Percutaneous Fine-needle Biopsy Research Articles

Complications and associated risk factors of image guided biopsies of thoracic lesions

Aims: The aim of this study is to determine the complications and associated risk factors of image guided percutaneus transthoracic biopsies of throracic lesions. Methods: Fifty-seven patients who had an ultrasound and computed tomography-guided percutaneous fine needle and tru-cut biopsy between 2006-2008 were evaluated retrospectively. Sixty biopsies were performed. Sensitivity and accuracy were calculated, and each patient was reviewed for complications, including pneumothorax and thoracic tube insertion. Results: Fine needle aspiration and tru-cut biopsy results in sensitivities and accuracies were similar to those in the literature. Pneumothorax was the most frequent complication. Length of normal lung parenchyma between the lesion and pleura and repeated puncture of the pleura more than two times were associated with an increased rate of pneumothorax and the results were statistically significant. Conclusion: Transthoracic computed tomography and ultrasound-guided biopsies are found to be cheap, easily achievable, and safe processes.

Efficacy and safety of CT-guided percutaneous fine needle aspiration and biopsy for malignant pulmonary lesions

Background: CT-guided percutaneous transthoracic fine needle aspiration (FNA) and core biopsy (CB) are commonly used to characterise lung lesions. There is conflicting information on which method is superior and wide variation in reported complication rates. Our objectives were to establish the efficacy and safety of percutaneous CT-guided FNA and CB in the diagnosis of malignant lung lesions. Methods: This retrospective study included patients who underwent CT-guided percutaneous FNA and/or CB for lung parenchymal lesions at Kasturba Medical College Mangalore, from January 2013 to December 2020. Ethical clearance was obtained from the Institutional Ethics Committee. Efficacy was determined by the adequacy of samples, sensitivity, specificity and diagnostic accuracy. Safety was assessed using the incidence of complications. Results: A total of 326 patients underwent both FNA and CB, and 49 underwent FNA alone. Adequate samples were obtained in 82.9% of FNA cases and 95.7% of CB cases. Considering biopsy as the gold standard, the sensitivity, specificity and diagnostic accuracy of FNA for malignancy were 95.19%, 80% and 91.27%, respectively. Kappa agreement between the two methods was substantial (0.767). Pneumothorax was the only complication observed, and was seen in 31 patients (8.2%), of which only one required chest tube drainage. The incidence of pneumothorax was significantly higher in patients with pre-existing lung disease such as COPD/emphysema (p value 0.000), patients with smaller lesions (p = 0.009), and deeper lesions from the pleura (p <0.0001). Conclusions: FNA and CB are both safe and effective procedures. In the absence of an onsite cytopathologist, we recommend a combination of both techniques.

Assessment of the clinical usefulness of ultrasound-guided cytological specimens obtained from gastrointestinal lesions in dogs and cats.

Cytological biopsies are an integral additional test to an abdominal ultrasound when a lesion is identified, but there is little published on factors that that may impact achieving a clinically useful sample of gastrointestinal lesions obtained by ultrasound-guided fine-needle cytologic biopsy. This retrospective, descriptive study aimed to assess factors that may influence the clinical usefulness of submitted cytological samples collected from gastrointestinal lesions by ultrasound-guided percutaneous fine-needle cytologic biopsy. Gastrointestinal cytological samples obtained from 25 dogs and 19 cats over 2.5 years were reviewed and determined as clinically useful or clinically useless as per the cytology report. Variables dependent on the ultrasound exam that were used in the analysis included lesion location, lesion thickness, loss of gastrointestinal layering, and the number of slides submitted. Thirty (30/44) of the submitted cytological samples were considered clinically useful. Factors associated with achieving a clinically useful sample in univariable models included the number of slides submitted and the thickness of the lesion. However, these two variables appear inter-related, as a weak correlation existed between them. Where histologic biopsies were obtained, a clinically useful sample had a partial or complete agreement with histology in three of 12 and eight of 12 cases, respectively. Ultrasound-guided fine-needle cytological biopsies of gastrointestinal masses provided a clinically useful sample in two-third of the cases, especially if more slides were provided to the cytologist and thicker lesions were sampled.

