Guided Core Biopsy Research Articles

EP484 - Triple negative male breast cancer: a case report

Abstract Background Male breast cancer (MBC) is a rare malignancy, may present at advanced disease stage. Triple negative breast cancer (TNBC) known to have the poorest prognosis of all other histological types of breast cancer. This paper presents a case of 71 years old gentleman diagnosed with TNBC. Materials and Methods A 71 years old male patient, presented with a right breast lump. Clinically he had a skin dent and a palpable 3cm lump underneath in the right breast axillary tail. Mammogram and breast US showed suspicious lesion in right breast axillary tail in addition to a suspicious lymph node in right axilla. Imaging guided core biopsies were taken from the breast and axillary abnormalities. The histology revealed grade1 invasive ductal carcinoma NST, ER 0, PR 0 and HER 2 negative. The Breast-Multidisciplinary Team meeting advised for mastectomy and axillary clearance, this has been performed. Result The postoperative Pathomorphology report revealed 23 mm triple negative invasive ductal carcinoma NST, grade 1with Ki67 10%, T2N1M0. The postoperative MDT recommended annual surveillance with mammogram for 5 years. Conclusions MBC is uncommon entity, accounting for < 1% of all breast cancer diagnosed in both genders and the MTNBC still is rarer, and mastectomy is the mainstay of surgical treatment in addition to chemotherapy and radiotherapy , however the later doesn’t affect the cause-specific survival rate.

Endometrioid Carcinoma Four Years After Hysterectomy: A Rare Case Report

It is quite a fascinating case as we have recently experienced in Mugda Medical College Hospital, a tertiary level teaching hospital in Dhaka, Bangladesh, that a woman was diagnosed and treated for endometrioid adenocarcinoma four years after her vaginal hysterectomy had been done. Our patient was presented with abdominal pain for nearly 2 weeks along with nausea, vomiting and generalized weakness. Ultrasound evaluation revealed a complex pelvic mass (8.6cm × 4.9cm). Chest x-ray revealed a left sided pleural effusion, while CT scan of the abdomen revealed heterogeneously enhancing complex pelvic mass and mild ascites. After a clinical correlation with all the pathological investigations, the patient was advised for a core biopsy. Ultrasonogram guided core biopsy was done. Histopathological examination showed a malignant ovarian epithelial tumor. Then she underwent an interventional or surgical procedure, which included an exploratory laparotomy, bilateral salpingo-oophorectomy with bilateral pelvic lymph node dissection and infracolic omentectomy done under general anesthesia. The final histopathological examination of the removed mass showed an endometrioid adenocarcinoma (Grade 2). Meanwhile, she was referred for radiation therapy (both vaginal brachytherapy and external pelvic radiation) after the patient had recovered from surgery. We will discuss this case as a part of our clinical interest and continuing education for our clinicians and residents. Mugda Med Coll J. 2024; 7(1): 53-55

Triple assessment breast clinics: The value of clinical core biopsies

BackgroundTriple Assessment Breast Clinics are designed for rapid diagnosis of symptomatic patients. When there is no concordance between clinical and radiological assessment, clinicians perform clinical core biopsies. In patients with a clinically suspicious examination (S4, S5) and normal imaging, clinically guided core biopsy should be performed as per NCCP guidelines. However, substantial research does not exist on the diagnostic value or use of clinical core biopsies in non-suspicious palpable (S3) lesions and practices differ in each health system.AimsThe aim of this research was to assess the diagnostic value of clinical core biopsies in nonsuspicious, probably benign palpable breast lesions (S3) where image guided cores were not indicated (R1/R2).MethodsThe cohort consisted of patients undergoing clinical core biopsies at a Symptomatic Breast Unit from January 2014 to 2019. Data regarding patient demographics, outcome of triple-assessment and incidence of malignancy were obtained from a prospectively maintained database and results were analysed using Minitab 2018.ResultsThree hundred and sixty patients had a clinical core biopsy performed in this period. Clinical examination scores for these patients were S1/S2 (66), S3 (277), S4 (15), and S5 (2). Radiology Scores were R1/R2 (355) and R3(5). Two patients with clinical score S3 (0.6%) were diagnosed with breast cancer due to their clinical cores. Both patients had normal mass imaging. There was no association between uncertain palpable breast lesions (S3), and atypia or malignancy on biopsy results when breast imaging was normal (P = 0.43, χ2 test).ConclusionDespite clinical core biopsies being used in triple assessment, there is no certainty in their value except that there is high clinical suspicion. Imaging modalities are constantly improving and are already well established. When the patient is assigned a clinical score of S3 and has normal radiology, a clinical core biopsy is not required in most cases.

