Gun Needle Research Articles

A Study on the Reflectivity according to the Material of Biopsy Gun Needle Used in Ultrasound Biopsy

A Study on the Reflectivity according to the Material of Biopsy Gun Needle Used in Ultrasound Biopsy

Safety and Adequacy of Ultrasound-Guided Percutaneous Renal Biopsy in Children: A Single-Center Experience.

BackgroundUltrasound-guided percutaneous renal biopsy (PCRB) is a commonly used technique to obtain renal tissue for histopathological diagnosis in children and adolescents. The objectives of this study include determining the indications for renal biopsy, documenting the safety and efficacy of ultrasound-guided PCRB, and documenting its complications along with histopathological findings in children.MethodologyThe Ethical Review Committee approved this cross-sectional study. Data of all children with either nephrotic or nephritic syndrome from January 2017 to September 2020 (at The Kidney Center Post Graduate Training Institute Karachi) who underwent ultrasound-guided PCRB were collected and analyzed. An ultrasonic examination was performed both before and after the biopsy.ResultsDuring the research period, 104 individuals underwent PCRB. The average age of the children biopsied was 7.44 ± 4.12 years (range = 1-17 years). The most prevalent reason for biopsy was nephrotic syndrome. Almost 94% of PCRBs were effective. Post-biopsy complications were detected in 16 cases, with peri-nephric hematoma being the most prevalent.ConclusionsIn children, ultrasound-guided PCRB can safely be performed under sedation in experienced hands with an automated biopsy gun needle. The use of real-time ultrasound guidance as well as the automated biopsy gun ensures good outcomes.

Focal Hepatic Steatosis That Appears as a Liver Mass in Imaging

f i f A man with heavy alcohol history (daily alcohol ingestion of 160 g for 25 years) presented for evaluation of cteric sclera and epigastric pain. Initial laboratory data were as ollows: white blood cell count, 10,500; hemoglobin, 14.3; plateet count, 121,000; aspartate aminotransferase/alanine aminoransferase, 325/66 IU/L; bilirubin level (total/direct), 26.4/12.8 g/dL; alkaline phosphatase, 177 IU/L; -guanosine triphosphate, 670 IU/L. Tumor markers (alpha-fetoprotein, carcinoembryonic antigen, protein induced by vitamin K absence or antagonist II) were within normal limits except carcinoembryonic antigen 199, 418.3 IU/mL. The computed tomography scan (Figure A) revealed hepatosplenomegaly and surface undulation of the liver, which represent alcoholic liver cirrhosis, and large bulging mass-like lesions (arrowheads) at segments I, IV, and V of the liver. Ascites was also noted. Sequential magnetic resonance imaging revealed mass-like enlargement of hepatic segments I, IV, and V, which were hyperintense on the in-phase (Figure B) and hypointense on opposed-phase (Figure C) chemical shift gradient echo images. These mass-like lesions showed no enhancement on contrast-enhanced dynamic studies. Ultrasonography-guided liver biopsy was performed with an 18-gauge gun needle. Obtained hepatic specimen included the area of hyperechoic mass-like lesion and adjacent hepatic parenchyma in segment V. Following pathologic examinations proved scattered neutrophils, severe fatty liver with hepatocyte swelling, and massive bilirubin pigment, which are consistent with alcoholic steatohepatitis (Figure D). Hepatic steatosis is frequently manifested in alcoholic liver disease with or without alcoholic hepatitis or cirrhosis. Even though the biopsy is considered the reference standard for assessment of hepatic steatosis, most patients do not undergo liver biopsy but are usually diagnosed as hepatic steatosis with ultrasonography.1 Ultrasonography is known as a routine noninvasive technique for the initial study of the liver in various clinical circumstances, but it still has severe diagnostic limitations, both in diffuse liver disease and in focal hepatic steatosis, that might lead to a misdiagnosis of hepatic mass.2 Especially in alcoholic liver disease, focal well-marginated fat deposit can be frequently diagnosed as hepatocellular carcinoma or its premalignant lesions such as regenerative or dysplastic nodules.1 Focal fatty deposition of the liver is usually a benign lesion that is developed by aberrant venous supply or focal metabolic change caused by perfusion decrease. It is usually represented as illdefined low attenuating lesions on computed tomography scan. For assessment of fatty accumulation of the liver, magnetic resonance imaging is widely used including chemical shift gradient echo imaging with in-phase and opposed-phase acquisitions.1,2 Hepatic steatosis might be present if there is a signal intensity loss on opposed-phase images in comparison with in-phase images, and the amount of hepatic fat present can also be quantified by assessing the degree of signal intensity loss.1 We can usually find the normal vascular structure that passes through the focal fatty deposition without distortion in contrast to true tumorous lesion (arrows in Figure A). Unlike at-containing lesions in other organs, the application of chemcal fat saturation sequences can be neither sensitive nor specific or the detection of fatty liver.1,2

Hybrid Procedure for Obstructive Neonatal Left Ventricular Tumors

We report the use of the hybrid procedure (bilateral pulmonary artery banding, ductal stenting followed by balloon atrial septostomy) in the first week of life for the treatment of two neonates with large left ventricular fibromas resulting in univentricular physiology. At 6 months of age, second-stage palliation was accomplished and the 2 patients are growing well with normal developmental milestones and no atrial or ventricular ectopy at 30 months. Hybrid strategy offers a less invasive, initial intervention and the options of typical second-stage univentricular palliation, conversion to biventricular physiology in cases of tumor regression, planned surgical resection, or transplantation.

