Biopsy Group Research Articles

Rectal suction biopsy versus incisional rectal biopsy in the diagnosis of Hirschsprung disease.

Hirschsprung disease is one of the most common congenital anomalies that affect colorectal function. Rectal biopsy demonstrating the absence of ganglion cells in the affected bowel is the gold standard for diagnosis. Suction and incisional rectal biopsies are appropriate methods for obtaining diagnostic tissue. The goal of this study is to determine if any differences in adequacy exist between suction and incisional rectal biopsies at our institution. We conducted a retrospective review of suction and incisional rectal biopsies for inadequacy per procedure at a tertiary pediatric hospital. Each procedure for rectal biopsy was also evaluated by a number of biopsies per procedure. We used a two-sample test of proportions to compare the inadequacy of suction vs. incisional biopsies. 133 rectal suction biopsy procedures (227 biopsies) and 125 incisional biopsy procedures (140 biopsies) were analyzed. In patients 6months of age and older, the percentage of inadequate procedures was substantially higher in the suction biopsy group (24.1% vs 0.9%, p < 0.01). A substantially higher proportion of inadequacy was found in the suction rectal biopsy group compared to the incisional cohort among the older patient cohort, suggesting incisional biopsies should be strongly considered as the primary rectal biopsy method in patients older than 6months.

Comparison of sentinel lymph node biopsy and elective neck dissection for early oral cavity squamous cell carcinoma patients with clinically node-negative necks: systematic review and meta-analysis.

This study aimed to compare the prognostic utility of sentinel node biopsy and elective neck dissection in early stage clinically node-negative oral cavity squamous cell carcinoma patients. PubMed, Scopus, Embase, Web of Science and Cochrane Library databases were searched up to March 2022. Hazard ratios, Kaplan-Meier curves, p-values and survival outcomes were extracted. Twelve studies involving 10 583 patients were included. No significant differences in overall survival between sentinel node biopsy and elective neck dissection groups were found. Heterogeneity was not detected in pooled overall survival, disease-free survival and disease-specific survival analyses (all I2 less than 50). In subgroup analyses by follow-up period, sentinel node biopsy and elective neck dissection had similar prognostic value. Sentinel node biopsy might be a valuable alternative to elective neck dissection for the management of early stage clinically node-negative oral cavity squamous cell carcinoma.

Axilla lymph node dissection can be safely omitted in patients with 1-2 positive sentinel nodes receiving mastectomy: a large multi-institutional study and a systemic meta-analysis.

This study aimed to evaluate whether axillary lymph node dissection (ALND) can be omitted in patients with 1-2 positive sentinel lymph nodes (SLNs) who received total mastectomy (TM). Consecutive breast cancer patients with 1-2 positive SLNs were retrospectively reviewed from a multi-institutional database. Patients were divided into sentinel lymph node biopsy (SLNB) group and ALND group. Administration of adjuvant chemotherapy and survival were compared between groups. To further verify the results, a meta-analysis was also conducted. Among the 1161 enrolled patients, 893 (76.9%) received ALND and 268 (23.1%) underwent SLNB alone. Administration of chemotherapy was comparable between the two groups (91.1% vs. 90.6%, P = 0.798), which was consistent in TM (P = 0.638) and BCS cohort (P = 0.576). After a median follow-up of 36months, no significant difference was observed between the two groups in recurrence-free survival (P = 0.583) regardless of surgery of breast. During further meta-analysis, 13 out of 4733 relative studies reported the association of axillary surgery and disease-free survival (DFS) or overall survival (OS) in 1-2 positive SLNs patients. Pooled analysis showed no difference in adjusted DFS (HR 0.84, 95% CI 0.70-1.02) or OS (HR 1.02, 95% CI 0.93-1.11) between SLNB and ALND groups. Survival benefit of ALND remained non-significant after restricting the analysis in four studies with patients only receiving BCS, or in three studies with patients only receiving TM. Further ALND does not impact adjuvant chemotherapy administration or disease outcome in breast cancer patients with 1-2 positive SLNs treated with TM.

242.2: Is There Any Role of Combined Use of Gene Expression Profiling and Donor Derived Cell Free DNA in Worsening Renal Allograft Function

