Closed Needle Biopsy Research Articles

Clinical and radiological aspects of idiopathic diabetic muscle infarction. Rational approach to diagnosis and treatment.

The systemic effects of diabetes mellitus are well recognised. The heart, kidney, central and peripheral nervous systems, and the distal parts of the limbs are often the site of end-organ damage resulting from ischaemia. Infarction of large muscle groups in the limb, not associated with gangrene, is uncommon. There have been few reported cases other than radiological descriptions of diabetic muscle infarcts. While previous reports have illustrated some of the clinical and radiological characteristics of this condition, the paucity of published cases makes it difficult to determine the most appropriate methods of diagnosis and treatment. During a five-year period we treated 14 patients with diabetes mellitus, aged from 32 to 59 years, who were referred to a musculoskeletal oncology service for suspected soft-tissue sarcoma, but were subsequently found to have a diabetic muscle infarct. Closed needle biopsy was performed in 13 without complications. In 12 patients, the symptoms resolved without surgical treatment.

Clinical and radiological aspects of idiopathic diabetic muscle infarction

The systemic effects of diabetes mellitus are well recognised. The heart, kidney, central and peripheral nervous systems, and the distal parts of the limbs are often the site of end-organ damage resulting from ischaemia. Infarction of large muscle groups in the limb, not associated with gangrene, is uncommon. There have been few reported cases other than radiological descriptions of diabetic muscle infarcts. While previous reports have illustrated some of the clinical and radiological characteristics of this condition, the paucity of published cases makes it difficult to determine the most appropriate methods of diagnosis and treatment. During a five-year period we treated 14 patients with diabetes mellitus, aged from 32 to 59 years, who were referred to a musculoskeletal oncology service for suspected soft-tissue sarcoma, but were subsequently found to have a diabetic muscle infarct. Closed needle biopsy was performed in 13 without complications. In 12 patients, the symptoms resolved without surgical treatment.

Closed Needle Biopsy of the Pleura is a Valuable Diagnostic Procedure

Closed Needle Biopsy of the Pleura is a Valuable Diagnostic Procedure

Closed Needle Biopsy of the Pleura is a Valuable Diagnostic Procedure

Closed Needle Biopsy of the Pleura is a Valuable Diagnostic Procedure

Investigation of Pleural Effusion: An Evaluation of the New Olympus LTF Semiflexible Thoracofiberscope and Comparison With Abram's Needle Biopsy

Recently, pulmonologists have performed thoracoscopy under local anesthesia using rigid thoracoscopes or flexible bronchoscopes. The latter allow greater access within the pleural cavity but are difficult to manipulate. The Olympus LTF semiflexible fiberoptic thoracoscope combines features of both instruments, having a solid body and a flexible terminal section. In the first study with this instrument, we evaluated ease of use and compared diagnostic yield with closed needle biopsy. Twenty-four patients with pleural effusion were investigated. Scottish University Hospital. Thoracoscopy was performed in the bronchoscopy suite after premedication with atropine and papaveretum. Following a standard Abram's needle biopsy, the LTF thoracoscope was inserted through a flexible introducer (Olympus Optical Co Ltd; Tokyo, Japan). The pleura was inspected and biopsy specimens were taken of suspicious areas. The final diagnosis was malignant pleural effusion in 16 of 24 patients. Ten of 16 were positive by Abram's biopsy, giving a sensitivity of 62%. Thirteen of 16 were positive by fiberoptic thoracoscopy, giving an improved sensitivity of 81%. The LTF thoracoscope was easy to use for pulmonologists experienced in rigid thoracoscopy and flexible bronchoscopy. Excellent views of the pleura were obtained from a single entry point. The procedure was well tolerated and no complications were encountered. The LTF thoracoscope allows excellent pleural access but a larger biopsy channel (currently 2 mm) might increase the accuracy of diagnosis.

