Needle Biopsy In Diagnosis Research Articles

Educational exchange in thyroid core needle biopsy diagnosis: enhancing pathological interpretation through guideline integration and peer learning.

While fine needle aspiration cytology (FNAC) plays an essential role in the screening of thyroid nodules, core needle biopsy (CNB) acts as an alternative method to address FNAC limitations. However, diagnosing thyroid CNB samples can be challenging due to variations in background and levels of experience. Effective training is indispensable to mitigate this challenge. We aim to evaluate the impact of an educational program on improving the accuracy of CNB diagnostics. The 2-week observational program included a host mentor pathologist with extensive experience and a visiting pathologist. The CNB classification by The Practice Guidelines Committee of the Korean Thyroid Association was used for the report. Two rounds of reviewing the case were carried out, and the level of agreement between the reviewers was analyzed. The first-round assessment showed a concordance between two pathologists for 247 thyroid CNB specimens by 84.2%, with a kappa coefficient of 0.74 (indicating substantial agreement). This finding was attributed to the discordance in the use of categories III and V. After peer learning, the two pathologists evaluated 30 new cases, which showed an overall improvement in the level of agreement. The percentage of agreement between pathologists on thyroid CNB diagnosis was 86.7%, as measured by kappa coefficient of 0.80. This educational program, consisting of guided mentorship and peer learning, can substantially enhance the diagnostic accuracy of thyroid CNB. It is useful in promoting consistent diagnostic standards and contributes to the ongoing development of global pathology practices.

Comparison of Fine Needle Aspiration and Core Needle Biopsy in Diagnosis of Granulomatous Mastitis Presenting with Breast Lump

Granulomatous mastitis is a chronic inflammatory disease of the breast with unknown etiology mostly seen in parous women shortly after their last pregnancy. It is crucial to differentiate granulomatous mastitis from cancer and definite diagnosis is established by histopathological examination. Its treatment is variable and the most appropriate treatment protocol is yet to be identified. Aim of the study was to compare the performances of fine needle aspiration and Core biopsy of breast lump verified by histopathological examination as “Gold standard”. 227 women presenting with breast lump were included in this study. After selection, fine needle aspiration and core biopsy were done at same sitting and follow-up resection histopathology with 122 cases (53.74%) were performed in the laboratory. 40(17.62%) cases were diagnosed granulomatous mastitis by either fine needle aspiration or core biopsy, the reports of 23 cases (57.5%) were concordant in both the procedures and discrepancy was observed in reporting of 17 cases (42.5%). 36 cases (90%) were resected for histopathology and 33 (82.5%) breast lumps were diagnosed granulomatous mastitis. Diagnostic accuracy, sensitivity, specificity, negative and positive predictive values of fine needle aspiration cytology and Core biopsy were calculated. The diagnostic accuracy of core biopsy was 97.54% and that of fine needle aspiration cytology was 89.34%. Specificity, sensitivity, positive and negative predictive values of core biopsy were 97.77%, 97.29%, 94.73% and 98.87% respectively. The specificity, sensitivity, positive and negative predictive values of fine needle aspiration were 97.77%, 70.27%, 92.85% and 88.88% respectively. The accuracy of core biopsy was much higher than that of fine needle aspiration and also the performances of the combination of two procedures were superior to the individual test alone.

Abstract GS03-01: Magnetic Resonance Imaging and a 12-Gene Expression Assay to Optimize Local Therapy for Ductal Carcinoma In Situ: 5-year clinical outcomes of E4112