Introduction: There are multiple noninvasive tests available to assess risk of renal allograft rejection. Donor-derived cell-free DNA (dd cf DNA) test is used to assess rejection in the settings of worsening renal allograft function while Gene profiling is used to assess the subclinical rejection in the settings of stable graft function. OmniGraf™ is a combination of Gene profiling and dd cf DNA tests and used for diagnosing possible subclinical rejection in the settings of stable renal allograft function. But not much has been observed in the settings of worsening renal allograft function. Here we are presenting our study aiming to correlate OmniGraf™ result with the biopsy outcomes. Methods: We selected 40 patients who had a biopsy either for cause or for protocol along with OmniGraf™ and serum creatinine checked around the same time of the biopsy. Patients were divided into 2 major groups, 1.protocol, and 2. For-cause biopsy, later subdivided into 4 groups depending on the OmniGraf™ result combinations. TX is considered No Rejection, Non-TX is considered increased risk of subclinical rejection.TRAC is the dd cf DNA test, High TRAC more than 0.7% is considered increased risk of rejection. Result: In the protocol biopsy group 12 out of 19 patients who had TX with normal TRAC had rejction on the biopsy.The normal result of OmniGraf™ TX with normal TRAC was supposed to predict no rejection, so if biopsy was not performed it might have missed 57% of rejection.This suggest that the normal result does not predict absence of rejection. The subgroup NonTX with Normal TRAC had 66% patients showing rejection,showed 100% rejection. This suggests that Non TX, irrespective of TRAC level is good in predicting possible rejection, irrespective of the type of rejection.In the for-cause biopsy group, the subgroup 2 of 2 patients with TX and normal TRAC had rejection on biopsy. Normal result of OmniGraf™ is not reliable to rule out rejection. The subgroup TX with high TRAC is good in capturing rejection for 6 out of 6 patients. This suggest that Tx may not be useful in this group in predicting rejection as dd cf DNA test, alone might have been able to predict the rejection. The subgroup Non TX with normal TRAC is showing 37.5 % patients, positive for rejection on biopsy while NON TX with high TRAC group has 60% of patients with rejection. This suggest that Non-TX part is good in predicting increasing risk of rejection in both groups irrespective of the High TRAC. Conclusion: Checking a single OmniGraf™ test to evaluate the risk without doing biopsy will miss subclinical rejection.It is probably more useful in serial monitoring of OmniGraf™ than one single value to capture subclinical rejection. Our data are limited to suggest clinical or statistical relevance, It would be useful to evaluate these results on a larger scale to understand the usefulness of this test in kidney transplant recipients with worsening renal allograft function.

Manual vacuum aspiration (women's MVA) for endometrial biopsy for patients with suspected endometrial malignancies.

Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual vacuum aspiration (MVA) system. We used the women's MVA system for endometrial sampling and evaluated its effectiveness in determining the presence of endometrial malignancy. Forty-seven samples were examined using the following procedures after measuring endometrial thickness by transvaginal ultrasonography: fractional curettage biopsy (Bx; 20 samples), total curettage under general anesthesia (T/C; 13 samples), and MVA (14 samples). The quality of the endometrial samples was classified into four types: 1-4, where 1 denoted poor and 4, good quality. The mean score of the MVA group was significantly higher than that of the partial curettage biopsy group (p=0.0065). No differences were observed between the MVA and total curettage groups (p=1.00). When patients were divided into two groups according to endometrial thickness (<10 mm or ≥10 mm) and analyzed, both the MVA and T/C groups did not show a significant difference in their scores compared to the Bx group when the endometrial thickness was <10 mm. However, when the endometrial thickness was ≥10 mm, the MVA and T/C groups had significantly better scores than the Bx group (p=0.0225 and p=0.0244, respectively). Vagal reflex, as an adverse event, was observed only in two patients in the Bx group (2/20, 10%). Considering its quality and safety, Karman-type MVA for endometrial sampling could be an alternative to fractional curettage using a metallic uterine curette sonde.

Biliary Epithelial Senescence in Cellular Rejection Following Live Donor Liver Transplantation

As with the hepatocytes, cholangiocyte senescence can also easily be detected in damaged small bile ducts and bile ductules during liver disease affecting the biliary system and cholangiocytes. Despite cellular senescence being a feature of chronic progressive cholangiopathies in adults, only a few studies have investigated its role in liver transplant rejection. Transplant biopsies displaying features of rejection were reviewed and classified based on the type of rejection and the time since transplantation. An immunohistochemistry panel has been applied for 3 senescent cell markers (p53, p21, p16). Immunohistochemical expression analysis for the biliary senescence markers (53 biopsies) was done in the post-transplantation periods (Group 1-4) for the cases with the histologically proven diagnosis of rejection. In post-transplant group 1 (<3 months), group 2 (3-6 months), group 3 (6-12 months) and group 4 (>12 months), any 2 senescent markers' positivity was noted in 5/14 (35.7%), 8/13 (61.5%), 16/17 (94.1%) and 9/9 (100%) biopsies respectively and were comparable in all four groups (P= 0.001). A comparison of early biopsies (Group1; 3 months) and late biopsies (Group 2,3&4; >3 months) revealed significantly higher expression in late biopsies (>3 months) (P= 0.001 for any two markers). In ACR, LAR, ECR, and CR/DR any two senescent markers were positive in 14/28 (50%), 12/13 (92.3%) cases, 9/9 (100%), and 3/3cases (100%). Senescent markers (any two) were comparable in all four histological groups (P < 0.001).LAR group had increased expression (P= 0.009 for any two markers and 0.001 for all three markers) and has increased progression to CR (P= 0.019) as compared to ACR. This study on a large number of LDLT allograft biopsies demonstrates the role of biliary senescence in rejection and suggests a pathobiological role for senescence in the poor prognosis seen in late acute cellular rejection and chronic rejection.

Frameless robot-assisted stereotactic biopsy: an effective and minimally invasive technique for pediatric diffuse intrinsic pontine gliomas.

