Percutaneous Biopsy Technique Research Articles

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

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

Percutaneous Liver Biopsy: Reflections and Refinements

Department of Medicine, University of Western Ontario, London, Ontario Correspondence: Dr Cameron N Ghent, University of Western Ontario, London, Ontario N6A 5A5. Telephone 519-642-3232, fax 519-642-2545, e-mail drghent@on.aibn.com Received for publication August 7, 2005. Accepted August 12, 2005 Almost 50 years ago, Menghini (1) described the one-second percutaneous suction liver biopsy and the needle that bears his name and revolutionized the practice of hepatology. He described some refinements a few years later (2) but the technique has changed little since then. It is, therefore, timely to re-evaluate the place of this timehonoured diagnostic test, given the tremendous changes that have revolutionized hepatology since then. Better diagnostic tests for many diseases have led to a decreased need for biopsy to make a diagnosis in many patients. The increasing resolution and sophistication of imaging modalities, such as ultrasound, computed tomography and magnetic resonance imaging, have decreased the need for obtaining liver tissue for histological examination in some patients, particularly those with focal liver lesions. However, three developments in hepatology have increased the need for biopsy. Among the reasons for increasing use of biopsy is the large population of newly diagnosed hepatitis C patients, many of whom require pretreatment biopsy, not for diagnosis but for staging, according to current practice guidelines (3). In addition, the increased use of liver transplantation as standard treatment of end-stage liver disease of diverse etiologies has led to more biopsies being performed to differentiate the cause of graft dysfunction, and to assess the suitability of potential donor livers for transplantation. The third major impact on the practice of hepatology is the dramatic increase in obesity, diabetes, hyperlipidemia and hypertension (the metabolic syndrome) in Western societies and its accompanying fatty liver problems requiring assessment by histology. This is another case of liver biopsy serving a role as largely a staging rather than a diagnostic procedure (4), although some selectivity is needed in choosing to biopsy big people with big livers. Excellent reviews of the indications, contraindications and technical aspects of this procedure have been recently published (5-8). The British Society of Gastroenterology has developed clinical practice guidelines for percutaneous liver biopsy (9), and the American College of Gastroenterology guidelines are specific to the use of liver biopsy as an outpatient procedure (10). The Canadian Association of Gastroenterology guidelines (11) are the most recent and do not differ substantially from earlier recommendations, but also do not meet the published arbitrary criteria for developing and using guidelines (12,13). This biased and personal review is based on over 30 years of performing and teaching the technique of percutaneous liver biopsy within academic health care centres and reviewing a large number of biopsy specimens with expert hepatopathologists. I will focus on some technical and some general aspects that are either neglected in other reviews or are commonly misunderstood by the neophyte gastroenterologists and hepatologists we attempt to teach. Alternative approaches to obtaining tissue such as transvenous biopsy, fine needle aspiration and operative or laparoscopic biopsy will only be mentioned when they are appropriate alternatives to routine transthoracic biopsy.

Image-guided breast surgery

With recent advances in technology and increased use of ultrasound, breast surgery has dramatically changed its approach towards nonpalpable lesions. Several image-guided diagnostic and therapeutic procedures have been implemented for the treatment of breast disease. Some of these modalities, including percutaneous image-guided biopsy techniques, were developed for the management of nonpalpable lesions, and they have been incorporated as the current standard of practice. Other innovating image-guided technologies, such as radiofrequency ablation and cryoablation therapy, are being explored in clinical protocols as promising new treament modalities. In this article, the authors review the indications, advantages, and application techniques of the most common and current image-guided procedures performed today for the approach of breast pathology.

Evaluation of different techniques for percutaneous needle biopsy of synovial membrane in the dog

Four different needles were evaluated for percutaneous needle biopsy (PNB) of the synovial membrane (SM) in six different joints (carpus, tarsus, elbow, shoulder, stifle, hip) from eight dog cadavers. Needle biopsies were retrieved with the Parker-Pearson (PP), a novel modified Parker-Pearson (PPM), the Tru-Cut (TC), and the Franklin-Silverman (FS) needles. The success rate of PNB to produce biopsies, of adequate histological quality, was assessed for each needle type and joint. The joints were subsequently surgically opened and standard open SM biopsies were harvested from an adjacent area. The articular cartilage was inspected and graded for damage caused by PNB sampling. The length of the intact synovial lining cell layer (SLCL) and the histological quality of the needle biopsies were compared to the open surgical biopsies. Success rates for the different needles were 49.2% (PPM), 37.5% (PP), 26.7% (TC), and 1.7% (FS). The highest success rates were achieved in the carpus and stifle; the lowest success rate was found in the hip joint. The intact SLCL from the PNB samples was an average of 3.4 times shorter than that of the surgical biopsies. The proportion of the samples with adequate histological quality was 81% for open surgical biopsies and 62% for PNB samples. The FS was found to produce the highest incidence of articular cartilage damage. The application of PNB for SM sampling is a valuable alternative to the open surgical biopsy in dogs. Modifications of the Parker Pearson needle by Arassy and Schumacher and novel modifications introduced by the authors, offer encouraging results, and merit further clinical and research investigations.