S2362 Paraneoplastic Mucous Membrane Pemphigoid: Not Your Typical Cause of Odynophagia

Introduction: Paraneoplastic Mucous Membrane Pemphigoid (MMP) is a rare inflammatory autoimmune disorder that primarily affects the oral, ocular and aerodigestive mucous membranes and is associated with an underlying malignancy. IgG, IgA, and C3 autoantibodies target basal membrane zones causing subepithelial blisters with erosive lesions in the mucosa. It is rarely seen in the clinical setting, with an incidence of 2-10 cases in 100,000 individuals. High clinical suspicion is needed in order to diagnose Paraneoplastic MMP presenting as odynophagia and dysphagia. Case Description/Methods: A 88 year old female presented with a 5 month history of worsening odynophagia, dysphagia to solids and liquids and a fifty pound weight loss. Physical examination was remarkable for diffuse erosive lesions of the oral mucosa, tense bullae on the soft palate, and bilateral temporal symblepharon along with inflammation of upper and lower eyelids. Laboratory workup demonstrated elevated Cancer Antigen-125 (574.20 U/mL). Immunofluorescence study of biopsies taken from esophageal mucosa, right lateral tongue lesions and the left inferior conjunctiva were remarkable for IgG, IgM, IgA interkeratinocytic deposits at lower level of the epidermis and C3 linear deposits at the dermoepidermal junction consistent with Paraneoplastic Mucous Membrane Pemphigoid. Chest-abdominal-pelvic computed tomography scan demonstrated an irregular enhancing right adnexal mass, intra-abdominal lymphadenopathy, left hemiabdomen omental metastatic deposits and bilateral pulmonary nodules. Computed tomography guided core biopsy of a left omentum deposit was remarkable for primary ovarian metastatic high grade serous carcinoma. Due to refractory odynophagia and dysphagia, intravenous Solumedrol was initiated with subsequent improvement of symptoms. Patient was discharged with multidisciplinary team follow up for chemotherapy initiation and Rituxan induction. Discussion: Paraneoplastic MMP is an uncommon autoimmune mucocutaneous disease diagnosed when there is presence of stomatitis, histologic features of acantholysis or interface dermatitis, demonstration of anti-plakin autoantibodies on biopsy, with an underlying neoplasm. Less than 500 cases have been reported where clinical features, presentation, and autoantibodies profiles have varied widely between patients highlighting the challenge of diagnosis. Early recognition of Paraneoplastic MMP presenting as odynophagia is difficult due to the overlap of symptoms in more prevalent conditions.

308 Fine Needle Aspiration Cytology vs Ultrasound Guided Core Biopsy in the Diagnosis of Parotid Neoplasia: An Up-to-Date Review

Abstract Aim Parotid tumours account for 80% of salivary neoplasms. Regarding diagnostic techniques, fine needle aspiration cytology (FNAC) has long been the technique for tissue sampling and can be optimised with ultrasound or presence of a cytopathologist. USCB differs in that it obtains a core of tissue which allows preservation of the tissue architecture. The authors performed a literature review to provide an update on current practice and outcomes of both techniques Method A literature review of EMBASE, Medline, PubMed and Google Scholar were conducted. Regarding USCB, four systematic reviews and meta-analyses were identified, alongside three other studies that were not included within these papers. Regarding FNAC, three systematic reviews and meta-analyses were identified, alongside seven other studies, not included within these papers, using optimised FNAC in sample sizes of over fifty. Results USCB has higher sensitivity, specificity, and lower non-diagnostic rates than optimised fine needle aspiration cytology (FNAC). It also has a significantly higher sensitivity for the detection of malignancy. Complications post-USCB are uncommon, with only one reported case of tumour seeding and no cases of permanent facial nerve dysfunction. The technique is less operator dependent than FNAC, with less variation in results between institutions. Conclusions USCB can be considered as the optimum tool of choice for diagnosis of parotid neoplasia. This would particularly be the case in centres utilising FNAC with high non-diagnostic rates or reduced diagnostic accuracy when compared to USCB published data or in centres establishing a new service.

