Image-guided Percutaneous Core Needle Biopsy Research Articles

Abstract PO5-07-09: ACCURACY OF STEREOTACTIC VACCUM-ASSISTED BREAST BIOPSY FOR INVESTIGATING SUSPICIOUS CALCIFICATIONS IN 2,021 PATIENTS A PUBLIC HOSPITAL IN BRAZIL

Abstract Backgroud: the gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation. Vacuum-assisted stereotactic biopsy (VASB) was developed to overcome some of these negative aspects of core-needle biopsy. Objectives: to evaluate the accuracy of vacuum-assisted stereotactic biopsy (VASB) in the investigation of non palpable suspicious calcifications. Methods: it was a retrospective study from July 2012 to December 2020, in which 2,021 women with suspicious calcifications detected on mammography (BI-RADS 4 and 5) had VASB performed at Hospital Estadual Pérola Byington, São Paulo, Brazil. Fragments were obtained and sent to anatomopathological study; a metal clip was placed on the biopsy site. Four groups were analyzed, based on the biopsy results: benign, precursor lesions, Ductal Carcinoma In Situ (DCIS) and Invasive Ductal Carcinoma (ICD). Results: patients median age was 55y (49-63y). Pathology results on VASB were classified respectively as benign n=1,340 (66.3%), precursor lesions n=84 (4.1%), DCIS n=441 (21.8%) and ICD n=156 (7.7%). The 60 patients with results benign on VASB, because anatomopathological disagreement, surgery was performed, with the following results: benign n=30 (50%), ICD e DCIS n=21 (35%) e precursor lesions n=9 (15%). The sensitivity of the method was 91.7 %, specificity was 97.1%, false negative rate was 3%, positive predictive value was 92.4%, negative predictive value was 96.9%. Conclusion: the VASB method has a good accuracy to distinguish lower and higher risk lesions groups comparing to the gold standard. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. Keywords: Calcifications; Vacuum-assisted stereotactic biopsy; Breast cancer; Diagnosis. Citation Format: Andressa Amorim, Andre Mattar, Marcelo Antonini, Reginaldo Coelho Lopes, Luciana Damous, Luiz Henrique Gebrim, Marina Diogenes, Marcellus Ramos. ACCURACY OF STEREOTACTIC VACCUM-ASSISTED BREAST BIOPSY FOR INVESTIGATING SUSPICIOUS CALCIFICATIONS IN 2,021 PATIENTS A PUBLIC HOSPITAL IN BRAZIL [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-07-09.

Ultrasound Guided Biopsy among Patients with Lung Lesions Undergoing Procedures in Interventional Radiology of a Tertiary Care Centre.

Minimally invasive image-guided percutaneous core needle biopsy can obtain tissue samples for diagnosis of subpleural lung cancer, which is crucial for the correct management of lung lesions. Common complications of lung biopsy include pneumothorax, parenchymal haemorrhage and haemoptysis. The study aimed to determine the prevalence of ultrasound-guided biopsy among patients with lung lesions undergoing procedures in interventional radiology of a tertiary care centre. A descriptive cross-sectional study was performed in the Department of Radiology and Imaging from 1 August 2018 to 30 September 2019 after obtaining ethical approval from the Institutional Review Committee. USG-guided biopsy of peripheral lung lesions was performed with an 18 gauge semiautomatic biopsy instrument and a 17 gauge coaxial needle. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 188 biopsy of lung lesions, ultrasound-guided biopsies were performed in 28 (14.89%) (9.80-19.98, 95% Confidence Interval). The prevalence of ultrasound guided biopsy among lung lesions is lower than other studies done in similar settings. biopsy; interventional radiology; lung neoplasms; prevalence.

The morbidity of open tumor biopsy for intraabdominal neoplasms in pediatric patients.