Diffuse intrinsic pontine gliomas (DIPGs) are prone to high surgical risks, and they could even lead to death due to their specific sites. To determine the value of frameless robot-assisted stereotactic biopsies of DIPGs, when compared it with microsurgical biopsies. We conducted a retrospective study of 71 pediatric patients who underwent biopsies from January 2016 to January 2021. (i) group 1: microsurgical biopsies, and (ii) group 2: frameless robot-assisted stereotactic biopsies. Demographic information, neuroimaging characteristics, pathological diagnoses, operation time, postoperative intensive care unit (ICU) stay time, postoperative hospitalization time, complications, cost, and perioperative mortality rate (POMR) were collected for analyses. 32 Cases underwent microsurgical biopsies (group 1) and 39 cases underwent frameless robot-assisted stereotactic biopsies (group 2). All cases were accurately diagnosed after surgery. There was no significant difference in gender, age, symptom times and tumor volumes between the two groups (p > 0.05); operation time, postoperative ICU, stay time and postoperative hospitalization time were longer in group 1 than in group 2 (p < 0.001); the intraoperative bleeding volumes and cost were higher in group 1 than in group 2 (p < 0.001). Group 1 patients required more perioperative blood transfusion than group 2 (p = 0.001), and the new neurological impairments were more frequent in group 1 than in group 2 (p = 0.003). The POMR was 9.38% (3/32) in group 1 and 0 in group 2 (p = 0.087). Frameless robot-assisted stereotactic biopsy was an effective and minimally invasive technique for pediatric DIPGs.

Combining Organoid Models with Next-Generation Sequencing to Reveal Tumor Heterogeneity and Predict Therapeutic Response in Breast Cancer.

Estrogen receptor-positive (ER+) breast cancer (BC) is a common subtype of BC with a relatively good prognosis. However, recurrence and death from ER+ BC occur because of tumor heterogeneity. This study aimed to explore tumor heterogeneity using next-generation sequencing (NGS) and tumor-organoid models to promote BC precise therapy. We collected needle biopsy, surgical excision, and cerebrospinal fluid (CSF) samples to establish tumor organoids. We found that the histological characteristics of organoids were consistent with original lesions and recapitulated their heterogenicity. In addition, the NGS results showed that PIK3CA and TP53 genes had detrimental mutations. BAP1, RET, AXIN2, and PPP2R2A genes had mutations with unknown function. The score for homologous recombination deficiency (HRD) of genome was 56, indicating that the tumor was likely sensitive to PARPi. The mutant-allele tumor heterogeneity (MATH) value of the tumor genome was 68.03, indicating high tumor heterogeneity. At last, we performed a drug screening on organoids. The toxicity of different drugs toward BC organoids originated from needle biopsy and surgical excision was tested, respectively. The IC50 values in the needle biopsy groups were paclitaxel 2.83 μM, carboplatin 61.47 μM, neratinib 0.8 μM, lapatinib >100 μM; in the surgical excision groups: trastuzumab >100 μM, docetaxel 0.036 μM, tamoxifen 20.54 μM, olaparib 5.478 μM, BYL719 < 0.1 μM. The toxicity data showed that the BC organoids could show dynamic characteristics of tumor progression and reflect the heterogeneity of BC. Our study demonstrates that the combined use of tumor organoids and NGS is a potential way to test tumor heterogeneity and predict drug response in ER + BC, which contributes to the development of personalized therapy.

Quantib Prostate Compared to an Expert Radiologist for the Diagnosis of Prostate Cancer on mpMRI: A Single-Center Preliminary Study.

Background: To evaluate the clinical utility of an Artificial Intelligence (AI) radiology solution, Quantib Prostate, for prostate cancer (PCa) lesions detection on multiparametric Magnetic Resonance Images (mpMRI). Methods: Prostate mpMRI exams of 108 patients were retrospectively studied. The diagnostic performance of an expert radiologist (>8 years of experience) and of an inexperienced radiologist aided by Quantib software were compared. Three groups of patients were assessed: patients with positive mpMRI, positive target biopsy, and/or at least one positive random biopsy (group A, 73 patients); patients with positive mpMRI and a negative biopsy (group B, 14 patients), and patients with negative mpMRI who did not undergo biopsy (group-C, 21 patients). Results: In group A, the AI-assisted radiologist found new lesions with positive biopsy correlation, increasing the diagnostic PCa performance when compared with the expert radiologist, reaching an SE of 92.3% and a PPV of 90.1% (vs. 71.7% and 84.4%). In group A, the expert radiologist found 96 lesions on 73 mpMRI exams (17.7% PIRADS3, 56.3% PIRADS4, and 26% PIRADS5). The AI-assisted radiologist found 121 lesions (0.8% PIRADS3, 53.7% PIRADS4, and 45.5% PIRADS5). At biopsy, 33.9% of the lesions were ISUP1, 31.4% were ISUP2, 22% were ISUP3, 10.2% were ISUP4, and 2.5% were ISUP5. In group B, where biopsies were negative, the AI-assisted radiologist excluded three lesions but confirmed all the others. In group-C, the AI-assisted radiologist found 37 new lesions, most of them PIRADS 3, with 32.4% localized in the peripherical zone and 67.6% in the transition zone. Conclusions: Quantib software is a very sensitive tool to use specifically in high-risk patients (high PIRADS and high Gleason score).