Pinpoint accuracy: guided core biopsy diagnostic accuracy in musculoskeletal lesions

Core biopsy is integral in the work-up of diagnosis for musculoskeletal lesions. Prior to referral through Christchurch hospital-a tertiary referral centre for sarcomas/musculoskeletal lesions, many patients undertake guided core biopsy in peripheral hospitals. We wished to assess the accuracy of these biopsies undertaken in the peripheral centres and compare to those done in the tertiary setting. A retrospective analysis of image-guided core biopsies done in the South Island of New Zealand over a 5year period was performed. An electronic database enquiry was made, and electronic notes were then screened for core biopsy results including subsequent biopsies done of the same lesion. Results from guided core biopsy were then recorded as diagnostic if the pathologist was able to reach or a definitive diagnosis, or guide management sufficiently. 223 patients with 229 biopsies were analysed. Overall accuracy of core biopsies were 83% across all centres. There were similar results between CT and ultrasound as well as soft tissue and bone lesions. Between the regions, the peripheral centres showed high accuracy compared with the tertiary centres. The regional centres demonstrated high diagnostic yield, and the current practice of providing core biopsy locally where possible prior to referral to a tertiary sarcoma, remains valid.

Retroperitoneal blue cell round tumor (Ewing sarcoma in a 35years old male)- case report.

IntroductionEwing sarcoma is a highly aggressive tumor. It's common presentation is primary bone tumor, but very rarely as soft tissue sarcoma both of which are under the spectrum of Ewing sarcoma family of tumors (EFT).Case presentationA 35 years old male who presented with advanced locally spreading tumor. He was diagnosed after presenting with epigastric pain and melena, CT abdomen revealed the retroperitoneal mass. CT guided core biopsy taken and was diagnosed as Ewing sarcoma. The patient presented with mass already grown so he was not a surgical candidate. Patient was managed symptomatically till he was sent for palliative care in a Sarcoma centre in Jordon and passed away on October 2021.DiscussionEwing Sarcoma family of tumors are group of small round blue cell tumors that are histogenetically related. The better known is Ewing ‘s sarcoma (EWS). It is a malignant small blue round cell tumor with variable degree of neuroectodermal differentiation. Retroperitoneal tumor are mostly malignant and accounts for one third of soft tissue sarcoma. They usually present as large masses at the time of the diagnosis. So they do not produce symptoms until they grow large enough to compress or invade contagious structures.ConclusionES-EWS is an aggressive tumor with high incidence of local recurrence and distant metastasis that's why is was given its poor prognosis characteristic. Multimodality treatment including surgical resection, chemotherapy and High dose radiotherapy will help in better survival rate.

