Needle Biopsy Research Articles

Adequacy of EUS–guided fine-needle aspiration and fine-needle biopsy for next-generation sequencing in pancreatic malignancies: A systematic review and meta-analysis

ABSTRACT Background and Objectives A majority of pancreatic malignancies are unresectable at the time of presentation and require EUS–guided fine-needle aspiration or fine-needle biopsy (EUS-FNA/FNB) for diagnosis. With the advent of precision therapy, there is an increasing need to use EUS-FNA/FNB sample for genetic analysis. Next-generation sequencing (NGS) is a preferred technology to detect genetic mutations with high sensitivity in small specimens. We performed a meta-analysis to evaluate the adequacy of EUS-FNA/FNB for NGS in pancreatic malignancies. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched from database inception to November 11, 2023. The primary outcome was the proportion of sufficient sample acquired by EUS-FNA/FNB in pancreatic malignancies for NGS. Secondary outcomes were the proportion of sufficient sample for NGS in pancreatic ductal adenocarcinoma (PDAC) and the detection rates of mutations in KRAS, TP53, CDKN2A, and SMAD4 and actionable mutations in PDAC. The pooled proportions were calculated using a random-effects model. Potential sources of heterogeneity were investigated with subgroup analyses and meta-regression. Results Twenty studies with 881 samples were included. The pooled adequacy of EUS-FNA/FNB sample for NGS was 89.9% (95% CI, 80.8%–96.7%) in pancreatic malignancies and 92.0% (95% CI, 81.3%–98.8%) in PDAC. Screening sample suitability before NGS testing was associated with lower adequacy in subgroup analysis (79.7% vs. 98.4%, P = 0.001). The pooled prevalences of mutations in KRAS, TP53, CDKN2A, and SMAD4 in PDAC were 87.4% (95% CI, 83.2%–91.2%), 62.6% (95% CI, 53.2%–71.7%), 20.6% (95% CI, 11.9%–30.8%), and 19.4% (95% CI, 11.2%–29.1%), respectively. The pooled prevalence of potentially actionable mutations in PDAC was 14.5% (95% CI, 8.2%–22.0%). Conclusions In the majority of cases, EUS-FNA/FNB can acquire adequate sample for NGS and identify tumor-specific mutations in patients with pancreatic malignancies. Strict pre-analysis screening criteria may negatively impact the sample adequacy and the success rate for NGS.

EUS-guided fine-needle biopsy versus fine-needle aspiration for histopathological evidence for type 1 autoimmune pancreatitis: A single-center retrospective study in China

ABSTRACT Background and Objectives EUS is recommended for guiding pancreatic tissue acquisition in suspected autoimmune pancreatitis (AIP) cases. However, there is a lack of comparative research on the effectiveness between EUS-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) for diagnosing AIP in China. This study aimed to evaluate the diagnostic accuracy of EUS-guided tissue acquisition (EUS-TA) specifically for type 1 AIP. Methods Between 2010 and 2023, individuals with AIP who received EUS-TA at Changhai Hospital were included in the study. Results A total of 173 patients diagnosed with AIP who underwent EUS-TA were included in the final analysis. Of these, 104 patients (60.1%) received EUS-FNA, and 69 patients (39.9%) underwent EUS-FNB. Sufficient pancreatic tissue samples (>5 cells/high-power field) were obtained in 164 of 173 patients (94.8%), with success rates of 94.2% for EUS-FNA and 95.7% for EUS-FNB (P > 0.05). EUS-FNB exhibited higher rates of reliable level 1 histopathological findings (40.9% vs. 16.3%, P < 0.001) and reliable level 2 histopathological findings (33.3% vs. 12.2%, P < 0.001) compared with EUS-FNA. Furthermore, a higher occurrence of IgG4-positive plasma cell infiltration (>10 cells/high-power field) was observed with EUS-FNB compared with EUS-FNA (74.2% vs. 27.9%, P < 0.001). The multivariate logistic analysis also revealed that EUS-FNA was less effective in obtaining reliable evidence compared with EUS-FNB, as evident in both level 2 (P = 0.002; odds ratio, 0.21; 95% confidence interval, 0.08–0.56) and level 1 (P = 0.001; odds ratio, 0.19; 95% confidence interval, 0.08–0.49) histopathological evidence. Conclusions EUS-FNB demonstrates higher rates of level 1 and level 2 histopathological findings, as well as more abundant IgG4-positive plasma cell infiltration, compared with EUS-FNA.

