Image-guided Needle Biopsy Research Articles

Radial Scar at Image-guided Needle Biopsy: Is Excision Necessary?

Optimal management of a lesion yielding radial scar (RS) without epithelial atypia on breast biopsy is controversial. In this single-institution study spanning 17 years, 53 patients with this biopsy diagnosis were evaluated in terms of clinical, radiologic, and pathologic features and outcomes. RSs were categorized as either "incidental" or as the "targeted" lesion according to defined criteria. Of 48 patients who underwent surgical excision after a diagnosis of RS on biopsy, only 1 had an "upgrade" diagnosis of malignancy (2%). No "incidental" RS was associated with the presence of malignancy on surgical excision. Meta-analysis of 20 RS excision studies demonstrated an overall upgrade rate of 10.4%, with a higher rate in patients with a diagnosis of RS with atypia (26%). The upgrade rate for RS without atypia was 7.5% overall. The lower rate of upgrade to malignancy in this study (2%) is likely related to the thorough radiologic-pathologic review undertaken. In the setting of multidisciplinary agreement and careful radiologic-pathologic correlation, it may be appropriate for patients with a biopsy diagnosis of RS without atypia to forego surgical excision in favor of imaging follow-up.

Miliary Mottling on Chest X-ray: An Unusual Presentation of Adenocarcinoma of the Lung

A 71-year-old woman presented with dry cough and shortness of breath. She also reported significant weight loss and loss of appetite. She was a chronic smoker with chronic obstructive pulmonary disease. Her chest x-ray (Figure 1A) showed innumerable bilateral opacities in a miliary pattern with a superimposed more confluent juxtapleural opacity (short arrow) in the left lateral upper lung zone and bilateral hilar lymphadenopathy (long arrows). She was initially suspected for miliary tuberculosis. However, tuberculin skin test was negative. Computed tomographic scan of the chest revealed multiple noncalcified nodular opacities of varying sizes throughout the lungs (Figure 1B). Bronchial wash and transbronchial biopsy were not diagnostic. Computed tomography-guided needle biopsy of the left upper lung revealed invasive well-differentiated adenocarcinoma with bronchoalveolar features.

The clinical utility of multimodal MR image-guided needle biopsy in cerebral gliomas

Purpose: Our aim was to evaluate the diagnostic value of multimodal Magnetic Resonance (MR) Image in the stereotactic biopsy of cerebral gliomas, and investigate its implications. Materials and Methods: Twenty-four patients with cerebral gliomas underwent 1H Magnetic Resonance Spectroscopy (1H-MRS)- and intraoperative Magnetic Resonance Imaging (iMRI)-supported stereotactic biopsy, and 23 patients underwent only the preoperative MRI-guided biopsy. The diagnostic yield, morbidity and mortality rates were analyzed. In addition, 20 patients underwent subsequent tumor resection, thus the diagnostic accuracy of the biopsy was further evaluated. Results: The diagnostic accuracies of biopsies evaluated by tumor resection in the trial groups were better than control groups (92.3% and 42.9%, respectively, p = 0.031). The diagnostic yield in the trial groups was better than the control groups, but the difference was not statistically significant (100% and 82.6%, respectively, p = 0.05). The morbidity and mortality rates were similar in both groups. Conclusions: Multimodal MR image-guided glioma biopsy is practical and valuable. This technique can increase the diagnostic accuracy in the stereotactic biopsy of cerebral gliomas. Besides, it is likely to increase the diagnostic yield but requires further validation.