LUNG CANCER DIAGNOSIS: NON-INVASIVE AND INVASIVE METHODS

This article reviews the literature and summarizes single institution experience of applying different diagnostic algorithms for lung cancer. All diagnostic methods can be divided into three groups: non-invasive; minimally invasive and invasive. The non-invasive methods include clinical examination; imaging methods for anatomical, functional and multimodal visualization; sputum cytological, analysis of the exhaled breath, detection of various blood and sputum markers. Minimally invasive methods include endoscopy, percutaneous fine-needle and core-needle biopsy. Invasive methods include diagnostic thoracoscopy and laparoscopy, mediastinoscopy, parasternal mediastinotomy and diagnostic thoracotomy. While creating an individual diagnostic plan for each patient it is necessary to carefully analyze the effectiveness, safety, sensitivity, specificity and of different methods available among wide range of modern diagnostic techniques. Optimization of lung cancer diagnosis methods, which includes early cancer detection, is one of priority areas of modern oncology. Many aspects of this problem remain unresolved and require further research

A bump: what to do next? Ultrasound imaging of superficial soft-tissue palpable lesions.

Soft-tissue palpable lesions are common in clinical practice, and ultrasound (US) represents the first imaging option in the evaluation of a patient with a soft-tissue swelling. A full and systematic US assessment is necessary, however. This includes grayscale, color- and power-Doppler, spectral-Doppler, and possibly elastography facilities, as well as a trained operator. Several lesions showing characteristic US features can be diagnosed confidently, without any further work-up, and the high spatial resolution of ultrasound in the superficial layers can be a powerful tool to discriminate their etiologies. Second-level options, to be reserved for indeterminate cases or those suspected malignant at initial ultrasound, include magnetic resonance imaging, percutaneous fine-needle aspiration or biopsy, and surgical-excision biopsy. In this article, we discuss the proper US approach for addressing superficial soft-tissue lesions.

2502 Rare Hepatic Adenomatosis Diagnosed by Endoscopic Ultrasound-Guided Fine-Needle Biopsy

INTRODUCTION: While hepatic adenomas are uncommon (1:100,000), hepatic adenomatosis (HA), defined as >10 adenomas, is even more rare (1-2.4:1,000,000) and poorly understood. HA poses a significant risk of hemorrhage and progression to hepatocellular carcinoma. Diagnosis by percutaneous fine needle biopsy (FNB) poses potential risk of infection and bleeding, and can be made more safely with endoscopic ultrasound FNB (EUS-FNB). Data on safety and efficacy of EUS-FNB in diagnosis of HA is limited, however it has high efficacy in the evaluation of gastrointestinal tumors and solid pancreatic lesions. This rare case of HA highlights the scarcity and risk factors of the condition while presenting a minimally invasive approach for diagnosis. CASE DESCRIPTION/METHODS: A 43-year-old female presented with nausea, vomiting, diarrhea, vague epigastric pain, and unremarkable past medical history with 20-year history of oral contraceptive pill (OCP) use. Laboratory results were significant only for elevated liver function tests and quickly resolving leukocytosis and symptoms. She was diagnosed with uncomplicated gastroenteritis but an abdominal CT incidentally showed multiple hepatic lesions scattered throughout the liver. MRI confirmed diffuse hepatic steatosis and numerous liver lesions (maximum diameter 3.51 cm) (Figure 2), consistent with hepatic adenomatosis vs. metastatic cancer. EUS-FNB was performed with pathology revealing inflammatory type hepatocellular adenoma (HA-I) (Figure 3). DISCUSSION: Although little evidence correlates the development of HA with the use of OCP's, there is a notably higher prevalence in females, consistent with the known association of adenoma and exogenous estrogen. Our patient's female gender and 20-year OCP use are the only currently understood risk factors for her HA. They are structurally composed of an extensive sinusoidal network and have minimal connective tissue covering, expanding the risk of intralesional hemorrhage and hemoperitoneum. Continuing to diagnose this condition through minimally invasive EUS-FNB can further illuminate risk factors for progression as well as aid in the understanding of HA's pathology and risk for malignant transformation and hemorrhage.