New biopsy after antibiotic treatment: effect on outcomes of assisted reproduction in patients with infertility and chronic endometritis

Research questionWhat is the effect of chronic endometritis on patients with infertility, the necessity of endometrial re-examination and the effect of improving chronic endometritis after one cycle of antibiotic treatment on pregnancy outcomes? DesignInfertile patients (n = 4003) who underwent IVF and intracytoplasmic sperm injection treatment were included. Pregnancy outcomes of groups positive for chronic endometritis were compared with groups that were negative (group 1). Patients that were positive were divided into the chronic endometritis new biopsy group (group 2) and chronic endometritis non-re-examination group (group 3). After doxycycline treatment and re-examination, the chronic endometritis new biopsy group was divided into improved chronic endometritis group (ICE) and not-improved chronic endometritis group (NICE), and their general indicators and reproductive outcomes were compared. ResultsNo significant difference was observed in embryo implantation, early or late pregnancy loss, ectopic pregnancy, clinical pregnancy and live birth rates between groups 2 and 3. The clinical pregnancy and live birth rates in the NICE group were significantly lower than those in the ICE group (P = 0.008 and P = 0.001, respectively). After controlling for potential confounding factors, age, average number of high-quality embryos, endometrial thickness on the day of embryo transfer and number and type of embryo transfer were factors associated with live birth rates. ConclusionsEndometrial re-examination of women with chronic endometritis treated with doxycycline had no effect on pregnancy outcomes. The first cycle of doxycycline treatment could effectively improve reproductive outcomes of women with five or more CD138+ cells/high-power field.

Double vitrification-warming cycles, coupled with blastocyst biopsy, impair live birth but do not affect neonatal outcomes.

To identify whether the transfer of blastocysts that have been vitrified, thawed, biopsied, revitrified, and subsequently rethawed affects clinical outcome and neonatal outcome. A retrospective study was conducted in a single assisted reproduction technology center from September 2016 to March 2021. Women undergoing single frozen euploid blastocysts transfer were stratified into two groups based on number of vitrification-thawing cycles: single vitrification coupled with single biopsy (group A, n=177) and double vitrification coupled with single biopsy (group B, n=30). Pregnancy and perinatal outcomes of the two groups were compared. Clinical pregnancy rates were similar between the two groups. Group B was associated with an increased likelihood of live birth when compared with group A by different multivariable analysis models (model 1: odds ratio, 0.42 [95% confidence interval, 0.18-0.97], P=0.041; model 2: odds ratio, 0.38 [95% confidence interval, 0.16-0.92], P=0.033). No major obstetrical complication was reported in the two groups and only one malformation live birth was reported in group A. The procedure of double vitrification-warming cycles, coupled with single biopsy, increases pregnancy loss and ultimately diminishes live birth but does not affect perinatal outcome. Future studies with a larger sample size would help to validate the results.

Tumor stage-specific trends of sentinel lymph node biopsy for vulvar melanoma (406)

<b>Objectives:</b> Vulvar melanoma is a rare and understudied malignancy. Due to its poor prognosis, management has included vulvectomy and complete bilateral inguinofemoral lymphadenectomy. The Standard of care for cutaneous melanomas is to perform sentinel lymph node (SLN) biopsy during excision of intermediate thickness lesions. Lymph node dissection in the inguinofemoral region can result in significant morbidity; thus, the utilization of SLN biopsy for vulvar melanoma is under active investigation. The Standard of care regarding SLN biopsy for vulvar melanoma is not yet determined due to limited prospective data. The objective of this study was to examine the trends and outcomes related to SLN biopsy for vulvar melanoma in the United States according to the local tumor stage. <b>Methods:</b> This population-based retrospective cohort study utilized the National Cancer Institute's Surveillance, Epidemiology, and End Result program from 2004 to 2018. The study population included women with non-metastatic T1-4 stage vulvar melanoma who underwent vulvectomy and had data regarding the method of nodal evaluation. The exposure assignment was based on nodal evaluation: lymphadenectomy, SLN biopsy, or no surgical nodal evaluation. The main outcome was <i>(i)</i> temporal trends of lymphadenectomy or SLN biopsy based on T stage, assessed with a three-year time increment and the Cochrane-Armitage trend test, and <i>(ii)</i> overall survival related to SLN biopsy assessed with inverse probability of treatment weighting propensity score. <b>Results:</b> A total of 729 women with T1-4 vulvar melanoma were examined for analysis. For T1 disease (<i>n</i>=215), the utilization of SLN biopsy significantly increased from 16.7% to 38.9% (<i>p</i>=0.002) over time. For T2 disease (<i>n</i>=156) and T3 disease (<i>n</i>=120), the frequency of SLN biopsy was unchanged during the study period (T2 disease, 22.6% to 26.6%, <i>p</i>=0.279; and T3 disease, 27.3% to 37.0%, <i>p</i>=0.812). For T4 disease (<i>n</i>=238), there was a statistically significant increase in the number of women receiving SLN biopsy from 21.2% to 32.9% (<i>p</i>=0.042) during the study period. Across the four disease groups, the SLN biopsy and LND groups had comparable overall survival in the weighted models (all <i>p</i>>0.05). <b>Conclusions:</b> This large sample size, population-based study found an upward trend in performance of SLN biopsy in both T1 and T4 vulvar melanoma in the past decade in the United States. In T2 and T3 vulvar melanoma, SLN biopsy did not increase. While SLN biopsy is standard in T2-3 cutaneous melanoma, it appears to be less utilized in these tumor stages of vulvar melanoma. Given the significant morbidity associated with inguinal lymph node dissection, further research is warranted on whether these trends have truly resulted in decreased perioperative morbidity.