Imaging of renal masses and staging of renal tumours

• Renal masses are a common, often incidental finding on cross-sectional imaging. • Ultrasound can readily characterize a mass as solid or cystic. • The Bosniak classification is based on CT but can equally well be applied to MRI or contrast-enhanced ultrasound. • CT is the main method for staging renal cell carcinoma (RCC), with MRI used in specific indications, such as to assess the extent of venous involvement. • Most solid renal masses are assumed to be RCC, although approximately 20% of masses under 3 cm will be benign. • The seventh edition of the American Joint Committee on Cancer TNM staging for renal cancer has been presented. • An overview of the therapeutic options for renal cancer is discussed. Renal masses are commonly encountered in adult radiological practice, with a range of appearances from entirely cystic to solid. Characterization of more complex cystic masses is a challenge, to which the now considerably refined Bosniak classification has been applied. The Bosniak classification will be discussed in detail, with the role of ultrasound, CT and MR described. Dealing with the indeterminate masses presents an additional challenge, which is greatly aided by dedicated CT and MR protocols. Benign tumours of the kidney include angiomyolipomas and oncocytomas. Prior to surgery, it is not always possible to confidently define a lesion as benign, although certain features, such as focal fat, are important. Radiology plays a vital role in imaging renal cell carcinoma (RCC). These tumours account for approximately 90% of all malignant renal masses. The incidence of RCC is increasing, which, at least in part, is a consequence of the exponential increase in cross-sectional imaging. This has resulted in the identification of many incidental tumours, which overall are of a lower stage. The epidemiology, presentation and relevance of the various surgical options will be reviewed. The imaging modalities applied to staging will be discussed, with an emphasis on multidetector CT. The TNM staging classification in its most recently revised form is described, with discussion of the challenges this presents to cross-sectional imaging. The role of ultrasound, CT, MR and positron emission tomography-CT in imaging RCC will be discussed. The use of imaging-guided needle biopsy and percutaneous ablation in the management of RCC is addressed. A brief mention is made of other cases of malignant renal masses, including transitional cell carcinoma and lymphoma.

Percutaneous image-guided needle biopsy of clavicle lesions: a retrospective study of diagnostic yield with description of safe biopsy routes in 55 cases.

To assess the diagnostic yield and diagnostic accuracy of image-guided percutaneous needle biopsy of clavicle lesions and to analyse the diagnostic spectrum of clavicular lesions referred to a tertiary musculoskeletal oncology centre. To further describe safe biopsy routes for biopsy of the unique clavicle bone. A retrospective review of all patients who underwent an image-guided clavicle biopsy during the period from August 2006 to December 2013. A total of 52 patients with 55 consecutive biopsies were identified and included in the study. Image-guided percutaneous biopsy was performed using CT (n = 38) or ultrasound (n = 17). There were 23 males and 29 females, with a mean age of 40 years (range 2 to 87 years). Forty-six of the 55 biopsies (83.6 %) yielded a diagnostic sample and 9 (16.4 %) were non-diagnostic. Thirty of 46 (65.2 %) lesions were malignant and 16 (34.8 %) were benign/non-neoplastic. The most common malignant lesions were metastases, 22 of 30 (73.3 %), followed by primary tumours in 8 of 30 (26.7 %). The most common benign/non-neoplastic lesion was chronic recurrent multifocal osteomyelitis (4 of 16, 25 %) followed by Langerhans cell histiocytosis, epithelioid haemangioma and osteomyelitis (each with 2 of 16, 12.5 %). There was complete agreement between the needle and surgical histology specimen in 12 of 13 subjects (92.3 %). No post-biopsy complications were reported. Image-guided percutaneous biopsy has high diagnostic yield and accuracy and the described approaches are a safe means of biopsy for clavicle lesions.

Prognostic Factors of Tumour Cellularity in Image-Guided Biopsies: Results from a Prospective Molecular Triage Trial (Moscato)

ABSTRACT Aim: MOSCATO (molecular-screening for cancer treatment optimization) is a prospective molecular triage trial based on on-purpose tumour biopsies to perform molecular portraits. We aimed at identifying factors that predict a high cellularity in image-guided tumour biopsy. Methods: The percentage of tumour cells was evaluated on each biopsy sample. The primary endpoint was the maximum percentage of tumour cells across the different samples. All CT-scan images were centrally reviewed. Non-parametric tests were used to compare the distribution of the maximum percentage of tumour cells, between subsets of patients (pts). Paired samples (central vs. peripheral) were compared when multiple samples were obtained. Results: Among the 460 enrolled pts from November 2011 to March 2014, 335 pts (73%) had an image-guided needle biopsy of the primary tumour (n=39, 12%) or a metastatic lesion (n=296, 88%). Biopsies were performed on liver (n=127, 38%), lung (n=71, 21%), lymph nodes (n=71, 21%), bone (n=11, 3%), and other tumour sites (n=55, 16%). Sixteen pts (5.7%) experienced a complication: pneumothorax in 8 pts treated medically, and haemorrhage in 8 pts requiring embolisation in 3 cases. The median percentage of tumour cells was 50% (Q1-Q3, 30-70%). Age, gender, on-going chemotherapy, target origin (primitive vs. metastasis), number of lesions in the biopsied organ, target lesion size, tumour growth rate, presence of necrosis and size of the needle were not statistically related to a high cellularity (P Conclusions: The majority of tumour biopsies provided molecular screening efficiency with a low rate of complications. Imaging modality used to guide to the biopsy, multiple samples, peripheral and central, and the chosen organ were the prognostic factors of cellularity. Disclosure: All authors have declared no conflicts of interest.

