Guided Core Biopsy Research Articles

Abstract No. 352 - Lung biopsy and management of pneumothorax in an outpatient center

This study evaluates CT guided core biopsy of the lung and management of pneumothorax (PTX) in a freestanding IR center. This retrospective study included 651 consecutive CT guided lung biopsies from March 2010 to June 2012 in 613 patients (273 male, 340 female, mean age 69) by IR physicians in an outpatient center. Biopsy was performed with sedation using the Achieve 20 gauge coaxial biopsy system (Cardinal,Dublin,Ohio). PTX was treated on site with a 14 fr Thal-Quick chest tube (n=37), or 10.5 fr multipurpose drain (n=6) attached to a Heimlich valve (Cook Medical, Bloomington, IN). Mean lesion size was 2.6 cm (range .5 - 9.5 cm) and depth was 1.7 cm (range 0-11.3 cm). 95% of patients received 2 or less CXR’s after biopsy, and the mean time to pre-discharge CXR was 1.7 hr (range 0 - 6hr). Samples showed malignancy in 416(64%), and 43(7%) had a specific benign diagnosis. No malignancy with concordant follow-up imaging was seen in 87(13%), and incomplete follow-up was found in 91(14%). 14(2%) of samples were falsely negative. Pneumothorax occurred in 95(15%) of cases. Chest tubes were placed for enlarging or symptomatic PTX in 43(6.6% of total biopsies) 0-72 hr (mean 6 hr) after biopsy. Of three delayed PTX’s at 24-72 hrs, two received chest tubes; one was aspirated. Hospitalization occurred in 7(16%) receiving chest tubes, either for suction or pain management. All but one hospitalized patient was transferred from the IR center. Apical positioned 14 fr tubes required a single tube exchange to control the PTX in 2 of 24 patients. Smaller tubes or 14 fr tubes not in the apex needed a single exchange in 7 of 19 patients (odds ratio 5.9 p<.05). Tube removal was delayed 24hrs if placed in late afternoon, and 7 patients had tubes through the weekend. All patients had successful tube removal 18 to 216 hrs (mean 52hr) after biopsy, 36(84%) as outpatients. Self limited hemoptysis occurred in 60 (9.2%) of patients. Two patients died after urgent transfer to the hospital; one death from massive hemoptysis, and one from complications of hemothorax. Core biopsy of the lung in an IR center is feasible, and pneumothorax can be safely managed as an outpatient.

Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions

PurposeTo determine the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) Virtual Touch IQ shear wave elastography in the discrimination of benign and malignant breast lesions. Materials and methodsConventional B-mode and elasticity imaging were used to evaluate 110 breast lesions. Elastographic assessment of breast tissue abnormalities was done using a shear wave based technique, Virtual Touch IQ (VTIQ), implemented on a Siemens Acuson S3000 ultrasound machine. Tissue mechanical properties were interpreted as two-dimensional qualitative and quantitative colour maps displaying relative shear wave velocity. Wave speed measurements in m/s were possible at operator defined regions of interest. The pathologic diagnosis was established on samples obtained by ultrasound guided core biopsy or fine needle aspiration. ResultsBIRADS based B-mode evaluation of the 48 benign and 62 malignant lesions achieved 92% sensitivity and 62.5% specificity. Subsequently performed VTIQ elastography relying on visual interpretation of the colour overlay displaying relative shear wave velocities managed similar standalone diagnostic performance with 92% sensitivity and 64.6% specificity. Lesion and surrounding tissue shear wave speed values were calculated and a significant difference was found between the benign and malignant populations (Mann–Whitney U test, p<0.0001). By selecting a lesion cut-off value of 3.31m/s we achieved 80.4% sensitivity and 73% specificity. Applying this threshold only to BIRADS 4a masses, we reached overall levels of 92% sensitivity and 72.9% specificity. ConclusionVTIQ qualitative and quantitative elastography has the potential to further characterise B-mode detected breast lesions, increasing specificity and reducing the number of unnecessary biopsies.

