Single Needle Pass Research Articles

1232 Outpatient Stereotactic Needle Biopsy Is a Cost-effective Strategy for Brain Tumor Patient Decision-making That Enhances Clinical Trial Accrual

INTRODUCTION: Although neuroradiological techniques have expanded, stereotactic needle biopsy is a simple, ubiquitous,and immediate strategy for established or potential brain tumor patients with atypical clinical and/or radiographic findings. METHODS: Outpatient stereotactic needle biopsies performed by a single surgeon from August 2020 through November 2022 were retrospectively reviewed. Electronic medical records were queried for clinical, perioperative, and tumor demographics. Financial records were queried for insurance and payment reports. Descriptive statistics were used to characterize comparisons among collected variables. RESULTS: 107 consecutive stereotactic needle biopsy procedures were conducted in adult brain tumor patients. All biopsies were performed using a single needle-pass in the outpatient setting, targeting supratentorial lesions in 89.7% of cases. Tissue diagnosis was established in 96% of procedures, with glioma being the most common histology. No intraoperative or perioperative complications occurred. Four patients (3.7%) were admitted overnight due to urinary retention (n = 2) and asymptomatic tract hemorrhage (n = 2), respectively. Insurance approval was sought preoperatively from non-commercial (31.7%) and commercial (68.3%) payors and approved in all cases. Postoperatively, 30.8% of patients received an experimental therapeutic on the basis of tissue analysis. CONCLUSIONS: We report the largest experience to date with outpatient stereotactic needle biopsy in newly-diagnosed and recurrent brain tumor patients. Our findings identify this strategy as a cost-effective alternative to advanced imaging that facilitates clinical trial accrual through tissue acquisition.

Complication Rate after Percutaneous Liver Biopsy Using a Real-time Ultrasound Approach and Introducing a Uniform Methodology: A Brief Report.

Following the initial liver biopsy attempts, several techniques using a wide range of methodologies and materials were developed. Many studies on the evaluation of post-liver biopsy complications were conducted. However, their fundamental limitation was significant variance in patient demographics and methodology, which might account for the inconsistent outcomes. Therefore, a uniform methodology to perform percutaneous liver biopsies that result in comparable outcomes around the world is required. This study aimed to determine the precise complication rate following percutaneous liver biopsy using a consistent method in all individuals. It also aimed to establish a consistent operating procedure for a percutaneous liver biopsy that yielded comparable outcomes. Between July 2018 and July 2019, 116 patients were enrolled in this retrospective study for percutaneous liver biopsy. All individuals underwent a biopsy using the same procedure. There was an attempt to exclude elements that could have an impact on the complication rate. For this purpose, the same type and size of needle were utilized. Moreover, a single needle pass, a subcostal approach, deep inspiration breath holding, identical pre- and post-biopsy preparation, real-time ultrasonography guidance, the use of a single operator, and the absence of sedation or general anesthesia were the other approaches that were used to minimize the impact of variables that could raise complication rates. The overall complication rate was 19.8%, of which 18.9% of patients experienced pain and mild bleeding, and one patient (0.9%) experienced hematoma necessitating precautionary hospitalization. The overall percentage of patients who experienced pain was 13.8%. No further complications were observed. The findings of this study could provide an accurate estimate of the post-liver biopsy complication rate. Furthermore, due to a lower complication rate than other practiced procedures, this uniform methodology could be an attractive alternative in clinical practice. However, more research is required to confirm these results.

Discrepancies in tumor mutation burden reporting from sequential endobronchial ultrasound transbronchial needle aspiration samples within single lymph node stations - brief report.

Tumour Mutation Burden (TMB) is a potential biomarker for immune cancer therapies. Here we investigated parameters that might affect TMB using duplicate cytology smears obtained from endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA)-sampled malignant lymph nodes. Individual Diff-Quik cytology smears were prepared for each needle pass. DNA extracted from each smear underwent sequencing using large gene panel (TruSight Oncology 500 (TSO500 - Illumina)). TMB was estimated using the TSO500 Local App v. 2.0 (Illumina). Twenty patients had two or more Diff-Quik smears (total 45 smears) which passed sequencing quality control. Average smear TMB was 8.7 ± 5.0 mutations per megabase (Mb). Sixteen of the 20 patients had paired samples with minimal differences in TMB score (average difference 1.3 ± 0.85). Paired samples from 13 patients had concordant TMB (scores below or above a threshold of 10 mutations/Mb). Markedly discrepant TMB was observed in four cases, with an average difference of 11.3 ± 2.7 mutations/Mb. Factors affecting TMB calling included sample tumour content, the amount of DNA used in sequencing, and bone fide heterogeneity of node tumour between paired samples. TMB assessment is feasible from EBUS-TBNA smears from a single needle pass. Repeated samples of a lymph node station have minimal variation in TMB in most cases. However, this novel data shows how tumour content and minor change in site of node sampling can impact TMB. Further study is needed on whether all node aspirates should be combined in 1 sample, or whether testing independent nodes using smears is needed.