Paradigm shift from lymphadenectomy to sentinel lymph node biopsy in vulvar cancer surgery (364)

<b>Objectives:</b> To examine trends, characteristics, and outcomes related to nodal assessment for vulvar cancer surgery in the United States. <b>Methods:</b> This is a retrospective observational cohort study querying the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population was 5,604 women with T1b or T2-smaller (<4cm) squamous cell carcinoma of the vulva who underwent primary vulvectomy from 2003-2018. Exposure allocation was based on nodal evaluation type, including lymphadenectomy (LND; <i>n</i>=3,319, 59.2%), sentinel lymph node (SLN) biopsy (<i>n</i>=751, 13.4%), or no surgical nodal evaluation (<i>n</i>=1,534, 27.4%). The main outcomes were <i>1)</i> trends and characteristics related to SLN biopsy assessed by the multinomial regression model, and <i>2)</i> vulvar cancer-specific survival assessed by comparing risk analysis and propensity score weighting. The sensitivity analysis included evaluation of the external cohort with T1a disease (<i>n</i>=1,291). Fig. 1 <b>Results:</b> The utilization of SLN biopsy increased from 5.7% to 23.3% in 2006-2018, while the proportion of LND decreased from 64.1% to 48.8% in 2010-2018 (p<0.05) (top panel). These associations remained independent in multivariable analysis: SLN biopsy use in 2015-2018 versus 2003-2006, with an adjusted-odds ratio of 3.57 (95% CI: 2.54-5.01, p<0.001), and LND use in 2015-2018 versus 2003-2006, with an adjusted-odds ratio of 0.79 (95% CI: 0.63-0.97, p=0.027). In a propensity score weighted model, 5-year cumulative rate for vulvar cancer-specific mortality was 15.2% (interquartile range: 12.1-18.9) for the SLN biopsy group and 16.9% (interquartile range 15.6-18.3) for the LND group (subdistribution-HR [sHR]: 0.90, 95% CI: 0.76-1.06, p=0.217) (bottom panel). Similar association was also observed in T1b disease (sHR: 0.88, 95% CI: 0.70-1.09, p=0.236), T2-smaller (<4cm) disease (sHR: 0.82, 95% CI: 0.50-1.33. p=0.419), and N0 cases (sHR: 0.93, 95% CI: 0.70-1.22, p=0.594). Increasing performance of SLN biopsy was also observed in T1a disease from 1.3% to 7.3% during the study period (p<0.001). <b>Conclusions:</b> The landscape of surgical nodal evaluation is shifting from lymphadenectomy to SLN biopsy in vulvar cancer surgery. This study suggests that an SLN biopsy-incorporated treatment approach is not associated with worse survival compared to LND.

Sentinel lymph node biopsy for stage II endometrial cancer: Utilization and outcomes in the United States (346)

