Needle Biopsy Research Articles

Rare case of bilateral primary breast angiosarcoma and review of literature

Primary angiosarcoma of the breast is very rare, accounting for 0.05% of all malignant breast tumors, and it usually occurs in younger individuals. To the best of our knowledge, bilateral primary angiosarcoma is extremely rare, with only 16 cases reported in the published literature. The imaging features might give a false impression of a benign lesion, delaying diagnosis. We report a case of a 34-year-old woman with a left breast lump. Her initial core needle biopsy was negative, and she was briefly lost to follow-up. However, when she returned with worsening symptoms, a vacuum-assisted biopsy revealed angiosarcoma. After undergoing surgery, she received radiation therapy but subsequently developed angiosarcoma in the contralateral breast. Our case is unique because we present the variable imaging appearances of angiosarcoma using imaging modalities such as mammography, ultrasound, MRI, and PET-CT, at the time of initial presentation, final diagnosis, and recurrence. We also report the successful use of a vacuum-assisted breast biopsy following a non-diagnostic core needle biopsy without experiencing overt bleeding during the procedure in a case of angiosarcoma. There have been very few reported cases in which vacuum-assisted biopsy has been performed in cases of angiosarcoma, indicating that it can be used in hypervascular masses without the risk of excessive bleeding, especially when an initial core biopsy is discordant.

Rhabdomyosarcoma Surgical Update.

Rhabdomyosarcoma (RMS) tumors arise from mesenchymal tissue and represent half of pediatric sarcomas, which in turn make up 7% of pediatric tumors. Advances in local control therapy of RMS have improved outcomes after surgical resection of the primary tumor, either before or after induction chemotherapy, even in the setting of metastatic disease. The utilization of diagnostic core needle and sentinel node biopsy techniques for lymph node staging are becoming more widely used. Over the past several years, refinement of prognostic factors with adoption of fusion status instead of histology, and optimized risk stratification schemas have been developed to assure appropriate therapy. There have been efforts between North American and European surgical oncology cooperative groups to standardize the care we provide, and yet there are still some philosophical differences to overcome.

Aberrant E-cadherin Expression in Lobular Carcinoma In Situ: A Comprehensive Immunohistochemical Evaluation of N-terminal, Extracellular, and C-terminal E-cadherin Domains.

E-cadherin (E-cad) immunohistochemistry is commonly used to distinguish lobular carcinoma in situ (LCIS) from ductal carcinoma in situ in histologically uncertain or ambiguous cases. Although most LCIS cases show an absence of E-cad expression on the neoplastic cell membranes, some show aberrant E-cad expression which can lead to diagnostic confusion. Awareness and understanding of the frequency, patterns, and distribution of aberrant E-cad staining in LCIS is crucial to achieving a correct diagnosis. We studied 55 LCIS cases diagnosed on core needle biopsy, classified each case by WHO subtype (classic, pleomorphic, or florid), and evaluated the frequency and patterns of aberrant E-cad expression using 3 different E-cad antibodies targeting the N-terminal (N), extracellular (EC), and C-terminal domains (C). Aberrant E-cad expression in one or more of the E-cad domains was identified in 17 cases (31%) and was significantly more frequent among LCIS variants (10/19, 56%) than among classic cases (7/36, 19.4%) (P=0.02). Among these 17 cases, aberrant E-cad expression was seen for all 3 domains in 10 cases, for EC+C in 4, for EC+N in 2, and for N only in 1. These results indicate that about one-third of cases of LCIS can show aberrant E-cad expression, that this is more common in variants than classic types of LCIS, and that this may be seen in different E-cad domains, most often in combination. These different patterns of aberrant E-cad expression may reflect different mechanisms of E-cad alterations in LCIS, the underlying nature of which merits further studies.

Pediatric Bone Sarcoma Biopsy Tract Excision: Is it Safe to Resect Separately?