Ultrasound Guided Core Biopsy versus Fine Needle Aspiration for Evaluation of Axillary Lymphadenopathy in Patients with Breast Cancer

Rationale and Objectives. To compare the sensitivities of ultrasound guided core biopsy and fine needle aspiration (FNA) for detection of axillary lymph node metastases in patients with a current diagnosis of ipsilateral breast cancer. Materials and Methods. From December 2008 to December 2010, 105 patients with breast cancer and abnormal appearing lymph nodes in the ipsilateral axilla consented to undergo FNA of an axillary node immediately followed by core biopsy of the same node, both with ultrasound guidance. Experienced pathologists evaluated the aspirate cytology without knowledge of the core histology. Cytology and core biopsy results were compared to sentinel node excision or axillary dissection pathology. Sensitivities were compared using McNemar's test. Results. Of 70 patients with axillary node metastases, FNA was positive in 55/70 (78.6%) and core was positive in 61/70 (87.1%) (P = 0.18). The FNA and core results were discordant in 14/70 (20%) patients. Ten cases were FNA negative/core positive. Four cases were FNA positive/core negative. Conclusion. Core biopsy detected six (8.6%) more cases of metastatic lymphadenopathy than FNA but the difference in sensitivities was not statistically significant. Core biopsy should be considered if the node is clearly imaged and readily accessible. FNA is a good alternative when a smaller needle is desired due to node location or other patient factors. This trial is registered with NCT01920139.

Computer tomography-guided core biopsies in a county hospital in Sweden: Complication rate and diagnostic yield

BACKGROUND:Core biopsies are valuable in obtaining sufficient tissue to ensure diagnosis of diseases in the thorax.OBJECTIVE:To evaluate the complication rate and the diagnostic yield in computer tomography (CT)-guided core biopsies performed in a county hospital in Sweden.METHODS:Medical journals, spirometry results, pathology reports and CT scans were reviewed in 463 consecutive cases, where a transthoracic core biopsy was performed between January 2005 and December 2010. Of these 380 (82%) were lung lesions, 48 (10%) were mediastinal lesions and 35 (8%) were pleural lesions.RESULTS:All patients underwent a chest X-ray 4 hours post-biopsy and pneumothorax was seen in 156/463 (34%) patients: 137 after lung biopsy and 17 after mediastinal biopsy. Chest tube insertion was required for 27 (17%) of these patients (6% of all core biopsies). Small intraparenchymal hemorrhages and hemoptysis were observed with subjective difficulty in one case. The diagnostic yield for the 463 patients was 212 (46%) cases of lung cancer, 188 (41%) benign lesions and 39 (8%) pulmonary metastases.CONCLUSIONS:A transthoracic core biopsy ensures diagnosis with a low complication rate and is suitable as an outpatient procedure. An increased risk for pneumothorax was observed when the biopsied lesion was small or when emphysema was in the path of the biopsy needle. Reduced lung function pre-biopsy or emphysema in the path of the biopsy needle increased the need for chest tube treatment of pneumothorax. A CT-guided core biopsy is safe and applicable in a county hospital.

Primary mediastinal large B-cell lymphoma: Clinical features, prognostic factors and survival with RCHOP in Arab patients in the PET scan era.

