Needle Biopsy Research Articles

The clinical outcomes and prognostic factors of dedifferentiated central chondrosarcoma in extremities

ObjectiveThis study was to analyze the clinical outcomes and prognostic factors of dedifferentiated central chondrosarcomas (DCCS) in extremities.MethodsA retrospective study was conducted on 49 patients (27 males, 22 females) who underwent surgical treatment between January 2001 and March 2023 in our institution. All patients were diagnosed with dedifferentiated central chondrosarcomas by needle biopsy or postoperative histopathological examination. The general characters, treatment and clinical outcomes were recorded in the follow-up and all surgical-related complications that occurred were recorded in this study. Overall, these data were used to analyse the prognostic factors of DCCS.Results49 patients were included in this retrospective study and there were no patients lost in the follow-up period. The median diagnosis age of all patients was 57 years old (ranging from 17 to 87) and the median follow-up time was 34 months (range, 1-289). The average tumor size was 9.6 ± 2.4 cm (3.0-15.5). Median overall survival (OS) and progression-free survival (PFS) were 34 and 23 months, respectively. The 1-year, 2-year, 5-year, and 10-year OS were 87.8% (95% CI 77.6%-98.0%), 71.4% (35/49), 28.6% (14/49) and 18.4% (9/49). And the 1-year, 2-year, 5-year, and 10-year PFS were 75.5% (95% CI 63.6%-87.4%), 49.0% (35/49), 26.5% (14/49) and 16.3% (9/49). Multiple variate analyses indicated metastasis, pathological fracture, Enneking staging and surgical margin were independent prognostic factors in extremity dedifferentiated central chondrosarcomas.ConclusionsDedifferentiated central chondrosarcomas in extremities still had a grave prognosis. Metastasis, pathological fracture, Enneking staging, and surgical margin were independent risk factors for prognosis.Evidence levelIV Therapic.

The Role of Fine-Needle Aspiration Cytology in the Evaluation of Breast Lumps.

Background Breast cancer is the most frequently diagnosed cancer in women worldwide, accounting for more than one in ten new cancer cases each year. It ranks as the second leading cause of cancer-related mortality among women. The majority of patients present with palpable breast lumps. Effective surgical management of breast cancer largely depends on accurate preoperative pathological diagnosis. This study evaluates the diagnostic accuracy and prognostic implications of fine-needle aspiration cytology (FNAC) compared with core needle biopsy (CNB) in breast carcinoma. Objectives The objectives of this study are to assess the sensitivity and specificity of FNACand CNB, to compare the diagnostic accuracy of FNAC and CNB against histopathological findings from gross specimens in the evaluation of breast lumps, and to identify and examine the limitations associated with both FNAC and CNB procedures. Materials and methods This study included female patients presenting with clinically suspicious palpable breast lumps at the General Surgery OPD of Bankura Sammilani Medical College and Hospital, Bankura. All patients underwent FNAC followed by CNB. The cytological and CNB diagnoses were compared with the final pathological diagnosis obtained from excisional biopsy. Results The study included 44 female patients aged 20 to 70 years. The most common age group for breast carcinoma was 50-59 years (36.36%). Malignancy was diagnosed in 75% of cases (33/44), with right breast involvement (65%) being more common than the left. The upper outer quadrant (59%) was the most frequently affected area. Among the 33 confirmed malignant cases, 69.70% had lesions larger than 5 cm. FNAC demonstrated a sensitivity of 93.93%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 84.61%, and diagnostic accuracy of 95.45%. CNB showed a sensitivity of 96.97%, specificity of 100%, PPV of 100%, NPV of 91.67%, and diagnostic accuracy of 97.73%. Both methods correlated significantly with the final histopathology results (p < 0.05). FNAC identified ductal carcinoma in 93.55% of cases, while CNB identified it in 96.77%. Conclusion CNBprovides additional information on receptor status but is more resource-intensive. FNACremains a cost-effective and time-efficient first-line diagnostic tool, especially in resource-constrained settings like rural India. FNAC should be employed for initial diagnosis, with CNB reserved for cases requiring further clarification.