A prospective study of biomarker-guided chemotherapy in patients with non-small cell lung cancer.

Purpose To assess the therapeutic value of biomarker-guided chemotherapy in patients with advanced non-small cell lung cancer (NSCLC).MethodsEighty-five NSCLC patients at stage IIIb or IV were divided into two groups based on the feasibility of biomarker analysis. Group A included patients with biomarker data (n = 41); Group B were patients without biomarker results (n = 44). Tumor samples obtained by fiberoptic bronchoscopy and computerized tomography-guided needle biopsy were analyzed by immunohistochemistry for intratumoral level of excision repair cross-complementing gene 1 (ERCC1), ribonucleotide reductase M1 (RRM1), and β-tubulin III. Chemotherapy regimens in Group A were determined according to the status of molecular signatures, whereas a standard gemcitabine plus cisplatin regimen was used for Group B. Tumor response, patient survival, and adverse effects were monitored for both groups.ResultsThe overall response rate, defined as complete response plus partial response, was 56.1 % for Group A, significantly higher than that in Group B (31.8 %; P = 0.024). The median progression-free survival (PFS) time was 5.2 months for Group A, significantly longer than that of Group B (4.1 months; P = 0.026). The 1-year survival rate of Group A was 65.9 %, significantly higher than that of Group B (40.9 %; P = 0.021), whereas the median overall survival times were 13.5 versus 12.5 months for Groups A and B, respectively (P = 0.483). The adverse effects in the two groups were essentially the same.ConclusionsBiomarker-tailored chemotherapy based on ERCC1, RRM1, and β-tubulin III expression showed significantly increased response rate, median PFS time, and 1-year survival rate in patients with NSCLC.

How safe is curettage of low-grade cartilaginous neoplasms diagnosed by imaging with or without pre-operative needle biopsy?

The pre-operative differentiation between enchondroma, low-grade chondrosarcoma and high-grade chondrosarcoma remains a diagnostic challenge. We reviewed the accuracy and safety of the radiological grading of cartilaginous tumours through the assessment of, first, pre-operative radiological and post-operative histological agreement, and second the rate of recurrence in lesions confirmed as high-grade on histology. We performed a retrospective review of major long bone cartilaginous tumours managed by curettage as low grade between 2001 and 2012. A total of 53 patients with a mean age of 47.6 years (8 to 71) were included. There were 23 men and 30 women. The tumours involved the femur (n = 20), humerus (n = 18), tibia (n = 9), fibula (n = 3), radius (n = 2) and ulna (n = 1). Pre-operative diagnoses resulted from multidisciplinary consensus following radiological review alone for 35 tumours, or with the addition of pre-operative image guided needle biopsy for 18. The histologically confirmed diagnosis was enchondroma for two (3.7%), low-grade chondrosarcoma for 49 (92.6%) and high-grade chondrosarcoma for two (3.7%). Three patients with a low-grade tumour developed a local recurrence at a mean of 15 months (12 to 17) post-operatively. A single high-grade recurrence (grade II) was treated with tibial diaphyseal replacement. The overall recurrence rate was 7.5% at a mean follow-up of 4.7 years (1.2 to 12.3). Cartilaginous tumours identified as low-grade on pre-operative imaging with or without additional image-guided needle biopsy can safely be managed as low-grade without pre-operative histological diagnosis. A few tumours may demonstrate high-grade features histologically, but the rates of recurrence are not affected.

The utility of image-guided percutaneous needle aspiration biopsy for the diagnosis of spontaneous vertebral osteomyelitis: a systematic review and meta-analysis