Objective:PMBCL is a distinct type of nonhodgkins lymphoma with specific clinicopathological features. To clarify clinical features, treatment alternatives and outcomes, we evaluated 28 Arab patients treated with chemotherapy or radiotherapy between 2006 and 2011.Patients and Methods:PMBCL lymphoma patients identified according to WHO classification and treated at KCCC between 2006 and 2011 were included in this study. Demographic and clinical data are presented as means or medians. Overall survival was estimated using the Kaplan-Meier method. Survival rates were compared using the log-rank test. A P < 0.05 was considered significant.Results:The median age of the patients was 31 years and the male to female ratio was 2:1. Majority of the patients (75%) presented with stage I/II disease. Most had features of local extension like pleural effusion (18%) and SVCO (39%). Only 11% of the patients had bone marrow involvement at presentation. 96% of the patients required biopsy from the mediastinal mass either by image guided core biopsy (75%) or by surgical biopsy. Most patients were treated by RCHOP and involved field radiotherapy. Patients with positive PET scan after RCHOP chemotherapy received salvage chemotherapy and BEAM autologous marrow transplant. The five year OS for the entire group was 85% while the PFS was 73%. Patients who had PET scan for response evaluation had better OS [P = 0.013] and PFS [P = 0.039] when compared with those patients who received only radiotherapy based on CT scan evaluation.Conclusion:PMBCL is a specific lymphoma entity seen in the young with good survival. The role of PET scan for response evaluation and the type of consolidation therapy needs to be further clarified

Pain during transrectal ultrasound-guided prostate biopsy and the role of periprostatic nerve block: what radiologists should know.

Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.

Retroperitoneal desmoid tumor with unusual appearance as a spontaneous ureteral rupture and rare association with desmoid tumor of the breast

Introduction: Desmoid tumors of retroperitoneum and breast are rare. their association is exceptional and their management is controversial. spontaneous ureteral rupture as a complication and a circumstance of discovery of the retroperitoneal desmoid tumor is a rare entity and poses management difficulties. to the best of our knowledge, this case is the first to present this exceptional association, and to report the ureteral rupture as a circumstance of discovery of the retroperitoneal desmoid tumor. case report: We present the first reported case, seen in a young girl without Gardner’s syndrome, in which upper ureteral rupture was the primary symptom of an aggressive retroperitoneal desmoid tumor. she underwent laparotomy for septic peritonitis secondary to rupture of the right ureter, in which initially right ureterocutaneostomy was done, later right nephrectomy was made; for recurrent right ureteral rupture. Imatinib (Glivec) 200 mg was prescribed. However, due to intractable diarrhea, the target therapy was discontinued. At follow-up, left breast desmoid tumor was diagnosed by mammography, sonography and magnetic resonance imaging scan; and confirmed by sonographically guided core biopsy; and large excision was made. At the last follow-up, radiological exams did not show any

Sonographically Guided Core Biopsy

We hypothesized that sonographically guided core biopsy is an effective method for the differential diagnosis of adnexal masses and evaluated patients who underwent core biopsies in our gynecologic oncology department. We reviewed the medical records of 55 patients who underwent sonographically guided core biopsies in our gynecologic oncology department between 2010 and 2013. Patients with suspected ovarian malignancies who were unsuitable for optimal debulking surgery and patients at risk for higher morbidity and mortality because of a poor performance status, suspected nongynecologic tumors, and peritoneal tuberculosis were indicated for sonographically guided biopsy. The indications for sonographically guided core biopsy were candidacy for suboptimal cytoreduction (n = 32 [58.2%]), a poor performance status (n = 11 [20.0%]), and suspected nongynecologic tumors (n = 12 [21.8%]). Histopathologic evaluations revealed primary ovarian tumors in 36 patients (65.5%). Tuberculosis was found to be the second most common disease (n = 8 [14.5%]) among the patients who underwent core biopsies. In 2 patients (3.6%), histologic examination revealed metastatic colorectal cancer. Sonographically guided core biopsy may be preferred as a minimally invasive procedure for managing adnexal masses, particularly in patients with advanced ovarian cancer and high comorbidities who might benefit from neoadjuvant chemotherapy and in cases of suspected nongynecologic tumors, including pelvic tuberculosis.

