Needle Biopsy Research Articles

Trends in Atypical Ductal Hyperplasia Diagnosis and Upgrade: A 20-Year Experience and Impact of MRI Use on Upgrade Rates.

Atypical ductal hyperplasia (ADH) is a benign proliferative breast lesion. Surgical excision of ADH is often recommended to rule out underlying malignant disease. The aim of this study was to evaluate the trends in ADH upgrade rates over time and identify the impact of magnetic resonance imaging (MRI) use on upgrade rates. Retrospective review of a prospectively maintained institutional database was used to identify women diagnosed with ADH by core needle biopsy between 2004 and 2022. Trends in ADH upgrade to in situ and invasive disease as well as clinicopathologic factors associated with upgrade were analyzed. A total of 975 ADH cases were identified between 2004 and 2022. Of these, 361 (37.0%) met our multidisciplinary criteria for excision and thus met the inclusion criteria for this study. A total of 93 (25.8%) patients were found to have upgrade on final surgical pathology. When compared across quartiles of time, there were no significant changes in overall rates of upgrade over the study time period despite changes in diagnostic modalities. In women selectively referred for excision based on standardized imaging and pathology criteria, enhancement on preoperative MRI was not found to be significantly associated with increased rates of ADH upgrade. While trends in diagnostic modality of ADH have changed over time, we found that rates of ADH upgrade have remained stable over time and are not associated with imaging modality, suggesting that enhancements in imaging technology have not improved our ability to preoperatively identify patients with a concurrent malignancy.

Preoperative MRI to Predict Upstaging of DCIS to Invasive Cancer at Surgery.

Ductal carcinoma in situ (DCIS) is overtreated, in part because of inability to predict which DCIS cases diagnosed at core needle biopsy (CNB) will be upstaged at excision. This study aimed to determine whether quantitative magnetic resonance imaging (MRI) features can identify DCIS at risk of upstaging to invasive cancer. This prospective observational clinical trial analyzed women with a diagnosis of DCIS on CNB. All the participantsunderwent preoperative 3T MRI. Quantitative MRI features from routine dynamic contrast-enhanced (DCE) MR images (e.g., peak percent enhancement [PE]) and from advanced high temporal-resolution DCE MR images (e.g., Ktrans) were measured. Clinical, pathologic, and mammographic features were reviewed. Associations with upstaging were summarized using the area under the receiver operating characteristic curve (AUC). Of 58 DCIS lesions at CNB, 15 (26%) were upstaged to invasive cancer at surgery. Of the 58 lesions, 46 (79%) enhanced on MRI, although enhancement alone was not significantly associated with upstaging (p = 0.71). Among the DCIS lesions that enhanced, higher PE was most strongly associated with upstaging (AUC, 0.81; adjusted p = 0.009) and outperformed MRI features acquired via high temporal resolution DCE-MRI (AUC, 0.50-0.73). Lesion span on MRI was not significantly associated with upstaging risk (AUC, 0.55; adjusted p = 0.61), nor were any clinical, pathologic, or mammographic features (p > 0.24). Quantitative features acquired from routine clinical breast MRI and advanced DCE-MRI demonstrated good performance in identifying which DCIS lesions were upstaged to invasive cancer at excision. These features may prove valuable for appropriate selection of active surveillance in future DCIS de-escalation trials.

ASO Visual Abstract: The Incidence of Adjacent Synchronous Ipsilateral Infiltrating Carcinoma and/or Ductal Carcinoma In Situ in Patients Diagnosed with Flat Epithelial Atypia by Core Needle Biopsy (TBCRC 034).

ASO Visual Abstract: The Incidence of Adjacent Synchronous Ipsilateral Infiltrating Carcinoma and/or Ductal Carcinoma In Situ in Patients Diagnosed with Flat Epithelial Atypia by Core Needle Biopsy (TBCRC 034).

Response to: Site of puncture in endoscopic ultrasound-guided fine needle biopsy: Does it change diagnostic outcome?