Abstract BACKGROUND. Advanced diagnostics such as magnetic resonance imaging (MRI) and gene-expression profiles are potentially useful to guide treatment in patients with ductal carcinoma in situ (DCIS). To evaluate these tests, we performed a prospective single arm multicenter study. We have previously reported the impact of MRI on surgical management of DCIS patients, and the effect of a 12-gene DCIS Score (DS) on radiotherapy (RT) use after wide local excision (WLE). We now report a pre-planned analysis of ipsilateral breast events (IBE) at 5-years. METHODS. Adult women with a core needle biopsy diagnosis of DCIS and eligible for WLE based on conventional imaging were registered following consent. All registered patients underwent breast MRI. Those still eligible, and willing, to receive WLE after appropriate follow-up biopsies underwent resection to free margins. DCIS sections were submitted to Exact Sciences for DS. Those with a low DS (< 39) were advised to omit RT; those with intermediate/high (inter/hi) DS (≥39) were advised to receive RT. All participants were monitored at 6-month intervals for any breast cancer event, and for survival. An IBE was defined as the first DCIS or invasive recurrence in the ipsilateral breast following the final WLE. Participants without IBE were censored by date of last contact or date of death for those who died. Follow-up was truncated at 5 years from WLE. Using data available as of 07-06-2023, Kaplan-Meier (K-M) curves were constructed to estimate the time-to-event distributions for subjects who received RT and for those who did not. The 5-year IBE rates and 95% confidence intervals (CIs) were estimated from K-M curves for all subjects with a DS (analogue of Intention to Treat [ITT] analysis), and for the subset who were compliant with their DS-based RT recommendation (Per Protocol analysis). The analyses were repeated for subgroups based on age at DCIS diagnosis (< 50 vs. ≥ 50). RESULTS. Of 339 women evaluable for the previously reported primary analysis (PMID 30653209), 171 (50.4%) underwent WLE with free surgical margins and had DS available for RT recommendations (ITT population). Of these, 7/82 low DS patients underwent RT, and 5/89 inter/hi DS patients declined RT; thus, the adherence to DS-based RT recommendations was 93%. At a median of 5 years of follow-up from final WLE, the ITT population experienced a total of eight IBE events (4.8%, 95% CI 2.4, 9.4) with 5-year IBE rates that were similar for participants with a low DS and for those with a inter/hi DS: 5.1% (95% CI: 1.9, 12.9) and 4.5% (95% CI 1.7, 11.7), respectively. Stratification by age did not alter these results: among women aged < 50 years (n=33), the IBE rate was 6.7% (95% CI 1.0, 38.7) for low DS and 5.6% (95% CI 0.8, 33.4) for inter/hi DS. Among women aged ≥ 50 years (n=138), the IBE rate was 4.7% (95% CI 1.5, 13.8) for low DS and 4.3% (95% CI 1.4, 12.7) for inter/hi DS. In the per-protocol analysis (N=159 adherent to RT recommendations), IBE rates were also similar for participants who had a low DS and no RT [5.5% (95% CI 2.1, 14.1)] and for those with inter/hi DS who received RT [4.8% (95% CI: 1.8% to 12.3%)]. Again, there was no discernible influence by age as categorized above. CONCLUSION. We report the first prospective data on use of DCIS Score for RT decisions, and 5-year IBE rates. We find that DS-based recommendations are followed by >90% of patients. Although the sample size is limited, the data are reassuring in that the IBE rate is similar between the low DS group treated with WLE alone and the inter/hi DS group treated with WLE and radiation, whereas prior studies have shown a marked difference in IBE rates by DS with excision alone. Therefore, this prospective trial provides strong evidence to support the omission of RT after surgery in DCIS patients with low DS, and its use in patients with intermediate/high DS. Citation Format: Seema Khan, Justin Romanoff, Constantine Gatsonis, Habib Rahbar, Ruth Carlos, Sunil Badve, Jean Wright, Constance Lehman, Worta McCaskill-Stevens, Ralph Corsetti, Derrick Spell, Kenneth Blankstein, Linda Han, Jennifer Sabol, John Bumberry, Ilana Gareen, Bradley Snyder, Lynne Wagner, Kathy Miller, Joseph Sparano, Christopher Comstock. Magnetic Resonance Imaging and a 12-Gene Expression Assay to Optimize Local Therapy for Ductal Carcinoma In Situ: 5-year clinical outcomes of E4112 [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 GS03-01.

The Essential Number of Ultrasound(US)- Guided Core Needle Biopsy in Diagnosis of Breast Cancer

The Essential Number of Ultrasound(US)- Guided Core Needle Biopsy in Diagnosis of Breast Cancer

The Essential Number of Ultrasound(US)- Guided Core Needle Biopsy in Diagnosis of Breast Cancer

The Essential Number of Ultrasound(US)- Guided Core Needle Biopsy in Diagnosis of Breast Cancer

Complications and Histopathological Findings of Image-Guided Core Needle Biopsy in Diagnosis of Cutaneous Calciphylaxis.