Background contextSpontaneous vertebral osteomyelitis (SVOM) is mostly acquired via hematogenous seeding. Diagnosis of SVOM is often delayed because of the insidious nature and rarity of this disease. The microbiological yield of image-guided needle biopsy varies between 36% and 91%. The utility and accuracy of this procedure have not been systematically reviewed. PurposeTo systematically review and assess the diagnostic accuracy of image-guided spinal biopsy for SVOM in adults when compared with combined reference standards. Study designA systematic review and meta-analysis. SampleSeven retrospective studies involving 482 patients with clinical and/or radiologic suspicion of SVOM who underwent image-guided spinal biopsy were included. Outcome measuresThe primary outcome measure was diagnostic odds ratio (DOR). Other outcomes included likelihood ratio of a positive test (LRP), likelihood ratio of a negative test (LRN), sensitivity, and specificity. MethodsWe searched in six medical databases through September 1, 2013 for studies evaluating the performance of image-guided spinal biopsy for SVOM with no limits on language or publication date. Combined reference standards, which included histopathologic findings consistent with vertebral osteomyelitis, identifications of pathogens from open surgery and/or blood cultures, and/or evidence of clinical and radiologic improvement after empiric antimicrobial therapy, were used for comparison. The random-effect model was used for meta-analysis. Two reviewers independently selected the studies. ResultsThree hundred fifty-eight potentially relevant studies were identified. Seven studies were included in our analysis. Two studies that used only single reference standard were excluded in the sensitivity analysis, and five studies involving 352 patients were pooled. Image-guided spinal biopsy had a DOR of 45.50 (95% confidence interval [CI], 13.66–151.56), an LRP of 16.76 (95% CI, 5.51–50.95), an LRN of 0.39 (95% CI, 0.24–0.64), a sensitivity of 52.2% (95% CI, 45.8–58.5), and a specificity of 99.9% (95% CI, 94.5–100). This is based on the assumption that combined reference standards are a valid standard for comparison. ConclusionsImage-guided spinal biopsy is highly specific and performs well in predicting SVOM, but has a moderate accuracy for ruling out this diagnosis. This procedure should be considered in the diagnostic work-up of adults suspected with SVOM.

Open versus needle biopsy in diagnosing neuroblastoma

BackgroundOpen surgical biopsy is traditionally advocated prior to initiating therapy in UKCCLG neuroblastoma protocols. We report a single centre experience comparing the utility of open biopsy vs image guided needle biopsy in aiding the definitive diagnosis and risk stratification of neuroblastoma – (Shimada classification, MYCN expression, cytogenetics – 1p 11q, 17 q). MethodsMedical records of all new cases of neuroblastoma presenting to a single UKCCLG centre during January 2002–July 2013 were examined. ResultsThirty nine patients underwent a biopsy of primary tumour for neuroblastoma during the study. Twenty one children had open biopsy and eighteen cases had a needle biopsy. Staging of neuroblastoma revealed - stage 4 (n=26), stage 3 (n=7), stage 2 (n=3) and stage 4S (n=3). Sites of primary tumour were adrenal gland (n=20), abdomen (n=12), thoracic (n=4), abdomino-thoracic (n=2) and abdomino pelvic regions (n=1). All patients (open vs needle) had adequate tissue retrieved for histological diagnosis of neuroblastoma. One needle and one open biopsy case did not have MYCN status determined despite adequate tissue sampling. Seventeen patients (7 open and 10 needle biopsies) had 1p and 17q status reported in MLPA testing (Multiplex Ligation-dependent Probe Amplification). No single patient required a repeat tumour biopsy. Morbidity in the series was minimal with only one child – open biopsy group, requiring emergent laparotomy to control bleeding from an abdominal primary tumour. No complications were recorded with needle biopsy. ConclusionsOpen and image guided needle biopsy appear to yield adequate tissue sampling for diagnosis, risk classification and staging of neuroblastoma. Further larger co-operative studies may usefully guide national and international protocols.

Intrapulmonary recurrence after computed tomography-guided percutaneous needle biopsy of stage I lung cancer.

Tumor seeding, along the needle tract after percutaneous needle biopsy, is a rare condition and most of the reported cases are implantation metastasis, which occurred in the chest wall or the pleura. We present a case of implantation metastasis that occurred in the pulmonary parenchyma, after a computed tomography-guided percutaneous needle biopsy (CT-PNB) of stage I lung cancer.

Trends and safety of image-guided percutaneous pleural biopsies in cancer patients.

6608 Background: Image-guided percutaneous pleural needle biopsy (IGPPB) is an important tool in the diagnosis and management of cancer patients. Complications of IGPPB include pneumothorax and che...