Response to: Site of puncture in endoscopic ultrasound-guided fine needle biopsy: Does it change diagnostic outcome?

Thy1c Cytology Is a Reliable Method of Excluding Thyroid Cancer in Dominant Cystic Nodules.

Traditional teaching dictated that patients with recurrent thyroid cysts undergo excision owing to a 12% risk malignancy. Ultrasound evaluation now determines management of these patients augmented by fine needle biopsy. In UK, a non-diagnostic category for thyroid cysts (Thy1c) exists, whereas the Bethesda system combines 'non-diagnostic-cyst fluid only' into Category I along with paucicellular and acellular results. The aim was to assess the ability of Thy1c cytology to exclude malignancy. We undertook a retrospective study of patients undergoing thyroidectomy with Thy1c cytology from analysis of the Unit database. Additionally, we made a retrospective search in our pathology database for reports combining 'papillary thyroid carcinoma' with 'cyst' or 'cystic' and compared histology with cytology. Between 2003 and 2023 115 patients (97 women, median age 44y, range 16-72) underwent thyroidectomy following Thy1c cytology. Indications for surgery included recurrent cyst (90%); compressive symptoms (9%) and one thyrotoxicosis. In no patient was the primary diagnosis malignant; multinodular goitre was commonest (87.76%); benign cyst (19.16%); follicular adenoma (5.4%) and coincidental pT1a classical papillary thyroid carcinoma (PTC) (4.3%). In the retrospective audit, 61 pathology reports contained 'PTC' and 'cyst'/'cystic'. The cystic element was in primary tumour (31.51%); nodal metastasis (17.28%) and adjacent benign disease (13.21%). Only 5 (8%) patients had Thy1c cytology; 4 had pT1a tumours and one a benign cyst and a 19 mm PTC. Thy1c category reliably excludes significant malignancy. For patients with symptomatic cysts, ultrasound assessment and Thy1c cytology can guide the clinician to treat with either ablation or resection without the fear of mistreating a thyroid cancer.

Classifying the molecular subtype of breast cancer using vision transformer and convolutional neural network features.

Identification of the molecular subtypes in breast cancer allows to optimize treatment strategies, but usually requires invasive needle biopsy. Recently, non-invasive imaging has emerged as promising means to classify them. Magnetic resonance imaging is often used for this purpose because it is three-dimensional and highly informative. Instead, only a few reports have documented the use of mammograms. Given that mammography is the first choice for breast cancer screening, using it to classify molecular subtypes would allow for early intervention on a much wider scale. Here, we aimed to evaluate the effectiveness of combining global and local mammographic features by using Vision Transformer (ViT) and Convolutional Neural Network (CNN) to classify molecular subtypes in breast cancer. The feature values for binary classification were calculated using the ViT and EfficientnetV2 feature extractors, followed by dimensional compression via principal component analysis. LightGBM was used to perform binary classification of each molecular subtype: triple-negative, HER2-enriched, luminal A, and luminal B. The combination of ViT and CNN achieved higher accuracy than ViT or CNN alone. The sensitivity for triple-negative subtypes was very high (0.900, with F-value = 0.818); whereas F-value and sensitivity were 0.720 and 0.750 for HER2-enriched, 0.765 and 0.867 for luminal A, and 0.614 and 0.711 for luminal B subtypes, respectively. Features obtained from mammograms by combining ViT and CNN allow the classification of molecular subtypes with high accuracy. This approach could streamline early treatment workflows and triage, especially for poor prognosis subtypes such as triple-negative breast cancer.

Circulating Cell-Free DNA Integrity for Breast and Prostate Cancer: What Is the Landscape for Clinical Management of the Most Common Cancers in Women and Men?