Desmoid-type fibromatosis of the breast in a male patient following cosmetic surgery: a rare case report

BackgroundDesmoid-type fibromatosis of the breast is a rare, benign, but locally aggressive tumor that typically affects women. Its presentation in male patients is exceedingly rare, and even more so following a cosmetic procedure such as liposuction. This case report describes a unique presentation of breast fibromatosis in a male patient, who developed the condition after undergoing liposuction for cosmetic purposes to define the pectoral area. The case highlights the diagnostic challenges it poses due to its malignancy-like appearance on imaging.Materials and methodsA 28-year-old male patient presented with a right palpable mass in the breast following a liposuction procedure aimed at enhancing pectoral definition. Imaging studies, including ultrasound and MRI, raised suspicion of a malignancy. However, histopathological analysis from a core needle biopsy revealed fibromatosis. The patient underwent surgical excision of the tumor, and histological evaluation confirmed the diagnosis of benign desmoid-type breast fibromatosis.ResultsHistopathological examination revealed benign fibromatosis with no evidence of malignancy. The tumor was completely excised with clear margins, and the patient has had no signs of recurrence during the follow-up period.ConclusionsThis case highlights the rare occurrence of breast fibromatosis in a male patient following liposuction for cosmetic purposes. Given its ability to mimic malignancy on imaging, early diagnosis and complete surgical excision are essential for effective management and to prevent recurrence.

Validation of ACR TI-RADS performance in transition age: results from a multicenter retrospective study by the TALENT study group.

Although thyroid nodules are less common in the pediatric population, the risk of malignancy is higher than in adult patients. The aim of this study was to evaluate the ultrasonographic predictive factors of malignancy in thyroid nodules and to validate American College of Radiologists (ACR) TI-RADS performance in transition age patients. One hundred forty-two patients aged between 14 and 21 years referred to the participating centers for FNA biopsy of a thyroid nodule between 2007 and 2022 were included and ultrasound reports and sonographic images were retrospectively analyzed. Nodule features were defined according to the ACR-TIRADS lexicon. Two reference standards were applied: FNA cytology and surgical histology. The diagnostic performance of single sonographic features was estimated. Significant predictors were then included in a multivariate regression model. Nodules included in ACR-TIRADS categories TR4 or TR5 had 10-fold increased risk of indeterminate or suspicious/malignant cytology [p < 0.001]. In univariate analysis, solid composition [p = 0.016] and presence of hyperechoic foci [p = 0.040] significantly increased the likelihood of malignant histology. In multivariate regression analysis, irregular margins [p = 0.011] and hyperechoic foci [p = 0.019] were independent predictors of indeterminate or suspicious/malignant cytology. Nodules included in ACR-TIRADS categories TR4 or TR5 had 10-fold increased risk of indeterminate or suspicious/malignant cytology in transition age. ACR-TIRADS was not able to rule-out malignancy compared to FNAB alone, suggesting the need to reconsider recommendations in the transition age group.