Complications and Histopathological Findings of Image-Guided Core Needle Biopsy in Diagnosis of Cutaneous Calciphylaxis.

Abstract P6-04-07: Primary Diagnosis of Breast Biopsies supported by AI versus Microscope: Multi-Site Clinical Reader Study

Abstract Objective This study aimed to clinically validate the use of an AI-based solution by pathologists for the primary diagnosis of breast core needle biopsies as compared with the gold standard practice (review on the microscope). Methods A two-arm prospective reader study comparing the performance of pathologists using an AI-based solution with pathologists using a microscope was performed at two sites (different staining and digital scanners). Both arms were compared to ground truth (GT) established by the consensus of two breast pathologists. Rates of major discrepancies between each arm and GT, as determined by an adjudicating pathologist, were compared. Results Eight pathologists participated in the study and reported on 385 cases (442 HES and 330 H&E slides), each case being reported twice, once in each study arm. Pathologists first reviewed only H&E/HES slides, if requested and available, they were provided with IHCs, while the AI results were on H&E/HES only. The major discrepancy rates of the microscope arm and of the AI arm against GT were 4.42% and 3.12%, respectively, demonstrating a 29.4% reduction in major discrepancies. Pathologists with AI demonstrated very high accuracy for the detection of invasive carcinoma with sensitivity and specificity of 100% for both, as well as for DCIS/ADH with sensitivity of 92.4% and specificity of 97.8%. Conclusions This multi-site reader study reports diagnostic accuracy improvements by pathologists performing diagnosis and reporting with the support of a first read AI solution for breast biopsies. The AI solution performed accurately and generalized well for different staining platforms and different scanners. Thus, AI solutions could be used as significant aiding tools for pathologists in clinical decision-making in routine pathology practice, enhancing the quality and reproducibility of diagnosis. Citation Format: Anne Salomon, Alona Nudelman, Joanna Cyrta, Marina Maklakovski, Anat Albrecht Shach, Geraldine Sebag, Giuseppe Mallel, Ira Krasnitsky, Tali Feinberg, Manuela Vecsler, Judith Sandbank. Primary Diagnosis of Breast Biopsies supported by AI versus Microscope: Multi-Site Clinical Reader Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-04-07.

VATS versus ultrasound-guided Abram`s needle biopsy in diagnosis of pleural diseases

VATS versus ultrasound-guided Abram`s needle biopsy in diagnosis of pleural diseases

Artificial intelligence system shows performance at the level of uropathologists for the detection and grading of prostate cancer in core needle biopsy: an independent external validation study

AbstractAccurate diagnosis and grading of needle biopsies are crucial for prostate cancer management. A uropathologist-level artificial intelligence (AI) system could help make unbiased decisions and improve pathologists' efficiency. We previously reported an artificial neural network-based, automated, diagnostic software for prostate biopsy, DeepDx® Prostate (DeepDx). Using an independent external dataset, we aimed to validate the performance of DeepDx at the levels of prostate cancer diagnosis and grading and evaluate its potential value to the general pathologist. A dataset composed of 593 whole-slide images of prostate biopsies (130 normal and 463 adenocarcinomas) was assembled, including their original pathology reports. The Gleason scores (GSs) and grade groups (GGs) determined by three uropathology experts were considered as the reference standard. A general pathologist conducted user validation by scoring the dataset with and without AI assistance. DeepDx was accurate for prostate cancer detection at a similar level to the original pathology report, whereas it was more concordant than the latter with the reference GGs and GSs (kappa/quadratic-weighted kappa = 0.713/0.922 vs. 0.619/0.873 for GGs and 0.654/0.904 vs. 0.576/0.858 for GSs). Notably, it outperformed the original report, especially in the detection of Gleason patterns 4/5, and achieved excellent agreement in quantifying the Gleason pattern 4. When the general pathologist used AI assistance, the concordance of GG between the user and the reference standard increased (kappa/quadratic-weighted kappa, 0.621/0.876 to 0.741/0.925), while the average slide examination time was substantially decreased (55.7 to 36.8 s/case). Overall, DeepDx was capable of making expert-level diagnosis in prostate core biopsies. In addition, its remarkable performance in detecting high-grade Gleason patterns and enhancing the general pathologist's diagnostic performance supports its potential value in routine practice.