Breast cancer (BC) and prostate cancer (PCa) are major health problems for women and men worldwide. Although therapeutic approaches have increased, the complexity associated with their heterogeneity and progression requires better ways to monitor them over time. Cell-free DNA integrity (cfDI) represents a viable alternative to needle biopsy and has the potential to be representative of cancer at all stages. In addition to the advantages of liquid biopsy in terms of cost and reduced invasiveness, cfDI can be used to detect repetitive DNA elements (e.g., ALU and LINE1), which could circumvent the problem of mutational heterogeneity in BC and PCa. In this review, we summarise the latest findings on cfDI studies in BC and PCa. The results show that cfDI has the potential to improve early detection, metastasis, and recurrence of BC, while limited studies prevent its clinical value in PCa from being fully defined. However, it is expected that further studies in the near future will help to introduce the use of cfDI as another biomarker for the clinical monitoring of BC and PCa patients.

Paediatric breast disease and developmental breast cysts - reflection on 20 years of experience.

Presentation with breast symptoms in the paediatric population is common but there is little existing literature on the workup and management of breast disease in this population. Retrospective series of 140 cases of breast disease in the paediatric population managed by a single surgeon in Adelaide, South Australia between 2004 and 2024. Review of patient demographics, presentation, investigation, management and outcomes of various breast symptoms and pathologies using descriptive analysis. We reviewed 140 cases including 135 females and 5 males, aged 8-18 years (median = 15). The most common reason for presentation was breast lump (n = 86, 61%), followed by large breasts (n = 13, 9%), asymmetry (n = 11, 8%), abnormal development (n = 8, 6%). Most patients were investigated with ultrasound (n = 101, 71%) and FNA biopsy was performed in cases of non-diagnostic ultrasound or to distinguish fibroadenoma from phyllodes tumour (n = 17, 12%). There was a single case of malignancy and the most common diagnoses were developmental breast cyst (n = 36, 26%) and fibroadenoma (n = 33, 24%). Gynaecomastia was the only diagnosis in males (n = 5, 4%). Majority of patients were managed non-operatively (n = 101, 72%), indications for surgery included fibroadenoma (n = 18, 13%), breast hypertrophy (n = 8, 6%) or abnormal breast development (n = 4, 3%). We reviewed 140 cases of breast disease in the paediatric population over a 20-year period. Malignancy in this population is rare but requires exclusion with history, examination and ultrasound where appropriate. Developmental breast cysts are the most common pathology, require early identification to avoid unnecessary invasive investigation and should be managed expectantly where possible.

Navigating the Uncertainty of B3 Breast Lesions: Diagnostic Challenges and Evolving Management Strategies.

B3 breast lesions, classified as lesions of uncertain malignant potential, present a significant diagnostic and therapeutic challenge due to their heterogeneous nature and variable risk of progression to malignancy. These lesions, which include atypical ductal hyperplasia (ADH), papillary lesions (PLs), flat epithelial atypia (FEA), radial scars (RSs), lobular neoplasia (LN), and phyllodes tumors (PTs), occupy a "grey zone" between benign and malignant pathologies, making their management complex and often controversial. This article explores the diagnostic difficulties associated with B3 lesions, focusing on the limitations of current imaging techniques, including mammography, ultrasound, and magnetic resonance imaging (MRI), as well as the challenges in histopathological interpretation. Core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) are widely used for diagnosis, but both methods have inherent limitations, including sampling errors and the inability to determine malignancy in some cases definitively. The therapeutic approach to B3 lesions is nuanced, with treatment decisions strongly influenced by factors such as the lesion size, radiological findings, histopathological characteristics, and patient factors. While some lesions can be safely monitored with watchful waiting, others may require vacuum-assisted excision (VAE) or surgical excision to rule out malignancy. The decision-making process is further complicated by the discordance between the BI-RADS score and biopsy results, as well as the presence of additional risk factors, such as microcalcifications. This review provides an in-depth analysis of the current diagnostic challenges and treatment strategies for B3 lesions, emphasizing the importance of a multidisciplinary approach to management. By synthesizing the most recent research, this article aims to provide clinicians with a clearer understanding of the complexities involved in diagnosing and treating B3 breast lesions while highlighting areas for future research, such as artificial intelligence and genomics, to improve the diagnostic accuracy and patient outcomes.