The utility of disc space and vertebral body specimens cell count differential for the diagnosis of native vertebral osteomyelitis: a prospective cohort study.

Diagnostic methods for native vertebral osteomyelitis (NVO) often yield inconclusive results. Image-guided spine biopsies for culture are specific but diagnose NVO in only 50% of cases. Pre-exposure to antimicrobials further reduces diagnostic yield. Our study assesses the value of neutrophil percentage in disc space fluid and vertebral body (DS/VB) samples for diagnosing NVO. Adults referred for spine biopsy at Mayo Clinic from August 2022 to September 2023 were consented and enrolled at the time of biopsy. Following routine specimen collection, the biopsy needle was rinsed in saline into an EDTA tube for cell analysis. NVO diagnosis required organism identification in spine tissue or blood and/or positive histopathology, and consistent symptoms and imaging. Sixty-eight patients were prospectively enrolled, comprising 14 with NVO and 54 with alternative diagnoses. The median biopsy sample polymorphonuclear (PMN) percentage for NVO patients was 80.5% (IQR 72.5-85.2), compared to 64.5% (IQR 54.0-69.0) for those without NVO (p < 0.001). Nine (64.3%) NVO patients received antibiotics within 10 days prior to spine biopsy. As a continuous measure, PMN differential showed a moderately strong ability in classifying NVO status with an area under ROC curve of 0.795; an optimal point on the curve of 71.5% corresponded to a sensitivity of 78.6%, specificity of 79.6%, negative predictive value of 93.5% and positive predictive value of 50.0%. PMN differential in DS/VB biopsies may serve as an effective diagnostic tool in the evaluation of patients with NVO particularly in ambiguous cases with an initially negative spine biopsy. Future efforts will aim to implement these findings within routine clinical practice.

S2848 Metastatic Breast Cancer Manifesting as Rectal LinitisPlastica Diagnosed With Endoscopic Ultrasound- Fine Needle Biopsy

S2848 Metastatic Breast Cancer Manifesting as Rectal LinitisPlastica Diagnosed With Endoscopic Ultrasound- Fine Needle Biopsy

Preliminary investigation: Feasibility study of a virtual reality breast biopsy simulation

Rationale and ObjectivesUltrasound-guided breast biopsies are the most frequently performed imaging-guided breast procedures. During training, learners may lack exposure due to limited volume and sensitive anatomy. Current simulation training often involves the use of manufactured or homemade (chicken or turkey breast) phantoms. Virtual reality is an emerging technology, allowing learners to have flexibility in learning, real-life interactive experiences and measurable feedback. The purpose of this study is to assess the feasibility of a novel virtual reality breast biopsy simulation trainer. MethodsThis was a HIPAA-compliant, IRB-approved prospective feasibility study. The participants were three fellowship-trained breast radiologists with varying years of experience. Participants received an introduction to the virtual reality (VR) breast biopsy simulation and brief training session, describing how to enter the simulation and navigate controls. The participants were instructed to perform as many breast biopsies as possible within a 15-min time period. One biopsy cycle consisted of entering the breast with the biopsy needle, taking a biopsy sample and removing the needle. Time to successfully biopsy the mass was recorded by the VR program, and this data was recorded to assess improvement from start to finish of the simulation. A post-procedure survey was administered to all participants immediately after completion of the simulation. Qualitative open-ended subjective feedback was also obtained via Qualtrics. ResultsAll three breast radiologists completed the simulation. There were no complications from the procedure, including no motion sickness or fatigue resulting in simulation termination. Results of data obtained from the simulation showed decreased time to successful biopsy (slope = -19.23) with each subsequent trial for all three participant breast radiologists. A decreased time to biopsy was associated with a higher cumulative number of successful biopsies (p = 0.0037). A higher number of cumulative successful biopsies was associated with decreased number of body entries (p = 0.0332) and biopsy fires (p = 0.0221) before a successful tissue sample. Mean responses for Likert scale survey results were overall high. The radiologists found the simulator to be engaging (4.67/5.00 ± 0.47), realistic (2.67/3.00 ± 0.47) and would recommend the simulation to other healthcare professionals (2.67/3.00 ± 0.47). The radiologists participating in the trial also provided overall favorable subjective feedback. ConclusionsThis study presents a novel approach for ultrasound-guided breast biopsy training with a VR simulation that showed to be successfully capable of recording time-to-completion of each biopsy attempt. Future studies will be directed toward assessing the utility of the simulation in improving trainee skills.