ROLE OF SHEAR WAVE ELASTOGRAPHY IN CHARACTERIZATION OF BREAST MASSES USING HISTOPATHOLOGY AS GOLD STANDARD

Background: More recent ultrasound technique like SWE have led to better degrees of breast mass characterization by estimating tissue stiffness based on the acoustically generated shear wave propagation speed through the tissue. To nd out the sensitivity and Aims and Objectives: specicity of shear wave elastography in characterizing palpable breast masses using histopathology as gold standard. Materials and methods: This prospective, cross-sectional study was from may 2020 to June 2021. All patients underwent B-mode ultrasound, SWE and USG guided core biopsy of breast mass, BI-RADS on USG with modications by SWE assigned, cut-off values for qualitative and quantitative variables of SWE for differentiation between benign and malignant masses were estimated. SWE ndings were corelated with histopathology. Results: On histopathology amongst 55 patients 27 (49%) were benign and 28 (51%) were malignant. On USG, 19 were BI-RADS3 and 36 were BI-RADS 4 (4a, n = 18; 4b, n = 14; 4c, n = 4) leading to 78.57% sensitivity and 48.15% specicity. On modied BI-RADS' using E-color and Emean/E-max, specicity improved to 66.67% and 77.78% respectively. Addition of SWE to ul Conclusion: trasound improves characterization of BI-RADS 3 and 4a masses. E-max, E-mean and E-color are the most useful SWE parameters to differentiate between malignant and benign breast masses

Correlation between radiological and biological features and clinical outcomes in early prostate cancer: an exploratory subgroup analysis

PTEN deletion and Ki-67 expression are two of the most promising biomarkers in prostate cancer (PCa). In the same manner, multiparametric magnetic resonance imaging (mp-MRI) guided core biopsy is a powerful tool for PCa detection and staging. The aim of the study is to assess whether a correlation can be identified between the pathological stage defined by an mp-MRI-guided core biopsy and Ki-67 expression and PTEN deletion. Such correlation might be useful for staging and treatment personalization in PCa. This investigation was conducted in the context of phase II clinical study "Short-term radiotherapy for early prostate cancer with a concomitant boost to the dominant lesion" (AIRC IG-13218), ClinicalTrials.gov identifier: NCT01913717. Nineteen patients underwent a further in-bore MRI-targeted core biopsy (MRI-TBx) on the dominant intraprostatic lesion (DIL); on this basis, an additional Gleason Score (GS) was determined. PTEN loss and Ki-67 expression on these samples were analyzed and correlated with both risk categories modifications and oncological outcomes (overall survival, biochemical and clinical relapse). GS was upgraded in 5 cases, with 4 patients re-classified as intermediate-risk and 1 patient as high-risk. The latter experienced a clinical local relapse. No correlations between up/down-staging, PTEN deletion, and Ki-67 expression were observed in this cohort. Further investigations are needed towards the identification of a pattern in the tumor aggressiveness-response in PCa treated with ultra-hypofractionated radiotherapy. Moreover, a possible relationship between biomarker analysis and imaging textural features could be explored.

SUPERIOR VENA CAVA SYNDROME SECONDARY TO ADULT T-CELL LYMPHOBLASTIC LYMPHOMA

Superior vena cave (SVC) obstruction can be a substantial contributor to morbidity and mortality in cancer and non-cancer patients. It is currently known to be almost exclusively secondary to malignancy, most frequently lung cancer. A case of SVC syndrome presenting with worsening right-sided chest pain, shortness of breath, facial swelling, neck distension, and cough developing over a period of 12 days is reported. The approach to diagnosis included imaging studies and tissue diagnosis. CT scan of the chest revealed a large right pericardial mass, hilar infrahilar adenopathy, moderate increased right base posterior effusion, and compressive atelectasis. A mediastinal lymph node CT guided core biopsy subsequently revealed adult T-cell lymphoblastic lymphoma. Due to rapid symptom progression, the patient was started on hyper-CVAD regimen and tumor lysis prophylaxis. The etiology, diagnosis, and treatment modalities of the SVC syndrome are discussed further in detail. Given the wide range of symptom severity, identifying and treating severe SVC syndrome promptly can be critical to patient outcomes.