Tumor biopsy is often essential for diagnosis and management of intraabdominal neoplasms found in children. Open surgical biopsy is the traditional approach used to obtain an adequate tissue sample to guide further therapy, but image-guided percutaneous core-needle biopsy is being used more often due to concerns about the morbidity of open biopsy. We used a national database to evaluate the morbidity associated with open intraabdominal tumor biopsy. We identified all patients undergoing laparotomy with tumor biopsy in the National Surgical Quality Improvement Project-Pediatric (NSQIP-P) database from 2012 to 2018 and measured the frequency of complications in the 30days postoperatively. We tested associations between patient characteristics and outcomes to identify risk factors for complications. We identified 454 patients undergoing laparotomy for biopsy of an intraabdominal neoplasm. Median postoperative hospital stay was 7days (IQR 4-12) and operative time was 117min (IQR 84-172). The overall complication rate was 12.1%, with post-operative infection (6%) and bleeding (4.2%) being the most common complications. Several patient characteristics were associated with bleeding, but the only significant association on multivariable analysis was underlying hematologic disorder. Open abdominal surgery for pediatric intraabdominal tumor biopsy is accompanied by significant morbidity. Postoperative infection was the most common complication, which can delay initiation of further therapy, especially chemotherapy. These findings support the need to prospectively compare percutaneous image-guided core-needle biopsy to open biopsy as a way to minimize risk and optimize outcomes for this vulnerable population.

Analysis of factors affecting the diagnostic yield of image-guided percutaneous core needle biopsy for peritoneal/omental lesions.

To evaluate the diagnostic yield, safety, and factors associated with the diagnostic yield of percutaneous core needle biopsy (PNB) for peritoneal/omental lesions. Consecutive 297 patients (67 men, 230 women; median age, 64years [range 15-87]) who underwent a PNB for 311 peritoneal/omental lesions at a single center from April 2010 to March 2020 were evaluated retrospectively. The preprocedural CT findings, diagnostic yield, sensitivity, specificity, PPV, NPV, technical success rate, and adverse events were analyzed. Surgical or clinical diagnosis with follow-up was the diagnostic reference standard. Adverse events were evaluated using the Society of Interventional Radiology guidelines. The median anteroposterior (AP) diameter and CT value of the target lesion were 24mm (range 5-78) and 46 HU (range -75 to 140), respectively. Ascites was interposed on the puncture route in 106 patients (34.1%). The technical success rate was 100%. The diagnostic yield, sensitivity, specificity, PPV, and NPV were 93.9%, 93.8%, 100%, 100%, and 20.8%, respectively. Minor complications were observed following five procedures (1.6%). The diagnostic yield was lower for fat-dominant lesions than for other lesions (82.6% vs. 95.8%, p = 0.002). The diagnostic PNB group had a greater AP diameter than did the non-diagnostic PNB group (27.3 ± 13.0 vs. 20.7 ± 8.4mm, p = 0.037). PNB for peritoneal/omental lesions provided a sufficiently high diagnostic yield and minimal adverse events. Lesions with a greater AP diameter and a higher density on CT would provide more diagnostic specimens from this technique.

Diagnostic yield and accuracy of image-guided percutaneous core needle biopsy of paediatric solid tumours: An experience from Italy

BackgroundPercutaneous core needle biopsy (PCNB) has become an accepted method to collect tumour tissue samples given its safety, minimal invasiveness, high accuracy and cost-effectiveness. ProcedureIt is a single centre, retrospective evaluation of 213 ultrasound (US) or computed tomography (CT) guided PCNBs of paediatric solid tumours performed from 2005 to 2017. Safety, diagnostic yield, accuracy, and efficacy assessments of the PCNB procedure were performed. Univariate logistic models were applied to assess the relation of the diagnostic yield with patient, procedure and lesion features. ResultsThe image-guide was US in 91.08% of biopsies; the needle gauge was ≥16 G in 69.01% of the biopsies. The anatomical site of lesion was deep in 113 biopsies (53.05%). The nature of the lesion was the only factor associated with diagnostic yield (OR: 4.04; 95% CI 1.23–13.28; p: 0.022), with benign lesion as an unfavourable factor. Complication incidence was 1.41%. Overall, the diagnostic yield of PCNB was 93.90% (95% CI: 89.79-96.71%), the diagnostic accuracy was 96.86% (95% CI: 93.29–98.84%) and the diagnostic efficacy was 93.33% (95% CI: 86.75–97.28%). Sensitivity was 97.94% (95% CI: 92.75–99.75%) and specificity 100% (95% CI: 66.37–100%). ConclusionPCNB can be recommended as the first-choice method for solid tumours diagnosis in paediatric, adolescent and young adult patients because of its high diagnostic success, safety and accessibility.