Modified gun-sight transjugular intrahepatic portosystemic shunt technique.

Conventional transjugular intrahepatic portosystemic shunt (TIPS) stent insertion is an established procedure with high rates of technical success. However, alternative techniques may increase success rates in the setting of challenging anatomy or limited resources. Originally described as a salvage porto-caval approach, we present a modified gun-sight porto-hepatic TIPS technique. A retrospective review was performed identifying patients who underwent modified gun-sight TIPS over a 1-year period. Six procedures were identified, with snares opened in the target hepatic and portal veins, fluoroscopic percutaneous transhepatic puncture through the snares, and wire pulled through-and-through to establish a parenchymal tract. Five modified gun-sight procedures were primary, and one was salvage. All modified gun-sight TIPS procedures were technically successful with a single needle pass, with patency and appropriate haemodynamic flow at 2 weeks. Advantages of the technique include fluoroscopic-guided transhepatic puncture utilising typically on-shelf low-cost equipment, without requiring a dedicated TIPS set or endovascular ultrasound. Disadvantages include liver capsular puncture. The modified gun-sight TIPS technique is an alternative approach utilising typically on-shelf and low-cost equipment for a targeted fluoroscopic-guided parenchymal puncture. The presented technique is an initial description of a novel alternative TIPS technique, which may be useful to consider in challenging cases.

Percutaneous balloon compression technique using intraoperative contrasted DynaCT for the treatment of refractorytrigeminal neuralgia: initial experience.

Percutaneous balloon compression (BC) is a well-established technique that can provide immediate relief to patients suffering from trigeminal neuralgia (TN). The general procedure of BC uses fluoroscopy imaging to guide the needle through the foramen ovale (FO). The aim of this study was to describe our experience with a novel technique using intraoperative contrast-enhanced DynaCT as an adjunct for more accurate and safer guidance of the needle to the FO. In this study, DynaCT was used to perform BC in 20 TN cases. The three-dimensional path of the needle was pre-planned using DynaCT obtained during the administration of IV contrast. The FO was accessed in a single pass along the path pre-determined from the DynaCT images, avoiding any major arteries and veins. DynaCT was also used for confirmation of the final position of the needle prior to insertion of the balloon as well as for confirmation of the position of the balloon after inflation. Intravenous contrast-enhanced DynaCT-guided percutaneous BC allowed precise advancement and positioning of the needle within the FO. It facilitated cannulation of the FO along a pre-determined path that avoided any major vascular structures. Clinical outcomes were excellent-all patients had a quick postoperative recovery, and there were no complications. The advantages of the contrast-enhanced DynaCT-guided technique include a single precise needle pass and avoidance of vessel injury. Precise placement of the balloon into different aspects of the FO can target trigeminal branches more selectively and allow for a better outcome.

A Novel Introducer for Ultrasound-Guided Cryoneurolysis Administration to Improve Patient Safety an d Functionality

Background: Percutaneous cryoneurolysis provides prolonged postoperative analgesia by placing a probe adjacent to a peripheral nerve and cooling the probe tip, inducing a reversible block that lasts weeks to months. Unfortunately, freezing the nerve can produce significant pain. Consequently, local anesthetic is generally applied to the nerve prior to cryoneurolysis, which, until now, required an additional needle insertion increasing both the risks and duration of the procedure. Case Presentation: Three patients underwent ultrasound-guided percutaneous cryoneurolysis of either the sciatic and saphenous nerves or the femoral nerve. In all patients, the local anesthetic injection and cryoneurolysis were accomplished with a single needle pass using the novel probe introducer. Conclusion: This introducer allows perineural local anesthetic injection followed immediately by cryoneurolysis, thereby sparing patients a second skin puncture, lowering the risks of the procedure, and decreasing the overall time required for cryoneurolysis. Key words: Cryoablation, cryoanalgesia, peripheral nerve block, postoperative analgesia, ultrasound

In Response.

