Role Of Image-guided Biopsy Research Articles

Role of Image-Guided Biopsy in the Diagnosis and Antimicrobial Management of Vertebral Osteomyelitis

Purpose The aim of this study was to evaluate the role of fluoroscopy-guided vertebral biopsy in vertebral osteomyelitis and determine if it results in a change in antimicrobial management based on bone culture yield. Materials and Methods This study is a retrospective chart review of 83 patients (49 men, 34 women; age range, 28–92 years; mean age, 56.9 years) with a diagnosis of vertebral osteomyelitis on imaging (computed tomography or magnetic resonance imaging) who underwent a fluoroscopy-guided biopsy from January 2010 to May 2015. Data collection included patient demographic information; etiology/risk factors for vertebral osteomyelitis; antibiotic exposure within 30 days before biopsy; blood, urine, and bone culture results; and any postprocedural change in antibiotic therapy. The primary outcome is culture yield from biopsy, whereas the secondary outcome is to determine if a change in antimicrobial therapy occurred based on biopsy results. A change in antimicrobial management is defined as transitioning from empiric antibiotic coverage to narrow-spectrum antibiotics based on positive bone culture yield or discontinuation of empiric antibiotic coverage based on negative culture yield. Biopsy culture yield was tested against a change in antimicrobial management with statistical analysis including the Fisher exact test. Results Positive bone culture yields were obtained in 22 (27%) of the 83 cases. Of the 22 that were positive, only 11 resulted in a change in antimicrobial management where broad empiric coverage was switched to narrow-spectrum organism-specific coverage. Of the remaining 61 negative cultures, only 2 (3%) had a change in management where the empiric antibiotic treatment was discontinued. Whether the culture results were positive or negative, 70 patients (84%) did not have any change in antimicrobial management after biopsy with the results being statistically significant (odds ratio, 27.3; 95% confidence interval, 5.25–141.82; P < 0.0001). Conclusions Vertebral biopsies do not cause a significant change in antimicrobial management in the majority of cases.

Role of image-guided biopsy and radiomics in the age of precision medicine.

Modern oncology requires precise tumor assessment to drive effective therapies. Image-guided biopsies are the current standard of care to characterize molecular alterations safely and effectively, but have inherent limitations due to tumor heterogeneity and accessibility, as well as from procedure related risks. Advancements in radiomics analysis provide the potential to retrieve useful incremental information to characterize molecular alterations from standard imaging data in a cost-effective and non-invasive manner, but currently suffers from lack of validation and standardization. The combination of techniques may provide the optimal solution for patient-tailored care, ultimately through the development of accurate and reliable virtual biopsy. In the advancement towards that goal, image-guided biopsy can prove radiomic suspicions and conversely radiomics can guide image-guided biopsy to improve tissue yield. Joint development of these two methods will improve cancer understanding and patient outcomes.

Diabetic mastopathy: imaging features and the role of image-guided biopsy in its diagnosis.

Purpose:The goal of this study was to evaluate the imaging features of diabetic mastopathy (DMP) and the role of image-guided biopsy in its diagnosis.Methods:Two experienced radiologists retrospectively reviewed the mammographic and sonographic images of 19 pathologically confirmed DMP patients. The techniques and results of the biopsies performed in each patient were also reviewed.Results:Mammograms showed negative findings in 78% of the patients. On ultrasonography (US), 13 lesions were seen as masses and six as non-mass lesions. The US features of the mass lesions were as follows: irregular shape (69%), oval shape (31%), indistinct margin (69%), angular margin (15%), microlobulated margin (8%), well-defined margin (8%), heterogeneous echogenicity (62%), hypoechoic echogenicity (38%), posterior shadowing (92%), parallel orientation (100%), the absence of calcifications (100%), and the absence of vascularity (100%). Based on the US findings, 17 lesions (89%) were classified as Breast Imaging Reporting and Data System category 4 and two (11%) as category 3. US-guided core biopsy was performed in 18 patients, and 10 (56%) were diagnosed with DMP on that basis. An additional vacuum-assisted biopsy was performed in seven patients and all were diagnosed with DMP.Conclusion:The US features of DMP were generally suspicious for malignancy, whereas the mammographic findings were often negative or showed only focal asymmetry. Core biopsy is an adequate method for initial pathological diagnosis. However, since it yields non-diagnostic results in a considerable number of cases, the evaluation of correlations between imaging and pathology plays an important role in the diagnostic process.

The many, atypical presentations of musculoskeletal hepatocellular carcinoma (HCC) metastases

PurposeTo demonstrate many uncommon, non-classical clinical presentations of HCC that have been gathered from an endemic region in the Nile Basin. Patients and methodsWe will highlight cases of high quality MDCT performed for various clinical symptoms not classically associated with advanced or metastatic HCC and the role of image-guided biopsy in diagnoses. These include: (a) gradual progressive weakness of lower limbs; (b) Retrosternal pain not responding to medications; (c) severe right hip pain; (d) progressive cheek swelling. These symptoms further corresponded to musculoskeletal abnormalities, not typically associated with HCC, including: (a) lumbar spinal cord compression by expansile vertebral body lesion; (b) direct invasion of chest wall; (c) large expansile metastasis of right acetabulum; (d) expansible rib lesions with rib destruction, (e) painful cheek swelling. ResultsIn numerous patients with a range of non-specific musculoskeletal complaints and various clinical presentations, the final diagnosis was HCC. The clinical presentation was dependent on uncommon skeletal deposits which were often expansile with the local effect of compression as underlying cause for the odd presentation. The important role of MDCT and Histopathological assessment in making correct diagnosis will be stressed. ConclusionHCC can often grow silently and may present late with odd non-classic clinical presentation.

Minimally Invasive Treatment of Small Renal Tumors: Trends in Renal Cancer Diagnosis and Management

Renal cell carcinoma is a common malignancy causing significant mortality. In recent years abdominal imaging, often for alternate symptomatology, has led the trend toward the detection and confirmation of smaller renal tumors. This has permitted the greater use of localized and nephron-sparing techniques including partial nephrectomy and image-guided ablation. This article aims to review the current role of image-guided biopsy and ablation in the management of small renal tumors. The natural history of renal cell carcinoma, the role of renal biopsy, the principles and procedural considerations of thermal energy ablation, and the oncological outcomes of these minimally invasive treatments are discussed and illustrated with cases from the authors' institution. Image-guided ablation, in particular, has changed the treatment paradigm and, by virtue of its increasingly evident efficacy and low morbidity, now favors the treatment of smaller tumors in patients previously unfit for surgery.

Imaging techniques for prostate cancer: implications for focal therapy

The multifocal nature of prostate cancer has necessitated whole-gland therapy in the past; however, since the widespread use of PSA screening, patients frequently present with less-advanced disease. Many men with localized disease wish to avoid the adverse effects of whole-gland therapy; therefore, focal therapy for prostate cancer is being considered as a treatment option. For focal treatment to be viable, accurate imaging is required for diagnosis, staging, and monitoring of treatment. Developments in MRI and PET have brought more attention to prostate imaging and the possibility of improving the accuracy of focal therapy. In this Review, we discuss the advantages and disadvantages of conventional methods for imaging the prostate, new developments for targeted imaging, and the possible role of image-guided biopsy and therapy for localized prostate cancer.