EBUS-TBNA Provides Highest RNA Yield for Multiple Biomarker Testing from Routinely Obtained Small Biopsies in Non-Small Cell Lung Cancer Patients - A Comparative Study of Three Different Minimal Invasive Sampling Methods

BackgroundMultiple biomarker testing is necessary to facilitate individualized treatment of lung cancer patients. More than 80% of lung cancers are diagnosed based on very small tumor samples. Often there is not enough tissue for molecular analysis. We compared three minimal invasive sampling methods with respect to RNA quantity for molecular testing.Methods106 small biopsies were prospectively collected by three different methods forceps biopsy, endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA), and CT-guided core biopsy. Samples were split into two halves. One part was formalin fixed and paraffin embedded for standard pathological evaluation. The other part was put in RNAlater for immediate RNA/DNA extraction. If the pathologist confirmed the diagnosis of non-small cell lung cancer(NSCLC), the following molecular markers were tested: EGFR mutation, ERCC1, RRM1 and BRCA1.ResultsOverall, RNA-extraction was possible in 101 out of 106 patients (95.3%). We found 49% adenocarcinomas, 38% squamouscarcinomas, and 14% non-otherwise-specified(NOS). The highest RNA yield came from endobronchial ultrasound guided needle aspiration, which was significantly higher than bronchoscopy (37.74±41.09 vs. 13.74±15.53 ng respectively, P = 0.005) and numerically higher than CT-core biopsy (37.74±41.09 vs. 28.72±44.27 ng respectively, P = 0.244). EGFR mutation testing was feasible in 100% of evaluable patients and its incidence was 40.8%, 7.9% and 14.3% in adenocarcinomas, squamouscarcinomas and NSCLC NOS subgroup respectively. There was no difference in the feasibility of molecular testing between the three sampling methods with feasibility rates for ERCC1, RRM1 and BRCA1 of 91%, 87% and 81% respectively.ConclusionAll three methods can provide sufficient tumor material for multiple biomarkers testing from routinely obtained small biopsies in lung cancer patients. In our study EBUS guided needle aspiration provided the highest amount of tumor RNA compared to bronchoscopy or CT guided core biopsy. Thus EBUS should be considered as an acceptable option for tissue acquisition for molecular testing.

Successful Endoscopic Ultrasound Guided Biopsies of Gastric Muscularis Propria in Gastroparesis Patients

Purpose: Loss of interstitial cell of Cajal (ICC) in the muscularis propria (MP) and inflammatory changes in the myenteric plexus are reported from full thickness biopsies (FTB) of the stomach wall in patients with gastroparesis (GP). These findings can aid in the diagnosis and treatment selection. However FTB use is limited by the need for surgery. We hypothesized that endoscopic ultrasound guided core biopsies (EUS-CB) can obtain sufficient MP tissue for histological examination in GP patients. We investigated the efficacy and safety of EUS-CB of the stomach antral wall in GP and compared the tissue to a surgically obtained FTB in the same patient. Methods: This is a prospective non-randomized feasibility trial. Patients with GP who were undergoing gastric neurostimulator placement were enrolled. Patients had a biopsy done by EUS FNA with a 19 G core needle, followed by FTB obtained surgically during neurostimualtor placement within 24 hours. Endoscopic and surgical specimens were compared for tissue morphology, count of ICC (c-kit stain), enteric neurons (S100 stain), and fibrosis (trichome) for each patient. Correlation coeffi cient of the ICC count per HPF was used to compare both specimens. Safety of the endoscopic procedure was assessed by examining the site of EUS biopsy during surgery as well as observing clinical outcomes. Results: Five female patients (mean age 41.6 years) were enrolled in the trial (four diabetic and one idiopathic GP). EUS-CBs were successful in obtaining sufficient tissue for histological assessment of ICC in all patients and for the myenteric plexus in 60% of patients (Table 1). There was a high correlation coefficient (0.8) when comparing both surgical and endoscopic groups for the loss of ICC. Figure 1 shows c-kit staining for ICC in the endoscopically obtained specimen. Mild serosal bruising and/or localized hematoma formations were noted at the sites of EUS biopsies in all five patients but no serosal tear or perforation was noted. No post-procedure complications were reported.Table: Table. Comparison of endoscopic and surgical biopsies obtained from the stomach's muscularis propriaFigure: C kit staining for ICC on EUS biopsy.Conclusion: EUS-CB of the gastric MP in GP patients is safe and provides enough tissue for complete histological assessment. This relatively non-invasive approach can replace surgical FTB and will revolutionize the diagnosis and management of patients with GP.