Biopsy is an essential part of proper diagnostic workup in pediatric bone sarcomas impacting surgical planning, chemotherapeutic treatments, and prognostic determination. Two main biopsy techniques are currently used: closed biopsy (core needle or fine needle aspiration) and open biopsy. Historical oncologic teaching is for resection of the biopsy tract with the tumor specimen due to the theoretical risk for biopsy tract tumor contamination; however, this can restrict surgical planning and increase morbidity. This study evaluates oncologic outcomes at this institution, comparing open versus closed biopsy, and biopsy tract resection with or separate from the main tumor resection. Retrospective review of a single institution of all patients treated for bone sarcomas from 2006 through December 2021. Patient and tumor characteristics, biopsy technique, biopsy resection method, and oncologic outcomes were collected. Subgroup statistical analysis was performed comparing closed biopsy and open biopsy techniques, and biopsy tract resection with the main tumor or separately. A total of 73 patients met the inclusion criteria, including 48 (65.8%) open biopsies and 25 closed biopsies [23 (31.5%) core needle biopsies and 2 (2.7%) fine needle aspirations]. Biopsy tract resection was performed with the main tumor in 36 (49.3%), separate in 37 (50.7%). There were no statistical differences in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy methodology analysis and biopsy tract removal methods. This study demonstrates the safety of both approaches for obtaining diagnostic tissues with low rates of biopsy tract seeding in both methods. In addition, it demonstrates that there is no difference in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy tract resection with or separate from the main tumor. Definitive surgical plan should not vary based on biopsy technique and biopsy tract management, but rather patient, tumor, institutional, and surgeon factors. Level III-retrospective chart review. The study was started after the patients were diagnosed and treated.

Pancreatic Well-Differentiated Neuroendocrine Tumors are Frequently Undergraded on Endoscopic Ultrasound-Guided Fine Needle Biopsy Sampling: A Single Institutional Experience.

Objectives. To determine the accuracy of grading pancreatic well-differentiated neuroendocrine tumors (PanNETs) on endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). Methods. Fifty-three (53) PanNETs from 52 patients with EUS-FNB and subsequent resection were included, including 1 patient with 2 synchronous tumors biopsied separately. Grade (G) was assigned as per the 2019 World Health Organization criteria. The concordance of grade between EUS-FNB and resection was measured using kappa statistic. Clinicopathologic features were compared between specimens with concordant or discordant grading. Results. Two-thirds of patients were male, and the median age was 62 years (range 27-85). Four received neoadjuvant therapy. 89% were nonfunctional, whereas 11% were functional. Concordance of grade between EUS-FNB and resection was moderate (kappa = 0.45). Precisely 25% (13 out of 51) of G1 or G2 specimens were discordant. G2 tumors were frequently undergraded on EUS-FNB (11 out of 18; 61%), whereas G1 tumors were only rarely overgraded (2 out of 33; 6%). Two G3 tumors were concordant. There was no correlation between concordance and other clinicopathologic features, except for perineural invasion. Conclusions. The concordance of PanNET grading between EUS-FNB and resection was moderate, and G2 tumors were frequently undergraded on EUS-FNB. Knowledge of this is important to recognize and acknowledge, as this could potentially impact treatment decisions in some patients.

CYSTIC LESIONS OF THE SALIVARY GLANDS(Report of 3 cases)

At least one-third of cystic salivary gland lesions are neoplastic. Cystic lesion of the salivary gland requires only surgery, because regardless of the type and location, drug therapy is not possible with this diagnosis.. If the cystic neoplasm is localized in a hard-to-reach place and if it is localized in the parotid gland, the surgical manipulation is performed from the outside, it is removed simultaneously with the parenchyma of the salivary gland. The FNA specimens from salivary gland cystic lesions can be no informative very often, because FNA of these lesions demonstrates hypocellular mucinous material contents, possibly with inflammatory cells and also scant epithelial cells. For example, the presence of mucin and admixed lymphocytes in cyst fluid can be demonstrated both in the benign inflammatory cysts and cystic neoplasms. A definitive diagnosis of cystic neoplasms of the salivary glands is possible only through histological examination of the neoplastic tissue. Prevention of cystic neoplasms of the salivary gland consists of preventing injuries and inflammations of the oral cavity, careful hygiene and regular visits to the dentist. This article presents cases of the salivary glands cystic neoplasms, which are the clinical interest.

Clinical feasibility of MRI-guided in-bore prostate biopsies at 0.55T.