We thank Wardhan and Smith1 for their interest in our recent research article.2 First, we had clearly predefined the primary outcome—the number of needle passes as “the number of forward advancements of the needle required to achieve successful dural puncture.”2 The number of passes/attempts required for success has been the main outcome measure of many previous publications on this subject3 because it represents the technical difficulty of neuraxial procedures along with the procedural time. Moreover, we considered excessive needle passes and insertion attempts during spinal anesthesia would increase the chance of traumatic needle manipulations near the epidural/intrathecal structures, postdural puncture headache, and infection and patient pain, discomfort, and dissatisfaction. Hence, providing spinal anesthesia via a single needle pass was recommended by consensus guidelines on neuraxial anesthesia and anticoagulation.4,5 We agree that the optimal medial angle of needle insertion is important to the successful paramedian approach.1 Ultrasound-assisted spinal anesthesia could be more accurately executed if the angle of the ultrasound probe was measured. The angle might be different according to the depth of intrathecal space and the distance from the midline to the site of probe applied. However, we considered it to be too difficult to implement in real practice. We did not measure the accurate angle of ultrasound probe but relied on the memory of the anesthesiologist of the angle of the probe in our study. In the landmark group in our study, the paramedian approach was used in 80%, whereas the midline approach was used in 20% of subjects as noted in Table 3.2 In the landmark group, we allowed the anesthesiologists to use either midline or paramedian approach at their own discretion. Since our study enrolled patients with abnormal spine anatomy, the anesthesiologists seem to have chosen to use paramedian approach rather than midline approach in most cases. For each of the 3 performers in this study, anesthesiologists A and C used a midline approach in 2 subjects, respectively. We do not believe that the predominant selection of midline approach would have changed our results. It must be better if we can avoid walking off the lamina, which requires multiple needle passes, to reach the interlaminar space regardless of approaches. Ultrasound-assisted spinal anesthesia may decrease unnecessary needle manipulations to locate the interlaminar space. Sun-Kyung Park, MDJin-Tae Kim, MD, PhDDepartment of Anesthesiology and Pain MedicineSeoul National University HospitalSeoul National University College of MedicineSeoul, Republic of Korea[email protected]

Computer-assisted needle navigation for pediatric internal jugular central venous cannulation: A feasibility study.

Vascular access for central venous catheter placement is technically challenging in children. Ultrasound guidance is recommended for pediatric central venous catheter placement, yet many practitioners rely on imprecise anatomic landmark techniques risking procedure failure due to difficulty mastering ultrasound guidance. A novel navigation system provides a visual overlay on real-time ultrasound images to depict needle trajectory and tip location during cannulation. We report the first pediatric study assessing feasibility and preliminary safety of using a computer-assisted needle navigation system to aid in central venous access. A prospective, institutional review board-approved feasibility study was performed. All participants provided written informed consent. Ten patients (mean age: 11.4 years, five males) underwent central venous catheter placement with ultrasound and navigation system guidance. All procedures were performed by interventional radiologists expert in vascular access. Feasibility was measured through binary (yes/no) responses from participating users assessing device usability and feasibility. The number of needle passes and procedure time measures were also recorded. Internal jugular veins (seven right sided, three left sided) were cannulated in all patients with no complications. Users confirmed navigation system feasibility in all 10 participants. Mean vein diameter and depth was 13.3 × 9.8 ± 3.4 × 2.1 and 7.0 ± 1.7 mm, respectively. Successful cannulation occurred in all patients and required only a single needle pass in 9 of 10 patients. Mean device set-up and vascular access times were 5:31 ± 2:28 and 1:48 ± 2:35 min, respectively. This pilot study suggests that it is feasible to use a novel computer-assisted needle navigation system to safely obtain central venous access under ultrasound guidance in pediatric patients.

Feasibility of lung cancer RNA acquisition from a single transbronchial or transthoracic needle pass (FASTT trial)