Optimization of percutaneous biopsy for diagnosis and pretreatment risk assessment of neuroblastoma.

Image-guided percutaneous core needle biopsy (PCNB) is increasingly utilized to diagnose solid tumors. The objective of this study is to determine whether PCNB is adequate for modern biologic characterization of neuroblastoma. A multi-institutional retrospective study was performed by the Pediatric Surgical Oncology Research Collaborative on children with neuroblastoma at 12 institutions over a 3-year period. Data collected included demographics, clinical details, biopsy technique, complications, and adequacy of biopsies for cytogenetic markers utilized by the Children's Oncology Group for risk stratification. A total of 243 children were identified with a diagnosis of neuroblastoma: 79 (32.5%) tumor excision at diagnosis, 94 (38.7%) open incisional biopsy (IB), and 70 (28.8%) PCNB. Compared to IB, there was no significant difference in ability to accurately obtain a primary diagnosis by PCNB (95.7%vs 98.9%, P=.314) or determine MYCN copy number (92.4%vs 97.8%, P=.111). The yield for loss of heterozygosity and tumor ploidy was lower with PCNB versus IB (56.1%vs 90.9%, P<.05; and 58.0%vs. 88.5%, P<.05). Complications did not differ between groups (2.9 % vs 3.3%, P=1.000), though the PCNB group had fewer blood transfusions and lower opioid usage. Efficacy of PCNB was improved for loss of heterozygosity when a pediatric pathologist evaluated the fresh specimen for adequacy. PCNB is a less invasive alternative to open biopsy for primary diagnosis and MYCN oncogene status in patients with neuroblastoma. Our data suggest that PCNB could be optimized for complete genetic analysis by standardized protocols and real-time pathology assessment of specimen quality.

Oncologic Accuracy of Image-guided Percutaneous Core-Needle Biopsy of Peripheral Nerve Sheath Tumors at a High-volume Sarcoma Center.

Peripheral nerve sheath tumors (PNSTs) are clinically heterogenous, comprising benign (BPNST) and malignant (MPNST) variants. BPNSTs can be managed with nerve-sparing excision or observation. MPNSTs require radical resection and multidisciplinary oncologic management (1, 15). Image-guided core-needle biopsy (IGCNBx) is the well-established standard to obtain preoperative tissue diagnosis of soft tissue tumors. However, there has been resistance to performing IGCNBx of PNSTs because of the presumed risk of nerve injury and unknown accuracy in determining malignancy. We sought to define the accuracy and safety of IGCNBx in PNSTs. All patients that underwent both IGCNBx and surgical resection of a PNST at our institution between 2002 and 2016 were analyzed. The accuracy of IGCNBx in determining malignancy was calculated, including subgroup analyses by histologic subtype and neurofibromatosis 1 status. Complication data were collected and analyzed. Among the 78 PNSTs with IGCNBx and postresection surgical pathology, 76% (n=59) had BPNST and 24% (n=19) had MPNST on postresection surgical pathology. IGCNBx accurately determined malignancy in 94% of cases. IGCNBx demonstrating schwannoma or MPNST were 100% accurate in determining malignancy. IGCNBx demonstrating neurofibroma or indeterminate results were 33% and 57% malignant on postresection surgical pathology, respectively. There were no long-term complications, including sensory or motor deficits, from IGCNBx. Percutaneous IGCNBx demonstrates 94% accuracy in differentiating benign from malignant PNSTs. IGCNBx demonstrating neurofibroma or indeterminate pathology should be interpreted with caution because of risk of malignant reclassification on surgical pathology. Our results reaffirm the safety of IGCNBx, as no patients experienced long-term complications.