Remifentanil Target-controlled Infusion Versus Standard of Care for Conscious Sedation During Ultrasound-guided Transbronchial Needle Aspiration and Biopsy: A Randomized, Prospective, Control Study.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in the diagnosis and staging of mediastinal lymph node lesions in lung cancer. Adequate sedation is an important part of the procedure as it provides patient comfort and potentially increases diagnostic yield. The sedation modality varies among centers and includes moderate sedation/conscious sedation, deep sedation, and general anesthesia. The object of this study will be the evaluation of patient's comfort and level of satisfaction with the involved health care providers (bronchoscopist and anesthesiologist) of remifentanil administration in target-controlled infusion (TCI) for conscious sedation in patients undergoing EBUS‑TBNA, with a prospective randomized study design versus the of standard sedation protocol with midazolam and/or fentanest and/or propofol. This study was carried out at the "Campus Biomedico di Roma" University Hospital between September 2021 and November 2021, with a total number of 30 patients enrolled who met the eligibility criteria, randomly divided into 2 groups: group 1 "REMIFENTANIL TCI" (experimental group) where the patients performed the EBUS-TBNA procedure under conscious sedation with infusion of remifentanil TCI with a target between 3 ng/mL and 6ng/mL and group 2 "STANDARD" (control group) with patients undergoing conscious sedation with the association of midazolam and/or fentanest and/or propofol in refracted boluses based on clinical needs. Complications, safety, and level of satisfaction of the operator, the anesthesiologist, and the patient were evaluated. The results show that sedation with remifentanil in TCI can improve the comfort level of patients, reducing the risks associated with the procedure (lower frequency of oversedations and hypotension), allowing for greater intraprocedural safety. Furthermore, the level of satisfaction of the anesthesiologist and that of the operator appears to be significantly higher in the Remifentanil group. The execution of a mild to moderate sedation with Remifentanil in TCI in patients undergoing EBUS is safe, tolerated, and allows to obtain greater intraprocedural comfort. Further studies and larger and more representative samples are obviously needed to confirm and strengthen the validity of a remifentanil TCI-based sedation in endoscopic diagnostics.

S4127 Septic Shock Due to Fusiform Bacterium Nucleatum After Endoscopic Fine Needle Biopsy of a Large Abdominal Mass

S4127 Septic Shock Due to Fusiform Bacterium Nucleatum After Endoscopic Fine Needle Biopsy of a Large Abdominal Mass

S4115 Unusual Occurrence of Significant Bleeding After Fine-Needle Biopsy of a Subepithelioid Gastrointestinal Stromal Tumor Successfully Managed with an Over-the-Scope-Clip (OTSC)

S4115 Unusual Occurrence of Significant Bleeding After Fine-Needle Biopsy of a Subepithelioid Gastrointestinal Stromal Tumor Successfully Managed with an Over-the-Scope-Clip (OTSC)

S4054 Endoscopic Ultrasound-Guided Fine-Needle Biopsy Unveils a Rare Mediastinal Ectopic Thyroid in an Elderly Male

S4054 Endoscopic Ultrasound-Guided Fine-Needle Biopsy Unveils a Rare Mediastinal Ectopic Thyroid in an Elderly Male

A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery.