Complications From Computed Tomography–Guided Core Needle Biopsy for Patients Receiving Stereotactic Body Radiation Therapy for Early-Stage Lesions of the Lung

BackgroundObtaining a tissue diagnosis has traditionally been standard practice before initiating therapy for early-stage non–small-cell lung cancer (NSCLC). In several recent studies from Europe and Asia, a substantial proportion of patients have received stereotactic body radiation therapy (SBRT) based only on the imaging characteristics of the suspicious lesion. The underlying assumption is that the risk of percutaneous needle biopsy may outweigh the benefits in a population that generally has underlying pulmonary dysfunction and other medical comorbidity. Nevertheless, there is limited information regarding biopsy-related complication rates in high-risk patients with early-stage NSCLC who are treated with SBRT. Materials and MethodsThis was a retrospective review of outcomes after biopsy in patients treated with SBRT. Complications of percutaneous core needle biopsy were analyzed in relation to patient and tumor characteristics. Each biopsy event was analyzed independently for patients with multiple biopsies. ResultsA total of 112 percutaneous biopsies were performed in 103 patients. Pneumothorax of any degree was observed in 40 patients (35%) (95% CI, 27%-45%), and 12 patients (10.7%) had a clinically significant pneumothorax requiring chest tube placement (95% CI, 6%-18%). The time to first fraction of SBRT was not different in patients who had a pneumothorax or placement of a chest tube. On multivariate analysis, age, performance status, smoking history, pack-years of smoking, chronic obstructive pulmonary disease history, and forced expiratory volume in the first second of expiration were not statistically significantly associated with chest tube placement. ConclusionComputed tomography–guided needle biopsy in a primarily medically inoperable patient population is safe, with an acceptable degree of complications.

Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method

Intraorbital tumours are often undetected for a long period and may lead to compression of the optic nerve and loss of vision. Although CT, MRI's and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal lesions this may prove especially difficult as the expansions are situated next to sensitive anatomical structures (eye bulb, optic nerve). In search of a minimally invasive access to the intraconal region, we describe a method of a three-dimensional, image-guided biopsy of orbital tumours using a combined technique of hardware fusion between 18F-FDG Positron Emission Tomography (18F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT). Method and materialWe present 6 patients with a total of 7 intraorbital lesions, all of them suffering from diplopia and/or exophthalmos. There were 3 female and 3 male patients. The patients age ranged from 20 to 75 years. One of the patients showed beginning loss of vision. Another of the patients had lesions in both orbits. The decision to obtain image-guided needle biopsies for treatment planning was discussed and decided at an interdisciplinary board comprising other sub-specialities (ophthalmology, neurosurgery, maxillofacial surgery, ENT, plastic surgery). All patients underwent 3D imaging preoperatively (18F-FDG PET/CT or 18F-FDG PET/CT plus MRI). Data was transferred to 3D navigation system. Access to the lesions was planned preoperatively on a workstation monitor. Biopsy-needles were then calibrated intraoperatively and all patients underwent three-dimensional image-guided needle biopsies under general anaesthesia. Results7 biopsies were performed. The histologic subtype was idiopathic orbital inflammation in 2 lesions, lymphoma in 2, Merkel cell carcinoma in 1, hamartoma in 1 and 1 malignant melanoma. The different pathologies were subsequently treated in consideration of the actual state of the art. In cases where surgical removal of the lesion was performed the histological diagnosis was confirmed in all cases. ConclusionThere is a wide range of possible treatment modalities for orbital tumours depending on the nature of the lesion. Histological diagnosis is mandatory to select the proper management and operation. The presented method allows minimal-invasive biopsy even in deep intraconal lesions, enabling the surgeon to spare critical anatomical structures. Vascular lesions such as cavernous haemangioma, tumour of the lacrimal gland or dermoid cysts present a contraindication and have to be excluded.

Computed tomography-guided needle biopsy of lung lesions: is fine needle aspiration really more accurate than core needle biopsy?

Computed tomography-guided needle biopsy of lung lesions: is fine needle aspiration really more accurate than core needle biopsy?

Response to “Computed tomography-guided needle biopsy of lung lesions: is fine needle aspiration really more accurate than core needle biopsy?”

Response to “Computed tomography-guided needle biopsy of lung lesions: is fine needle aspiration really more accurate than core needle biopsy?”