A Case of CASTLE Preoperatively Diagnosed Using Core Needle Biopsy

A Case of CASTLE Preoperatively Diagnosed Using Core Needle Biopsy

Low-grade adenosquamous carcinoma of the breast: a case report

Background: Low-grade adenosquamous carcinoma (LGASC) is categorized as a metaplastic carcinoma, but differs from other types of metaplastic carcinoma in having a more favorable prognosis. Due to its rarity and unusual and inconsistent presentation, there is little information available regarding its characteristics, making correct diagnosis a challenge. Case presentation: We report herein the case of a 54-year-old Japanese woman who presented with a lump in her left breast. She was found to have a benign lesion which continually relapsed, necessitating repeated excisions, ultimately leading to the diagnosis of LGASC after the third excision. Guidelines for the treatment of LGASC emphasize complete tumor excision, with adjuvant therapies only considered in cases with positive lymph node metastasis. Consequently the patient underwent total mastectomy but postoperative chemotherapy was not administered, and the patient was followed up with regular observation. By 20 months postoperatively, there was no sign of recurrence. Conclusion: LGASC has distinctive pathological features of the intimate admixture of well-developed glands and solid squamous cell nests within a fibrotic or cellular spindle stroma. It is difficult to determine preoperatively with cytology or needle biopsy because LGASC mimics benign tumors. It is typically triple-negative, but it has an indolent behavior. Adjuvant therapy after surgery is considered unnecessary for triple-negative status, but there is no clear evidence. We aimed to provide more data on the disease characteristics, presentation, and treatment outcome. Accumulation of further evidence is warranted to refine diagnostic and therapeutic strategies of LGASC.

Comparison of diagnostic performances of ATA guidelines, ACR-TIRADS and EU-TIRADS and Modified K-TIRADS: A single center study of 4238 thyroid nodules.

Several ultrasound (US) -based risk stratification systems (RSS) for managing thyroid nodules have been developed and introduced into clinical practice. However, there are essential differences among these systems. This study aimed to determine and compare the category-based diagnostic performance of four US-based risk stratification systems in the detection of thyroid cancer: ACR-TIRADS, ATA, K-TIRADS, and EU-TIRADS. 4238 nodules with FNA biopsy taken between January 2018 and December 2021 were included in the study. Nodules were classified according to US imaging features and compared with biopsy results. The diagnostic success of the risk stratification systems was evaluated and compared. Of the 4238 nodules, 3861 (%91,1) were benign and 376 (%8,9) were malignant. Malignancy was significantly higher in hypoechoic and marked hypoechoic nodules (p=0.001), and solid nodules (p=0.002). For detection of malignancy, AUCs were 0.862, 0.850, 0.842 and 0.835 for 2017 ACR-TIRADS, EU-TIRADS, for KTA-TIRADS and 2015 ATA guidelines, respectively. EU-TIRADS showed the highest sensitivity (91%), whereas ACR-TIRADS had the highest specificity (87%). Compared to other risk stratification systems, ACR-TIRADS resulted in significantly fewer unnecessary biopsies (p = 0.009). All RSSs show high diagnostic accuracy, and have their own advantages and disadvantages. While deciding which RSS should be chosen, the population, the prevalence of the disease and gender distribution should be considered.

Diagnostic yield and complications of ultrasoundguided trans-thoracic biopsies by pulmonologists: a single-centre retrospective study of lesions with pleural contact.

Introduction Ultrasound-guided trans-thoracic needle biopsy (US-TTNB) is a method of choice for the diagnostic management of peripheral lung lesions and pleural masses for pulmonologists. If complication risk factors and diagnostic yield have been well reported for CT-guided biopsies, publications for US-TTNB in this field are very scarce. Methods The primary objective of this study was to describe the diagnostic yield of US-TTNB carried out by pulmonologists defined by a definitive histopathological diagnosis Secondary objectives were to identify factors that may influence diagnostic yield and to describe complications of this procedure. Between September 2015 and December 2022, charts of consecutive patients presenting peripheral lesion with pleural contact and having undergone US-TTNB were retrospectively analyses. ROC curves were performed to assess the probability of having a contributing biopsy (definitive histology) depending on scannographic measurements and the number of punctures. Univariate and then multivariate analysis were performed to look for variables associated with complications. Results One hundred and fifty nine patients were enrolled in this study. Among them, diagnosis was obtained for 140 patients (88% success rate). The histology was in favor of a neoplastic process in 96% of cases (135/140). Analysis of the ROC curves showed that the depth of the lesion (AUC 75%; CI95% 65-85; cut-off 3.0cm), the width of the lesion (AUC 73%; CI95% 63-86; cut-off 3.9cm), the pleural contact (AUC 68%; CI95% 57-80; cut-off 3.8cm) and the number of biopsies (AUC 70%; CI95% 59-81; cut-off 3 biopsies) were the variables associated with diagnostic yield. Complications occurred for 27 patients (17%) mainly pneumothorax (6%), hemoptysis (6%), and sepsis (6%) Univariate analysis showed a significant association between pneumothorax and lesion depth (OR 0.68; 95% CI 0.65-0.92; p = 0.03) with a predicted probability > 5% for a depth < 4cm according to general linear model analysis. Univariate and multivariate analysis revealed a significant association between the number of biopsies and the risk of sepsis (OR 1.90; 95% CI 1.19-3.26; p = 0.01) with a predicted probability > 5% for more than 4 biopsies. Conclusion US-TTNB is a reliable diagnostic procedure that can be performed by pulmonologists. The depth, width, pleural contact of the lesion and the number of biopsies are key variables associated with diagnostic yield. The depth of the lesion is associated with the risk of pneumothorax, and the number of biopsies with the risk of pulmonary sepsis.