Diagnostic ability and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy diagnosis for malignant pleural mesothelioma.

BackgroundMalignant pleural mesothelioma (MPM) is a highly invasive malignant tumor. Ultrasound guidance has the advantages of real-time, convenience and nonradiative. We sought to identify diagnostic value and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy (US-PPNB) for MPM.MethodsPatients who underwent US-PPNB between March 2014 and March 2020 and were finally diagnosed with MPM were retrospectively analyzed. We retrospectively analyzed the US-PPNBs pathological results of all patients clinically confirmed as MPM, and divided US-PPNBs into correctly and incorrectly diagnosed groups. Patient, thoracic, and biopsy variables that affected diagnostic accuracy were assessed. All variables significant on univariate analyses were subjected to multivariate logistic regression to identify significant predictors of diagnostic accuracy. We derived cutoffs for all significant continuous variables and used the Mantel–Haenszel test to determine whether the diagnostic accuracy of US-PPNB for MPM increased with pleural thickness.ResultsIn total, 49 patients with clinically confirmed MPM underwent US-PPNB; 37 diagnoses were correct and 12 were incorrect (accuracy = 75.5%). The pleura was significantly thicker in the correctly diagnosed group (p < 0.001). The pleural thickness cutoff was 4.15 mm and diagnostic accuracy increased with pleural thickness grade (p for trend <0.05). The diagnostic accuracy was significantly higher when 16-G rather than 18-G biopsy needles were used (p < 0.05). Multivariate logistic regression showed that pleural thickness (odds ratio: 17.2, 95% confidence interval: 2.8–104.1, p = 0.002) and needle size (odds ratio: 6.8, 95% confidence interval: 1.0–44.5, p = 0.044) independently predicted diagnostic accuracy.ConclusionUS-PPNB afforded high MPM diagnostic accuracy, and pleural thickness and needle size significantly impacted accuracy.

The role of core needle biopsy in diagnostic breast pathology

During the last several years core needle biopsies, with or without vacuum assistance, have become the gold standard sampling procedure for diagnosis of palpable and non-palpable mammary lesions. The advantages of core needle biopsy over fine needle aspiration and open surgical biopsies are well-established. In the era of de-escalation of therapy and with the greater use of neoadjuvant treatment, the pathologists are ever more critical in guiding management decisions in breast pathology so there is an imperative for precision of core needle biopsy diagnosis. However, the fragmented nature or the small size of the sample, may cause diagnostic pitfalls and precise radiologic-histopathologic correlation is needed for optimal patient management. This article provides a review on several issues regarding the evaluation of core needle biopsies.

Computer-Aided Detection of Quantitative Signatures for Breast Fibroepithelial Tumors Using Label-Free Multi-Photon Imaging.

Fibroadenomas (FAs) and phyllodes tumors (PTs) are major benign breast tumors, pathologically classified as fibroepithelial tumors. Although the clinical management of PTs differs from FAs, distinction by core needle biopsy diagnoses is still challenging. Here, a combined technique of label-free imaging with multi-photon microscopy and artificial intelligence was applied to detect quantitative signatures that differentiate fibroepithelial lesions. Multi-photon excited autofluorescence and second harmonic generation (SHG) signals were detected in tissue sections. A pixel-wise semantic segmentation method using a deep learning framework was used to separate epithelial and stromal regions automatically. The epithelial to stromal area ratio and the collagen SHG signal strength were investigated for their ability to distinguish fibroepithelial lesions. An image segmentation analysis with a pixel-wise semantic segmentation framework using a deep convolutional neural network showed the accurate separation of epithelial and stromal regions. A further investigation, to determine if scoring the epithelial to stromal area ratio and the SHG signal strength within the stromal area could be a marker for differentiating fibroepithelial tumors, showed accurate classification. Therefore, molecular and morphological changes, detected through the assistance of computational and label-free multi-photon imaging techniques, enable us to propose quantitative signatures for epithelial and stromal alterations in breast tissues.