In-bore MRI-guided biopsy allows direct visualization of suspicious lesions, biopsy needles, and trajectories, allowing accurate sampling when MRI-ultrasound fusion biopsy is not feasible. However, its use has been limited. Wide-bore, lower-field, and lower-cost scanners could help address these issues, but their feasibility for prostate biopsy is unknown. The purpose of our study was to evaluate the feasibility of in-bore MRI-guided prostate biopsy using a large-bore (80cm), 0.55T scanner. Nineteen participants (68 ± 10 years) with suspected prostate cancer (PCa) were recruited for this Institutional Review Board (IRB) approved study (May 2023 -October 2024). Prebiopsy diagnostic scans and intra-procedural T2-weighted images were used for lesion localization. PSA levels, lesion sizes, cancer detection rates, positive core volume percentage, ISUP (International Society of Urological Pathology) grade groups (GG), positive volume cores, skin to target distances, and procedure durations were reported. Seventeen participants underwent biopsies (four transrectal, thirteen percutaneous). Two participants were excluded. Twenty lesions (mean size 1.9 ± 1.2cm) were biopsied which showed various GG cancers (GG1, GG2, GG3, GG4, and GG5), with positive cores ranging from 10 to 100%. 20% of the lesions were benign. Compared to previous biopsies, 22.2% (2/9) had new cancer detections, 22.2% (2/9) showed a GG upgrade, and 33.3% (3/9) had increased positive core volume, while 11.1% (1/9) showed no upgrade and 11.1% (1/9) had benign findings. Among biopsy-naïve participants, 75% (6/8) had cancer detected, and 25% (2/8) had benign findings. One new cancer was detected near a hip prosthesis due to reduced imaging artifacts. Average total procedure time was 77 ± 21min for transrectal and 74 ± 22min for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14min, respectively. Identifying and accurately targeting suspicious prostate lesions is feasible using a 0.55T MRI scanner.

Adverse events of 20-22G second-generation endoscopic ultrasound-guided fine-needle biopsy needles for solid lesions in the upper gastrointestinal tract and adjacent organs: Systematic review and meta-analysis.

Previous research has conducted meta-analyses on the diagnostic accuracy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). However, studies on adverse events (AEs) have been limited and sporadic and have included a highly diverse group of patients (with upper and lower gastrointestinal tract issues) and needles of varying sizes (19-22-25G). The purpose of this systematic review and meta-analysis was to determine the incidence of AEs related to the utilization of 20-22G second-generation EUS-FNB needles subsequent to puncture of the upper gastrointestinal tract and adjacent organs. We searched the PubMed, Embase, and SCIE databases from January 1, 2010, to December 31, 2023. The primary outcome was percentage of summary AEs. Subgroup analyses were based on needle type, needle size, and lesion site. A total of 99 studies were included in the analysis, with 9303 patients. The overall AE rate for 20-22G second generation EUS-FNB needles in upper gastrointestinal EUS-FNB was 1.8% (166/9303), with bleeding being the most common AE at 44.0%. The percentages of pancreatitis, abdominal pain, and other AEs were 24.1%, 21.1%, and 10.8%, respectively. Patients undergoing hepatic EUS-FNB had the highest incidence of AEs at 14.0%, followed by submucosal lesions at 3.2% and pancreatic lesions at 2.6%. EUS-FNB is a safe procedure with a relatively low risk of upper gastrointestinal AEs (1.8%) and no associated deaths. Postoperative bleeding and pancreatitis are the most common complications of EUS-FNB. Most AEs are mild and self-limiting in severity, and serious complications are very rare.

Traction-assisted endoscopic ultrasound-guided fine-needle biopsy using the clip-with-thread method for small gastric subepithelial lesions: Randomized controlled trial (with video).

Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing gastric subepithelial lesions (SELs), but diagnosing lesions smaller than 20 mm remains challenging. We developed traction-assisted EUS-FNB (TA-EUS-FNB) using the clip-with-thread method to enhance diagnostic accuracy by stabilizing the lesion and providing counter-traction for easier needle access. This study evaluates the effectiveness of TA-EUS-FNB in diagnosing small gastric SELs. In this prospective, randomized, controlled cross-over trial (August 2019-November 2022), 30 patients with gastric SELs <20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs. The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (n = 15, 50%), leiomyomas (n = 8, 26.7%), schwannomas (n = 2, 6.7%), aberrant pancreas (n = 3, 10%), and inflammation (n = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, P = 0.035) anddiagnostic yield (86.7% vs. 63.3%, P = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1-96.3% vs. 66.7%, 95% CI 41.7-84.8%; P = 0.20) and specificity (100%, 95% CI 79.6-100% vs. 100%, 95% CI 79.6-100%) were comparable between the methods. No adverse events were observed in the study. TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs <20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.

Prospective validation of ORACLE, a clonal expression biomarker associated with survival of patients with lung adenocarcinoma.