Needle tract recurrences after closed biopsy for sarcoma: Three cases and review of the literature

Percutaneous closed needle biopsy of musculoskeletal neoplasms has gained in popularity. However, it remains controversial whether or not to resect the needle tract for fear of a local recurrence. A single published case report exists, noting the lone tract recurrence of an extremity skeletal osteosarcoma. We report on three additional individuals who demonstrated that tract local recurrences may occur after a closed needle biopsy for nonosteosarcoma, nonextremity sarcomas. For perspective, the world literature is reviewed to identify tract recurrences for other malignancies and the results of needle biopsy in musculoskeletal neoplasms. Eighty-nine percent of needle tract local recurrences occur when carcinomas are subjected to biopsy, as reported in the literature. Forty-seven cases since 1950 are described representing essentially all tumor types. The nature of musculoskeletal neoplasms makes closed biopsy more difficult than for softer, more homogeneous, and easier to access neoplasms. Local recurrences of sarcoma may occur in closed needle biopsy tracts. Strong consideration should be given to open biopsy and tract resection.

Role of Closed-Needle Biopsy in the Diagnosis of Malignant Mesothelioma of the Pleura

We appreciate the comments of Dr. Roggli and agree with him that closed-needle biopsy is not always sufficient to make the diagnosis of malignant mesothelioma of the pleura. There is no single diagnostic test, pathologic or otherwise, for malignant mesothelioma of the pleura. Some biopsy samples will require more pathologic testing than others to help separate malignant mesothelioma from adenocarcinoma. However, not all biopsy samples require all pathologic tests to be performed on them for a diagnosis to be made. The histochemical stains Alcian blue and colloidal iron can be positive in both malignant mesothelioma and adenocarcinoma. In malignant mesothelioma, Alcian blue and colloidal iron can stain positive due to their reaction with hyaluronic acid. In adenocarcinoma, Alcian blue and colloidal iron can stain positive due to their reaction with chondroitin sulfate. Hyaluronidase can be used to help separate the two. Exposure of the tissue to hyaluronidase will digest hyaluronic acid present in a mesothelioma; on subsequent exposure to Alcian blue or colloidal iron, the mesothelioma will fail to stain. However, hyaluronidase will not digest the chondroitin sulfate present in adenocarcinoma; on subsequent exposure to Alcian blue or colloidal iron the adenocarcinoma will still result in a positive reaction. There are many antibodies available for use in immunohistochemical testing to differentiate malignant mesothelioma from adenocarcinoma. Of these antibodies, CEA is the most useful. However, no single antibody is diagnostic. Although some authors have found electron microscopy to be useful,1Dewar A. Valente M. Ring N.R. Corrin B. Pleural mesothelioma of the epithelial type and pulmonary adenocarcinoma: an ultrastructure and cytochemical comparison.J Pathol. 1987; 152: 30916Crossref Scopus (51) Google Scholar others have found this not to be the case.2Suzuki Y. Churg J. Kannerstein M. Ultrastructure of human malignant diffuse mesothelioma.Am J Pathol. 1976; 85: 241-262PubMed Google Scholar, 3Churg A. Diseases of the pleura.in: Thurlbeck W.M. Pathology of the lung. Thieme-Stratton, New York1988: 769-802Google Scholar At the time of our diagnoses of malignant mesothelioma of the pleura, electron microscopy was not available at our institution. In our study, we were able to make a diagnosis of malignant mesothelioma of the pleura in 20 cases utilizing some of the pathologic tests available. In these 20 cases, tissue was obtained at closed-needle biopsy of the pleura in 12. In 10 of these 12 cases a diagnosis of malignant mesothelioma of the pleura was made without subjecting the patient to an open pleural biopsy. These findings show that the yield of malignant mesothelioma of the pleura by closed-needle biopsy, in their study, is higher than previously recorded. We suggest that this finding may be due to the improvement in pathologic tests that have become available in the past 10 years. In light of these findings, we suggest that a closed-needle biopsy be performed before proceeding to open pleural biopsy when a diagnosis of malignant mesothelioma of the pleura is considered. The advantage to the patient, as well as the considerable reduction of hospital costs, in making a diagnosis by closed-needle biopsy is obvious. However, should a closed needle biopsy be nondiagnostic, we surely do not suggest that the investigation stop there. On the contrary, if a closed-needle biopsy is nondiagnostic for malignant pleural mesothelioma, open pleural biopsy or thoracoscopy should be performed. Role of Closed-Needle Biopsy in the Diagnosis of Malignant Mesothelioma of the PleuraCHESTVol. 105Issue 1PreviewThe article by Beauchamp et al,1 which appeared in the October 1992 issue of Chest, purports to test the hypothesis that closed-needle biopsy may be sufficient in many cases to make a diagnosis of malignant mesothelioma of the pleura. In a study of 20 consecutive patients with a histopathologic diagnosis of mesothelioma, the diagnosis was made by closed-needle biopsy alone in 12 cases. Therefore, the authors argue, closed-needle biopsy is sufficient to make a diagnosis of mesothelioma. The circular nature of this reasoning is obvious, and in and of itself is sufficient to invalidate the conclusions of the study. Full-Text PDF