Rare case of bilateral primary breast angiosarcoma and review of literature

Primary angiosarcoma of the breast is very rare, accounting for 0.05% of all malignant breast tumors, and it usually occurs in younger individuals. To the best of our knowledge, bilateral primary angiosarcoma is extremely rare, with only 16 cases reported in the published literature. The imaging features might give a false impression of a benign lesion, delaying diagnosis. We report a case of a 34-year-old woman with a left breast lump. Her initial core needle biopsy was negative, and she was briefly lost to follow-up. However, when she returned with worsening symptoms, a vacuum-assisted biopsy revealed angiosarcoma. After undergoing surgery, she received radiation therapy but subsequently developed angiosarcoma in the contralateral breast. Our case is unique because we present the variable imaging appearances of angiosarcoma using imaging modalities such as mammography, ultrasound, MRI, and PET-CT, at the time of initial presentation, final diagnosis, and recurrence. We also report the successful use of a vacuum-assisted breast biopsy following a non-diagnostic core needle biopsy without experiencing overt bleeding during the procedure in a case of angiosarcoma. There have been very few reported cases in which vacuum-assisted biopsy has been performed in cases of angiosarcoma, indicating that it can be used in hypervascular masses without the risk of excessive bleeding, especially when an initial core biopsy is discordant.

Rhabdomyosarcoma Surgical Update.

Rhabdomyosarcoma (RMS) tumors arise from mesenchymal tissue and represent half of pediatric sarcomas, which in turn make up 7% of pediatric tumors. Advances in local control therapy of RMS have improved outcomes after surgical resection of the primary tumor, either before or after induction chemotherapy, even in the setting of metastatic disease. The utilization of diagnostic core needle and sentinel node biopsy techniques for lymph node staging are becoming more widely used. Over the past several years, refinement of prognostic factors with adoption of fusion status instead of histology, and optimized risk stratification schemas have been developed to assure appropriate therapy. There have been efforts between North American and European surgical oncology cooperative groups to standardize the care we provide, and yet there are still some philosophical differences to overcome.

Aberrant E-cadherin Expression in Lobular Carcinoma In Situ: A Comprehensive Immunohistochemical Evaluation of N-terminal, Extracellular, and C-terminal E-cadherin Domains.

E-cadherin (E-cad) immunohistochemistry is commonly used to distinguish lobular carcinoma in situ (LCIS) from ductal carcinoma in situ in histologically uncertain or ambiguous cases. Although most LCIS cases show an absence of E-cad expression on the neoplastic cell membranes, some show aberrant E-cad expression which can lead to diagnostic confusion. Awareness and understanding of the frequency, patterns, and distribution of aberrant E-cad staining in LCIS is crucial to achieving a correct diagnosis. We studied 55 LCIS cases diagnosed on core needle biopsy, classified each case by WHO subtype (classic, pleomorphic, or florid), and evaluated the frequency and patterns of aberrant E-cad expression using 3 different E-cad antibodies targeting the N-terminal (N), extracellular (EC), and C-terminal domains (C). Aberrant E-cad expression in one or more of the E-cad domains was identified in 17 cases (31%) and was significantly more frequent among LCIS variants (10/19, 56%) than among classic cases (7/36, 19.4%) (P=0.02). Among these 17 cases, aberrant E-cad expression was seen for all 3 domains in 10 cases, for EC+C in 4, for EC+N in 2, and for N only in 1. These results indicate that about one-third of cases of LCIS can show aberrant E-cad expression, that this is more common in variants than classic types of LCIS, and that this may be seen in different E-cad domains, most often in combination. These different patterns of aberrant E-cad expression may reflect different mechanisms of E-cad alterations in LCIS, the underlying nature of which merits further studies.

Pediatric Bone Sarcoma Biopsy Tract Excision: Is it Safe to Resect Separately?