Comparison of biliary brush biopsy and fine needle biopsy in the diagnosis of biliary strictures

Purpose: The purpose of this study is to evaluate the accuracy of percutaneous fine needle biopsy (FNB) and brush biopsy (BB) at a cancer center.Material and methods: Retrospective analysis of all bile duct biopsies performed in Interventional Radiology between January 2000 and January 2015 was performed. FNB was performed under real-time cholangiographic guidance using a notched needle directed at the bile duct stricture. BB was performed by advancing a brush across the stricture and moving it back and forth to scrape the stricture. Biopsy results were categorized as true positive (TP), true negative (TN), false positive (FP) and false negative (FN) based on pathology reports and confirmed by surgical specimens or clinical follow-up of at least six months. Fisher’s exact test was used to compare the rate of TP in FNB and BB.Results: One-hundred and nineteen patients underwent FNB or BB. Fifteen were censored because of lack of follow-up. The remaining 104 patients underwent a total of 117 bile duct biopsies during the study period: 34 FNB and 83 BB. There were no complications in either group. In the FNB group 22/34 (64%) biopsies were TP, 4/34(12%) were TN and there were 8(24%) FN biopsies. In the BB group, 20/83 (24%) were TP, 38/83 (46%) TN and 25/83 (30%) FN biopsies. There were no FP biopsies in either group. The sensitivity of detecting malignancy by FNB was significantly higher than that by BB (73% vs 44%, p < .0005). There were no complications associated with FNB or BB.Conclusions: FNB of bile duct strictures is safe and has a higher sensitivity for detecting malignancy than BB.

Burkitt Lymphoma Mimicking as Pancreas Adenocancer With Liver Metastases

Primary lymphomas of the pancreas are uncommon and Burkitt lymphoma (BL) involving pancreas is very rare. It is important to recognize this entity because it can resemble adenocarcinoma of the pancreas but its management is entirely different. We describe a case of synchronous pancreatic, duedonal and liver involvement of BL in a 34-year-old man who presented with acute pancreatitis. Abdominal computed tomography revealed a hypoechogenic area within the head of the pancreas and multiple hypoechogenic areas in the liver. Upper gastrointestinal (GI) endoscopy revealed multiple ulcerated polypoid lesions in the duodenum. Percutaneous fine-needle aspiration biopsy of the liver lesions and endoscopic biopsy of duedonal lesions revealed BL. This is an unusual presentation of BL with pancreatic, duedonal and liver involvement which mimicks as pancreas adenocarcinoma with liver and duedonal metastases. J Med Cases. 2017;8(10):315-317 doi: https://doi.org/10.14740/jmc2899w

P-197 - Diagnostic management of volumetric formations of head of pancreas

Introduction: Improved diagnostic results in volumetric formations of the pancreatic head. Methods: Work performed at the Department of Surgery of the Tashkent Medical Academy on the basis of the Republican Clinical Hospital №1 of Tashkent. In July 2015, we examined 57 patients (32 (56.1%) men and 25 (43.9%) women with a mean age of 62,9 ± 11,4 years) with volume formations of the head of the pancreas of various origins. All patients with suspected pancreatic cancer in the first stage was carried ultrasound imaging, determination of CA 19-9 in the blood serum and carrying out percutaneous biopsy. In 32 (82%) of patients with obstructive jaundice, these studies were carried out after ERCP with transpapillyarnymendoprotezirovaniemholedoha and normalization bilirubinemia level. Magnetic resonance imaging was performed (23 (40.3%) patients) modes - T1 FL, T2 TSE, T2 HASTE. MRI performed beskontrastnym way, using a special program of MR myelography. In order to histological verification performed percutaneous fine needle biopsy tissue volumetric formations of the pancreas (41 (71.9%) patients). The study was carried out under the control of ultrasound tomography using 18G caliber biopsy needle and puncture gun company Pro-Mag. Results: We propose the following algorithm: the detection of volumetric formation in the head of the pancreas, is not complicated by obstructive jaundice, shows the definition of the level of CA 19-9 and percutaneous fine needle biopsy tissue. In case of a negative response and histological normal level of CA 19-9, or a slight increase in its dynamic monitoring is recommended, repeated ultrasound and determination of CA 19-9 in 1 month, and in case of a significant increase in tumor marker levels should be repeated fine needle biopsy under ultrasound guidance. In the presence of jaundice perform ERCP with endoscopic prosthesis choledochal for decompression of the biliary tract. If you can not perform palliative draining operation with biopsy and subsequent investigation of tumor markers. After regression of jaundice performed fine needle biopsy of the pancreas and the definition of CA 19-9. In the group of patients with pancreatic head cancer CA 19-9 level was: Median 437.9 U/ml (interkvantilny span from 77.0 to 6273ed/ml) in patients with chronic pancreatitis - a median of 5.2 units/ml (interkvantilny magnitude from 2.2 to 18.1 units./mL), the sensitivity was 90.9%. Conclusion: None of the given research methods alone can not reliably verify the nature of the bulk of the pancreas head. The proposed algorithm has allowed to verify diagnostic methods in 40 (70.2%) patients with pancreatic cancer and 17 (29.8%), chronic pancreatitis indurativnyy followed by a choice of tactics of treatment.