A successful method of obtaining percutaneous liver biopsy samples of sufficient quantity for trace mineral analysis in adult swine without the aid of ultrasound

Objectives: The objectives of this study were to determine if liver biopsy samples could be obtained percutaneously from large adult swine safely and in sufficient quantity to evaluate trace mineral status, and to determine if liver samples could be obtained without the aid of ultrasound. Materials and methods: Twelve healthy pigs with an average weight of 209 kg were randomly divided into two equal groups. The principal group of pigs were anesthetized and placed in left lateral recumbency. Percutaneous liver biopsies were performed, according to the expected anatomical location of the liver, for trace mineral analysis and histopathology. All principal pigs were necropsied 48 hours after the procedure and evaluated for significant lesions. Blood samples were obtained from all pigs, before anesthesia and 48 hours after the procedure, for hematology and serum chemical analysis. Results: Liver tissue was successfully obtained from all six principal pigs. An average of 440 mg of liver was obtained for trace mineral analysis. Hematology, serum chemical analysis, and necropsy results indicated no clinically significant complications as a result of the biopsy technique. Discussion: It appears that obtaining percutaneous liver biopsies of sufficient quantity for trace mineral analysis can be performed safely in adult pigs without the aid of ultrasound. This procedure may circumvent the need to obtain liver tissue via necropsy or laparotomy. Implications: Use of this percutaneous biopsy technique provides sufficient tissue for researchers to evaluate the trace mineral reservoir status of adult swine without requiring necropsy or laparotomy.

Transthoracic needle biopsy of lung masses: a survey of techniques

In order to assess the range and everyday use of the various techniques for percutaneous transthoracic needle biopsy of lung masses in the USA and Canada, we surveyed thoracic radiologists in academic and community practice on their standard approach to the procedure. The 300 questionnaires that were mailed to members of the Society of Thoracic Radiology throughout the USA and Canada contained specific questions on their approach to a transthoracic needle biopsy of a routine case of a 3cm lung mass located in the right lower lobe 1cm from the pleural surface. A total of 140 (47%) members responded. Of the 139 responders who performed lung biopsies, 103 (74%) were located at a teaching centre affiliated to a university or medical school, and 36 (26%) were community-based radiologists. In total 97 (70%) replied that they would perform the procedure under CT guidance, 31 (22%) under either CT or fluoroscopy guidance, and 11 (8%) only under fluoroscopy. Fine-needle aspiration was the procedure of choice for the given case by 101 (73%) responders, whereas 20 (14%) preferred doing core biopsy, and 18 (13%) chose both techniques. On-site cytology confirmation for obtaining diagnostic material was available to 101 (73%) responders. Before performing the procedure, 107 (77%) verified coagulation tests whereas 32 (23%) did not. Follow-up imaging for pneumothorax assessment was not routinely performed by 15 (11%) responders. The majority of radiologists performed percutaneous transthoracic needle biopsy of a lung mass under CT guidance, by fine-needle aspiration, using repeated pleural puncture technique, and with a cytologist on site. A significant minority did not obtain coagulation screening before the procedure, and a small minority did not routinely assess for pneumothorax by late chest radiography.

Biopsy of the Transplanted Kidney

This article describes the current state-of-the-art technique of percutaneous transplant renal biopsy. A brief overview of the history of transplant renal biopsy is given. The indications and contraindications are discussed, including pre- and postprocedure patient management. The technique of the procedure and the devices that are available in the market are described.