PATHOLOGY AND RENAL OUTCOME OF THREE UNCOMMON FACES OF CRESCENTRIC GLOMERULONEPHRITIS

AIMS: Rapidly progressive glomerulonephritis (RPGN) presents with rapidly deteriorating renal function (> 50% loss of glomerular ltration rate /GFR within 3 months) associated with nephritic urinary sediments and crescents in biopsy. Crescentric IgA Nephropathy, Anti-GBM (Glomerular basement membrane) disease and combined IgA Nephropathy with Anti-GBM disease are three uncommon reasons of RPGN. We have compared clinicopathological. Immunouorescence (DIF) and renal outcome of three groups. Setting and designs: Prospective, cross-sectional, single centre study. METHODS AND MATERIALS :Ultrasonography guided core biopsies obtained, one stained with hematoxylin-eosin, periodic acid-Schiff, Masson's trichrome, and silver methenamine stain another one with immunouorescence conjugated IgG, IgM, IgA, C3, C1q, kappa and lambda stain. Demographic, clinicopathological and therapeutic parameters with survival data were collected. STATISTICAL ANALYSIS USED: Done using software (GraphPad PRISM 6). RESULTS: We have included 9 cases of crescentric IgA Nephropathies, 6 cases of AntiGBM diseases and 2 cases of combined IgA Nephropathy and AntiGBM diseases. Signicant difference seen in the incidences of hypertension, hemoptysis, serum creatinine, anti GBM antibody, total number of crescents and mesangial hypercellularity, fragmentation of GBM etc. IgG, IgA and kappa positivity in DIF show signicant difference. Survival analysis and mortality versus dialysis dependence and complete and partial remission versus no remission showed no difference between these three groups. CONCLUSIONS: Proper and early clinicopathological diagnosis is important since all are of poor renal outcome. Further renal outcome of the combined disease is same as that of individual ones.

Transvaginal Ultrasound-Guided Core Biopsy-Experiences in a Comprehensive Cancer Centre.

Simple SummaryAdequate histological diagnosis defines the treatment in gynaecologic oncology. Although transvaginal ultrasound (TVUS) has widespread use in the diagnosis of pelvic tumours, TVUS-guided core biopsy is not a common procedure. In this study we summarize our experience in TVUS-guided biopsies performed in a comprehensive cancer centre, discussing the results of 303 patients who underwent this procedure. In addition, we compare the histological results of the biopsies with subsequent surgical histological results in 94 cases. Our study demonstrates that TVUS-guided core biopsy is a safe and effective histological sampling procedure providing adequate tissue for pathological evaluation in 99% of cases. Compared to surgically obtained histology, this procedure can reliably guide therapy, as its performance is satisfactory. In our opinion, TVUS-guided core biopsy is an effective diagnostic method providing possible benefits to patients referred for suspicion of gynaecological malignancy.In this paper, we report our experience of transvaginal ultrasound (TVUS)-guided core biopsies involving 303 patients referred to the gynaecological ultrasound unit of our national comprehensive cancer centre. Adequate histologic specimens were obtained in 299 patients (98.7%). The most common sites of biopsy sampling were the adnexa (29.7%), the vaginal stump or wall (13.5%), the uterus (11.6%) and the peritoneum (10.2%). Malignancy was confirmed in two-thirds of patients (201/303) and a primary malignancy was diagnosed in 111 of the 201 histologically verified malignant cases (55.2%). Interestingly, 23.9% (48/201) of malignant tumours were proven to have a non-gynaecological origin. Among them, gastrointestinal tumours occurred the most frequently (31/48 patients). Three abscesses were discovered following the biopsy procedure, resulting in a complication rate of 1%. In 94 (31%) patients, subsequent surgery allowed the comparison of the ultrasound-guided and surgically obtained histologic results. We found inaccuracy in 12 cases (12.8%), which is discussed in this paper in detail. Sensitivity, specificity, PPV and NPV to diagnose malignancy was 94.8%, 94.1%, 98.7% and 80.0%, respectively. This is the largest study reported to date about the efficacy and safety of TVUS-guided core biopsy in evaluating pelvic lesions giving rise to a suspicion of gynaecological cancer.