Basic Knowledge in Soft Tissue Sarcoma.

Sarcoma is rare and heterogenous with various subtypes having a different prognostic. Desmoid is a tumour with a local aggressiveness; GIST with KIT mutation responds massively to target treatment as IMATINIB, whereas soft tissue sarcoma and leiomyosarcoma are very aggressive with poor response to systemic therapies. Interventional radiology plays an important role in the diagnosis of sarcomas with image-guided percutaneous core needle biopsy being the most commonly used biopsy technique in the diagnosis of sarcomas. Biopsy access routes discussed with the surgeon, and skin access is tattooed. Surgery is a mainstay of sarcoma treatment; the resection can be large. Indeed, resection objective is R0 because quality of surgical margins impacts local control and survival. Radiotherapy is possible in neoadjuvant or in adjuvant treatment to improve local control rate. Recently radiotherapy enhancer injected percutaneously in soft tissue sarcoma has proven benefit in increasing the rate of R0 complete surgical resection. Several studies showed better local control rate linked with post-operative radiotherapy. In patients affected by oligometastatic disease, complete surgical resection of all metastatic sites is in fact considered the primary treatment because complete remission is critical for cure. The decision making to use local therapies is complex, depends upon diverse presentations and histologies, and should always be taken in a multidisciplinary discussion. Today, percutaneous image-guided treatments with ablation technologies (radiofrequency ablation, cryotherapy, microwaves ablation) provide high rate of durable local control for small-sized malignant deposit in many organs including lung, liver and bones. Sarcoma must be managed by multimodality treatment in expert reference centres. Such management has a considerable impact on the prognosis.

Abstract P3-04-01: The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital

Abstract Background: The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Stereotactic vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up, especially when stereotactic VABB is used to investigate microcalcifications. This method is expensive but cost effective when used to investigate microcalcifications classified as BI-RADS 4 and 5. Methodology: We performed a review in 1,354 patients with suspicious mammography microcalcifications, classified as BI-RADS 4 or 5 that were seen in Perola Byington Hospital from July 2012 to July 2017 in São Paulo-Brazil. We have used aHologic Lorad Multicare Platinum Stereotactic Prone Breast Biopsy and a Surus Pearl (Hologic, Malbolrough, Massachusetts, USA), with gauge 9 probe. Four to eight fragments (median of 6) were obtained with the placement of a metal clip in the bed that the biopsy was performed, and histopathological analysis was made. Results:The histopathological study of the lesions revealed benign alterations in 956 (68%) of our patients. The findings were positive for malignancy in 358 patients (29%) and the precursor lesions were diagnosed in 40 (3%). In 81 cases (5.9%) the findings were discordant. The sensitivity of the method was 84.4%, specificity was 96.1%, false negative rate was 4.5%, positive predictive value (PPV) was 89.8%, negative predictive value (NPV) was 93.8%. In literature review the sensitivity varies 91.5-100%, specificity 81.9-110%, false negative rate 0-3.3%, PPV 92.2-100% and NPV 80.5-99.5%. All patients with positive or discordant cases underwent surgical treatment to increase the margin or complete removal of the lesion. Conclusions: The VABB is an outpatient procedure that avoids hospital admissions for diagnostic elucidation in most of cases suspected of malignancy. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. In addition to presenting the cost lower than the surgical biopsy it indirect increases the supply of hospital beds for cancer treatment. Citation Format: Mattar A, Amorim AG, Ramos MdNM, Shida JY, Fonseca GR, Hegg R, Gebrim LH. The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-04-01.