IntroductionRNA isolation from tumor tissue is used for biomarker analyses and validation. Limited diagnostic material from small volume biopsies combined with an increasing demand for standard histologic, molecular characterization, and next generation sequencing applications often leads to limited material for research. We sought to evaluate small volume sampling of lung cancer tissue collected from a single needle pass during a diagnostic procedure and determine if it can provide RNA of acceptable quantity and quality. MethodsWe enrolled 140 patients with probable primary bronchogenic carcinoma and collected RNA from a dedicated FNA aspiration. Total RNA (ηg), RNA integrity number (RIN), and %Mass in base pairs were evaluated from each patient sample. A customized nanoString nCounter® 95-gene panel was used to profile the expression patterns of feature NSCLC genes. We compared gene expression patterns that distinguish lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) in our cohort with a corresponding Cancer Genome Atlas (TCGA) NSCLC datasets. ResultsOf the 149 patients consented. RNA-extraction was performed in 101 eligible patients. A satisfactory total RNA mass and RIN was quantified for all samples with a similar distribution among cellular subtypes. Mean %-Mass over 300 base pairs was noted for all specimens and 96% of samples met criteria to perform genetic evaluation with our commercialized gene expression assay. The FNA-derived transcriptomic results showed excellent consistency with the TCGA counterparts, and the differential expression pattern of LUAD vs LUSC subtypes were highly similar. DiscussionIn this study, RNA retrieval from a single-pass FNA regardless of procedural approach showed equivalence and suitability for gene expression assessments. RNA extraction from small volume samples has the potential to provide valuable material for genetic profiling.

A new technique of ultrasound guided percutaneous renal biopsy by perforated probe and perpendicular needle trajectory.

The percutaneous biopsy of native kidneys according to the classical methodology is performed under real time ultrasound guidance with the needle introduction along a trajectory of about 30°, aimed to the lower pole of the kidney. Recently, a variant of the classical technique has been introduced by which a perforated ultrasound probe is used to guide the needle along a perpendicular trajectory to the terminal section of the lower kidney pole where the front and back margins of the cortical kidney tissue join each other without renal sinus interposition so to offer to the needle a 3-4 cm thick cortical tissue front which allows to obtain a cortical tissue sample suitable for histological examination even with a single needle pass, while at the same time limiting the possibility of damaging the smaller kidney calices of the lower group whose lesion causes hematuria. In this paper, we present a large survey (50 patients) to compare to data from the literature obtained by using similar needle gauge and with a similar follow-up period after biopsy. The result of this comparison confirms the efficacy of this variant of the classical technique because in front of a statistically lower number of needle passes, it allowed to obtain 100% of samples suitable for histological analysis, in absence of major complications and with a statistically lower post-biopsy hemoglobin drop in comparison to that observed in a group of 44 patients biopsied with a greater number of needle passes, in the only study of the literature which is directly comparable to our study in relation to needle gauge and duration of monitoring.

Adverse events of EUS-guided FNA of pancreatic cystic and solid lesions by using the lexicon proposed in an ASGE workshop: a prospective and comparative study

Pancreatic cysts and solid lesions are routinely examined by EUS-guided FNA (EUS-FNA). The aim of this study was to compare the incidence of adverse events (AEs) of this procedure by using the lexicon recommended by the American Society for Gastrointestinal Endoscopy (ASGE). This was a prospective and comparative study of patients who underwent EUS-FNA in which a 22-gauge needle was used. In the pancreatic cystic lesions group (group I), complete fluid evacuation in a single needle pass was attempted, and ciprofloxacin was given during the procedure and for 3 days after. In the pancreatic solid lesions group (group II), the number of passes was determined by the on-site evaluation of the sample. AEs were defined and graded according to the lexicon recommended by the ASGE. Patients were followed for 48 hours, 1 week, and 1 month after the procedure. A total of 146 patients were included, 73 in group I and 73 in group II. Potential factors influencing the incidence of AEs (ie, access route for FNA) were similar in both groups. AEs occurred in 5 of 146 patients (3.4%; 95% confidence interval [CI], 1.3%-8%): 4 in group I (5.5%; 95% CI, 1.7%-13.7%) and 1 in group II (1.4%; 95% CI, -0.5% to 8.1%) (P = .03). Severity was mild in 1 of 5 patients (20%) and moderate in 3 of 5 patients (60%). One patient with a solid mass in the head of the pancreas had a duodenal perforation after EUS and died after surgery. All other AEs occurred in the first 48 hours and resolved with medical therapy. There were 3 incidents of transient hypoxia and self-limited abdominal pain in 1 and 2 patients, respectively. No patients were lost to follow-up. EUS-FNA of pancreatic cysts has an AEs rate similar to that of solid pancreatic masses, which is small enough to consider this procedure a safe and effective method for managing patients with both types of lesions. AEs occurred early after EUS-FNA, and patients should be closely followed during the first 2 days after the procedure.