Human tumors are diverse in their natural history and response to treatment, which in part results from genetic and transcriptomic heterogeneity. In clinical practice, single-site needle biopsies are used to sample this diversity, but cancer biomarkers may be confounded by spatiogenomic heterogeneity within individual tumors. Here we investigate clonally expressed genes as a solution to the sampling bias problem by analyzing multiregion whole-exome and RNA sequencing data for 450 tumor regions from 184 patients with lung adenocarcinoma in the TRACERx study. We prospectively validate the survival association of a clonal expression biomarker, Outcome Risk Associated Clonal Lung Expression (ORACLE), in combination with clinicopathological risk factors, and in stage I disease. We expand our mechanistic understanding, discovering that clonal transcriptional signals are detectable before tissue invasion, act as a molecular fingerprint for lethal metastatic clones and predict chemotherapy sensitivity. Lastly, we find that ORACLE summarizes the prognostic information encoded by genetic evolutionary measures, including chromosomal instability, as a concise 23-transcript assay.

Tailoring Renal Mass Biopsy: Optimal Core Number and Location Based on Tumor Size for Enhanced Diagnostic Accuracy- A Prospective Ex-Vivo Study.

To determine the optimal number and location of biopsy cores in renal masses based on mass size in order to maximize diagnostic accuracy. This observational study included 360 patients with renal masses, who were divided equally into six groups. Each group was matched in terms of mass size (mass size category: ≤ 4 cm (T1a), 4-7 cm (T1b), 7-10 cm (T2a), and > 10 cm (T2b)). Core needle biopsies were taken after resection of the mass in an ex-vivo setting. The masses in the first, second, third, and fourth groups underwent 1, 2, 3, and 4 peripheral biopsies, respectively. The masses in the fifth and sixth groups were subjected to 1 and 2 central biopsies, respectively. The results of the biopsies were compared with permanent histopathology results, and the impact of mass size, number of biopsy cores, and location of biopsies on the accuracy of biopsy results were analyzed. In T1a and T1b size categories, the most accurate diagnostic results were obtained with three peripheral or two central biopsies. However, in T2a and T2b size categories, the most accurate diagnostic results were obtained with four peripheral or two central biopsies. Histological characteristics of the masses did not have statistically significant effect on the diagnostic accuracy of the biopsies. Our findings demonstrate that for masses ≤ 7 cm, three peripheral or two central samples provide the highest diagnostic accuracy. For masses larger than 7 cm, four peripheral or two central biopsy cores offer the best diagnostic accuracy.

Indolent Angiomatoid Fibrous Histiocytoma Mimicking a Benign Cystic Tumor

Angiomatoid fibrous histiocytoma (AFH) is a rare intermediate tumor that is often difficult to diagnose radiologically and pathologically. Herein, we report a case of AFH in the knee that was initially misdiagnosed as a cystic lesion. The tumor was first identified eight years earlier during the patient’s initial visit, when plain magnetic resonance imaging (MRI) was performed, leading to a diagnosis of a cystic lesion. At the current visit, the tumor had subsequently enlarged, and pain had appeared. Contrast-enhanced MRI was performed at our hospital, revealing enhancement suggestive of a solid tumor. A needle biopsy was performed, raising suspicion of AFH. Wide resection was performed, and AFH was diagnosed using histopathological findings and fluorescence in situ hybridization (FISH). Although there are several characteristic imaging findings of AFH, they are non-specific, and small tumors can be easily overlooked. Furthermore, histopathological findings lack specific immunohistochemical markers, making morphological appearance, combined with FISH findings recently reported as useful, important for preventing misdiagnosis. Since cystic lesions can occur in various locations besides the knee, it is recommended to perform contrast-enhanced MRI for accurate diagnosis when there is an increase in size or the appearance of symptoms, as plain MRI alone may lead to misdiagnosis.

Stage IV malignant transformation of mature cystic teratoma palliatively treated with concurrent chemoradiotherapy: A case report

BACKGROUND Malignant transformation (MT) of mature cystic teratoma (MCT) has a poor prognosis, especially in advanced cases. Concurrent chemoradiotherapy (CCRT) has an inhibitory effect on MT. CASE SUMMARY Herein, we present a case in which CCRT had a reduction effect preoperatively. A 73-year-old woman with pyelonephritis was referred to our hospital. Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) revealed squamous cell carcinoma. The patient was diagnosed with MT of MCT. Due to her poor general condition and renal malfunction, we selected CCRT, expecting fewer adverse effects. After CCRT, her performance status improved, and the tumor size was reduced; surgery was performed. Five months postoperatively, the patient developed dissemination and lymph node metastases. Palliative chemotherapy was ineffective. She died 18 months after treatment initiation. CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT; CCRT suppressed the disease and improved quality of life.