Percutaneous Multiple-Site Parietal Pleural Biopsy: Description and Evaluation of a New and Safe Technique

(1) To describe a new percutaneous pleural biopsy technique to obtain multiple-site parietal pleural biopsy specimens in patients with pleural effusion (PE), and (2) to evaluate its effectiveness and safety compared to current techniques. Prospective interventional study. University teaching hospital. Consecutively referred for evaluation of exudative PE. With the patient in a semirecumbent position, a 9F sheath was inserted by the Seldinger technique into the pleural cavity on the midaxillary line under local anesthesia and fluoroscopic guidance. An 8F bioptome was introduced through it, and biopsy specimens were taken from several sites on the costal and diaphragmatic pleura. After biopsy, PE was completely evacuated, and the sheath was removed. During the 2-year pilot study, we procured, on average, 14 adequate pleural specimens from each of the 28 patients (age range, 15 to 81 years) on the first attempt. Histopathologic examination revealed tuberculous pleuritis (18 patients), metastatic adenocarcinoma (1 patient), and nonspecific pleuritis (9 patients). Postprocedure, 25 patients had rapid symptomatic improvement without recurrence of PE. No major complications occurred during or after the procedure (mean follow-up period, 2 years). Our new biopsy procedure can be performed easily, safely, and with increased diagnostic sensitivity and patient comfort. Unlike other biopsy techniques, it provides adequate multiple-site pleural biopsy specimens, in all cases, on the first attempt without any morbidity and mortality. It has a therapeutic potential to provide rapid symptomatic relief and treatment by pleurodesis. We recommend this procedure for patients whose conditions remain undiagnosed after undergoing needle biopsy or for those who cannot tolerate it, before considering more aggressive diagnostic interventions. This is the best alternative when thoracoscopy or thoracotomy are not available or when patients are at high risk for complications from them.

Transjugular Liver Biopsy in Patients with EndStage Renal Disease

To assess the efficacy and safety of transjugular liver biopsy (TJLB) in patients with end-stage renal disease (ESRD) who are undergoing hemodialysis treatment. Forty-six consecutive patients with liver disease who were undergoing hemodialysis were included in this study. An 18-gauge Tru-cut transjugular needle with a 20-mm throw was used to obtain liver tissue. All procedures were performed under fluoroscopic guidance. A single pathologist reviewed the biopsy specimens and assessed the size of fragments, number of portal tracts, and adequacy of the specimens for histologic diagnosis. All complications were recorded. The results were compared with the outcomes of percutaneous liver biopsy carried out at our institution in 32 patients with ESRD. TJLB and percutaneous biopsy techniques yielded adequate specimens for histologic diagnosis in all patients. The mean length of the largest fragments of tissue obtained via the transjugular and percutaneous routes were 16 mm +/- 4 and 14 mm +/- 3, respectively (P = NS). There were no major complications among patients who underwent TJLB. Percutaneous liver biopsy was complicated by hemorrhage in four of 32 patients (12%), three of whom required blood transfusion. TJLB is an effective and safe technique to obtain liver tissue in patients with ESRD and is associated with a lower complication rate than percutaneous liver biopsy.

Transcutaneous ultrasound-guided pancreatic biopsy in cattle and its safety: a preliminary report

This study describes a free-hand technique for percutaneous pancreatic biopsy in cattle with ultrasound-guidance using a 14G spinal biopsy needle. Its safety was evaluated based on 36 consecutive procedures. To assess the immediate effects of pancreatic biopsy, 31 cows were necropsied shortly after the procedure and examined. The remaining five cows were examined daily for eight days and then necropsied and examined. No life-threatening complications nor clinically detectable abnormalities were observed. Changes indicative of inflammation were not apparent in total and differential WBC counts or in total protein and fibrinogen concentrations. A small increase of amylase activity was detected in only one cow kept for the eight-day observation period. Serum lipase activity increased significantly on day four after biopsy. Urea nitrogen, creatinine, glucose and the activities of aspartate aminotransferase, alanine aminotransferase, and γ-glutamyltransferase remained within reference ranges. Changes in the peritoneum and pancreas observed at necropsy were negligible. We conclude that percutaneous ultrasound-guided pancreatic biopsy did not appear to influence the cow’s condition adversely and the procedure provided an excellent method of obtaining a pancreatic specimen for histological examination. The procedure was considered safe, fast, cost-effective, and practical when performed properly. We believe that the technique can be used in cows with suspected pancreatic disease for making an ante mortem diagnosis.

Simultaneous pancreas-kidney and pancreas transplantation.

The discovery of insulin in 1922 changed the treatment of type 1 diabetes mellitus (DM) forever. Insulin was the first effective therapy for type 1 DM; however, its success engendered a terrible paradox for patients with this disease. The use of insulin transformed type 1 DM from a rapidly fatal

Localization and biopsy of breast lesions by magnetic resonance imaging guidance.