Audit on clinical coding of breast surgery clinic outcomes

Audit on clinical coding of breast surgery clinic outcomes

Tissue bulge during stereotactic core biopsy

In full field digital mammography (FFDM) the whole breast is subjected to compression with a perspex compression paddle in order to reduce breast thickness and improve image quality. Once a mammographic abnormality has been detected using FFDM and a decision to proceed with a stereotactic (X-ray) guided core biopsy has been made, a different compression paddle is utilised. This paddle has a central aperture in order to allow access to the lesion for biopsy.Clinical observations made during biopsy procedures have revealed that a bulge of tissue forms within the aperture. The magnitude of the bulge of tissue and BI-RAD breast density was recorded in 15 consecutive patients. Results showed an average of 18.7% (range 11.3–30%) increase in the breast thickness (over the bulge region) compared to the surrounding compressed breast.BI-RAD breast density category 3 had on average the lowest measured thickness and the greatest percentage of tissue bulge. Overall, results confirm that for all patients there was a measurable tissue bulge that varied from 6 mm to 10 mm, representing between 10.14% and 23.08% of additional tissue not measured by the machine. In clinical practice a perceivable difference in lesion visibility was subjectively indicated between the FFDM images and the stereotactic scout biopsy image.The suggested hypothesis from these observations is that there may be an association between the magnitude of the tissue bulge and the ability to accurately perceive certain lesions during stereotactic biopsy procedures. A phantom study is in progress to determine how lesion visibility varies with the amount of tissue bulge.

Time-related changes in yield and harms of screening breast MRI.

1508 Background: MRI has been accepted as a useful adjunct to screening mammography in high-risk women. Concerns remain over false positive findings, however, and little is known about harms and yield over time. Such information will help women decide about enhanced surveillance. Methods: Of 350 high risk patients offered MRI screening, 320 underwent 757 screens with a 1.5 Tesla magnet from 2008 to 2012 alternating (q 6 mo.) with digital mammography. Data collected included patient characteristics, mammographic density, estimated lifetime risk, and need for additional imaging and/or biopsy. Harms were defined as second look ultrasounds, US or MRI guided core biopsies, surgical biopsies or recommendation for short interval follow up. Estimates of harms over time were modeled by logistic regression. A significance level of 0.05 was used for all testing. Results: Compliance with MRI screening as recommended was 91% with the first MRI, and was not associated with age, race or level of risk. Harms were highest with the first MRI and decreased significantly with subsequent MRIs. Of 59 biopsies, 7 were malignant. Two were found in MRI 1, 3 in MRI 3 and 2 in MRI 4. Women with biopsies resulting from false positive findings were significantly younger (median age 44.5 as compared with 48; p=0.049) and were more likely to have extremely dense breast tissue (36% vs 17%; p=0.028.) Conclusions: This study of highly compliant high risk patients supports the use of MRI as an adjunct to mammography for early detection. The rate of harmful events decreased over time, yet cancer detection did not. This information is critical in counseling women who are considering annual screening breast MRI, particularly younger women and those with dense tissue. [Table: see text]

Su1534 Endoscopic Ultrasound-Guided Fine Needle Aspiration With and Without Preceding Core Biopsy: a Case-Control Study Evaluating the Effect of Core Biopsy on FNA Yield

Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is the preferred diagnostic method for pancreatic, subepithelial, and other lesions in close proximity to the gastrointestinal tract. More recently EUS guided core biopsies of such lesions have been increasingly utilized in conjunction with FNA in the hope of increasing the diagnostic yield of the EUS-guided approach. It is not clear, however, if a core biopsy impacts the yield of the subsequent FNA. This study compares the diagnostic accuracy of FNA with a bedside cytopathologist with and without a preceding core biopsy.