Intraosseous lipoma of the calcaneus. A case report

The intention of this report is to heighten the practitioner's clinical suspicion of intraosseous lipoma of the calcaneus. The apparent infrequency of this diagnosis may be attributed to the dependence on radiographic evaluation and the use of closed needle biopsy. Thus, to make a proper diagnosis, a computed tomography scan with the rate of attenuation and, ultimately, a large tissue biopsy with attentive gross and microscopic examination are necessary.

Aspergillus Osteomyelitis of the Spine

Aspergillosis involving either the vertebral body or the intervertebral disc is a rare cause of osteomyelitis of the spine. The following is a report of five cases of Aspergillus fumigatus infection of the spine treated successfully with amphotericin B and 5-flucytosine. In three patients, the diagnosis was established at closed-needle biopsy; two patients with paraplegia had an anterior decompression and fusion. The follow-up period ranged from 19 to 48 months.

Clinical Characteristics of the Patient with Nonspecific Pleuritis

To determine if patients with nonspecific pleuritis could be clinically distinguished from those with malignant or granulomatous pleural disease, the medical records and chest roentgenograms of all patients who had a closed needle biopsy of the pleura during a five-year period from January 1979 to December 1983 were reviewed. A total of 119 patients were categorized based upon their ultimate diagnosis as having malignant (n = 41), granulomatous (n = 25), or nonspecific pleuritis (n = 53). Weight loss, fever greater than 38 degrees, a positive PPD, a pleural fluid lymphocytosis of greater than 95 percent, and an effusion which occupied more than half a hemithorax were significantly more common in the patients with malignant or granulomatous disease. Based on these results, a conservative approach is recommended for the patient with an initial biopsy which reveals only nonspecific pleuritis who has none of the criteria, but an aggressive diagnostic work-up in the individual with two or more criteria is advocated.

Tuberculosis, of the sacroiliac joint: clinical features, outcome, and evaluation of closed needle biopsy in 11 consecutive cases

Sacroiliac joint (SIJ) involvement has been reported in up to 9.7 percent of patients with skeletal tuberculosis. Lack of awareness of this now uncommon form of infection often leads to diagnostic delay and increased morbidity. Eleven consecutive cases of SIJ tuberculosis are reported; clinical and radiologic features, diagnosis, treatment, and outcome are discussed. Buttock pain was the presenting complaint in all patients. However, radicular pain in the lower back (seven patients) or lower limb (10 patients) was common and in one patient precipitated an unnecessary surgical intervention. SIJ tuberculosis is frequently an isolated phenomenon. Therefore, direct sampling of the SIJ is necessary to establish the diagnosis. The recently described technique of closed needle biopsy of the SIJ was employed in all 11 patients and established the diagnosis in nine of the 11.

Diagnosis of pleural malignant mesothelioma in life--a practical approach.