Contrast-enhanced MRI of the breast has proved to be a valuable tool in the detection and work-up of breast lesions. Most of these lesions are small and not visible by other imaging modalities, such as mammography or US. Thus, only MR-guided preoperative localization techniques or MR-guided percutaneous biopsy can provide a histologic work-up of such lesions. MR-guided preoperative localization seems to be a well-established procedure. However, MR-guided biopsy is still problematic. Although prototypical biopsy systems have been developed, considerable progress is still required. Problems exist with MR-guided biopsy due to severe needle artifacts and tissue shift during the intervention. Thus, needle biopsy currently is not recommended for lesions smaller than 10 mm. This work reviews current techniques for MR-guided preoperative localization and percutaneous biopsy in breast lesions. The diagnostic accuracy achievable with these techniques will be discussed, as well as the potential for new research opportunities and directions. J. Magn. Reson. Imaging 2001;13:903-911.

Muscle biopsy and muscle fiber hypercontraction: a brief review.

The percutaneous muscle biopsy technique is an important tool used in exercise and applied physiology to study human skeletal muscle structure, adaptation, and regeneration. One important use of this technique has been the assessment of ultrastructural muscle damage, especially in tissue samples obtained following strenuous exercise protocols, often involving eccentric muscle actions. In this brief review, we define and describe hypercontracted fibers, and outline how such fibers may adversely affect the interpretation of muscle damage from fixed tissue. Evidence suggests that hypercontracted fibers present in healthy skeletal muscle samples are likely to be artifacts related to the muscle biopsy procedure, as opposed to intrinsic degeneration present prior to the biopsy. When hypercontracted fibers are noted as being intrinsic to a muscle sample (e.g., in myopathy or following an extreme eccentric stimulus), such fibers are generally associated with the infiltration of inflammatory cells, indicative of a regenerative response. In contrast, hypercontracted fibers resulting from the biopsy procedure are not typically associated with an inflammatory response. The major sources of hypercontracted fibers are outlined and recommendations for their interpretation are discussed.

Percutaneous liver core biopsy in rats: an alternative to minilaparotomy

Summary Sampling of rat hepatic tissue for histomorphological analysis is usually performed in two different ways: either by killing the animals or by minilaparotomy. In this study we describe a percutaneous core biopsy technique which has been used on day 7, 14 and 21 after allogeneic rat liver transplantation (DA → LEW) in order to examine grafts for rejection in different treatment groups. Fifty-two liver biopsies were performed in 24 animals using a 16-gauge intravenous cannula. Forty-five provided usable specimens which were sufficient for both light or electron microscopy and immunohistochemical analyses to determine the degree of graft rejection. In 7 cases (13.5%) sampling was unsuccessful, especially on day 21 after transplantation, as the plastic cannula could not penetrate the hardened tissue. In 3 animals (5.8%) puncture was immediately followed by death due to perforation of the diaphragm or ether intoxication. In conclusion, this technique is a reliable method for providing ample tissue samples from the rat liver with a low risk of complications.

Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients.

Many studies have documented an association between chronic low back pain (LBP) and deficits in back muscle strength and endurance. The sub-optimal performance is believed to be the result of alterations in the size and structure of the muscle, although the long-standing issue of whether the observed changes precede or are a consequence of the pain remains unresolved. If consequent to the problem, and predominantly related to disuse of the muscles, then it may be expected that a relationship between muscle structure and symptom duration would exist. Lumbar paraspinal muscle samples were obtained from 59 chronic LBP patients using the percutaneous biopsy technique. The samples were subject to routine histochemical analysis for the examination of muscle fibre type characteristics and cytochemical architectural changes. In 55 of the patients, the gross cross-sectional areas of magnetic resonance images of the trunk muscles were also measured. Multivariate analysis showed that symptom duration was the strongest predictor of the individual proportions of the fast-fatigable type IIX fibres; with age and gender included in the model, nearly 30% of the variance in fibre type distribution could be accounted for. Duration of pain had no influence on fibre size. Gross muscle cross-sectional area correlated directly with lean body mass and inversely with age, but showed no relationship with symptom duration. Pathological changes in the internal fibre structure were more frequently encountered in older patients, and were independent of symptom duration. The results suggest that, over the long term, fibre type transformations rather than alterations in fibre size are the predominant changes to be found in the muscles of chronic LBP patients. The direction of change supports the results of many previous studies that have demonstrated corresponding differences in the fatigability of the muscles. There is a strong case for the early implementation of active measures to attempt to offset the development of these changes in back pain patients.

The use of percutaneous needle muscle biopsy in the diagnosis of myopathy.