Uncommon Breast Metastasis From Rectal Carcinoma Clearly Revealed on 68Ga-FAPI-04 PET/CT

Abstract Breast metastasis from rectal carcinoma is very rare. We report a case of imaging findings of breast metastasis in a 31-year-old woman who underwent laparoscopic radical tumor resection 8 months ago. 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT showed 4 small breast nodules with intense 68Ga-FAPI uptake (SUVmax, 9.22) but slight 18F-FDG uptake (SUVmax, 1.95). Needle biopsy supported a diagnosis of metastasis from rectal adenocarcinoma.

Isolated Tuberculous Osteomyelitis of Calcaneus in an Immune-Competent Adult Patient With Literature Review: A Case Report.

We present a case of isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient with a 5-year follow-up. The diagnosis was established by core needle aspiration and biopsy. He was treated with antituberculous chemotherapy and immobilization. The lesion healed with collapse of the calcaneal tuberosity that clinically resulted in shortening and heel valgus. A literature review is also presented. Isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient is rare. It may pose diagnostic dilemma, and orthopaedist should work through the differential diagnosis.

Endoscopic Ultrasound-Guided Fine-Needle Biopsy as a Novel Approach for Risk Stratification of Pancreatic Cystic Lesions

Endoscopic Ultrasound-Guided Fine-Needle Biopsy as a Novel Approach for Risk Stratification of Pancreatic Cystic Lesions

Needle tract seeding of thyroid cancer after biopsy of distant metastasis: a retrospective cohort.

Imaging-guided percutaneous core needle biopsy is currently the most common technique for the investigation of potentially malignant bone lesions. It allows precise needle placement and better visual guidance, leading to improved diagnostic accuracy. Needle tract seeding (NTS) is a rare complication of biopsies in general, and its true incidence remains unknown. This study aimed to assess the risk of NTS in patients with thyroid cancer who underwent bone biopsy. For our cohort, we extracted data from the electronic medical record at the Mayo Clinic in Rochester (Minnesota, USA). Inclusion criteria included patients with a history of thyroid cancer who underwent biopsy for bone metastasis between 1/1/2014 and 10/1/2023. We identified a cohort of 20 patients that fit our inclusion criteria. Of these 20 patients, 2 patients developed NTS after CT-guided bone biopsy. Cases of seeding had a larger tumor size, a more aggressive histopathological presentation, a significantly shorter duration between cancer diagnosis and bone metastasis, and underwent more tumor manipulation procedures, such as biopsy and radiofrequency ablation, in contrast to those without seeding. In conclusion, our study identified NTS to have an incidence of 10% after biopsies of bone metastasis related to thyroid carcinoma. These are likely the result of an interplay of risk factors, including tumor biology, penetrated tissues and procedural technical details. Further studies with larger sample sizes are needed to confirm our findings and identify strategies to mitigate NTS.

Changes in Breast Cancer Risk Associated with Benign Breast Disease from 1967 to 2013.

Benign breast disease (BBD) increases breast cancer (BC) risk progressively for women diagnosed with non-proliferative (NP) change, proliferative disease without atypia (PDWA), and atypical hyperplasia (AH). Leveraging data from 18,704 women in the Mayo BBD Cohort (1967-2013), we evaluated temporal trends in BBD diagnoses and how they have influenced associated BC risk over four decades. BC risk trends associated with BBD were evaluated using standardized incidence ratios (SIRs) and age-period-cohort modeling across four eras-pre-mammogram (1967-1981), pre-core needle biopsy (CNB) (1982-1992), transition to CNB (1993-2001), and CNB era (2002-2013). With a median follow-up of 15.8 years, 9.9% of women were diagnosed with BC (invasive and/or DCIS). From the pre-mammogram era to the CNB era, we observed a significant increase in BC risk, rising from an SIR of 1.61 to 1.99. The proportion of proliferative BBD diagnoses (PDWA or AH) increased markedly over time (28.1% to 49.7%), as did the proportion of DCIS events (11% to 28%; chi-square p < .001). Within specific BBD categories, the risk of invasive BC increased modestly. While absolute risk of BC within BBD categories remained stable, the relative risk of BC after BBD increased over time due to notable increases in higher risk BBD lesions, specifically PDWA and AH. These findings illustrate how evolving screening practices have changed the risk profile of BBD and should inform management strategies for patients with BBD in modern clinical settings.