The Diagnostic Value of Ultrasound-Guided Cervical Core Needle Biopsy in Diagnosis of Lymphoma in Suspected Patients.

Background: Core needle biopsy (CNB) guided by imaging modalities seems to be an acceptable modality for diagnosis of lymphoma due to its safety, good applicability, availability as well as diagnostic accuracy, however; Studies have not reached a consensus on its diagnostic accuracy and factors affecting its performance. The present study aimed to assess the value of ultrasound-guided cervical CNB in the diagnosis of lymphoma in suspected patients. Materials and Methods: This cross-sectional study was performed on 46 consecutive patients (20 to 82 years) with cervical mass or lymphadenopathy suspected of lymphoma and were candidates for diagnostic evaluation. Ultrasound-guided core needle biopsies (UGCNB) were done by a single radiologist under guided ultrasonography. The diagnostic value of UGCNB in the diagnosis and determination of specific lymphoma subtypes was assessed. Results: Using UGCNB led to the diagnosis of lymphoma in 34.8% and non-lymphoma lesions in 43.5%, while the diagnosis remained unclear in other 21.7% with a total UGCNB-based identification rate of 78.3%. No patient with lymphoma was missed. All patients were followed up over a 6-month period. In none of the cases, clinical diagnosis and treatment response were found contrary to the initial pathologic diagnosis. No significant complication such as hematoma or infection was reported. Conclusion: UGCNB has a high diagnostic value for determining the nature of the cervical lesions suspected of lymphoma.

Real-time diagnosis and Gleason grading of prostate core needle biopsies using nonlinear microscopy

Rapid histologic assessment of fresh prostate biopsies may reduce patient anxiety, aid in biopsy sampling, and enable specimen triaging for molecular/genomic analyses and research that could benefit from fresh tissue analysis. Nonlinear microscopy (NLM) is a fluorescence microscopy technique that can produce high-resolution images of freshly excised tissue resembling formalin-fixed paraffin-embedded (FFPE) H&E. NLM enables evaluation of tissue up to ~100 µm below the surface, analogous to serial sectioning, but without requiring microtome sectioning. One hundred and seventy biopsies were collected from 63 patients who underwent in-bore MRI or MRI/ultrasound fusion biopsy procedures. Biopsies were stained in acridine orange and sulforhodamine 101, a nuclear and cytoplasmic/stromal fluorescent dye, for 45 s. Genitourinary pathologists evaluated the biopsies using NLM by translating the biopsies in real time to areas of interest and NLM images were recorded. After NLM evaluation, the biopsies were processed for standard FFPE H&E and similarities and differences between NLM and FFPE H&E were investigated. Accuracies of NLM diagnoses and Gleason scores were calculated using FFPE histology as the gold standard. Pathologists achieved a 92.4% sensitivity (85.0–96.9%, 95% confidence intervals) and 100.0% specificity (94.3–100.0%) for detecting carcinoma compared to FFPE histology. The agreement between the Grade Group determined by NLM versus FFPE histology had an unweighted Cohen's Kappa of 0.588. The average NLM evaluation time was 2.10 min per biopsy (3.08 min for the first 20 patients, decreasing to 1.54 min in subsequent patients). Further studies with larger patient populations, larger number of pathologists, and multiple institutions are warranted. NLM is a promising method for future rapid evaluation of prostate needle core biopsies.

A study of benign breast disease management based on clinical, radiological and pathological assessment