Mo1484 The Utility of Endoscopic Ultrasound (EUS)-Fine Needle Aspiration (FNA) for the Diagnosis of Pancreatic Cystic Neuroendocrine Tumors (PCNETs): a Decade of Single Center Experience

performance of EUS guided core biopsy. The yield of the core biopsy as compared to FNA with onsite cytopathologists is not known. Methods: All patients referred for EUS guided biopsy were considered for EUS guided core biopsy followed by EUS guided FNA between February 2011 and November 2012 at the Houston Veterans’ Affairs Medical Center. Patients were excluded if they had cystic lesions, small lesions ( 1cm) or if interposing vascular structures prevented the intervention. Study patients were evaluated with two core biopsies using 22 gauge needles followed by FNA guided by a bedside cytopathologist. Results of the core biopsy were reported by a second pathologist at a later date. The yield (percent accurate diagnosis) was compared between the two groups. The agreement between the 2 approached was examined using the Kappa (K) statistic. The final diagnosis was defined using a conglomerate of surgical pathology, follow-up studies, and clinical course. Results: Twenty six patients were included in the final analysis, of which 96% were male and 61% were Caucasian. 69.2% had pancreatic lesions and 30.8% had other upper GI lesions including lymph nodes and subepithelial lesions. The mean number of passes was 3.2 for FNA, and the mean procedure time was 39.4 minutes. The final diagnosis was malignant in 92.3% and benign in 7.7%. Sensitivity and specificity were 83% and 100% respectively for FNA, and 71% and 100% respectively for core biopsy. Diagnostic accuracy was 84.6% for FNA and 73.1% for core biopsy. The two approaches yield was in agreement in 88.4% with a kappa statistic of 0.66 (95% CI: 0.33 0.99) indicating substantial agreement. Conclusions: The diagnostic yield of two passes with a 22 gauge core biopsy needle is comparable to the current gold standard of FNA with a bedside cytopathologist. Performance of two core biopsies could represent a time efficient and widely available alternative to FNA with a bedside cytopathologist.

Detection and tumour grading of prostate cancer in community hospitals

Several studies have examined the variations between community pathologists and urological pathologists with respect to the detection and Gleason grading of prostate cancer via transrectal ultrasound–guided core biopsies of the prostate gland.1 Most studies are based on American and European hospitals, thus I congratulate Newell and colleagues2 on their study examining these differences in the Canadian population. The authors found a significantly higher rate of categorical diagnosis of prostate cancer at prostate gland biopsy in community hospitals than in university hospitals (58% v. 33%). Detection secondary to case-finding can be more evident in a community where prostate cancer screening may have been delayed and can explain the higher detection rates of prostate cancer found in their study. Several other factors are known to influence the yield of prostatic biopsy in the detection of cancer, including serum prostate-specific antigen (PSA) levels, findings from digital rectal examinations (induration v. hard nodules) and age. We also know that the size of the prostate may be a factor influencing prostate cancer detection rates. In Canada, where health care is provided in a single-payer system with limited resources, community urologists may have a different threshold for biopsy compared with university urologists. Furthermore, Newell and colleagues found significant variations among community pathologists in the diagnosis and grading of prostate cancer at biopsy. Previous studies have also shown that community pathologists tend to “undergrade” prostate cancer found at biopsy.1 In the present study, the incidence of Gleason score 6 prostate cancer was 36% compared with 49% in the literature; however, without review of all prostate gland biopsies by a dedicated urological pathologist, it is not possible to determine whether community pathologists in Canada also “undergrade” prostate cancer. Factors such as the size of the prostate and the extent of prostatic biopsies have been recently shown to influence Gleason scores and the incidence of “upgrading” on prostatectomy specimens; these factors should be taken into account when evaluating this specific issue.3 In larger glands, elevated serum PSA levels (the driving factor for a biopsy) are commonly the result of benign prostatic hyperplasia that is concomitantly present when cancer is found. The cancers detected in this setting typically can be well differentiated and low in volume. I believe it is beneficial to obtain a second consultation with a urological pathologist — especially for patients with prostate cancer who are being considered for active surveillance — to ensure the absence of higher-grade disease.