108 Developing A Non-Biopsy Protocol for The Female Cohort 25-29 Years with Clinically Typical Fibroadenoma Conforming to Maxwell Criteria on Ultrasound – Our Peninsular Experience in Wirral

Abstract Introduction The aim of this study was to introduce a non –biopsy protocol in our department for benign breast lump referrals confirmed as typical U2/3 fibroadenoma on imaging. Current UK guidance is not to biopsy sonographically typical fibroadenoma in women under 25 years. We have studied our population extending the radiological Maxwell criteria reflecting benign outcomes in 25-29 years cohort. Method Retrospectively data was collected of all women between 25-29 years of age undergoing core biopsies for ultrasound confirmed fibroadenoma between 2014 and 2019 over a period of five years. The number of cancers picked up was compared with the number of referrals and the discordance between radiological diagnosis of fibroadenoma and histopathological confirmation of malignancy was recorded. Results A total of 1707 referrals were made across five years. n = 175 image guided core biopsies were carried out for U2, U3, U4 lesions appearing as fibroadenoma on ultrasound. Out of these (n = 175), all lesions coded U2/3 (n = 165) based on Maxwell criteria on ultrasound were negative for cancer. U4 lesions on ultrasound were confirmed as cancers mimicking fibroadenoma(n = 10). Conclusions This retrospective audit of 1707 patients provides sound evidence for non-biopsy of typical fibroadenoma in 25–29 years cohort sonographic features meet strict criteria.

Computed tomography-guided transfacial buccal space core biopsy of deep head and neck space lesions: our experience

Deep head and neck space lesions can present a number of diagnostic challenges due to their deep anatomical position and difficult access for diagnostic tissue sampling. We describe a series of percutaneous ‘transfacial’ buccal space computed tomography (CT)-guided core biopsies of these lesions and subsequent histological findings. Six patients underwent CT-guided core biopsy of deep parotid, parapharyngeal, or masticator space lesions over a 30-month period. We describe our biopsy technique and correlate our histological findings with subsequent surgical resection where performed. Five of six of CT-guided biopsies obtained sufficient tissue for histological interpretation with varying findings, including salivary gland tumours and squamous cell carcinoma confirmed on subsequent resection. One patient was treated palliatively following core biopsy. No biopsy-related complications were observed. In our small series, percutaneous CT-guided transfacial biopsy via the buccal space has proved an excellent option for the minimally invasive tissue acquisition of deep head and neck space lesions.

Abstract PS2-39: A peninsular experience - developing a non-biopsy protocol for the female cohort 25-29 years with clinically typical fibroadenoma conforming to maxwell criteria on ultrasound

Abstract Abstract.Abstract1: IntroAim: The aim of this study was to introduce a non -biopsy protocol in our department for benign breast lump referrals confirmed as typical U2/3 fibroadenoma on imaging. The cohort of women between 25-29 years of age with sonographic features (Maxwell non-biopsy criteria) U2/3 typical of fibroadenoma does not miss malignancy. Current UK guidance is not to biopsy sonographically typical fibroadenomas in women under 25 years. We have studied our population extending the radiological Maxwell criteria reflecting histologically benign outcomes even in this group of 25-29 years.MethodsMethods: Retrospectively data was collected of all women between 25-29 years of age undergoing core biopsy for ultrasound confirmed both simple and complex fibroadenomas at Clatterbridge General Hospital between 2014 and 2019 over a period of five years. The number of cancers picked up was compared with the number of referrals and the discordance between radiological diagnosis of fibroadenoma and histopathological confirmation of malignancy was recorded.ResultsResults: We saw increment in referrals in this group of young women from n=260 to n=386 over the five year study period. A total of 1707 referrals were made across five years. n=175 image guided core biopsies were carried out for U2,U3,U4 lesions appearing as fibroadenoma on ultrasound. Out of these (n=175), all lesions coded U2/3 (n=165) based on Maxwell criteria on ultrasound were negative for cancer. U4 lesions on ultrasound were confirmed as cancers mimicking fibroadenoma(n=10).ConclusionConclusion: This retrospective audit of 1707 patients provides sound evidence for safe non-biopsy of typical fibroadenomas in women 25-29 years when clinical and sonographic features meet strict criteria. We started using the non-biopsy protocol using Maxwell criteria for U2/3 lesions. We discharged women in this group if they met all the protocol criteria, i.e., their lesion does not appear suspicious clinically, has all the ultrasound appearances typical of a fibroadenoma U2/3, and they do not have any compounding circumstances (e.g., family history, genetic predisposition). As routine, we advise all women who are discharged without follow-up to examine their breasts regularly and return if they detect any changes including increase in lesion size. We need data to be audited prospectively and provide level 1 evidence to the same effect. Citation Format: Tahera Arif, Mohammed Shameem Absar, Raman Vinayagam. A peninsular experience - developing a non-biopsy protocol for the female cohort 25-29 years with clinically typical fibroadenoma conforming to maxwell criteria on ultrasound [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-39.