Metachronous metastasis of papillary thyroid carcinoma to the parotid gland: a case report and review of the literature.

We present a case of metachronous metastasis of papillary thyroid carcinoma to the parotid gland, this being an extremely rare metastasis, and a literature review. A 56-year-old female patient presented with a history of a slowly growing mass on the left side of the neck. The patient reported a medical history of thyroidectomy due to papillary thyroid carcinoma 23 years previously and neck dissection for lymph node metastases 10 years previously, with additional therapy using radioactive iodine in both cases. Computed tomography (CT) of the neck revealed a single nodular solid mass in the tail of the left parotid gland which showed heterogeneous intake of contrast agent. FNA biopsy of the left parotid gland revealed cells typical of papillary thyroid carcinoma with positive immunochemistry for TTF-1. Due to this new metastasis, a total parotidectomy with preservation of the facial nerve was performed and additional therapy with radioactive iodine was administered. Despite the fact that papillary thyroid carcinoma has a low incidence of regional and distant metastases, there are a few rare cases with distant metastases reported in the literature. Thus, awareness, especially among endocrinologists, and a multidisciplinary approach are crucial to ensure early detection and efficient treatment of these rare cases, distant metastases being the main cause of mortality and of reduction of overall survival rate among these patients.

Endoscopic Ultrasound-Guided Pancreatic Tissue Sampling: Lesion Assessment, Needles, and Techniques

Endoscopic ultrasound (EUS)-guided tissue sampling includes the techniques of fine needle aspiration (FNA) and fine needle biopsy (FNB), and both procedures have revolutionized specimen collection from the gastrointestinal tract, especially from remote/inaccessible organs. EUS-FNB has replaced FNA as the procedure of choice for tissue acquisition in solid pancreatic lesions (SPLs) across various society guidelines. FNB specimens provide a larger histological tissue core (preserving tissue architecture) with fewer needle passes, and this is extremely relevant in today’s era of precision and personalized molecular medicine. Innovations in needle tip design are constantly under development to maximize diagnostic accuracy by enhancing histological sampling capabilities. But, apart from the basic framework of the needle, various other factors play a role that influence diagnostic outcomes, namely, sampling techniques (fanning, aspiration or suction, and number of passes), collection methods, on-site evaluation (rapid, macroscopic, or visual), and specimen processing. The choice taken depends strongly on the endoscopist’s preference, available resources at the disposal, and procedure objectives. Hence, in this review, we explicate in detail the concepts and available literature at our disposal on the topic of EUS-guided pancreatic tissue sampling to best guide any practicing gastroenterologist/endoscopist in a not-to-ideal set-up, which EUS-guided tissue acquisition technique is the “best” for their case to augment their diagnostic outcomes.