This review documents a practical approach to the pathological diagnosis of pleural malignant mesothelioma based on the closed needle biopsy and effusion cytology, thus avoiding the need to resort to open surgery. Tissue diagnosis is often difficult, and the pathologist's opinion may be influenced by a consideration of three factors: the clinical setting; the adequacy and availability of specimens; and the criteria for assessment and interpretation of these. The level of confidence with which a tissue diagnosis of mesothelioma can be established using limited material depends on there being an appropriate clinical background including a history of asbestos exposure. Without this, the diagnosis should be a qualified or tentative one. For an adequate tissue sample to be obtained, the closed needle biopsy procedure is best performed by an experienced operator. All aspirated pleural effusions should be forwarded for cytological evaluation. In addition to conventional morphological studies, adequate samples permit ancillary tests to be carried out. A combined interpretive approach utilizing both histopathology and cytology is recommended in order to increase the accuracy of the diagnosis.

CT-Guided Closed Biopsy of the Spine

Twenty-two patients with mass or destructive lesions at different levels of the spine underwent closed needle biopsy guided by computed tomography (CT). Eighteen of the 22 specimens obtained were sufficient for a histologic diagnosis. In one, normal bone tissue obtained was not consistent with the clinical and radiographic picture, resulting in a false negative diagnosis. Except for one patient who developed transient quadriparesis that resolved spontaneously within 2 days, no bleeding complications or neurologic deficits attributable to the procedure were noted. Closed needle biopsy of spinal lesions under CT guidance is advocated as a safe and convenient technique for all levels of the spine. Modifications of the needle used and more experience will be necessary to increase the yield of positive results.

Phenobarbital treatments lower DDT body burden in rhesus monkeys.

Decreased DDT, DDD, DDE in blood and DDA in urine followed phenobarbital treatments (10 mg/kg/day, 11 days, intramuscular (im)) in three male rhesus monkeys (Macaca mulatta). Animals were fed DDT diets containing up to 500 ppm DDT during a 3-year period. Induction of liver monooxygenases was confirmed by reduced in vivo antipyrine plasma half-life and increased in vitro oxidation rates of dihydroisodrin, p-nitroanisole and benz(alpha)pyrene by homogenates of liver obtained from closed needle biopsy. Chlorohydrocarbon blood levels significantly decreased during the induction period (days 1-11). Concentrations on day 28 were at or below pre-DDT exposure levels. Urine DDA gradually decreased in all monkeys from days 16 to 28.

Aspergillus Flavipes Group Osteomyelitis

Lumbar vertebral osteomyelitis caused by Aspergillus Flavipes group organisms developed in a nonchronically immunosuppressed patient. Diagnosis was confirmed morphologically and culturally from both closed needle biopsy of the vertebrae and subsequent lumbar laminectomy. The patient was treated with 3 g of amphotericin B with apparent eradication of the organism.

Enzyme activities in human liver biopsies: assay methods and activities of some lysosomal and membrane-bound enzymes in control tissue and serum.

1. Highly sensitive technique are described for the assay of plasma membrane (5'-nucleotidase, alkaline phosphatase), microsomal (neutral alpha-glucosidase, leucyl-2-naphthylamidase) and biliary canalicular (gamma-glutamyltransferase) enzymes and for nine acid hydrolases (acid phosphatase, phosphodiesterase, beta-glucosidase, alpha-glucosidase, alpha-galactosidase, beta-galactosidase, alpha-mannosidase, N-acetyl-beta-glucosaminidase, beta-glucuronidase) in human liver. 2. Optimum and specific assay systems have been developed which give linear kinetics for all enzymes. 3. The range of enzyme activities in samples of human liver, obtained by closed needle biopsy, and sera have been determined.