Biopsy is an essential part of proper diagnostic workup in pediatric bone sarcomas impacting surgical planning, chemotherapeutic treatments, and prognostic determination. Two main biopsy techniques are currently used: closed biopsy (core needle or fine needle aspiration) and open biopsy. Historical oncologic teaching is for resection of the biopsy tract with the tumor specimen due to the theoretical risk for biopsy tract tumor contamination; however, this can restrict surgical planning and increase morbidity. This study evaluates oncologic outcomes at this institution, comparing open versus closed biopsy, and biopsy tract resection with or separate from the main tumor resection. Retrospective review of a single institution of all patients treated for bone sarcomas from 2006 through December 2021. Patient and tumor characteristics, biopsy technique, biopsy resection method, and oncologic outcomes were collected. Subgroup statistical analysis was performed comparing closed biopsy and open biopsy techniques, and biopsy tract resection with the main tumor or separately. A total of 73 patients met the inclusion criteria, including 48 (65.8%) open biopsies and 25 closed biopsies [23 (31.5%) core needle biopsies and 2 (2.7%) fine needle aspirations]. Biopsy tract resection was performed with the main tumor in 36 (49.3%), separate in 37 (50.7%). There were no statistical differences in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy methodology analysis and biopsy tract removal methods. This study demonstrates the safety of both approaches for obtaining diagnostic tissues with low rates of biopsy tract seeding in both methods. In addition, it demonstrates that there is no difference in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy tract resection with or separate from the main tumor. Definitive surgical plan should not vary based on biopsy technique and biopsy tract management, but rather patient, tumor, institutional, and surgeon factors. Level III-retrospective chart review. The study was started after the patients were diagnosed and treated.

Pancreatic Well-Differentiated Neuroendocrine Tumors are Frequently Undergraded on Endoscopic Ultrasound-Guided Fine Needle Biopsy Sampling: A Single Institutional Experience.

Objectives. To determine the accuracy of grading pancreatic well-differentiated neuroendocrine tumors (PanNETs) on endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). Methods. Fifty-three (53) PanNETs from 52 patients with EUS-FNB and subsequent resection were included, including 1 patient with 2 synchronous tumors biopsied separately. Grade (G) was assigned as per the 2019 World Health Organization criteria. The concordance of grade between EUS-FNB and resection was measured using kappa statistic. Clinicopathologic features were compared between specimens with concordant or discordant grading. Results. Two-thirds of patients were male, and the median age was 62 years (range 27-85). Four received neoadjuvant therapy. 89% were nonfunctional, whereas 11% were functional. Concordance of grade between EUS-FNB and resection was moderate (kappa = 0.45). Precisely 25% (13 out of 51) of G1 or G2 specimens were discordant. G2 tumors were frequently undergraded on EUS-FNB (11 out of 18; 61%), whereas G1 tumors were only rarely overgraded (2 out of 33; 6%). Two G3 tumors were concordant. There was no correlation between concordance and other clinicopathologic features, except for perineural invasion. Conclusions. The concordance of PanNET grading between EUS-FNB and resection was moderate, and G2 tumors were frequently undergraded on EUS-FNB. Knowledge of this is important to recognize and acknowledge, as this could potentially impact treatment decisions in some patients.

CYSTIC LESIONS OF THE SALIVARY GLANDS(Report of 3 cases)

At least one-third of cystic salivary gland lesions are neoplastic. Cystic lesion of the salivary gland requires only surgery, because regardless of the type and location, drug therapy is not possible with this diagnosis.. If the cystic neoplasm is localized in a hard-to-reach place and if it is localized in the parotid gland, the surgical manipulation is performed from the outside, it is removed simultaneously with the parenchyma of the salivary gland. The FNA specimens from salivary gland cystic lesions can be no informative very often, because FNA of these lesions demonstrates hypocellular mucinous material contents, possibly with inflammatory cells and also scant epithelial cells. For example, the presence of mucin and admixed lymphocytes in cyst fluid can be demonstrated both in the benign inflammatory cysts and cystic neoplasms. A definitive diagnosis of cystic neoplasms of the salivary glands is possible only through histological examination of the neoplastic tissue. Prevention of cystic neoplasms of the salivary gland consists of preventing injuries and inflammations of the oral cavity, careful hygiene and regular visits to the dentist. This article presents cases of the salivary glands cystic neoplasms, which are the clinical interest.