Less invasive, inexpensive, and minimally time-consuming muscle biopsy techniques are desirable if their diagnostic yield is similar to that of open muscle biopsy. This article reviews the technique of semi-automated percutaneous needle muscle biopsy and its utility in diagnosis of neuromuscular diseases. Although direct comparisons with open biopsy are not available, the data indicate that percutaneous needle biopsy is quite useful for diagnosis of inflammatory as well as other forms of myopathy. The specimens can also be utilized for molecular diagnostic studies and cell culture.

CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma

The advent of radiologic guidance techniques for percutaneous biopsy has changed the approach to the routine diagnosis of mediastinal lymphoma. The aim of the present study was to evaluate the diagnostic accuracy of CT-guided percutaneous core-needle biopsy (PCNB) in the clinical management of patients with mediastinal lymphoma. The results of 49 CT-guided PCNB of mediastinal lymphoma performed under local anesthesia in 42 ambulatory patients were analyzed. A positive diagnosis of lymphoma was obtained in 30 of 42 patients, with an overall success rate of 71.5%. The technique was equally successful in the diagnosis of Hodgkin's and non-Hodgkin's lymphoma. There were no major complications. Percutaneous CT-guided CNB of mediastinal lymphoma is a quick, safe, accurate, and efficient alternative to open biopsy in the evaluation of mediastinal lymphoma, mainly at presentation. It should become the preferred initial diagnostic procedure for obtaining histologic samples in patients with suspected mediastinal lymphoma.

Regulation of human muscle contraction at the cellular and molecular levels.

The rat is the most extensively characterized species with regard to regulation of muscle contraction and myofibrillar protein isoform expression, but there is reason to question whether results from small mammals, such as the rat, can be extrapolated directly to larger mammals, such as man. Studies of human muscle contraction have primarily used different in vivo muscle function measurements, i.e. measurements of force at different speeds of movement during electrical stimulation or voluntary activation. These measurements give important information on overall muscle function, but they are of limited value for our understanding of regulation of muscle contraction. In basic science, cellular- and molecular-physiological methods have been used for many years, but these techniques have so far only rarely been used in studies of human muscle contraction. Detailed studies of human muscle contraction can be performed in the short muscle fibre segments obtained by the percutaneous muscle biopsy technique both at the cellular and molecular level. The skinned fibre preparation in combination with a novel in vitro motility assay offers a unique possibility to investigate regulation of human muscle contraction at the cellular and molecular levels in the same muscle cell segment in both health and disease, i.e. in muscle cells characterized according to the type and amount of expressed myofibrillar protein isoforms.

Transvenous liver biopsy

In patients with an indication for histological evaluation of diffuse liver disease a transvenous approach may be advisable if a percutaneous technique is contraindicated by severe coagulopathy or ascites. In general, the procedure may be performed as an aspiration core, or forceps biopsy technique using a transjugular approach. Alternatively, the forceps biopsy technique may be performed via a transfemoral access. Adequate specimens for histologic diagnosis may be obtained in 77-100% with either biopsy technique. Complications after transvenous liver biopsies occur in 0-20% with an overall mortality rate below 0.5%. Although the transvenous liver biopsy techniques take more time and are more expensive than percutaneous biopsy techniques, they represent a safe and effective alternative for obtaining adequate liver samples for histological diagnosis in special clinical settings.

A percutaneous large-needle aspiration biopsy technique for histologic examination of the testis in infertile patients

Objective: To describe a relatively new percutaneous large-needle aspiration biopsy technique for histologic examination of the testis in infertile patients. Design: Retrospective analysis of clinical and pathologic data. Setting: Clinical and academic research environment. Patient(s): Sixty-six infertile patients who underwent testicular biopsy. Intervention(s): Local anesthesia was induced through spermatic cord block with lidocaine, and a relatively large needle (usually 18- or 20-gauge) was introduced percutaneously into the testicle without a scrotal incision. Main Outcome Measure(s): The number of seminiferous tubules per histologic section of each testicular biopsy sample. Result(s): A mean of 74 seminiferous tubules were obtained in the histologic sections of each biopsy sample. This number varied according to the size of the needle used; it was 24.7 when a 21-gauge needle was used, 56.2 when a 20-gauge needle was used, and 103 when an 18-gauge needle was used. The biopsies were performed in the office. No significant hematomas occurred, no antibiotic prophylaxis was prescribed, and no postbiopsy medical or pharmacologic interventions were required. Conclusion(s): Tissue specimens as large as those obtained with open surgical biopsy can be obtained from the testicles of infertile patients with the use of a percutaneous technique that is easier, less costly, and safer than any previously reported.