Objectives: To examine trends and outcomes related to sentinel lymph node (SLN) biopsy for stage II endometrial cancer. Methods: This is a retrospective observational cohort study querying the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. The study population was 6,314 women with T2 endometrial cancer who underwent hysterectomy from 2010-2018. Exposure allocation was based on nodal evaluation type: lym- phadenectomy (LND; n=4,915, 77.8%), SLN biopsy (n=340, 5.4%), or no surgical nodal evaluation (n=1,059, 16.8%). The main outcomes were (i) trends and characteristics related to nodal evaluation assessed by multinomial regression and (ii) overall survival assessed by an inverse probability of treatment weighting propensity score analysis. A sensitivity analysis was performed to examine concurrent LND in women who underwent SLN biopsy. Results: The utilization of SLN biopsy increased from 1.6% to 16.1%, while the number of LND decreased from 81.5% to 65.7% between 2010 and 2018 (both, p<0.05). In multivariable analysis, the utilization of SLN biopsy increased 45% annually (adjusted-odds ratio: 1.45, 95% CI: 1.37-1.54, p<0.001). The frequency of SLN biopsy alone exceeded the frequency of SLN biopsy with concurrent LND in 2017 (6.8% vs 3.4%), followed by a continued increase in SLN biopsy alone (11.2% vs 4.9%) in 2018. In the weighted model, the 3-year overall survival rate was 79.9% for the SLN biopsy group and 78.6% for the LND group (HR: 0.98, 95% Cl: 0.80-1.20, p=0.831). Similarly, the SLN biopsy alone without a concurrent performance of LND had comparable overall survival compared to the LND group (HR: 0.90, 95% CI: 0.59-1.36, p=0.615). Conclusions: Utilization of SLN biopsy in stage II endometrial cancer increased significantly over time, and SLN biopsy-incorporated nodal assessment was not associated with worsened short-term survival. Objectives: To examine trends and outcomes related to sentinel lymph node (SLN) biopsy for stage II endometrial cancer. Methods: This is a retrospective observational cohort study querying the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. The study population was 6,314 women with T2 endometrial cancer who underwent hysterectomy from 2010-2018. Exposure allocation was based on nodal evaluation type: lym- phadenectomy (LND; n=4,915, 77.8%), SLN biopsy (n=340, 5.4%), or no surgical nodal evaluation (n=1,059, 16.8%). The main outcomes were (i) trends and characteristics related to nodal evaluation assessed by multinomial regression and (ii) overall survival assessed by an inverse probability of treatment weighting propensity score analysis. A sensitivity analysis was performed to examine concurrent LND in women who underwent SLN biopsy. Results: The utilization of SLN biopsy increased from 1.6% to 16.1%, while the number of LND decreased from 81.5% to 65.7% between 2010 and 2018 (both, p<0.05). In multivariable analysis, the utilization of SLN biopsy increased 45% annually (adjusted-odds ratio: 1.45, 95% CI: 1.37-1.54, p<0.001). The frequency of SLN biopsy alone exceeded the frequency of SLN biopsy with concurrent LND in 2017 (6.8% vs 3.4%), followed by a continued increase in SLN biopsy alone (11.2% vs 4.9%) in 2018. In the weighted model, the 3-year overall survival rate was 79.9% for the SLN biopsy group and 78.6% for the LND group (HR: 0.98, 95% Cl: 0.80-1.20, p=0.831). Similarly, the SLN biopsy alone without a concurrent performance of LND had comparable overall survival compared to the LND group (HR: 0.90, 95% CI: 0.59-1.36, p=0.615). Conclusions: Utilization of SLN biopsy in stage II endometrial cancer increased significantly over time, and SLN biopsy-incorporated nodal assessment was not associated with worsened short-term survival.

Local and systemic therapy may be safely de-escalated in elderly breast cancer patients in China: A retrospective cohort study.

BackgroundFor elderly patients with breast cancer, the treatment strategy is still controversial. In China, preoperative axillary lymph node needle biopsy is not widely used, resulting in many patients receiving axillary lymph node dissection (ALND) directly. Our study aims to determine whether local and systemic therapy can be safely de-escalated in elderly breast cancer.MethodsPatients aged ≥70 years were retrospectively enrolled from our institution’s medical records between May 2013 and July 2021. Groups were assigned according to local and systemic treatment regimens, and stratified analysis was performed by molecular subtypes. Univariate and multivariate survival analyses were used to compare the effects of different regimens on relapse-free survival (RFS).ResultsA total of 653 patients were enrolled for preliminary data analysis, and 563 patients were screened for survival analysis. The mean follow-up was 19 months (range, 1–82 months). Axillary lymph node metastases were pathologically confirmed in only 2.1% of cN0 cases and up to 97.1% of cN+ cases. In the aspect of breast surgery, RFS showed no significant difference between mastectomy and BCS group (p = 0.3078). As for axillary surgery, patients in the ALND group showed significantly better RFS than those in the sentinel lymph node biopsy (SLNB) group among pN0 patients (p = 0.0128). Among these cases, the proportion of cN+ in ALND was significantly higher than that in SLNB (6.4% vs. 0.4%, p = 0.002), which meant axillary lymph nodes (ALNs) of ALND patients were larger in imaging and more likely to be misdiagnosed as metastatic. With regard to adjuvant therapy, univariate and multivariate analyses showed that RFS in different comprehensive adjuvant regimens were similar especially among hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)− subgroup where patients who did not receive any adjuvant therapy accounted for 15.7% (p > 0.05).ConclusionsIt is feasible to reduce some unnecessary local or systemic treatments for elderly breast cancer patients, especially in HR+/HER2− subtype. Multiple patient-related factors should be considered when making treatment plans.

