Core Biopsy Procedures Research Articles

Design of an Endoscopic Biopsy Needle With Flexural Members

As a minimally invasive means of extracting a tissue sample from a patient, current endoscopic biopsy needles generally do not preserve tissue histology and often require multiple attempts to obtain a tissue sample. This paper presents an endoscopic biopsy needle with internal flexures that enables tissue to enter the hollow needle and then be severed from the surrounding tissue when the needle is withdrawn. Using force-deflection and sample weight data from 10× scaled prototypes, variations of a flexural design captured 1.1grams of a tissue phantom on average, as compared to wedge-type designs that averaged 0.7-0.8grams. Sample mass exhibited an increase in mass as the feature angle decreased. Peak entrance forces (P2) for the flexure design were lower than for both wedge and extended wedge designs, and resistance forces (S2) were higher upon needle extraction. A low-angle (15 and 30deg) feature also produced a lower entrance friction (S1) and higher exit resistance (S2) compared with 45 and 60deg features. These results suggest that a biopsy needle with 15deg flexures could increase sample length and mass as well as sampling success rates for core biopsy procedures. Future tests of the flexural biopsy needle design will use this information to determine dimensions for laser cut features of 1× scale needles.

Apoptosis Induction by the Core Biopsy Procedure

TO THE EDITOR: Dr Menard et al support our observation of tumor reduction in their pilot study, and cytocidal rather than cytostatic mechanism of action of trastuzumab. We acknowledge that there could be other mechanisms by which trastuzumab may assert its effect, including antibody dependent cytotoxicity through an intact immune system. Nonetheless, in our study, apoptosis was observed in 20 of 25 patients with matched baseline and week 1 specimens after trastuzumab exposure. If core biopsies were in fact responsible for the induction of apoptosis, then all the samples would demonstrate induction of apoptosis. Moreover, subsequent biopsies did not confer further increase in cleaved caspase 3, thereby reducing the likelihood that the biopsy procedure contributed to the increase in apoptosis. Finally, in neoadjuvant chemotherapy trials, similar biopsy procedures were performed. Most importantly, we and others have performed multiple biopsies of the primary tumor at the same time without intervening therapy, and demonstrated no increase in apoptosis with biopsies taken from different sites within the tumor. We therefore stand by our findings that the main mechanism of action of trastuzumab is by induction of apoptosis, and not by cell cycle inhibition.

Application of Core Biopsy in Revision Arthroplasty for Deep Infection

A preliminary core biopsy was performed in 168 consecutive joint arthroplasties (141 hips and 27 knees) before revision for suspected deep infection. Data of the core biopsy and subsequent revision procedures were available for 159 cases. Biopsies and revisions were all performed by one surgeon, and the exchange procedures were all undertaken in an ultra clean air enclosure. Biopsy material was cultured both aerobically and anaerobically and the results compared to that of the specimens obtained at the subsequent exchange procedure. In 116 patients (70%), the culture and sensitivity results were identical in samples from core biopsy and samples obtained during revision procedure (either no growth or growth of same organisms). When compared to intraoperative specimen report, 25 biopsies (15%) gave an apparently false-positive result. In 16 instances, a false-negative result was seen, but repeat biopsy in 4 of these cases was positive. The final diagnosis of infection was made using all available clinical and investigative data. When compared to final diagnosis, the sensitivity of core biopsy was 88%, the specificity was 91%, and the accuracy was 89%. Core biopsy was successful in identifying the organisms with the sensitivities to antibiotics in 80% of the disease-positive cases, hence, offering the opportunity to add the most appropriate antibiotic to bone cement during the exchange procedure.

Retrieval of lost microcalcifications during stereotactic vacuum-assisted core biopsy.