Quality Gaps and Comparative Effectiveness in Lung Cancer Staging: The Impact of Test Sequencing on Outcomes

Evidence-based guidelines recommend mediastinal sampling as the first invasive test in patients with suspected lung cancer and mediastinal adenopathy. The goal of this study was to assess practice patterns and outcomes of diagnostic strategies in this patient population. We conducted a retrospective analysis of all patients in 2009 who had mediastinal adenopathy without distant metastatic disease to determine whether guideline-consistent care was delivered. Guideline-consistent care was defined as mediastinal lymph node sampling being performed as part of the first invasive procedure. One hundred thirty-seven patients were included. Guideline-consistent care was provided in 30 cases (22%). Patients receiving guideline-consistent care had fewer invasive tests than patients with guideline-inconsistent care (1.3 ± 0.5 tests/patient vs 2.3 ± 0.5 tests/patient, respectively; P < .0001) and fewer complications (0 of 30, 0% vs 18 of 108, 17%; P = .01). Most of the complications (16 of 18) were related to CT image-guided needle biopsy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was sufficient to guide treatment decisions without any other invasive tests in 88 patients (64%). Although not all the complications and costs due to CT image-guided biopsies could have been avoided, roughly two-thirds could have been eliminated by just changing the testing sequence. Quality gaps in lung cancer staging in patients with mediastinal adenopathy are common and lead to unnecessary testing and increased complications. In patients with suspected lung cancer without distant metastatic disease with mediastinal adenopathy, EBUS-TBNA should be the first test.

Multimodal non-linear optical imaging for label-free differentiation of lung cancerous lesions from normal and desmoplastic tissues

Lung carcinoma is the leading cause of cancer-related death in the United States, and non-small cell carcinoma accounts for 85% of all lung cancer cases. One major characteristic of non-small cell carcinoma is the appearance of desmoplasia and deposition of dense extracellular collagen around the tumor. The desmoplastic response provides a radiologic target but may impair sampling during traditional image-guided needle biopsy and is difficult to differentiate from normal tissues using single label free imaging modality; for translational purposes, label-free techniques provide a more promising route to clinics. We thus investigated the potential of using multimodal, label free optical microscopy that incorporates Coherent Anti-Stokes Raman Scattering (CARS), Two-Photon Excited AutoFluorescence (TPEAF), and Second Harmonic Generation (SHG) techniques for differentiating lung cancer from normal and desmoplastic tissues. Lung tissue samples from patients were imaged using CARS, TPEAF, and SHG for comparison and showed that the combination of the three non-linear optics techniques is essential for attaining reliable differentiation. These images also illustrated good pathological correlation with hematoxylin and eosin (H&E) stained sections from the same tissue samples. Automated image analysis algorithms were developed for quantitative segmentation and feature extraction to enable lung tissue differentiation. Our results indicate that coupled with automated morphology analysis, the proposed tri-modal nonlinear optical imaging technique potentially offers a powerful translational strategy to differentiate cancer lesions reliably from surrounding non-tumor and desmoplastic tissues.

Rib osteoblastoma as an incidental finding in a patient with adolescent idiopathic scoliosis

The purpose of this article is to present an unreported case of rib osteoblastoma associated with progressive adolescent idiopathic scoliosis and to discuss thoracogenic scoliosis as a potential cause of curve progression after tumor resection. An 11-year and 8-month-old girl with adolescent idiopathic scoliosis was referred with an incidental finding of an expansile lesion in the posterior left seventh rib. A computed tomography-guided needle biopsy established the diagnosis of benign osteoblastoma. Transarterial embolization was performed followed by wide resection. Sixteen months after surgery the patient underwent posterior spinal fusion to address her scoliosis progression during the growth spurt. Forty-one and 25 months after rib resection and spinal fusion, respectively, the patient remains asymptomatic, without local tumor recurrence, and with excellent correction of her spinal deformity. Although scoliosis secondary to rib osteoblastoma has been described in the literature, rib osteoblastoma may coexist with idiopathic scoliosis. In such a case, surgical management of osteoblastoma should not interfere with treatment of idiopathic scoliosis.

Pleural recurrence after surgery for pleomorphic adenoma arising from peripheral lung: computed tomography-guided percutaneous needle biopsy as a possible mechanism of local failure

A 75-year-old male was referred to our hospital because of an abnormal shadow found in the right lung 2 years prior that had been increasing in size. Chest computed tomography showed a 1-cm well-defined nodule in the periphery of the right middle lobe. Although a computed tomography-guided percutaneous needle biopsy was performed, the results were indeterminate. In observations over the course of 1 year, the tumor size increased. Surgical resection was finally performed for diagnosis and treatment, and histological findings revealed a pulmonary pleomorphic adenoma. 2 years after surgery, pleural dissemination unfortunately developed. We present here a case of recurrence as pleural dissemination despite complete resection of a pulmonary pleomorphic adenoma arising from peripheral lung tissue. There is a possibility that the local failure is related to percutaneous needle biopsy.