Endoscopic ultrasound (EUS) is routinely used for fiducial marker placement (FMP) to guide stereotactic radiation of pancreatic tumors, but EUS-FMP explicitly to guide surgery has not been studied in a prospective, controlled manner. Multipurpose EUS systems have been developed that facilitate simultaneous EUS-FMP at the time of biopsy. We aimed to evaluate the feasibility of EUS-FMP to guide pancreatic resection. In this prospective trial, we enrolled patients with resectable pancreas masses undergoing tissue sampling and placed preloaded fiducials immediately after biopsy. Intraprocedure confirmation of carcinoma, neuroendocrine, and nonlymphomatous neoplasia by rapid on-site evaluation and lesion size <4 cm was required. The main outcomes were the feasibility and ease of preoperative placement and intraoperative detection of the markers using predefined Likert scales. In 20 patients, EUS-FMP was successful before planned surgery and placement was technically straightforward (Likert Scale: 9.1 ± 1.3; range: 1, most challenging to 10, most facile). Intraoperative detection was feasible and improved when compared with a pre-established comparator of 5 representing an equivalent lesion without a marker (Likert Scale: 7.8 ± 2.2; range: 1, most difficult to 10, most facile; P = 0.011). The mean tumor size on EUS was 1.7 ± 0.9 (range: 0.5 to 3.6) cm. EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS-fine needle biopsy.

Enhanced Artificial Intelligence Methods for Liver Steatosis Assessment Using Machine Learning and Color Image Processing: Liver Color Project.

The use of livers with significant steatosis is associated with worse transplantation outcomes. Brain death donor liver acceptance is mostly based on subjective surgeon assessment of liver appearance, since steatotic livers acquire a yellowish tone. The aim of this study was to develop a rapid, robust, accurate, and cost-effective method to assess liver steatosis. From June 1, 2018, to November 30, 2023, photographs and tru-cut needle biopsies were taken from adult brain death donor livers at a single university hospital for the study. All the liver photographs were taken by smartphones then color calibrated, segmented, and divided into patches. Color and texture features were then extracted and used as input, and the machine learning method was applied. This is a collaborative project between Vall d'Hebron University Hospital and Barcelona MedTech, Pompeu Fabra University, and is referred to as LiverColor. A total of 192 livers (362 photographs and 7240 patches) were included. When setting a macrosteatosis threshold of 30%, the best results were obtained using the random forest classifier, achieving an AUROC = 0.74, with 85% accuracy. Machine learning coupled with liver texture and color analysis of photographs taken with smartphones provides excellent accuracy for determining liver steatosis.

EP.05A.08 The Accuracy of Bronchoscopy and Transthoracic Needle Biopsy for Diagnosing Lung Cancer - A Systematic Review

EP.05A.08 The Accuracy of Bronchoscopy and Transthoracic Needle Biopsy for Diagnosing Lung Cancer - A Systematic Review

Percutaneous core needle biopsy for para-aortic retroperitoneal lesions: impact of size and location on diagnostic accuracy of computed tomography-guided biopsy and feasibility of ultrasound guidance

Percutaneous core needle biopsy for para-aortic retroperitoneal lesions: impact of size and location on diagnostic accuracy of computed tomography-guided biopsy and feasibility of ultrasound guidance

S4104 Initial Experience With the Transmural Use of a New Endoscopic Ultrasound Core Needle Biopsy Device: A Case Series

S4104 Initial Experience With the Transmural Use of a New Endoscopic Ultrasound Core Needle Biopsy Device: A Case Series

Assessment of ultrasound-guided tru-cut needle pleural biopsy in the diagnosis of unexplained exudative pleural effusion compared to medical thoracoscopy

Background Ultrasound-guided needle biopsy (USGNB) allows for precise and immediate viewing of pleural lesions, effusions, and needle placement without ionizing radiation. This study aimed to assess the efficacy of US-guided tru-cut needle pleural biopsy in diagnosing unexplained exudative pleural effusion compared to medical thoracoscopy (MT), focusing on safety, accuracy, time, and cost of the treatment. Patients and methods This observational cross-sectional research was conducted on 40 patients over 18 years old, of both sexes, with unexplained exudative pleural effusion. The patients were randomly separated into two equal groups. The girst group is USGNB and the second group is MT. Results Group II exhibited substantially greater costs, sedation levels, procedure duration, biopsy site discomfort, surgical emphysema, lung expansion failure, and psychological distress compared to group I (P&lt;0.05). There was no notable disparity between the two groups regarding radiological detection of pleural effusion, pleural fluid properties, procedural observations, histological results, and diagnostic effectiveness. The duration of hospitalization was considerably shorter in group I compared to group II, assessed from the day of the operation to the day of release (P=0.001). Conclusion USGNB is an important tool in the diagnosis of pleural effusion after failure of pleural fluid analysis, which is performed by a chest physician is an accurate, safer, lower in cost, and shorter in duration with fewer complications compared with MT.