Frequency of detection of carcinoma of prostate by TRUS guided core biopsy in patients with PSA level of 4 to 10 ng/ml: A comparison of eight verses fourteen core biopsies.

Objective: To compare the frequency of detection of prostatic carcinoma in patients with prostatic specific antigen level of 4 to 10ng/ml by TRUS guided eight versus fourteen core biopsies in a tertiary care hospital. Study Design: Interventional Comparative study (Randomized Control Trial). Setting: Department of Urology, Jinnah Hospital, and Lahore. Period: January, 2014 to February, 2019. Material & Methods: 340 patients included in the study, according to inclusion criteria, were divided in two groups of 170 patients each. Eight core biopsies were taken in one group and 14 core biopsies were taken in other group by single radiologist to diagnose carcinoma of prostate. Prostatic carcinoma was labeled when pathologist find atypical cells or anaplasia in the biopsy tissues under microscope. Results: Carcinoma of prostate was detected in 123 (36%) patients while rest 217 (64%) showed negative result on histopathology examination. Age of patients in both groups ranged from 40 to 62 years with mean 49.32+5.464 years. The CoP was detected in 55 out of 179 patients younger than 50 years and 68 out of 161 patients older than 50 years. Amongst the 123 patients having been detected CoP, 82 (67%) patients has PSA values ranging 6 to 10 ng/ml while just 41 (33%) has value of 4 to 5 ng/ml. The frequency of detection of CoP among patients having PSA values ranging from 4 to 10ng/ml. by TRUS guided eight core biopsy and fourteen core biopsy group is 17.35% and 18.82% respectively. Conclusion: There is no difference in the frequency of detection of CoP by TRUS guided fourteen core biopsy and eight core biopsy techniques.

Clinical performance of Xpert MTB/RIF on contrast-enhanced ultrasound-guided core biopsy specimens for rapid diagnosis of superficial tuberculous lymphadenitis in high TB burden settings.

The diagnosis of superficial tuberculous lymphadenitis (TBLN) remains difficult due to low detection rate of etiology. To increase the diagnostic value for TBLN, contrast-enhanced ultrasound (CEUS) guided core biopsy was introduced to obtain the specimen followed by Xpert MTB/RIF (Xpert) and other methods testing and to explore the optimum diagnostic pattern for TBLN in China. A prospective study was performed on patients with suspected superficial TBLN. All patients underwent CEUS-guided core biopsy from which specimens were tested by histopathology, Xpert, acid-fast bacilli (AFB), and MGIT960 culture (MGIT960), respectively. The diagnostic values were calculated and compared. A total of 328 patients were included the study, 272 were diagnosed as TBLN (254 definite TB, 18 probable TB) and 56 cases with Non-TBLN, and 100% (272/272) of TBLN patients obtained diagnosis sampled by CEUS-guided core biopsy. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of comprehensive diagnosis on the specimens by CEUS-guided core biopsy for TBLN were 100% ( 272/272, 95% CI 98.26-100.00), 94.64% (53/56, 95% CI 84.20-98.61), 98.91% (272/275, 95% CI 96.58-99.72), and 100% (53/53, 95% CI 91.58-100%), respectively. Xpert obtained 93.31% (237/254) of etiology detection rate on the specimens sampling by CEUS-guided biopsy. The etiology detection rate was associated with histopathological caseous necrosis. Current examinations on specimens by CEUS-guided core biopsy can achieve a high diagnostic efficacy for TBLN. Pathological differentiation of CEUS-guided biopsy tissue, then followed by Xpert, may be the best pattern for the diagnosis of TBLN in high TB burden areas.