Modern views on skin biopsy in the diagnostic algorithm of dermatooncological diseases

Background. Malignant neoplasms of the skin are fairly common tumors in the world population and among the population of Ukraine. The main method of diagnosing skintumors is a biopsy, which allows establishing a diagnosis at an early stage and ensures the cure of most patients.&#x0D; Purpose. To evaluate modern recommendations for skin biopsy in the diagnosis of dermato-onсological diseases.&#x0D; Materials and methods. The search for sources of information was conducted using the MEDLINE/PubMed, EMBASE/ExcerptaMedica, CochraneLibrary, PubMed та Google Scholar databases using the following keywords: skin biopsy, skin tumors, diagnosis, melanoma. Among the identified sources, works without statistical analysis, descriptions of individual cases, articles without conclusions, and sources with duplicate results were excluded. The search depth was 10 years.&#x0D; Results. As a result of the conducted search, 57 publications were found that corresponded to the declared purpose. The most common methods are: puncture, shaving, excisional and incisional biopsy. Most guidelines recommend full-thickness excisional biopsy as the preferred procedure for the diagnosis of suspected melanoma. It is indicated that a statistically significant mortality rate was found in the puncture biopsy group. Most observations showed no significant differences in melanoma recurrence between excisional biopsy and puncture groups. Given the clinical diversity of melanoma, there is no uniformity in the types of biopsies performed to diagnose melanoma. The most inaccurate method turned out to be the punch biopsy method, which is associated with an increased risk of underdiagnosis of melanoma.&#x0D; Conclusions. A skin biopsy is a mandatory first step to establish a definitive diagnosis of a skin tumor. Excisional complete biopsy is the most justified in most cases of diagnosis. Rational biopsy technique remains an issue that needs further study.

P-139 The incidence of monozygotic twins after the usage of calcium ionophore or after trophectoderm biopsy in ART treatment

Abstract Study question To investigate whether the usage of calcium ionophore or trophectoderm biopsy affect the occurrence of monozygotic twins (MZT) in assisted reproductive treatment (ART) treatment. Summary answer Despite the increase was not statistically significant, higher percentage of MZT were observed in both group with calcium ionophore usage and trophectoderm biopsy. What is known already The incidence of monozygotic twins (MZT) in natural conception is approximately 0.4% worldwide but it is estimated that there is at least a 2-fold rise in the incidence of MZT after assisted reproductive technology compared with natural conception, although the reason is still under debate. The effectiveness of calcium ionophore in assisting oocytes activation and fertilisation has been widely studied. Most studies reported no impact upon embryo viability and reproductive potential after trophectoderm biopsy. However, the impact of calcium ionophore or trophectoderm biopsy on subsequent in vivo development of the blatocyst remains unclear. Study design, size, duration This is a retrospective observational cohort study of frozen embryos transfers (FET) that have achieved clinical pregnancy between January 2019 and October 2021. In this study, 709 FET cycles were included and analysed based on i) with or without calcium ionophore treatment after ICSI/IVF on oocytes retrieval day; ii) with or without trophectoderm biopsy on day 5 or 6. The results were analysed to identify possible risk factors affecting the prevalence of monozygotic twins. Participants/materials, setting, methods The cases with positive beta-hCG test were followed-up and analysed for the occurrence of MZT. The diagnosis of MZT was established by transvaginal ultrasound performed at 4-6 weeks after the transfer. The visualization of uteri containing more than one fetus, either in one sac (monochorionic monoamniotic) or in two sacs separated by a septum (monochorionic diamniotic) is suggestive of MZT. Data were analysed by Fisher’s exact test and Odd Ratio. Main results and the role of chance Data comprising a total of 709 FET cycles in a single clinical setting were analysed. Among 449 cases of clinical pregnancies, 8 cases of MZT occurred. A higher percentage of MZT (1.78%) after blastocyst transfer in ART treatment was observed as compared to natural conception (0.04%). There was a higher incidence of MZT in trophectoderm biopsy group as compared with non-biopsy group (2.3% vs 1.45% respectively, odds ratio [OR]= 1.59, 95% CI 0.39–6.46). However, there was no statistically significant (P-value=0.556, CI = 95%). The incidence of MZT following the calcium ionophore usage was higher compared with the group without calcium ionophore usage (2.33% versus 1.72%, OR = 1.36, 95% CI 0.16–11.3). There was no significantly higher risk of MZT with calcium ionophore versus non-calcium ionophore cycles (P-value= 0.493, CI = 95%). Limitations, reasons for caution The sample examined in this study is limited in size thus more studies are needed to achieve satisfactory statistical power. MZT diagnosed with ultrasound is difficult to differentiate from dichorionic monozygotic twins. The definitive diagnosis of monozygosity is only possible by DNA analysis of all the twins born. Wider implications of the findings These findings can draw attention to study the effect of calcium ionophore on embryo development and the mechanism behind MZT. Based on the findings, the patients undergoing ART treatment should be informed with the risk associated with higher incidence of MZT. Trial registration number NA

Association between sentinel lymph node biopsy and micrometastasis in endometrial cancer