Initial experience with transmural use of a new endoscopic ultrasound electric core needle biopsy device: Case series.

Background and study aims Endoscopic ultrasound-guided biopsy via fine-needle biopsy/fine-needle aspiration (FNB/FNA) is currently the standard method to sample tumors in the mediastinum and abdomen. Although specimens obtained with these needles are acceptable, a histological diagnosis is not always possible. Recently, a new EUS-guided core needle biopsy (EUS-CNB) device became available. Herein, we describe the first experience with its use in a transmural fashion. Patients and methods This was a case series of patients who underwent EUS-CNB at an academic center. All patients provided written informed consent and were observed in the hospital ≥ 48 hours after the procedure. Results A total of 8 patients underwent EUSC-CNB: five in the pancreas, two in the retroperitoneum, and one in the mediastinum. The diagnostic accuracy of EUS-CNB was 100% after one actuation. In four patients, same-session FNB and EUS-CNB were obtained from the same lesion with superior tissue sample in the latter. No adverse events were documented. Conclusions To our knowledge this is the first report on transmural use of EUS-CNB in gastroenterology. Our findings suggest that the device is effective and safe. Larger studies comparing it with FNA/FNB needles will be required to further assess performance and safety.

Diagnostic accuracy of percutaneous transthoracic needle biopsy among peripheral pulmonary lesions: a multicenter observational study

Introduction: The diagnosis of peripheral pulmonary lesions (PPL) poses a significant challenge, prompting the widespread utilization of various modalities to ensure the precision in diagnosis. This study aims to assess the diagnostic accuracy of computed tomography-guided percutaneous transthoracic needle biopsy (CT-PTNB) in the context of pulmonary malignancy. Methods and materials: This multicenter retrospective observational study, included 1317 cases of CT-PTNB performed on adult patients with PPLs from January 2018 to December 2022 in Mashhad, Iran. The pathology results of CT-PTNB from 94 cases were compared to the definitive pathology results obtained through methods such as surgery to assess the sensitivity, specificity, and overall accuracy of CT-PTNB in diagnosing of pulmonary malignancy. Results: CT-PTNB exhibits an accuracy of 82.98%, with sensitivity and specificity rates of 75.41 and 91.43%, respectively. This study underscores the issue of false-negative results in CT-PTNB and underscores the importance of integrating clinical, radiological, and additional diagnostic modality to guide diagnostic decisions. Conclusion: In this large-scale multicenter study, the accuracy of CT-PTNB for diagnosis of pulmonary malignancy is acceptable but fairly low compared to previous studies.