Factors affecting the accuracy and safety of computed tomography-guided biopsy of intrapulmonary solitary nodules ≤30 mm in a retrospective study of 155 patients.

Computed tomography (CT)-guided percutaneous fine needle biopsy is a common method for lung biopsy. The objective of this study was to investigate factors affecting the accuracy and safety of CT-guided percutaneous lung biopsy of nodules ≤30 mm in diameter. Between January 2013 and March 2014, 155 patients underwent a CT-guided percutaneous biopsy procedure on an intrapulmonary solitary nodule measuring ≤30 mm in diameter. Prospectively collected data were retrospectively reviewed and examined for the influence of clinical and pathological characteristics (age, gender, smoking status, adhesion of nodule to the pleura, puncture depth, nodule size and time of biopsy) on the accuracy of biopsy and incidence of pneumothorax and hemorrhage. The accuracy of CT-guided biopsy was 90.3% (140/155). Biopsies predominantly contained lung adenocarcinoma (114/140; 81.4%) or squamous cell carcinoma of the lung (10/140; 7.1%). Accuracy was significantly dependent on nodule size, ranging in accuracy from 85 to 97% for patients with nodule diameters of ≤20 or 21-30 mm, respectively (P<0.05). Pleural adherence of the nodule significantly increased the accuracy of the biopsy (P<0.05). Patients with a nodule of 11-20 mm in diameter had a significantly higher incidence of pneumothorax compared with patients with a smaller nodule (P=0.013). In conclusion, the nodule size and adhesion to the pleura influenced the accuracy of CT-guided biopsy of intrapulmonary nodules that were ≤30 mm in diameter. Nodule size may also affect the incidence of severe complications. CT-guided percutaneous lung biopsy has a high accuracy and is easy and safe to conduct for intrapulmonary solitary nodules of ≤30 mm in diameter.

Huge dilatation of the azygos vein (Aneurysms of the azygos vein).

Introduction: Huge dilatacion of the azygos vein (Aneurysms of the azygos vein) are rare and can sometimes mimic a paratracheal or posterior mediastinal mass. Objective: It is important to confirm the diagnosis with radiologic tools before performing invasive procedures, which carry the risk of hemorrhage. Discussion: The usual diagnosis of a mediastinal mass by mediastinoscopy or percutaneous fine-needle aspiration or biopsy is very hazardous if there is a venous varix. Noninvasive thoracic contrast CT scanning is a safe and better choice for diagnosis.

Tracking HCC pathogenesis but not the tumor cells after biopsy

Two articles in this month’s issue of the Journal reveal new insights into intracellular pathways in hepatocytes that contribute to tumorigenesis in an animal model, and provide reassurance about the safety of percutaneous fine needle biopsy in patients with suspected HCC being evaluated for liver transplantation.

Fatal haemorrhage from an Ultrasound Guided Fine Needle Aspiration of the liver in a patient with Primary Hepatocellular Carcinoma: Case report

A case of fatal haemorrhage is reported among 72 ultrasound (US) guided percutaneous fine-needle aspiration liver biopsies (FNAB) performed in the gastro- intestinal unit of Medicine Department in a tertiary hospital. The patient had primary hepatocellular carcinoma (PHCC) with advanced hepatic cirrhosis. Death was due to bleeding from liver nodule resulting in intra-peritoneal haemorrhage. Pre-procedure laboratory tests did not reveal the existence of major bleeding disorders in the patient. This event is our first experience, but colour flow Doppler ultrasound guidance has been reported to prevent its occurrence. The use of FNAB for the diagnosis of PHCC should therefore be guided with colour flow Doppler ultrasound scan to prevent haemorrhage. In addition, there should be proper selection of patients for FNAB especially in areas where there are no colour flow Doppler ultrasound scans.

