. Weight and diameter of cryobiopsies correlated positively with longer activation times and larger diameters of the cryoprobe. The weight of the biopsies was tissue dependent: lung < liver < stomach. Only little tissue dependency was found for the biopsy diameter. The biopsy size increased when the probe was pressed on the tissue during cooling. Cryobiopsies can be taken from different tissue types with flexible cryoprobes. The size of the samples depends on tissue type, probe diameter, application time, and pressure exerted by the probe on the tissue. Even the cryoprobe with the smallest diameter can provide larger biopsies than a forceps biopsy in lung. It can be expected that the same parameters influence the sample size of biopsies in vivo.

Endoscopic-ultrasound-guided mural trucut biopsy in the investigation of unexplained thickening of esophagogastric wall

Esophageal and/or gastric wall thickening raises the possibility of malignancy. Endoscopic-ultrasound-(EUS-)guided targeted biopsy of the thickened wall is possible. We aimed to evaluate the efficacy and safety of EUS-guided mural trucut biopsies (TCB) in detecting underlying malignancy in patients with thickened esophagogastric wall and negative mucosal biopsies. Patients with alarm symptoms referred for EUS-guided sampling after negative endoscopy and mucosal biopsy were included in the study. All patients had radial EUS reporting abnormal thickening of the esophageal/gastric wall. A linear-array echoendoscope and a 19-gauge trucut needle were used for sampling. Clinical and investigatory data were collected prospectively between 2004 and 2008. Thirty-one patients (20 men) aged 60 - 74 years (median 67 years) were included. All patients had thickened esophageal wall (n = 10), gastric wall (n = 21), or both on radial EUS. Prior to EUS, patients had undergone 1 - 5 endoscopies (median 1.2) and 2 - 8 mucosal biopsies (median 4). The median esophageal and gastric wall thicknesses were 12 and 18 mm respectively. During sampling 1 - 5 needle punctures (median 3) were made. On EUS-TCB, an adequate specimen for histology was obtained in 28/31 patients (90 %). The size of the tissue cores was 4 - 10 mm (median 6mm). Malignancy was confirmed in 16/31 patients (54 %) on histology, and in 11/31 patients (35.4 %) an underlying malignancy was excluded. There was no significant correlation between wall thickness and biopsy size (rho = 0.11, 95 %CI- 0.25 to - 0.45, two-sided P = 0.53). EUS-TCB had sensitivity, specificity, and positive and negative predictive values of 85 %, 100 %, 100 %, and 74 % respectively. There were no immediate or late complications. EUS-guided mural TCB is a safe and effective technique in the investigation of esophagogastric wall thickening in patients with alarm symptoms and has high sensitivity and specificity for the diagnosis of a cancer.