Comparing needle types and aspiration techniques in EUS-TA to optimize diagnostic efficacy and specimen quality in patients with pancreatic lesions

PurposeIn solid pancreatic lesions (SPLs), we compared the diagnostic efficacy of a 19G fine-needle aspiration (FNA) needle and a 22G ProCore fine-needle biopsy (FNB) needle, We also compared the specimen quality between the standard suction (SS) technique and heparinized wet-suction (HWS) technique.MethodsAll cases of endoscopic ultrasound-guided tissue acquisition (EUS-TA) by 19G FNA or 22G FNB for SPLs in a single-centre hospital were retrospectively reviewed. The diagnostic yield was compared between the 19G and 22G groups. Univariate and multivariate logistic regression analyses were used to identify optimal factors for a correct histological diagnosis. We also examined tissue integrity, the length of the tissue cores, and the rate of blood cell contamination between the SS and HWS groups.ResultsOne hundred seventy-one and sixty-three patients were included in the comparisons of needle types and suction techniques, respectively. The 19G group had higher histological diagnosis rates compared to the 22G group for the first pass (87.8% vs. 70.4%, p = 0.005), the second pass (82.2% vs. 65.4%, p = 0.012), the first two passes (90.0% vs. 72.8%, p = 0.004), and the final diagnosis (91.1% vs. 79%, p = 0.025). Through macroscopic on-site evaluation, a significantly higher proportion of patients in the 22G group required a third needle pass compared to the 19G group (88.9% vs. 67.8%, p = 0.002). The total procedure time was shorter in the 19G group than in the 22G group (p &amp;lt; 0.001). The HWS group showed superiority over the SS group in terms of the total length of tissue cores (p &amp;lt; 0.001) and the total length of white tissue cores (p = 0.005). The HWS group, compared to the SS group, can enhance the tissue integrity (p = 0.024) and reduce blood cell contamination (p = 0.040) during the first needle pass. There was no significant difference in complication rates between the needle puncture groups (p = 0.770) or the aspiration technique groups (p = 0.654).ConclusionCompared to the 22G FNB needle, endoscopists should consider using the 19G FNA needle when appropriate. Furthermore, the use of the HWS technique for the first pass is recommended to improve specimen quality.

Comparison of diagnostic yield and safety of endobronchial ultrasound-guided mediastinal lymph nodal cryobiopsy and endobronchial ultrasound-guided Franseen tip needle biopsy.

In this prospective study, we evaluated the diagnostic yield and safety of two endobronchial ultrasound (EBUS) biopsy techniques - mediastinal cryobiopsy (EBUS-MCB) and Franseen tip needle biopsy (EBUS-ANB) - in patients with undiagnosed mediastinal lymphadenopathy. The study included 30 patients who underwent both EBUS-MCB and EBUS-ANB, with four biopsies taken from each patient using both methods. The results demonstrated that EBUS-MCB provided a higher diagnostic yield (96.4%) compared to EBUS-ANB (73.3%). Specimens from EBUS-MCB showed fewer artifacts and a higher density of granulomas and were adequate for ancillary studies in all cases. The most common complication observed was minor bleeding, which was more common with EBUS-MCB (36.6% versus 13.3%, p=0.04). This study demonstrates that EBUS-guided cryobiopsy has a higher diagnostic yield when compared to EBUS-guided Franseen tip needle biopsy and that both biopsy techniques have an acceptable safety profile. Larger studies comparing these two techniques are necessary to confirm the findings of the current study.

A Solid Pseudopapillary Tumor of the Pancreas Incidentally Detected by 68Ga-Pentixafor PET/CT in a Patient With Primary Aldosteronism.

A 27-year-old woman underwent 68Ga-pentixafor PET/CT for primary aldosteronism localization and characterization. No functional adrenal nodules were detected by 68Ga-pentixafor PET/CT, whereas a hypodense nodule with focal pentixafor uptake was incidentally discovered in the head of pancreas. Retrospective analysis of contrast-enhanced CT scan revealed a subtly enhancing nodule devoid of calcification in the pancreatic head. Pancreatic cancer cannot be excluded. 18F-FDG PET/CT was suggested, and the scan showed an FDG-avid lesion in the same region. Needle biopsy was performed, and the pathological result is solid pseudopapillary tumor, a rare pancreatic tumor of low malignant potential.