Diagnostic Outcome of Image-Guided Percutaneous Core Needle Biopsy of Sclerotic Bone Lesions: A Meta-Analysis.

This systematic review and meta-analysis aimed to evaluate the diagnostic outcome (diagnostic yield and accuracy) of image-guided percutaneous core needle biopsy (CNB) of sclerotic bone lesions. A computerized search of the PubMed and EMBASE databases was performed to identify relevant original articles on the use of image-guided percutaneous CNB of sclerotic bone lesions. The pooled proportions of the diagnostic yield and pooled accuracy estimates were assessed using random-effects modeling. We also performed subgroup analyses of the diagnostic yield according to the drill systems (battery-powered vs manual). Heterogeneity among studies was determined using the inconsistency index (I2). Meta-regression analyses were performed to evaluate the potential sources of heterogeneity. Fifteen eligible studies, involving 969 sclerotic bone lesions for diagnostic yield, and 242 sclerotic bone lesions for diagnostic accuracy, were included. The pooled proportion of the diagnostic yield of image-guided percutaneous CNB of sclerotic bone lesions was 74% (95% CI, 62-84%), and the pooled accuracy estimate for differentiation between benign and malignant lesions was 87% (95% CI, 77-93%). In the subgroup analysis, the pooled proportion of the diagnostic yield of the battery-powered drill system (76.7% [95% CI, 64.0-85.8%]) was higher than that of the manual drill system (65.2% [95% CI, 58.0-71.8%]). In the meta-regression analyses, no variables were significantly different (p = 0.13-0.93). In conclusion, we determined that image-guided percutaneous CNB of sclerotic bone lesions is an accurate diagnostic technique with good diagnostic yield, particularly when the battery-powered bone biopsy system is used.

Evaluation of a Soft Tissue Mass in the Extremity or Trunk

Soft tissue sarcoma (STS) represents a diverse group of malignant tumors derived from mesenchymal elements. Evaluation of a soft tissue mass of the trunk or extremity starts with a detailed history and physical examination, which will help guide further diagnostic evaluation. Imaging should then be obtained for an STS, with MRI being the preferred modality for the trunk or extremities. Imaging can assist with diagnosis and delineate the extent of the primary lesion, including the relationship to contiguous structures, for treatment planning and assessing resectability. Pathology diagnosis is most commonly performed via examination of a specimen obtained through image-guided percutaneous core-needle biopsy. This requires multidisciplinary planning between Surgery and Radiology to place the needle within the anticipated definitive surgical incision to allow for en bloc resection of the needle tract. Once the diagnosis of an STS is made, appropriate staging studies should be performed based on the history and physical examination and tumor histology, grade, and size. Clinical and pathology data are used to stage STS patients using the American Joint Committee on Cancer staging system, which incorporates the STS site, size and grade of the primary tumor, and absence or presence of nodal and distant metastatic disease. This review contains 6 figures, 6 tables and 50 references Key words: core-needle biopsy, extremity, histology, imaging, risk factors, soft tissue mass, soft tissue sarcoma, staging evaluation, trunk, tumor grade

Evaluation of a Soft Tissue Mass in the Extremity or Trunk

Soft tissue sarcoma (STS) represents a diverse group of malignant tumors derived from mesenchymal elements. Evaluation of a soft tissue mass of the trunk or extremity starts with a detailed history and physical examination, which will help guide further diagnostic evaluation. Imaging should then be obtained for an STS, with MRI being the preferred modality for the trunk or extremities. Imaging can assist with diagnosis and delineate the extent of the primary lesion, including the relationship to contiguous structures, for treatment planning and assessing resectability. Pathology diagnosis is most commonly performed via examination of a specimen obtained through image-guided percutaneous core-needle biopsy. This requires multidisciplinary planning between Surgery and Radiology to place the needle within the anticipated definitive surgical incision to allow for en bloc resection of the needle tract. Once the diagnosis of an STS is made, appropriate staging studies should be performed based on the history and physical examination and tumor histology, grade, and size. Clinical and pathology data are used to stage STS patients using the American Joint Committee on Cancer staging system, which incorporates the STS site, size and grade of the primary tumor, and absence or presence of nodal and distant metastatic disease. This review contains 6 figures, 6 tables and 50 references Key words: core-needle biopsy, extremity, histology, imaging, risk factors, soft tissue mass, soft tissue sarcoma, staging evaluation, trunk, tumor grade