Benign breast disorders are usually hormone induced and therefore usually seen in the reproductive period of life with dramatic fall in incidence after menopause. As compared to breast cancers, benign breast lesions are 10 times more common.&#x0D; The aim of the study was to determine the spectrum and incidence of various benign breast diseases in female patients attending our institute and to compare the results with those of other studies.&#x0D; Material and methods: 80 cases of benign breast diseases which were clinically diagnosed and confirmed pathologically or radiologically were subjected for therapeutic interventions and the results were analysed.&#x0D; Results: In the present study of 80 cases, the age group most affected by benign breast diseases was 21-30 years. 63 patients (78.8 %) presented with lump in the breast and 23 patients’ common symptom is pain. In most of the cases of lump had duration between 7-12 months (38.8 %), pain for 1-5 days (13.8 %), discharge for 0-5 days (11.3 %). Both breasts were involved in 6 cases (7.5 %) whereas right and left breasts are equally involved in 47 cases each (46.25 %). Most of the patients were nulliparous (46.3 %) followed by multiparous (38.8 %) and uniparous (15.0 %). Fibroadenoma constituted in 53.8 % of patients (44 cases), breast abscess constituted 21.25 % (17 cases). The most commonly affected age group was 21-30 years. 63 patients (78.8 %) presented with lump in the breast and 23 patients presented with pain. HRUSG findings correlated with that of clinical diagnosis in 70 cases. 60 cases underwent core biopsy, and in 41 cases (68.33 %) there were fibroadenoma and 7 cases (11.66 %) fibro adenosis. 59 cases (73.75 %) underwent excision, and 18 cases (22.5 %) incision and drainage.&#x0D; Conclusion: The most common benign breast disease was fibroadenoma. Most common age group affected with benign breast disease was 21-30 years. 88.7 % of clinical diagnosis, 90.3 % of radiological diagnosis, 93.3 % of core needle biopsy diagnoses were correlating with the histopathology diagnosis

Deep Learning-Based Computed Tomography Imaging to Diagnose the Lung Nodule and Treatment Effect of Radiofrequency Ablation.

This study aimed to detect and diagnose the lung nodules as early as possible to effectively treat them, thereby reducing the burden on the medical system and patients. A lung computed tomography (CT) image segmentation algorithm was constructed based on the deep learning convolutional neural network (CNN). The clinical data of 69 patients with lung nodules diagnosed by needle biopsy and pathological comprehensive diagnosis at hospital were collected for specific analysis. The CT image segmentation algorithm was used to distinguish the nature and volume of lung nodules and compared with other computer aided design (CAD) software (Philips ISP). 69 patients with lung nodules were treated by radiofrequency ablation (RFA). The results showed that the diagnostic sensitivity of the CT image segmentation algorithm based on the CNN was obviously higher than that of the Philips ISP for solid nodules <5 mm (63 cases vs. 33 cases) (P < 0.05); it was the same result for the subsolid nodule <5 mm (33 case vs. 5 cases) (P < 0.05) that was slightly higher for solid and subsolid nodules with a diameter of 5–10 mm (37 cases vs. 28 cases) (P < 0.05). In addition, the CNN algorithm can reach all detection for calcified nodules and pleural nodules (7 cases; 5 cases), and the diagnostic sensitivities were much better than those of Philips ISP (2 cases; 3 cases) (P < 0.05). Patients with pulmonary nodules treated by RFA were in good postoperative condition, with a half-year survival rate of 100% and a one-year survival rate of 72.4%. Therefore, it could be concluded that the CT image segmentation algorithm based on the CNN could effectively detect and diagnose the lung nodules early, and the RFA could effectively treat the lung nodules.

Isolated prostatic tuberculosis mimicking prostatic carcinoma: a needle biopsy diagnosis

Genitourinary tuberculosis is uncommon and mostly involves kidneys, seminal vesicles and epididymis. Isolated prostatic tuberculosis is rarely reported and is an under recognized entity. Here, we report such a case which clinically mimicked prostatic carcinoma and was subsequently diagnosed on image guided needle biopsy.

Core needle biopsy diagnosis of musculoskeletal tumors at a small regional treatment center and at sarcoma referral centers are equally effective and accurate: a retrospective case series