A tale of two uropathologists: concordance of Gleason Grade Groups in prostatic adenocarcinoma over needle biopsies and radical prostatectomies

Objective: The standard 12-core transrectal prostate needle biopsies don’t reflect the tumor entirely. Approximately 35-36% of needle biopsy diagnoses of Gleason grade group (GG) 1 are upgraded upon radical prostatectomy (RP). Pathologists are not in perfect concordance in Gleason scoring. Two uropathologists in a university hospital aimed to determine how concordant needle biopsy GGs were with RP GGs. Moreover, they also assessed how frequently they up-/down-graded the needle biopsy GGs each other gave when they graded RPs. Material and Methods: In-house prostate needle biopsies and RPs from 31/01/2020 to 10/09/2022 were retrieved from the hospital database. Patients who had both a needle biopsy and an RP were included. Whether each case was down-/up-graded upon RP, GGs and the pathologist that reported the cases were tabulated. Results: One hundred and thirty cases were assessed. Needle biopsy and RP GGs were identical in 63,1% (n=82). Pathologist1 (P1) assessed both the needle biopsy and RPs of 41 patients, 8 of which they downgraded and 8 upgraded (19,5%). Pathologist2 (P2) assessed both the needle biopsy and RP samples of 23 patients; downgrading 13% (n=3) and upgrading 17,4% (n=4) of cases. Where the needle biopsy was reported by P2 and RP was reported by P1 (n=48), 10 (20,8%) were downgraded and 8 (16,7%) were upgraded. The reverse scenario was noted in 18 patients; 2 (11,1%) of which were downgraded, 5 (27,8%) were upgraded. While P2 showed a tendency to upgrade more frequently, this was not statistically significant (p=0,2774, Pearson chi-square). Discussion: The two uropathologists’ up- and down-grading rates seemed concordant. Routine practice doesn’t allow time for one pathologist to re-score the other’s cases, nor is every case consulted. Looking back at pathologist-specific tendencies to up/downgrade one’s own or a colleague’s scores may help direct ourselves and others to curb tendencies to over/undergrade.

Comparison of different puncture needles used for endoscopic ultrasound-guided fine-needle biopsy of Gastrointestinal subepithelial lesions (≤ 2 cm) with respect to the adequacy of specimen collection: study protocol for a multicenter randomized prospective trial

BackgroundGastrointestinal subepithelial lesions (SELs) range from benign to malignant. Endoscopic ultrasound (EUS)-guided fine-needle biopsy (EUS-FNB) is used widely for pathological diagnosis of SELs. Early diagnosis and treatment are important because all Gastrointestinal stromal tumors (GISTs) have some degree of malignant potential. Diagnosing SELs with EUS-FNB is more difficult than diagnosing other tumors because an accurate diagnosis of GIST requires a sufficient tissue sample for immunostaining, which is part of the diagnostic protocol. Moreover, EUS-FNB is less accurate for diagnosis based on samples from SELs measuring ≤ 2 cm. However, our retrospective study showed that more than 50% of patients with SELs ≤ 2 cm were diagnosed as GIST. Therefore, EUS-FNB needles are required with adequate sampling in SELs measuring ≤ 2 cm. Previously, we conducted a retrospective single-center study of SELs measuring ≤ 2 cm, and reported that EUS-FNB with a Fork-tip needle was superior to that with a Franseen needle in that the former acquires sufficient sample. This multicenter comparative open-label superiority study is designed to verify whether a 22G Fork-tip needle is superior to a 22G Franseen needle with respect to sample acquisition.Methods/designPresent study will randomly assign for 110 patients (55 in the Fork-tip needle group and 55 in the Franseen needle group) with SELs measuring ≤ 2 cm, all of whom are managed at one of the 10 participating endoscopic centers. The primary endpoint evaluates the superiority of a 22G Fork-tip needle over a 22G Franseen needle for collection of an adequate tissue specimen at the first puncture. The secondary endpoints compare successful puncture rate, procedure completion rate, number of adverse events, diagnostic suitability of the first puncture specimen for GIST, and the number of punctures required until adequate specimen collection.DiscussionThe outcomes may provide insight into the optimal needle choice for diagnosis of SELs ≤ 2 cm, thereby aiding development of practice guidelines. Present study is expected to promote early definitive diagnosis of GISTs, thereby increasing the number of cases that can receive curative treatment and improving prognosis.Trial registrationJapan Registry of Clinical Trials (JRCT; trial registration: jRCTs052230144). Registered December 13, 2023. (URL; https://jrct.niph.go.jp/re/reports/detail/76858).