Bleeding Complications following Image-Guided Percutaneous Biopsies in Patients Taking Clopidogrel—A Retrospective Review

PurposeTo report incidence of bleeding after image-guided percutaneous core needle biopsy performed in patients taking clopidogrel within 5 days. Materials and MethodsThis was a retrospective review of image-guided percutaneous core needle biopsies performed in patients with clopidogrel use within 5 days of the procedure between January 2002 and November 2014. Data including biopsy site, needle size, number of samples, and serum coagulation studies were collected. Routine follow-up of patients was performed 24–72 hours after biopsy. Major bleeding complications were defined as grade 3 or greater using Common Terminology Criteria for Adverse Events. There were 63 deep biopsies performed in 63 patients with recent use of clopidogrel. Mean time of clopidogrel abstinence before biopsy was 2.9 days ± 1.9 (median 3 days). Clopidogrel had been taken within 24 hours of the biopsy by 12 patients. There were 48 patients (76%) who also took aspirin within 5 days of the procedure. The most common procedure was liver biopsy (21/63; 33%), followed by lung (12/63; 19%), abdominal/pelvic/retroperitoneal mass (12/63; 19%), and renal (11/63; 17%) biopsies. ResultsA major bleeding complication (1/63; 1.6%) occurred after injury to an intercostal artery during lung biopsy, which was successfully treated with coil embolization. No minor bleeding complications were identified. ConclusionsIn this study comprising a small number of patients undergoing various biopsy procedures, recent clopidogrel use was associated with a very low incidence of major bleeding.

Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population.

A paucity of literature describes the use of imaged-guided percutaneous core needle biopsy for the diagnosis and characterization of pediatric soft-tissue masses and lesions. To retrospectively determine whether image-guided percutaneous core needle biopsy is adequate for diagnosing and characterizing benign and malignant pediatric soft-tissue masses and lesions. We identified children (≤18years old) who underwent US- or CT-guided percutaneous core needle biopsy of a soft-tissue mass or other lesion between January 2012 and March 2014. Using medical records, we documented the following data: age and gender, site of the mass or lesion, size and number of biopsy specimens, whether the biopsy procedure was diagnostic, whether sufficient tissue was obtained for necessary ancillary testing (e.g., cytogenetic evaluation), and whether there was a procedural complication within 1week. One hundred eight soft-tissue masses or lesions were biopsied under imaging guidance in 84 children; 39 (46%) were girls. Mean age ± standard deviation (SD) was 12.1 ± 5.1years (range 6months to 18years). Of these procedures, 105/108 (97%) were diagnostic; 82/108 (76%) were US-guided; 87/108 (81%) were performed using a 17-gauge introducer needle/18-gauge biopsy instrument. The mean number ± SD of core needle biopsy specimens obtained was 8.9 ± 5.0. For newly diagnosed malignancies, adequate tissue was obtained for ancillary testing in 28/30 (93%) masses. One minor complication was documented. Image-guided percutaneous core needle biopsy of pediatric soft-tissue masses is safe, has a high diagnostic rate, and provides sufficient tissue for ancillary testing.

Factors influencing the diagnostic yield and accuracy of image-guided percutaneous needle biopsy of pediatric tumors: single-center audit of a 26-year experience.