Prostate gland biopsies and prostatectomies: an Ontario community hospital experience

Transrectal ultrasound-guided core biopsies of the prostate gland and prostatectomies have become common procedures at many community hospitals in Canada, especially in the era of serum prostate-specific antigen (PSA) screening for prostate cancer. The Gleason grading of prostate cancer in biopsies and prostatectomies is a major determinant used for treatment planning. There is evidence in the literature that suggests important discordance between community hospital pathologists and urological pathologists with respect to the Gleason grading of prostate cancer. Our objective was to determine the diagnostic rates and Gleason scoring patterns for prostate gland biopsies and prostatectomies at our institution compared with the literature. We conducted a retrospective review of all prostate gland biopsies and prostatectomies performed at the Grey Bruce Health Services from January 2005 to September 2005. We collected data from 194 biopsies and 44 prostatectomies. We obtained prebiopsy serum PSA levels and digital rectal exam results for all patients from urologists' office records. The average age for men having biopsies was 65.8 (standard deviation [SD] 8.6) years, and the average prebiopsy serum PSA level was 8.7 (median 7.1, SD 6.2) mug/L. The rates of diagnosis from prostate gland biopsies of benign (17.6%), high-grade prostatic intraepithelial neoplasia (11.0%), atypical small acinar proliferation suspicious for invasive malignancy (13.2%) and invasive prostatic adenocarcinoma (58.2%) at our institution were significantly different than those reported in the literature (p < 0.001). We observed a significant variation in the rates of these diagnoses among the community hospital pathologists in our study (p = 0.004). There was a strong correlation between the increasing number of positive core biopsy sites and increasing Gleason scores in biopsies (p < 0.001). There was also a strong correlation between increasing pre-biopsy serum PSA levels and increasing Gleason scores in biopsies (p < 0.001). A substantial proportion (21.9%) of the biopsies given the Gleason score of 6 had a Gleason score of 7 in the prostatectomy specimen. Our results showed a significant difference in prostate gland biopsy categorical diagnoses compared with the literature. There were also significant differences in categorical diagnoses of prostate gland biopsies among the community hospital pathologists in our study. The data identify a strong positive correlation between the increasing number of positive core biopsy sites and increasing Gleason scores in biopsies, as well as a strong positive correlation between increasing prebiopsy serum PSA levels and increasing Gleason scores in biopsies that revealed cancer. We would encourage other community hospital pathologists, in collaboration with their urologists, to review periodically their prostate gland pathology practices in an attempt to improve the uniformity of diagnoses.

CT‐guided core biopsy of malignant lung lesions: How many needle passes are needed?

The study aims to determine the number of needle pass in the CT-guided core needle biopsy (CNB) in making a diagnosis of pulmonary malignancy. A total of 434 CNB records were retrospectively reviewed. The specimen obtained from each needle pass was put in a formalin container and then labelled for separate histopathological reporting. The patients were divided into five groups according to the total number of needle passes (n = 1, n = 2, n = 3, n = 4 and n ≥ 5). In each of the groups 2-4, it was analysed how many needle passes are required before a plateau in diagnostic yield is achieved. CNB produced 283 true-positive and 23 false-negative diagnosis of malignancy. Cumulative sensitivity significantly (P < 0.05) increased between the first and second as well as the second and the third (if done) needle passes, but not between the third and fourth ones. Three coaxial needle passes might be optimal in the diagnosis of lung malignancy.