Percutaneous Fine Needle Biopsy in Pancreatic Tumors: A Study of 42 Cases

The technological progress within the range of methods of pancreas imaging and their more common accessibility selects a group of patients requiring a microscopic diagnosis. Percutaneous fine needle aspiration biopsy under the control of ultrasonography (PCFNA/USG) is the method commonly used in determining the character of a focal pancreatic lesion. Aim of the Work. An assessment of the accessibility of PCFNA biopsy in the assessment of solid and cystic changes in a pancreas and the correlation of the results of imaging examination, cytological smear and concentration of a serous marker CA19-9. Material and Methodology. In our material we analysed 43 cases of tumors of the pancreas among the patients who were at the average age of 59 ± 10.4 (14 women, 28 men) diagnosed by PCFNA biopsy. Results. In a group we are 23 cases of cancer, 12 cases of inflammation and 7 cases of cellular atypia for which 2 cases of IPMN were included. The sensitivity of the method was 92.5% but specificity was 68%. In our opinion PCFNA/USG is a method of the comparable sensitivity and specificity with fine needle aspiration biopsy with EUS control and its efficiency depends to a considerable degree on experience and interdisciplinary collaboration.

Pulmonary Cryptococcosis Presenting Solitary Pulmonary Nodule in an Immunocompetence: A Case Report and Review of the Korean Literatures

In immunocompetent individuals, pulmonary cryptococcosis is a rarely diagnosed fungal infection. It’s common radiological find ings are multiple pulmonary nodules. We report a case of pulmonary cryptococcosis in a 67-year-old woman who presented with solitary pulmonary nodule (SPN) on chest computed tomography (CT). She complained of intermittent blood tinged sputum for 10 days. She was a non-smoker and had no clinical evidence of immonosuppression. Pathological examination of the lung tissue core via percutaneous fine needle biopsy revealed chronic granulomatous inflammation compatible with cryptococcosis on the special stain. She received 6 months of antifungal therapy with fluconazole and the SPN was disappeared on the CT after antifungal therapy. We also reviewed that the features of pulmonary cryptococcosis presenting SPN in immnocompetent patients reported in the Korean literatures.

Most Renal Oncocytomas Appear to Grow: Observations of Tumor Kinetics With Active Surveillance

We examined the growth of tissue proven renal oncocytoma on serial imaging to improve our understanding of its natural history. We reviewed the charts of 69 patients with oncocytoma diagnosed by biopsy or surgery between 2004 and 2010. A total of 29 cases were managed by active surveillance for at least 12 months and had 3 or more imaging events. Tumor size was documented and the average tumor growth rate was calculated using a random coefficient model. Interaction terms were used to investigate correlations between variables of interest, including age at diagnosis, gender, symptom status, laterality, initial tumor size, surveillance duration and number of imaging events. At a mean surveillance duration of 40 months 80% of oncocytomas increased in size. Based on the random coefficient model the estimated average growth rate was 0.16 mm monthly (95% CI 0.097-0.228, p <0.0001). We identified no variables that significantly correlated with growth. Despite its low metastatic potential renal oncocytoma appears to progress locally with a growth rate similar to that of RCC. Thus, absent tumor growth on serial imaging is not a robust prognostic factor for benign histology. Biopsy remains the mainstay of diagnosis. At centers where it can be performed safely and accurately, active surveillance of tissue proven oncocytoma appears to be safe in the short term. Alternative management includes partial nephrectomy and minimally invasive approaches. To our knowledge this is the largest study of oncocytoma natural history.