Image-guided percutaneous core needle biopsy is a common procedure for diagnosis of both solid tumors and hematological malignancies in children. Despite recent improvements, a certain rate of non-diagnostic biopsies persists. To assess the factors influencing the diagnostic yield and accuracy of percutaneous core needle biopsies of pediatric tumors. We conducted a single-center retrospective study of a 26-year experience with image-guided biopsies in children and young adults. Using uni- and multivariate analysis, we evaluated the association of diagnostic yield and accuracy with technical factors (image-guided procedure, pathological technique) and clinical factors (complication rate, histological type and anatomical location). We retrieved data relating to 396 biopsies were performed in 363 children and young adults (mean age: 7.4 years). Overall, percutaneous core needle biopsy showed a diagnostic yield of 89.4% (95% confidence interval [CI] 85.9-92.2) and an accuracy of 90.9% (CI 87.6-93.6) with a complication rate of 2.5% (CI 1.2-4.6).The diagnostic yield increased with the use of advanced tissue assessment techniques (95.7% with immunohistochemistry versus 82.3% without immunohistochemistry; P < 0.0001) and an increased number of passes (mean: 3.96 for diagnostic biopsies versus 3.62 for non-diagnostic biopsies; P = 0.044). The use of advanced pathological techniques and an increased number of passes are the two main factors influencing the diagnostic success of biopsies in pediatric tumors.

Predictors of diagnostic success in image-guided pediatric soft-tissue biopsies.

Image-guided percutaneous core needle biopsy (PCNB) of soft-tissue lesions is a minimally invasive technique that can provide a definitive diagnosis for treatment. Anatomical and age considerations in children require judicious use of safe percutaneous biopsy techniques. There are, however, limited data on the determinants of diagnostic yield in soft-tissue lesions in this population. To assess lesion-related and technical factors that affect diagnostic yield and safety in PCNB of pediatric soft-tissue lesions. This was a retrospective cohort study of 205 PCNB performed from January 2000 to July 2014. Diagnostic yield and its associations with technical and lesion-related factors were evaluated using bivariate analysis. The mean patient age was 11.1 ± 6.9years (interquartile range [IQR]: 4.3-16years). Ultrasound guidance alone was used in 91% of cases. The mean number of passes was 7.5 ± 3.2 (IQR: 5-9 passes) per case. The overall diagnostic yield was 75% and the overall accuracy was 88%. Performing fewer than four passes was associated with a nondiagnostic biopsy (P = 0.001). There were no lesion or other technical factors that predicted a diagnostic biopsy. There were two complications (1%) over 14years. Image-guided PCNB is a safe and effective means for the diagnosis of pediatric soft-tissue abnormalities. Aside from performing at least four passes, our data show no technical or lesion-related factors that increase diagnostic yield in pediatric PCNB of soft-tissue lesions.

Image-guided Percutaneous Core Needle Biopsy of Musculoskeletal Tumors in Children

The use of image-guided percutaneous core needle biopsy (PCNB) to obtain tissue diagnosis of musculoskeletal lesions has become the standard of care in adult patients with a success rate of over 80%. Previous reports indicate a similar success rate in diagnosing pediatric solid tumors. In this large study, we analyzed >10 years of data in which PCNB was used for tissue diagnosis of musculoskeletal lesions in children; we evaluated the histopathologic accuracy, anesthetic requirements, and complications of these procedures. In 122 children, tissue diagnosis was successfully obtained in 82% of cases, and there were 0 complications associated with the procedure. There was a significantly higher PCNB diagnostic success rate in malignant lesions (93%). These data suggest that the use of PCNB is a safe and effective means of diagnosing musculoskeletal lesions in children.