The Prostate Needle Biopsy Gun: Busting a Myth

It is widely reported that a prostate biopsy gun needle advances 0.5 cm and then obtains the subsequent 1.5 cm of tissue. Based on this presumed skip area it is recommended that the needle tip must be placed 0.5 cm from the capsule before firing to obtain the capsule with the specimen. Contrary to this longstanding recommendation, in our experience we have observed that there is no such skip area. We determined the actual content of a needle core by obtaining biopsies from an apple model with clinical correlation to validate our findings. Using 3 types of spring-loaded biopsy needles we obtained 24 cores from an apple. We placed the biopsy needle tip directly adjacent to the capsule before firing the biopsy gun. Visual inspection of each biopsy core was done to confirm the presence or absence of the capsule (red apple peel). All cores had confirmed presence of the apple peel, confirming the absence of a skip area in the first 0.5 cm. Using spring-loaded biopsy guns we observed in an apple model that the capsule is obtained when the biopsy needle tip is placed directly adjacent to the capsule. Urologists placing the biopsy needle tip directly on the capsule in line with the projected trajectory will obtain the prostatic capsule in the specimen and should not withdraw the needle unless the gland depth is short enough so that there is risk of firing past the gland.

Large-needle percutaneous aspiration biopsy of the testicle in men with nonobstructive azoospermia

Two hundred thirteen testicular specimens of men with nonobstructive azoospermia were obtained by large-needle percutaneous aspiration biopsy. The mean values of the number of seminiferous tubules per histologic section, dimension, weight, and the fraction of biopsies with spermatogenetic cells (53, 0.2 x 0.3 x 0.62 cm, 385 mg, and 63%, respectively) were similar to those obtained by open or other surgical biopsy techniques that were used for assisted fertilization in the same type of patients.

Testicular biopty gun needle biopsy in collecting spermatozoa for intracytoplasmic injection, cryopreservation and histology.

Using testicular spermatozoa from either open biopsy (29 cycles) or biopty gun needle biopsy (49 cycles), a total of 81 intracytoplasmic sperm injection (ICSI) cycles among 57 couples were carried out from January, 1994 to September, 1997. In six cycles, no spermatozoa were obtained, and in three cycles spermatozoa from both needle and open biopsies were used. The fertilization (37% after open and 41% after needle biopsy) and pregnancy rates (29% per embryo transfer compared with 16% per embryo transfer) were similar after both open and needle biopsies. Five pregnancies were achieved among the 14 couples with non-obstructive azoospermia of the male partner, four of these after needle biopsy. It was possible to use cryopreserved testicular spermatozoa after both needle and open biopsies, and one pregnancy started after using cryopreserved testicular spermatozoa in both groups. Histological needle biopsy was carried out in 62 cases, and they were all diagnostic, giving 15-20 cross-sections of seminiferous tubuli per biopsy. Testicular needle biopsy using a 14 gauge biopsy needle gave a sufficient amount of tissue and spermatozoa for ICSI, cryopreservation and histology, even in non-obstructive azoospermia. This technique is simpler and cheaper than open biopsy and, hence, it can be regarded as the optimal method for the retrieval of testicular spermatozoa.

Yield and efficacy of biopty gun testis needle biopsy

Objectives. To assess whether a preliminary skin incision enhances diagnostic yield of percutaneous testis biopsy and to further evaluate the clinical efficacy of this procedure. Methods. A total of 45 men (67 testes) underwent testicular biopsy with two passes of a Biopty gun spring-loaded needle. Twenty-seven biopsies were performed without a preliminary skin incision (group 1), and 40 were performed after a small scrotal incision (group 2). In 56 testes, needle biopsy histopathologic diagnosis was compared with that of open biopsy or orchiectomy specimens from the same patient. Needle and surgical specimens were fixed in Bouin’s solution and sent separately for independent, blinded, histologic interpretation. Results. Complications of the procedure were negligible. In all 67 needle biopsies, specimen quality was adequate for histopathologic interpretation. The mean number of seminiferous tubules obtained from needle biopsy was 28% higher among patients having a preliminary skin incision (25.9) compared with those without (18.7, P = 0.023). Correlation between needle and open histopathologic diagnosis was excellent (55 of 56, 98%). Conclusions. A preliminary skin incision made before needle biopsy increases the diagnostic yield of percutaneous testis biopsy. Percutaneous testis biopsy using the Biopty gun needle provides equal diagnostic information when compared with open testis biopsy or orchiectomy specimens. The concomitant reduction in morbidity and cost make this an attractive diagnostic procedure.

Needle Biopsy Associated Tumor Tracking of Adenocarcinoma of the Prostate

We reviewed 350 previously biopsied completely submitted clinical stage B radical prostatectomy specimens resected between January 1, 1987 and December 31, 1988 in an attempt to identify the incidence of needle biopsy associated tumor tracking into periprostatic soft tissue. We identified 7 cases (2.0%) of needle biopsy associated tumor tracking, 3 in which the only tumor penetration in the gland was limited to the needle track. The maximal soft tissue extension from the biopsy site ranged from 0.1 to 1.2cm. and approached the nearest soft tissue margin to within 0.5mm. in 4 cases. In contrast to prior reports showing clinically evident tracking only with transperineal biopsies from high grade tumors, 6 of our 7 cases were of intermediate grade (in the glandular and tracking components) and 6 had transrectal biopsies. Needle biopsy associated tumor tracking occurred with core (14 gauge) and biopsy gun needles (18 gauge). An additional 13 cases (3.7%) showed some features of needle biopsy associated tumor tracking but they were equivocal. These findings have significant implications in light of recent proposals advocating serial mapping of prostate cancers using the biopsy gun with potential conservative observation of smaller tumors.