Diagnosis of pleural tuberculosis in the era of thoracoscopic surgery

Background Before thoracoscopic surgery, diagnosing tuberculous (TB) pleurisy was a medical challenge. Thoracoscopy is the most accurate but expensive method for TB pleurisy diagnosis. TB is common in low-income countries, where financial limitations prevent the use of thoracoscopy, motivating the search for a cheaper alternative. Patients and methods A prospective study was done from January 2019 to January 2023 to evaluate diagnostic methods for patients with exudative pleural effusions (PE) of unknown etiologies. The demographic, radiological, procedural, and histological data of exudative PE patients were analyzed. All patients were examined for adenosine deaminase (ADA) and lymphocyte/neutrophil ratio in pleural fluid. Ultrasound-guided Abrams needle biopsy and video-assisted thoracoscopic surgery pleural biopsies were obtained, and histopathological results were assessed. Results Of 250 patients with PE, 161 (64%) had TB PE, 72 (28.8%) had malignant PE, and 17 (6.8%) had idiopathic PE. Sensitivity of ADA (≥40 U/l) was 88%, lymphocyte/neutrophil ratio (≥0.75) was 86.1%, and their overall sensitivity was 91%. They had 93.2, 86.3, and 100% specificity, respectively. For ultrasound-guided Abrams needle biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 66, 46.5, and 78.4%, respectively. All were 100% specific. For thoracoscopic biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 100, 86.6, and 100%, respectively. All were 100% specific. The assay sensitivity of pleural fluid and tissue Xpert Mycobacterium tuberculosis/rifampin resistance was 12.5 and 49.7%, respectively. Both were 100% specific. Combining ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and an ultrasound-guided Abrams needle biopsy yielded 92.4% sensitivity and 100% specificity. Conclusion Combining pleural fluid ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and ultrasound-guided Abrams needle biopsy can accurately detect TB PE in high-TB populations. It may be an affordable alternative to thoracoscopy in countries with limited resources.

Validation of Metallothionein Immunohistochemistry as a Highly Sensitive Screening Test for Wilson Disease

Wilson’s disease (WD) is a rare autosomal recessive condition with protean clinical manifestations that results from biallelic ATP7B mutations. However, non-destructive tissue tests to be applied clinically to tissue specimens are not widely available to effectively assess patients for possible WD. Previously, we showed that metallothionein (MTH) immunohistochemistry has a high sensitivity and specificity for WD diagnosis and, thus, represents a potentially powerful diagnostic tool that can be used in routine histologic sections. We sought to validate this finding in a large cohort of bona fide WD patients and to correlate metallothionein expression with other histologic features.We identified 91 cases of WD, which included 28 needle biopsies and 64 explants from 14 centers worldwide. Histologic features were evaluated, and a histopathological pattern was assigned to each case. All cases were evaluated with Masson trichrome and MTH immunohistochemistry (clone UC1MT, Abcam) using previously published technique. Liver tissues from chronic cholestatic diseases (n= 42) were used as controls.The median age of the cohort was 28.5 years. Out of 91 total cases, 83 were positive for MTH immunostain. In the controls, all 42 cases were negative for MTH immunostain. The sensitivity and specificity of MTH immunostain for WD were 91.20% and 100%, respectively.MTH immunohistochemistry is a highly sensitive and specific cost-effective screening tool for WD. It can be used for patients across age groups, varied histologic patterns, and fibrosis stages. This marker could prove to be a valuable tool in the evaluation of patients with possible WD.

Ultrasound-guided core needle biopsy of deep fascia: A cadaveric study evaluating feasibility, accuracy and reliability.

Over the past few decades, researchers and clinicians have dedicated significant attention to fascial tissues. Current interest focuses on their anatomical and pathophysiological features. Breakthroughs in ultrasound (US) and magnetic resonance imaging (MRI) have enhanced our ability to study the dynamics and alterations of the tissue structures. However, a microscopic perspective is also essential for a comprehensive understanding of some pathologies of the fasciae. The aim of this study was to investigate, using a cadaveric study: (1) the ease of visualization of the landmarks used for the US-guided fascial core needle biopsy (CNB); (2) the consistency and accuracy of needle placement inside fascial layers using US guidance and confirmed by histological examination; (3) inter-rater reliability. We assessed the feasibility of US-guided CNB in different topographical regions of human cadavers: the thoracolumbar fascia (TLF), fascia lata (FL), and crural fascia (CF). The results, confirmed by histological examination, revealed no significant difference in needle placements between the in-plane approaches in the long and short axes for all locations and fasciae studied (long axis: 91.88%; short axis: 96.22%); p > 0.05. US-guided core needle biopsy with the in-plane approach is feasible, consistent and reliable. It could provide most or all of high-quality fascial tissue samples required for pathological examination. It could also reveal changes in fascial pathologies, capturing the exact site of pathology thanks to US guidance, in particular in patchy diseases such as eosinophilic fasciitis.