Soft-tissue tumor of myoepithelial origin in leg with secondary bone changes: A rare case report

Myoepithelial tumors in skin and soft tissue are uncommon, but have been increasingly characterized over the past decades. They equally affect men and women of all age groups. Lesions are more frequent in extremities and limb girdles. Due to presence of varied architectural and cytological features both within a lesion and between different tumors, immunohistochemistry may be required to diagnose these tumors. We report a rare case of myoepithelial tumor of soft tissue of lower extremity with secondary bone changes on radiographs, as well as magnetic resonance imaging and histopathological correlation. The tumor was initially noticed as a painless, deep soft-tissue mass in the left lower limb; thereafter, the patient started complaining about chronic left lower limb radicular pain. A core needle biopsy was then performed, which discloses nests of ovoid to plasmacytoid cells having monomorphic round nuclei, inconspicuous nucleoli, and clear cytoplasm. Immunohistochemically, the tumor cells were positive for AE1, P40, CK 5/6, and vimentin markers.

Interdigitating dendritic cell sarcoma presenting as retroperitoneal mass and obstructive jaundice. An uncommon entity of complex diagnosis.

A 60-year-old male was admitted for obstructive jaundice secondary to a 2 cm retroperitoneal lesion. Ultrasound endoscopy (UES) with fine needle biopsy (FNB) was performed, as well as endoscopic retrograde cholangiopancreatography (ERCP) with placement of a metal stent for bile duct drainage. Initially IgG4-related disease was suspected from FNB. After 8 months of treatment the patient attended with a progression evidenced in computed tomography (CT) with retroperitoneal adenopathies and liver metastasis, with involvement of duodenum and fistulation towards hepatic angle of colon. Upper endoscopy and colonoscopy was performed. The patient underwent a cephalic duodenopancreatectomy with antrectomy and right hemicolectomy. The histological study of the specimen revealed cells of fascicular distribution, fusiform aspect, with ovoid nuclei, accompanied by a polymorphic inflammatory infiltrate with mononuclear cells. Immunohistochemistry (IHQ) was positive for S100, CD21, CD23, D2-40 and Bcl-2 and negative for CD1a, CD2, CD3, CD4, CD5, CD8, CD20, CD79a, PD1, desmine, langherin, c-kit, PDGFR. These findings were suggestive of interdigitating dendritic cell sarcoma (IDCS). Systemic chemotherapy with R-CHOP was initiated and after the first 4 cycles of treatment, retroperitoneal adenopathies regressed, with stability of metastatic liver disease.

Extramedullary plasmacytoma of the pancreas diagnosed by endoscopic ultrasonography-guided fine needle biopsy.

EMP in the head of the pancreas is difficult to diagnose, many of them postmortem, EUS-FNB in experienced hands in conjunction with immunohistochemistry and flow cytometry is a valuable tool.

Bipolar radiofrequency track cautery during abdominal biopsies: teaching points and lessons learned.

Abdominal percutaneous needle biopsies are commonly performed minimally invasive procedures to obtain tissue samples for histopathological diagnosis. Severe post-biopsy bleeding is uncommon but can be associated with prolonged hospitalization, additional interventions, morbidity, and death. Many factors may increase bleeding risk and various peri-procedural and intra-procedural strategies may minimize bleeding risk. Bipolar radiofrequency track cautery is one method that may reduce the risk of post-biopsy bleeding or tumor seeding. This paper offers an illustrative case-based review of teaching points and lessons learned in our experience using a commercially available bipolar radiofrequency track cautery device during percutaneous image-guided abdominal biopsies.

CT-augmented digital tomosynthesis image reconstruction in image-guided bronchoscopy interventions.