The purpose of our report was to describe patients in whom calcifications in the breast that were unequivocally removed during stereotactic core biopsy using the Mammotome device were not detected on the initial specimen radiograph. The lost calcifications in each instance were subsequently found when the tubing and contents of the debris canister were strained through a nonadhering dressing and radiographed. Additional situations in which calcifications are not seen on the initial specimen radiograph are described and recommendations are made. When vacuum-assisted core biopsy procedures are performed, it is important to be aware of the possibility that calcifications may be aspirated into the debris canister, thus compromising the accuracy of the histopathologic diagnosis. We recommend changing the tubing and the debris canister after each procedure and, in certain situations, sending the strained canister contents to pathology for evaluation.

Practical considerations in the pathologic diagnosis of needle core biopsies of breast.

The success of needle core biopsy procedures and the validity of pathologic diagnoses made on material from the procedures are key determinants in planning the optimal management of a wide variety of breast diseases. The most common diagnostic problems encountered in these biopsy specimens include lobular and ductal proliferations, sclerosing and papillary lesions, cellular fibroepithelial tumors, and minimally invasive or microinvasive carcinoma. This review provides practical guidance to help narrow the differential diagnosis of lesions on needle core biopsies and offers guidelines for the pathologic reporting of these specimens.

Use of breast core biopsy in the United States: results of a national survey.

We analyzed the results of a national survey to determine the current use and practice of breast core biopsy. A survey was mailed to 1700 members of the Society of Breast Imaging who reside in the United States. The questions included frequency of biopsy, specialty of responsible physician, type of guidance used, physician credentialing, method and duration of follow-up, referral patterns, scheduling practices, and types of lesions biopsied. Opinions about the future usefulness of breast core biopsy were solicited. We received 458 responses (27% response rate) from 48 states and the District of Columbia. Eighty-one percent of the respondents indicated that breast core biopsy is performed at their practice or institution: among these, 85% are performed solely by radiologists. Of those performing the procedure, 61% do not have special credentials. Seventy-one percent use both stereotaxic and sonographic guidance. For follow-up after the procedure, patients are tracked manually and by computer in near-equal proportions. The median period of patient follow-up is 12 months: 11% of the respondents track indefinitely. Surgeons and primary care physicians most commonly refer patients for core biopsy. The procedure is most often performed after notification of the referring physician (76%), and 80% of the respondents schedule core biopsy without prior surgical consultation. Masses and calcifications categorized as probably benign to highly suspicious are included as indications for core biopsy. Forty percent of the respondents offer core biopsy on the same visit as when an abnormality is found. Eighty percent of the respondents believe the procedure will increase in use 48% believe that core biopsy will replace most surgical biopsies for nonpalpable lesions. Breast core biopsy is widely used in the United States for sampling a broad spectrum of imaging abnormalities. Both sonographic and stereotaxic guidance are commonly used. Credentialing requirements, practice patterns, and follow-up after the core biopsy procedure vary considerably among different sites.

CT-guided transthoracic needle biopsy: A comparison between automated biopsy gun and fine needle aspiration

Aims: We retrospectively investigated the diagnostic accuracy and complication rate of transthoracic core biopsy using an automated biopsy gun and compared the findings with those of aspiration needle biopsy. Patients and Methods: Seventy-three patients underwent 74 core biopsy procedures and 50 patients underwent 52 aspiration biopsy procedures. Of these, a final diagnosis was obtained in 107 lesions with surgery or clinical course. Fifteen patients in which a final diagnosis was not obtained were excluded from the study on diagnostic accuracy. Thus, in the study of diagnostic accuracy, 63 core biopsy procedures for 62 lesions are included. Core biopsy was performed with an 18 G cutting needle using an automated biopsy gun. Aspiration biopsy was performed with a 20 G aspiration needle. Results: Core biopsy yielded sufficient material in 57/63 procedures (90.5%). A correct diagnosis was obtained in 36 procedures (85.7%) for malignant leisons and a specific benign diagnosis was obtained in 11 procedures (52.4%). Aspiration biopsy yielded a correct diagnosis in 26 procedures (81.3%) for malignant leisons and in seven (46.7%) for benign lesions. The overall correct diagnosis were 75.8% and 71.7% with core biopsy and aspiration biopsy, respectively. Core biopsy gave a higher predictive rate than that of aspiration biopsy for both benign and malignant lessons ( P < 0.02). Pneumothorax occurred in 18/74 (24.3%) patients with core biopsy and in 18/45 (40.0%) patients with aspiration biopsy. Of these, three with core biopsy and two with aspiration biopsy needed tube drainage. The other complication was haemoptysis, which occurred in six patients following core biopsy and in three after aspiration biopsy. All nine cases subsided spontaneously. There were no fatal complications. Conclusions: Core biopsy with a biopsy gun increase the diagnostic accuracy with a higher histologic predictive rate and no obvious additional risk of complications.