Clinical feasibility of MRI-guided in-bore prostate biopsies at 0.55T.

In-bore MRI-guided biopsy allows direct visualization of suspicious lesions, biopsy needles, and trajectories, allowing accurate sampling when MRI-ultrasound fusion biopsy is not feasible. However, its use has been limited. Wide-bore, lower-field, and lower-cost scanners could help address these issues, but their feasibility for prostate biopsy is unknown. The purpose of our study was to evaluate the feasibility of in-bore MRI-guided prostate biopsy using a large-bore (80cm), 0.55T scanner. Nineteen participants (68 ± 10 years) with suspected prostate cancer (PCa) were recruited for this Institutional Review Board (IRB) approved study (May 2023 -October 2024). Prebiopsy diagnostic scans and intra-procedural T2-weighted images were used for lesion localization. PSA levels, lesion sizes, cancer detection rates, positive core volume percentage, ISUP (International Society of Urological Pathology) grade groups (GG), positive volume cores, skin to target distances, and procedure durations were reported. Seventeen participants underwent biopsies (four transrectal, thirteen percutaneous). Two participants were excluded. Twenty lesions (mean size 1.9 ± 1.2cm) were biopsied which showed various GG cancers (GG1, GG2, GG3, GG4, and GG5), with positive cores ranging from 10 to 100%. 20% of the lesions were benign. Compared to previous biopsies, 22.2% (2/9) had new cancer detections, 22.2% (2/9) showed a GG upgrade, and 33.3% (3/9) had increased positive core volume, while 11.1% (1/9) showed no upgrade and 11.1% (1/9) had benign findings. Among biopsy-naïve participants, 75% (6/8) had cancer detected, and 25% (2/8) had benign findings. One new cancer was detected near a hip prosthesis due to reduced imaging artifacts. Average total procedure time was 77 ± 21min for transrectal and 74 ± 22min for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14min, respectively. Identifying and accurately targeting suspicious prostate lesions is feasible using a 0.55T MRI scanner.

Adverse events of 20-22G second-generation endoscopic ultrasound-guided fine-needle biopsy needles for solid lesions in the upper gastrointestinal tract and adjacent organs: Systematic review and meta-analysis.

Previous research has conducted meta-analyses on the diagnostic accuracy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). However, studies on adverse events (AEs) have been limited and sporadic and have included a highly diverse group of patients (with upper and lower gastrointestinal tract issues) and needles of varying sizes (19-22-25G). The purpose of this systematic review and meta-analysis was to determine the incidence of AEs related to the utilization of 20-22G second-generation EUS-FNB needles subsequent to puncture of the upper gastrointestinal tract and adjacent organs. We searched the PubMed, Embase, and SCIE databases from January 1, 2010, to December 31, 2023. The primary outcome was percentage of summary AEs. Subgroup analyses were based on needle type, needle size, and lesion site. A total of 99 studies were included in the analysis, with 9303 patients. The overall AE rate for 20-22G second generation EUS-FNB needles in upper gastrointestinal EUS-FNB was 1.8% (166/9303), with bleeding being the most common AE at 44.0%. The percentages of pancreatitis, abdominal pain, and other AEs were 24.1%, 21.1%, and 10.8%, respectively. Patients undergoing hepatic EUS-FNB had the highest incidence of AEs at 14.0%, followed by submucosal lesions at 3.2% and pancreatic lesions at 2.6%. EUS-FNB is a safe procedure with a relatively low risk of upper gastrointestinal AEs (1.8%) and no associated deaths. Postoperative bleeding and pancreatitis are the most common complications of EUS-FNB. Most AEs are mild and self-limiting in severity, and serious complications are very rare.