Background: Although incisional biopsy (IB) is the gold standard for diagnosing musculoskeletal tumors, core needle biopsy (CNB) is becoming common. Many large sarcoma referral centers have evaluated the accuracy of CNB, but its accuracy at smaller centers is unknown. Methods: After IRB approval, a retrospective study of patients undergoing CNB and IB for musculoskeletal tumor diagnosis at Texas Tech University Health Sciences Center from 2006 to 2018 was performed. All patients underwent surgical excision of their tumor. Final pathology was the gold standard for analysis. Biopsy effectiveness and accuracy for determining malignancy and pathology was determined. Complications from biopsies and diagnostic errors were evaluated. Results: Efficacy of CNB was 83.1% for bone and 97.7% for soft-tissue tumors; IB was 100% effective. Accuracy of determining malignancy of bone tumors was 89.8% for CNB and 100% for IB, while that for soft-tissue tumors was 92.9% with CNB and 100% with IB. Accuracy of CNB determining pathology of bone tumors was 73.1% for malignant and 42.4% for benign tumors, while IB determined pathology of 100% of malignant and 75% of benign tumors. For soft-tissue tumors, CNB accurately diagnosed 88.9% of malignant and 52% of benign tumors while IB accurately diagnosed 100% of malignant and benign soft-tissue tumors. There were no procedural complications related to biopsy. Conclusions: The data in this study show that CNB and IB performed at a small treatment center are effective and accurate for diagnosis of musculoskeletal tumors. Level of Evidence: Level IV.

Comparison of Usefulness of Ultrasound-Guided Fine Needle Aspiration and Core Needle Biopsy in Diagnosis of Cervical Lymphadenopathy

Background and Objectives The purpose of this study is to compare diagnostic outcome and safety of fine needle aspiration (FNA) and core needle biopsy (CNB) in patients with cervical lymphadenopathy. Subjects and Method This retrospective studies were conducted on 164 cases with cervical lymphadenopathy that had undergone FNA, and 44 cases that had undergone CNB. The cytopathological results from FNA and CNB were compared with the histopathological results confirmed by excisional biopsy in the nodes according to different sizes and radiological levels, respectively. Diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were evaluated according to disease entities.Results FNA is more accurate than CNB in most of the sizes and at all cervical levels. However, there is no statistically significant difference between the results of the two tests. Sensitivity and NPV for diagnosis of malignant lymphoma are higher with FNA than with CNB. However, specificity and PPV for malignant lymphoma are higher with CNB than with FNA. Also CNB showed superior sensitivity, PPV and NPV for metastatic lymphadenopathy. Conclusion Although CNB is beneficial in reducing the false negative rate, it still has several limitations. Since CNB has no statistically significant advantage over FNA, FNA can be a good alternative method with less complication and high diagnostic value for lesions where CNB is difficult to perform.

Diagnostic challenges of focal nodular hyperplasia: interobserver variability, accuracy, and the utility of glutamine synthetase immunohistochemistry.

The diagnosis of focal nodular hyperplasia (FNH) and the interpretation of glutamine synthetase (GS) staining can be challenging on biopsies. We aimed to evaluate the reproducibility of needle biopsy diagnosis of FNH, the effect of GS immunohistochemistry on FNH diagnosis, and which histological features are most useful for the diagnosis of FNH. The study included virtual needle biopsies generated from 75 resection specimens (30 FNHs, 15 hepatocellular adenomas, 15 hepatocellular carcinomas, and 15 non-lesional liver specimens). Pathologists were reasonably accurate (83.1%) in the diagnosis of FNH with haematoxylin and eosin alone. Ductular reaction and nodularity had the highest sensitivity for a diagnosis of FNH (88.1% and 82.2%, respectively), whereas central scar was the most specific feature (90.6%). The presence of two or more of the classic histological features had 89.6% sensitivity and 86.2% specificity for a diagnosis of FNH. Diagnostic accuracy was significantly higher with the addition of a GS stain. A map-like GS staining pattern was highly specific (99.3%) for FNH. However, GS staining was interpreted as non-map-like in 14.4% of reviews of true FNH cases, and overall interobserver agreement for interpretation of the GS staining pattern was only moderate (kappa=0.42). Pathologists are reasonably accurate in the diagnosis of FNH on virtual biopsies, and GS staining improves accuracy. However, a subset of FNH cases remain challenging. Steatosis and a pseudo-map-like GS staining pattern were associated with increased difficulty. Therefore, although a map-like GS staining pattern is useful for confirmation of a diagnosis, the lack of a map-like GS staining pattern on needle biopsy does not necessarily exclude a diagnosis of FNH.