Displacement of carcinomatous epithelium in surgical breast specimens following stereotaxic core biopsy.

A variety of needling procedures in the breast may lead to dislodgment and displacement of fragments of breast carcinoma into tissue outside the target lesion of the needling procedure. To assess how frequently displaced fragments of carcinoma are seen in surgical breast specimens following stereotaxic core needle biopsies, slides were reviewed from 43 consecutive cases of breast carcinoma in which surgical excision and/or mastectomy had been performed following an initial diagnostic stereotaxic 14-gauge core biopsy procedure. In 12 of 43 (28%) cases, displaced carcinomatous fragments were identified outside of the main tumor mass. These patients were subjected to other needling procedures that included local anesthetic injection at the time of core biopsy (43 cases), needle localization (22 of 43 cases), suture placement (18 of 43 cases), and fine-needle aspiration (1 of 43 cases). Attributing carcinomatous displacement solely to the core needle biopsy is complicated by these additional needling procedures. In 18 instances, local anesthetic injection by 25-gauge needle was the only needling procedure other than the core biopsy. In 7 of these 18 (39%) cases, fragments of displaced carcinoma were observed outside the main tumor mass. The authors have previously observed only one case in which a 25-gauge needle was associated with epithelial displacement, suggesting that the core biopsy was more likely to have been the cause of displaced epithelium in these cases. Long-term clinical follow-up will be necessary to determine the biologic and clinical significance of these findings.

USE OF ULTRASOUND‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY AND AUTOMATED CORE BIOPSY FOR THE DIAGNOSIS OF GASTROINTESTINAL DISEASES IN SMALL ANIMALS

The purpose of this study was to evaluate the usefulness of ultrasound‐guided fine‐needle aspiration biopsy and core biopsy in the diagnosis of infiltrative gastrointestinal diseases. Six dogs and seven cats with clinical signs of gastrointestinal disease underwent ultrasonography and intestinal lesions were identified. One or more ultrasound‐guided fine‐needle aspiration biopsy and/or core biopsy procedures were performed in each patient. Each patient also underwent one of the following additional procedures for comparison of results: 1) surgery (n=4), 2) endoscopy (n=2), 3) post mortem exam (n=3), and, 4) for lymphoma diagnosed with ultrasound‐guided procedures, response to chemotherapy (n=4). Correct diagnoses were obtained in nine of the 13 patients, incorrect diagnoses in two of the 13 patients, and inconclusive diagnoses in two of the thirteen patients. Of the 16 total ultrasound‐guided procedures performed, ten were confirmed as correct, three as incorrect, and three were non‐diagnostic. Intestinal lesions with bowel wall thickness greater than 2.0 cm had a higher percentage of correct diagnoses than lesions of lesser wall thickness. Gastric lesions had a higher percentage of correct diagnoses than small and large intestinal lesions. Malignant lesions had a higher percentage of correct diagnoses than benign lesions. There were no complications. Ultrasound‐guided gastrointestinal fine‐needle aspiration biopsy and core biopsy appears to be a safe, accurate, and rapid procedure for use in the diagnosis of infiltrative gastrointestinal disease.