Kikuchi Disease with enlargement of intramammary lymph node

We describe a rare case of intramammary lymphadenopathy due to Kikuchi-Fujimoto disease. A 15-year old female presented to the Breast Clinic with complaints of a tender, palpable right breast lump. An ultrasound of the area of concern demonstrated an enlarged 2.9 cm intramammary lymph node with preservation of the fatty hilum. An ultrasound guided core biopsy of the lymph node confirmed the diagnosis of Kikuchi-Fujimoto disease.

Diagnostic accuracy of contrast-enhanced digital mammography in comparison with sonomammography for characterization of focal asymmetries

BackgroundMammographic focal asymmetry represents normal breast tissue, benign, or malignant lesions. Accurate characterization is important for better management. The study evaluates diagnostic accuracy of contrast-enhanced digital mammography (CEDM) for characterization of focal asymmetries seen in 2D mammography.ResultsThe study was done prospectively on 38 females among 360 patients who underwent baseline sonomammographic assessment for diagnostic and screening purposes. Complementary ultrasound was performed only when a finding was detected in cases of screening mammograms. Focal asymmetries were evaluated according to Breast Imaging Reporting and Data System (BI-RADS) lexicon 2013. CEDM was performed and followed by ultrasound (US) guided core biopsy for solid lesions or aspiration for cystic lesions. CEDM processing resulted in recombined image showing enhancing abnormality. Low energy image and recombined image findings were analyzed blindly and classified into focus enhancement, mass enhancement, non-mass enhancement, and non-enhanced lesions. CEDM and sonomammography findings were compared regarding pathological probability and multiplicity. Histopathology was the reference standard.Mass enhancement showed strong correlation with malignant pathology. Non-mass enhancement showed no correlation with particular pathology. All non-enhanced focal asymmetries were benign in pathology or normal tissue. Rim enhancement needed second look ultrasound evaluation. CEDM was superior to sonomammography with higher sensitivity (77.8%, 65.7% respectively), NPV (0.8, 0.6), accuracy (0.6, 0.2) but lower specificity (81.8% vs. 100%). Multiplicity detection by CEDM was 26.3% and by sonomammography was 10.5%.ConclusionCEDM is more accurate than sonomammography in determination of normal tissue, benign, or malignant lesions in cases of mammographic focal asymmetry. CEDM is more accurate in detection of multiplicity. Undesired biopsies were avoidable with proper management of suspicious and malignant lesions.

Granulomatous prostatitis: A clinico-pathological series of 27 cases

Objectives: This study aimed to assess the incidence and discern the histomorphological spectrum of granulomatous prostatitis. Methods: A retrospective analysis of histopathological records of 1773 prostatic specimens received in the pathology department was done over a period of seven years. All histologically proven cases of granulomatous prostatitis were retrieved, the relevant clinical data were collected from patient records and the lesions were categorized accordingly. Results: Out of 1773 cases, 27 cases of granulomatous prostatitis were identified. The age range of these patients was between 50 and 89 years. Among the patients, non-specific granulomatous prostatitis (NSGP) was the most common followed by tubercular prostatitis, post-surgical prostatitis and xanthogranulomatous prostatitis. Three cases of post-surgical prostatitis were associated with malignancy. Serum prostate-specific antigen (PSA) levels ranged between 0.8 and 20.94 ng/mL (median 10.78 ng/mL). The diagnosis was made by histopathological examination of transrectal ultrasound (TRUS)-guided core biopsies, Trucut biopsies, transuretheral resection of prostate chips, prostatectomy and cystoprostatectomy specimens. Conclusion: In the present study, the incidence of granulomatous prostatitis was 1.5%. The patients usually present as hard nodules on digital rectal examination along with raised serum PSA levels. Carcinoma or benign prostatic hyperplasia was kept as a clinical diagnosis in these cases. Since the diagnosis of granulomatous prostatitis is made on histopathological examination only, meticulous histomorphological assessment is therefore required to reach a definitive diagnosis of granulomatous prostatitis.