ObjectiveSentinel lymph node (SLN) biopsy is increasingly utilized at surgical staging for early endometrial cancer. This study examined the association between SLN biopsy and micrometastasis in endometrial cancer. MethodsThis is a retrospective cohort study examining the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program. The study population was 6,414 women with T1-2 endometrial cancer who underwent primary hysterectomy and surgical nodal evaluation. Exclusion criteria included cases with isolated tumor cells. Exposure assignment was surgical nodal evaluation (SLN biopsy or lymphadenectomy). Main outcome measure was micrometastasis, assessed by inverse probability of treatment weighting propensity score in a stage-specific fashion. ResultsIn T1a disease (n = 4,608), SLN biopsy was performed in 1,164 (25.3%) cases. SLN biopsy was associated with a 90% increased likeliness of identifying micrometastasis compared to lymphadenectomy (1.3% versus 0.7%, odds ratio 1.90, 95% confidence interval 1.02–3.55, P = 0.040). In T1b disease (n = 1,369), 270 (19.7%) cases had SLN biopsy. The incidence of micrometastasis was significantly higher in the SLN biopsy group compared to the lymphadenectomy group (8.4% versus 5.0%, odds ratio 1.74, 95% confidence interval 1.06–2.86, P = 0.028). In T2 disease (SLN biopsy in 57 [13.0%] of 437 cases), the incidence of micrometastasis was similar between the two groups (7.9% versus 7.0%, odds ratio 0.88, 95% confidence interval 0.30–2.60, P = 0.818). ConclusionThis study suggests that SLN biopsy protocol may identify more micrometastasis in the regional lymph nodes of T1 endometrial cancer. Whether national-level increase in the utilization of SLN biopsy for early endometrial cancer results in a stage-shifting to advanced disease on a population-basis warrants further investigation.

Abstract 5078: Metaproteomic analysis of IBD associated colorectal cancer

Abstract Inflammatory bowel disease (IBD) increases the risk of developing colorectal cancer by 60%. The composition of gut flora and its interaction with mucosal cells plays a key role in the development of IBD and colorectal cancer. However, the actual cause-effect relationship between dysbiosis of the gut microbiome and human IBD and associated colorectal cancer has not been well established. In the current study, we sought to characterize colon mucosa adherent microbiota using metaproteomics to understand the colon micro-environment and the host-microbiome interactions. Three groups of colon biopsies were included in our analysis: healthy controls, Non-progressors (IBD patients without dysplasia or cancer) and Progressors (IBD patients who have dysplasia or cancer). The biopsy samples were analyzed by LC MS/MS and the bacterial proteins were identified using the Human Microbiome Project (HMP) human gut microbiome database. The inferences of bacterial taxonomy, bacterial enzymes and Gene ontology (GO) pathways were processed through Unipept. Examining bacterial composition between different sample groups showed no statistically significant difference at the levels of phyla and classes. However, a significant reduction of Holdemanella biformis was observed when comparing Progressors vs Non-progressors. Holdemanella biformis has recently been proposed to be endogenous anti-tumourigenic bacterial strains. Decrease of this bacterial species in Progressors suggested that it may be a protective bacteria preventing the progression of IBD associated colorectal cancer. Analysis of Gene Ontology (GO) biological processes identified GO terms that were significantly different among the Progressor, Non-progressor and healthy groups. For example, the GO term ‘detoxification of arsenic containing substances’ was significantly underrepresented in the Progressor group compared to healthy and Non-progressor groups. Furthermore, several bacterial enzymes were significantly different between the three groups. In particular, oxidoreductases were significantly decreased in the Progressor group compared to healthy and Non-progressor groups. While the implications of these significantly enriched or depleted bacterial biological processes and bacterial enzymes in the neoplastic progression of IBD warrant further investigation, the results from our current study provide new insight into understanding how gut microbiota as a modulator of microenvironment may contribute to progression of IBD-associated colorectal cancer. Citation Format: Nobel Bhasin, Prerna Dabral, Victoria Poplaski, Lisa Lai, Hong-Yuan Tsai, Mary Bronner, Teresa Brentnall, John Valentine, Jordon March, Antone Opekun, Robert Britton, Pan Sheng, Ru Chen. Metaproteomic analysis of IBD associated colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5078.

Infection complications after transrectal ultrasound-guided prostate biopsy: A radiology department's experience and strategy for improvement.

Transrectal ultrasound (TRUS)-guided prostate biopsy is a common procedure performed to diagnose prostate cancer. The risk of infection complications is well-described in the literature, and strategies to avoid such complications continue to evolve over time. We performed a retrospective review of our infection complications and propose a strategy for improvement. We reviewed clinical outcomes from patients undergoing TRUS-guided prostate biopsy at our institution from November 2018 to November 2020. We reported the antimicrobial prophylaxis received, whether the biopsy was systematic or targeted, and we examined the rate of clinically significant infection complications and hospitalization. Among 312 men who underwent TRUS-guided prostate biopsy during the study period, seven (2.2%) had an infection. Four patient groups with distinct antimicrobial regimen were identified; the largest of these patient groups received a three-day course of cefixime and a single dose of fosfomycin (59%). The proportion of patients with infection complications across these groups did not demonstrate a statistically significant difference (p=0.803). There was no significant difference in proportion of infection between systematic and targeted biopsy groups (3.0% vs. 0%, p=0.204). The proportion of patients hospitalized was 1.3%, with a mean length of stay of four days. We report a rate of clinically significant infection following TRUS-guided prostate biopsy of 2.2%. Due to our referral pathway, we have an inconsistent approach to antimicrobial prophylaxis, although there was no statistically significant difference in infection rate between the groups. We propose a standardized approach that may lead to improved patient outcomes.