Ultramicro Analysis for Copper, Cadmium, and Zinc in Human Liver Tissue by Use of Atomic Absorption Spectrophotometry and the Heated Graphite Tube Atomizer

We describe a method of analysis for copper, cadmium, and zinc in a 15-mg (wet weight) sample of human liver by atomic absorption spectrophotometry. The sample is digested with nitric acid (1.0 mol/liter), evaporated, and dilute HNO3 (10 mmol/liter) added. The reconstituted acid mixture is injected into the graphite tube atomizer for analysis of Cu and Cd and aspirated into the air--acetylene flame for measurement of Zn. The absorbance for each metal is suppressed with increasing pH. NaNO3, KNO3, KCl, and NaCl (e.g.) quench the Cd absorbance in acid solutions that contain no protein, but not in the presence of protein. Metal ions added to the predigestion human liver sample at 10 percent and 100 percent of the intrinsic metal concentrations were, respectively, 93 percent and 90 percent accounted for analytically in the case of Cu, 98 percent and 102 percent for Zn, and 101 percent and 93 percent for Cd. Analysis of a National Bureau of Standards' Bovine Liver Standard Reference Material yielded results corresponding to 99 percent (Cu), 112 percent (Zn), and 91 percent (Cd) of the mean expected concentrations of these metals. The between-run coefficient of variation for the bovine liver material was 6 percent for Cu, 9 percent for Zn, and 10 percent for Cd. For 16 histologically normal samples of human liver, the mean values were: Cu, 26; Zn, 293; and Cd, 6.0 nanograms of metal per milligram dry weight, in agreement with values published previously. The method can be easily and reliably applied to small samples of liver obtained by closed-needle biopsy.

Peritoneoscopy: its value in the diagnosis of liver disease

The value of peritoneoscopy in the diagnosis of liver disease was determined in a prospective way by examining the livers of 36 consecutive cadavers and comparing the results of routine closed liver biopsy with those of peritoneoscopy and guided needle biopsy. Peritoneoscopy appears to offer a distinct advantage over closed needle biopsy in the diagnosis of metastatic liver disease and may be helpful in the evaluation of acute intra-abdominal processes.

Importance of bone marrow biopsy in the clinical staging of Hodgkin's disease.

The advent of new forms of therapy in the treatment of Hodgkin's disease requires accurate clinical staging. Although many patients with Hodgkin's disease have evidence of marrow involvement at autopsy, examination of the marrow during life by aspiration techniques infrequently demonstrates this. This difference relates both to the fibrous and granulomatous nature of the lesion which prevents aspiration of marrow particles and to the disruption of marrow architecture by aspiration. In contrast, closed needle biopsy of the posterior iliac crest overcomes these limitations. Of 49 patients studied, 11 had positive biopsy evidence of Hodgkin's disease even though aspiration studies had been unrevealing. Of these 11, 6 had been classified initially as Stage III and thus required reclassification to Stage IV. Biopsy failed to demonstrate marrow involvement in 5 of 39 patients who had marrow involvement proved at autopsy. These data indicate that with positive findings, marrow biopsy can be a helpful tool for the more accurate staging of advanced Hodgkin's disease.

Marmoset liver organ culture infected with herpes virus

Fragments of adult marmoset liver were taken for organ culture by both open incisional biopsy and closed-needle biopsy. These fragments were placed on a matrix of human fibrin foam and maintained in nutrient medium. By light microscopy, liver cells stained with H and E showed beginning degeneration in the central portion of the fragment and cytoplasmic basophilia in the peripheral portion of the fragment after 12 hours in culture. By 3 days, the central portion of the fragment was necrotic, whereas the liver cells in the peripheral portion appeared intact but slightly enlarged and vacuolated. Electron microscopic examination of liver fragments through day 8 revealed that the ultrastructure of hepatocytes in vitro was very similar, if not identical, with hepatocytes in vivo . Marmoset liver organ cultures, after 6 days of incubation, were inoculated with herpes simplex virus. Specimens taken for electron microscopy at 48 hours after inoculation revealed that many hepatic parenchymal cells were infected. These cells contained intranuclear herpes virus particles in various stages of assembly. Thus, differentiated liver parenchymal cells maintained in culture are capable of supporting virus replication.