Transbronchial needle biopsy is crucial for diagnosing lung cancer, yet its efficacy depends on accurately localizing the target lesion and biopsy needle. Digital tomosynthesis (DTS) is considered a promising imaging modality for guiding bronchoscopy procedures due to its low radiation dose and small footprint relative to cone-beam computed tomography (CBCT). However, the image quality of DTS is still not sufficient for an accurate guidance, mainly due to its limited-angleacquisition. Preoperative computed tomography (CT) scans are often performed prior to bronchoscopy interventions for diagnosis or to plan the procedure. The CT images are of high quality and are characterized by a high spatial resolution compared to intraoperative DTS images. These patient-specific prior CT images and the intraoperative DTS images share a fair amount of anatomical information. The main differences only stem from patient positioning and respiratory motion. When these differences are addressed properly, prior CT images augment intraoperative DTS image reconstruction with strong prior knowledge and potentially enhance DTS imagequality. We propose in this work a prior-aided DTS image reconstruction technique leveraging prior CT images to improve DTS image quality. This technique is based on a recently published deformable CT-to-DTS image registration algorithm which is customized for bronchoscopy interventions. The main idea is to register a prior CT image to an intermediate DTS image reconstructed using the standard iterative algebraic reconstruction technique (ART), then to re-reconstruct the DTS image using ART and the registered prior CT image as a firstestimation. The proposed prior-aided reconstruction method was tested on a physical phantom and six patient bronchoscopy datasets. Real DTS data acquired with a pseudo-linear (PL) scan geometry and simulated DTS data generated according to a spherical ellipse (SE) scan geometry were considered. Results evaluated qualitatively by visual inspection and quantitatively by computing Pearson's correlation (PC) with respect to the reference CBCT images suggest significant improvements in image quality using the prior-aided DTS reconstruction compared to the standard zero-initialized ART reconstruction. PC coefficients of the six patient datasets were on average and using a zero-initialized ART reconstruction with SE data and PL data, respectively, and and using the proposed prior-aided reconstruction with SE data and PL data,respectively. While the initial estimation in iterative reconstruction algorithms is often overlooked, we proved that initial estimation is of critical importance in DTS image reconstruction and we have demonstrated the profound advantages of integrating prior CT images in intraoperative DTS image reconstruction. CT-augmented DTS offers a viable alternative to CBCT in guiding bronchoscopy interventions at a fraction of the radiation dose. Further clinical studies are needed to validate improved diagnosticyield.

High Diagnostic Yield of Fine Needle Biopsy for Pancreatic Serous Cystadenomas - a Multi-Center Study.

Distinguishing serous cystadenoma, a benign pancreatic cyst, from potentially malignant mucinous pancreatic cystic lesions carries significant clinical and prognostic implications; and while endoscopic ultrasound-guided fine needle aspiration is the standard diagnostic tool, its low diagnostic yield often results in additional workup. This study evaluates diagnostic yield of fine needle biopsy (FNB) on lesions suggestive of serous cystadenoma on endoscopic ultrasound. Patients with microcystic EUS appearance were identified through retrospective chart review in two institutions. Prior cross sectional imaging diagnosis was also obtained. All microcystic lesions with classic "honeycomb" appearance for serous cystadenoma on EUS were targeted for FNB and their pathology evaluated. Patients were identified through database search from 2015 to 2022 and procedure information was obtained through a retrospective chart review from two large academic centers. Thirty-one patients with suspected serous cystadenoma who underwent EUS-FNB were included. EUS FNB was successful in obtaining diagnosis in 96.8% of patients. Serous cystadenoma was diagnosed via EUS FNB in 27 of 31 patients (87.1%). Of the remaining four patients, there was one invasive pancreatic ductal adenocarcinoma, one pancreatic neuroendocrine tumor, one intraductal papillary mucinous neoplasm, and one nondiagnostic sample. EUS-FNB sampling for histopathology is a safe and accurate diagnostic tool for pancreatic serous cystadenoma. When microcytic lesions are found on endoscopic ultrasound, our study results suggest that fine needle biopsy for histopathology should be considered as the initial diagnostic evaluation tool given the demonstrated improved diagnostic yield for serous cystadenoma.

18F-AlF-NOTA-FAPI-04 Superior to 18F-FDG PET/CT in Detecting Primary Tumor and Metastatic Lymph Nodes in a Cervical Cancer Patient.

A 41-year-old woman with an enlarged right supraclavicular lymph node underwent a fine-needle biopsy, which confirmed the presence of metastatic squamous cell carcinoma. To identify the primary tumor, an 18F-FDG PET/CT scan was performed, revealing multiple metabolically active lymph nodes throughout the body, but no primary lesion was identified. Subsequently, an 18F-AlF-NOTA-FAPI-04 PET/CT scan was conducted, which demonstrated increased abnormal uptake in the cervix and revealed additional metabolically active lymph nodes. Thus, a biopsy of the uterine cervical region was performed, and the results confirmed cervical squamous cell carcinoma.