A rare primary malignant solitary fibrous tumour of the liver

Solitary fibrous tumour (SFT) usually occurs in the pleura but can rarely present as a primary liver tumour. Although SFT is usually slow growing and has a favourable prognosis, few malignant SFTs have been reported in the literature. We present a malignant SFT in a 78-year-old male who presented with acute epigastric pain. CT of the abdomen showed a large mass in left lobe of liver. A fine needle aspiration after embolisation and CT guided core biopsy were reported as solitary fibrous tumour. He underwent a left hemi hepatectomy showing a 17×13cm encapsulated tumour attached to the liver capsule. Microscopically the tumour was composed of spindle cells amongst wavy collagen fibres. The stroma showed both myxoid and hyalinised areas as well as areas of necrosis with stag horn like dilated vessels (hae-mangiopericytoma like appearance). Focally there was marked cellular pleomorphism with more than 4 mitosis per 10 high power fields. Tumour cells showed positivity for CD99, CD34, BCL-2 and vimentin. These features are suggestive of a high grade malignant SFT of the liver. The patient remains free of recurrence on follow-up. Most of the extra pleural SFTs behave in a benign fashion, but 10–15% tend to be aggressive. There is no strict correlation between morphology and behaviour in these tumours. This case is presented for its rarity.

Correlation of Pathological Complete Response with Radiological Evaluation after Neoadjuvant Chemotherapy of Breast Carcinoma

Introduction: Neoadjuvant chemotherapy is the standard treatment modality in locally advanced breast cancer, and accepted as an alternate modality in operable breast cancer. Pathological Complete Response (pCR) is a surrogate for better outcome. The identification of the most sensitive clinical and radiological method to pCR will be helpful in patient’s management. Patients and methods: Multicenterprospective study assessed the correlation between (pCR) and radiological Complete Response (rCR) using different radiological modalities. 125 female with primary measurable stage II or III non inflammatory breast cancer, were enrolled in the study after pathological confirmation using image guided core biopsy. Pathological assessment was done. All eligible cases received neoadjuvant chemotherapy (FEC) IV every 3 weeks for three cycles followed by Docetaxel IV every 3 weeks for three cycles. Trastuzumab was added in Her2neu positive patients concomitantly with docetaxel. Radiological evaluation was done before chemotherapy and prior to definitive surgery. pCR was defined as complete disappearance of invasive tumor cells in both breast surgical specimen and lymph nodes. Patients who achieved pCR were correlated with truly positive rCR by different modalities. The results were statistically analyzed using the Kappa method for agreement. Results: 20% of the patients achieved pCR 25/125. All these patients received 6 cycles of chemotherapy, only 4 patients received Trastuzumab. Conservative surgery was performed in 80% of cases and MRM in 5/25 of them. True radiological Complete Response (rCR) was achieved in 56% of patients by mammography, 17/25 (68%) of patients by ultrasonography who showed complete disappearance of the mass. 23/25 (92%) achieved rCR morphologically by Dynamic MR-Mammography and in 24/25 (96%) of cases using the kinetic data. MR Spectroscopy showed rCR in (92%) cases. In our study, predictions made on the basis of MRI showed a better correlation with the pathological response after neoadjuvant chemotherapy than did estimations made on the basis of mammography or sonography. The sensitivity, specificity, PPV and NPV for Dynamic MRI in predicting complete pathological response were 96%, 94%, 89% and 99% respectively. The sensitivity, specificity, PPV and NPV for MRS were 92%, 92%, 85% and 97% respectively while the sensitivity, specificity, PPV and NPV for Mammography were 44%, 87%, 61% and 87% respectively and the sensitivity, specificity, PPV and NPV for ultrasonography were 68%, 90%, 77% and 92% respectively. Conclusion: The most sensitive radiological methods correlated with pCR were dynamic MR mammography and MR Spectroscopy, further studies using new modalities and larger number of patients is required to confirm our results.