A Case of Synchronous Lung Adenocarcinoma and Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue Type

Abstract SESSION TYPE: Cancer Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Extranodal marginal zone B-cell lymphoma (extranodal MZL) of mucosa-associated lymphoid tissue (MALT) type, also called MALT lymphoma, is a distinct subgroup of non-Hodgkin's lymphoma (NHL). More than two thirds of primary pulmonary NHLs are extranodal MZLs but they account for less than 0.5% of all primary lung neoplasms. Only a few cases of simultaneous lung cancer and pulmonary extranodal MZL have been reported. Also, it is extremely rare that primary extranodal MZL occurs in the large airways. To our knowledge, only one case of lung cancer coexisting with extranodal MZL of the large airway has been reported. We report a case of synchronous lung adenocarcinoma and primary extranodal MZL of the left main bronchus.CASE PRESENTATION: A 60-year old woman was referred to our hospital with a pulmonary nodule in the right upper lung seen on chest radiograph during a routine health checkup. She had never smoked. A chest radiograph showed a nodule in the right upper lung. A chest computed tomographic (CT) scan showed a peripherally located 2.4 × 1.8 cm sized solid nodule in the anterior segment of the right upper lobe. Fluorine 18-labeled fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT scan revealed abnormal FDG uptake in the right upper lobe lung nodule and in the right hilar lymph node. She underwent CT image-guided percutaneous core needle biopsy of the nodule in the right upper lobe. Additionally, a flexible bronchoscopic examination was performed to identify the endobronchial lesion. At bronchoscopy, a few small variable-sized protrusions were observed in the proximal left main bronchus and a biopsy was performed . The needle biopsy specimens of the right lung nodule showed non-mucinous adenocarcinoma. Immunohistochemical stains were positive for CK7 and TTF-1, and negative for CK20. Histopathology of the bronchoscopic biopsy specimens of the left main bronchus lesions showed diffuse proliferation of atypical lymphoid cells beneath the mucosal epithelium. Immunohistochemical stains showed diffuse strong positive for CD20, and were negative for CKpan and CD10. The bronchial lesion was diagnosed as extranodal marginal zone B-cell lymphoma of MALT type. She underwent right upper lobectomy and lymph node dissection for the lung adenocarcinoma. However, she did not receive specialized therapy for extranodal MZL of the left main bronchus. Since then she has been observed regularly.DISCUSSION: Synchronous primary malignancy and extranodal MZL in the same anatomical sites, such as stomach and lung is very unusual. To our knowledge, there is only one other report showing the coexistence of lung cancer and pulmonary extranodal MZL of the large airway. However, in that case, the histology of lung cancer was squamous cell carcinoma. The present case is the first report of the simultaneous occurrence of lung adenocarcinoma and pulmonary extranodal MZL of the large airway. The cause of the synchronous lesions in our case is uncertain. We postulate that a pulmonary extranodal MZL may coincide with a lung adenocarcinoma by accident. Little is known about the mechanism of the simultaneous occurrence of these different tumors. Moreover, the two different malignancies were located in different lungs in this case. However, other possible causes may include common etiologic factors and genetic or epigenetic alterations participating in the development of both the lung adenocarcinoma and extranodal MZL. Further studies will be required to clarify the relationship between lung adenocarcinoma and pulmonary extranodal MZL. It is necessary to accumulate more cases with both malignancies.CONCLUSIONS: In conclusion, we report a unique case of pulmonary extranodal MZL of main bronchus coexisting with lung adenocarcinoma. The patient was asymptomatic and was diagnosed with pulmonary extranodal MZL by chance during investigation of an endobronchial lesion.1) Jaffe ES, Harris NL, Stein H, Vardiman JW. World Health Organization Classification of Tumors. Pathology and Genetics of Tumors of Haematopoietic and Lymphoid tissue. Lyon: International Agency for Research on Cancer; 2001.DISCLOSURE: The following authors have nothing to disclose: Chi Young Jung, Young June JeonNo Product/Research Disclosure InformationKeimyung University Dongsan Hospital, Daegu, Republic of Korea.

The Current Role of Vacuum Assisted Breast Biopsy System in Breast Disease

The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up. In recent years, with the advancement of VABB instruments and techniques, many outcome studies have reported on the use of VABB for resecting benign breast lesions with a curative intent. VABB is highly accurate for diagnosing suspicious breast lesions and is highly successful at treating presumed benign breast lesions. Thus, in the near future, VABB will be routinely offered to all appropriately selected patients.