Traction-assisted endoscopic ultrasound-guided fine-needle biopsy using the clip-with-thread method for small gastric subepithelial lesions: Randomized controlled trial (with video).

Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing gastric subepithelial lesions (SELs), but diagnosing lesions smaller than 20 mm remains challenging. We developed traction-assisted EUS-FNB (TA-EUS-FNB) using the clip-with-thread method to enhance diagnostic accuracy by stabilizing the lesion and providing counter-traction for easier needle access. This study evaluates the effectiveness of TA-EUS-FNB in diagnosing small gastric SELs. In this prospective, randomized, controlled cross-over trial (August 2019-November 2022), 30 patients with gastric SELs <20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs. The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (n = 15, 50%), leiomyomas (n = 8, 26.7%), schwannomas (n = 2, 6.7%), aberrant pancreas (n = 3, 10%), and inflammation (n = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, P = 0.035) anddiagnostic yield (86.7% vs. 63.3%, P = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1-96.3% vs. 66.7%, 95% CI 41.7-84.8%; P = 0.20) and specificity (100%, 95% CI 79.6-100% vs. 100%, 95% CI 79.6-100%) were comparable between the methods. No adverse events were observed in the study. TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs <20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.

Prospective validation of ORACLE, a clonal expression biomarker associated with survival of patients with lung adenocarcinoma.

Human tumors are diverse in their natural history and response to treatment, which in part results from genetic and transcriptomic heterogeneity. In clinical practice, single-site needle biopsies are used to sample this diversity, but cancer biomarkers may be confounded by spatiogenomic heterogeneity within individual tumors. Here we investigate clonally expressed genes as a solution to the sampling bias problem by analyzing multiregion whole-exome and RNA sequencing data for 450 tumor regions from 184 patients with lung adenocarcinoma in the TRACERx study. We prospectively validate the survival association of a clonal expression biomarker, Outcome Risk Associated Clonal Lung Expression (ORACLE), in combination with clinicopathological risk factors, and in stage I disease. We expand our mechanistic understanding, discovering that clonal transcriptional signals are detectable before tissue invasion, act as a molecular fingerprint for lethal metastatic clones and predict chemotherapy sensitivity. Lastly, we find that ORACLE summarizes the prognostic information encoded by genetic evolutionary measures, including chromosomal instability, as a concise 23-transcript assay.

Tailoring Renal Mass Biopsy: Optimal Core Number and Location Based on Tumor Size for Enhanced Diagnostic Accuracy-A Prospective Ex-Vivo Study.

To determine the optimal number and location of biopsy cores in renal masses based on mass size in order to maximize diagnostic accuracy. This observational study included 360 patients with renal masses, who were divided equally into six groups. Each group was matched in terms of mass size [mass size category: ≤ 4cm (T1a), 4-7cm (T1b), 7-10cm (T2a), and >10cm (T2b)]. Core needle biopsies were taken after resection of the mass in an ex-vivo setting. The masses in the first, second, third, and fourth groups underwent 1, 2, 3, and 4 peripheral biopsies, respectively. The masses in the fifth and sixth groups were subjected to 1 and 2 central biopsies, respectively. The results of the biopsies were compared with permanent histopathology results, and the impact of mass size, number of biopsy cores, and location of biopsies on the accuracy of biopsy results were analyzed. In T1a and T1b size categories, the most accurate diagnostic results were obtained with three peripheral or two central biopsies. However, in T2a and T2b size categories, the most accurate diagnostic results were obtained with four peripheral or two central biopsies. Histological characteristics of the masses did not have statistically significant effect on the diagnostic accuracy of the biopsies. Our findings demonstrate that for masses ≤7cm, three peripheral or two central samples provide the highest diagnostic accuracy. For masses larger than 7cm, four peripheral or two central biopsy cores offer the best diagnostic accuracy.