Peritoneal seeding of hepatocellular carcinoma: Clinicopathological characteristics of 17 autopsy cases

Peritoneal seeding (PS) of hepatocellular carcinoma (HCC) is uncommon, and the clinicopathological features are poorly understood. A total of 181 autopsy cases of HCC, including 171 cases with detailed clinical information, was investigated for PS and evaluated. PS was identified in 17 cases (9.4%), and was locally (70.6%) or entirely (29.4%) distributed in the peritoneal cavity, involving the diaphragm (76.5%), omentum (47.1%), or alimentary tract serosa (47.1%). Compared with primary HCC, PS showed similar or slightly undifferentiated features (88.2%) and exhibited more differentiated features (11.8%). In 15 cases (88.2%) of HCC with PS, primary HCC showed membranous β-catenin immunoreactivity. However, in five cases (33.3%), respective PS lost this immunoreactivity. PS was significantly associated with rupture of HCC (P= 0.012), direct diaphragmatic invasion (P= 0.001), and lymph node metastasis (P < 0.001), indicating these are high risk factors for PS; there was no significant association with a past history of percutaneous fine-needle biopsy, percutaneous ethanol injection and/or radiofrequency ablation (P= 0.97), or metastasis to lung (P= 0.13), bone (P= 0.71), or adrenal gland (P= 0.79). PS can infrequently proliferate aggressively with more differentiated features. Loss of membranous β-catenin expression may be associated with PS of HCC.

Hepatic Angiomyolipoma: A Clinical Experience in Diagnosis and Treatment

Hepatic angiomyolipoma is a rare mesenchyme-derived neoplasm often misdiagnosed as hepatocellular carcinoma, and the treatment for it remains controversial. To develop the optimal preoperative diagnoses means and treatment modalities of hepatic angiomyolipoma. Retrospective analysis of the clinical features, treatment, and prognostic data of 17 hepatic AML patients admitted to Chinese People's Liberation Army Generation Hospital between 1996 and 2006. Most hepatic angiomyolipoma were solitary. The overall preoperative diagnostic rate was 18% and the most common misdiagnosis was hepatocellular carcinoma (10/17, 59%). In three patients, observation was performed for 2-3 years before being admitted. The tumors increased 1-9 cm in size in all patients. All of the 17 patients finally received various liver resection procedures, and postoperative mortality and morbidity was 0 and 12% (2/17). After a median follow-up period of 73 months, the tumor recurred only in one patient 9 years post-operatively. Hepatic angiomyolipoma should be suspected in liver tumor patients with normal α-fetoprotein levels and no concomitant hepatitis. Preoperative MRI combined with percutaneous fine-needle biopsy should be the diagnostic methods of choice. Small hepatic AML proved through pathologic examination (<5 cm) may be managed by observation with close follow-up, but surgery is indicated in patients suffering from large tumors or significantly larger tumors during follow-up.

Preoperative diagnosis of solitary fibrous tumor of the kidney with percutaneous fine needle biopsy and management with laparoscopic partial nephrectomy: One case report and literatures review

Solitary fi brous tumor (SFT) of the kidney is a rare spindle cell neoplasm and all reported SFTs of the kidney were diagnosed through pathological examination and immunohistochemical study after open nephrectomy or open radical nephrectomy[1-3]. We present a case of SFT of the kidney diagnosed through fine needle core biopsy preoperatively in a 50-year-old female and managed with laparoscopic partial nephrectomy. Due to the diffi culty in discriminating between malignant and benign growth pattern of this tumor entity, a regular follow-up after conservative treatment is mandatory.

Ultrasound-guided thin-needle biopsy in focal liver diseases. I. Malignant hepatic tumors

Eighty-six patients with focal liver disease underwent sonography-guided percutaneous fine needle biopsy for definitive diagnosis. Twenty-five out of twenty-six neoplastic liver tumors were correctly recognized as malignant. A sensitivity of 96% and a specificity of 98% (25 true positives, 60 true negatives, 1 false negative) was obtained. The high accuracy rate of this diagnostic procedure is explained by the precision of sonographic guidance and the copious excision of tissue material. In 57% of the malignant tumors, small tissue cylinders were obtained besides cytological material, which allowed a definitive tumor diagnosis in 11 out of 15 cases by histologic examination. In addition, the histologic evaluation of tissue fragments enables the differentation between primary and secondary hepatic malignomas. Because of the higher specificity of histological diagnosis, fine needle puncture of solid liver tumors should always provide tiny tissue cylinders for histologic examination.