Performance Characteristics of a New Flexible Nitinol 19-Gauge Endoscopic Ultrasound-Guided Fine Needle Aspiration Needle

We would like to report out results with the use of new flexible nitinol 19 gauge (G) endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) needle. We studied the performance characteristics of this new EUS needle (Expect™ 19 Flex; Boston Scientific, Natick, MA, USA) in cases considered difficult to perform with traditional stainless steel 19 G needles. Inclusion criteria were 1) lesion in the pancreatic head, 2) nondiagnostic prior EUS-FNA, 3) subepithelial lesion in proximal stomach, and 4) passage of 0.035 wire needed to facilitate EUS-guided therapeutic procedure. Ten EUS procedures were done in 10 patients. We experienced technical success in all patients (100%). Adequate for cytologic evaluation specimen was obtained by mean of 1.2 (range, 1 to 2) passes in all eight patients (100%: six pancreatic head mass, one prior nondiagnostic EUS-FNA, and one gastric subepithelial lesion). One pseudocyst drainage and one pancreatic duct drainage were both successful. In one patient we were unable to achieve the final diagnosis despite the adequate specimen for evaluation by our cytologist. Of the seven cases in which final tissue diagnosis was achieved, FNA established the diagnosis in five (71%), and the remaining two required surgical biopsy. For all patients, the diagnostic yield of FNA was five out of eight (63%). Performance characteristics needle scores (1, best; 3, same; 5, worst compare with stainless steel 19 G needle) were passability through the scope 1.67±0.5, sharpness 1.55±0.53, visualization 2.22±0.44, durability 2.33±0.71, connection to the scope 2.44±0.73, ergonomics 2.44±0.53, and overall performance 1.89±0.33. There were no complications. In summary, our findings further expand on the data reported by Varadarajulu et al.1 We demonstrate that in cases considered difficult to perform with traditional stainless steel 19 G needles, the new flexible 19 G nitinol EUS needle provides high procedure success rate. In most cases requiring tissue sampling, cytologic diagnosis was achieved with a single needle pass. Performance characteristics of the new flexible needle were superior to the traditional 19 G needles, but the diagnostic yield remained the same. The limitations of our study are the subjectively-rated needle performance characteristics by one endoscopist and a small sample size. Further studies are required to better validate these findings and evaluate the new needle's abilities to obtain histologic samples.

PTH-152 Nurse Delivered day Case Paracentesis - a Single Centre Experience

IntroductionRefractory ascites is a debilitating consequence of end stage liver and other diseases. Treatment options are limited and include recurrent large volume paracentesis (LVP). Admission for LVP requires usage of...

Feasibility and yield of a novel 22-gauge histology EUS needle in patients with pancreatic masses: a multicenter prospective cohort study

The option of obtaining tissue samples for histological examination during endoscopic ultrasound (EUS) has theoretical and practical advantages over cytology alone. The aim of this study was to evaluate the feasibility, yield, and diagnostic accuracy of a new EUS 22-G fine-needle biopsy (FNB) device in patients with solid pancreatic masses in a multicenter, prospective study. All consecutive patients who underwent EUS-guided fine-needle biopsy (EUS-FNB) using a newly developed 22-G FNB needle between September 2010 and October 2010 were enrolled in the study. The EUS-FNB technique was standardized among the participating endoscopists. Only a single needle pass was performed. A total of 61 patients (35 males, mean age64.2±12.4years) with solid pancreatic masses with a mean size of 32.4±8.5mm (range13-90mm) participated. EUS-FNB was performed through the duodenum in 35 cases (57.4%) and was technically feasible in all but one of the 61 (98.4%) patients without complications. Tissue samples for histological examination were obtained from 55 patients (90.2%) and were deemed adequate in 54 of the cases (88.5%). The diagnoses established by EUS-FNB were adenocarcinoma (39 patients), neuroendocrine tumors (5), chronic focal pancreatitis (5), sarcoma (2), lymphoma (1), acinar cellular tumor (1), and pancreatic metastasis from renal cell carcinoma (1). In an intention-to-treat (ITT) analysis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the histologic diagnosis of a pancreatic mass were 87.5, 100, 100, 41.7, and 88.5%, respectively. EUS-FNB was technically feasible in 98% of patients with a solid pancreatic mass. A suitable sample for histological evaluation was obtained in 88.5% of the cases after only one single needle pass. The apparently low negative predictive value is likely to be improved by increasing the number of needle passes.

Ultrasound-Guided Popliteal Block Through a Common Paraneural Sheath Versus Conventional Injection

The macroscopic anatomy of a common paraneural sheath that surrounds the sciatic nerve in the popliteal fossa has been studied recently in a human cadaveric study. It has been suggested that an injection through this sheath could be an ideal location for local anesthetic administration for popliteal block. The aim of the present study was to evaluate the hypothesis that popliteal sciatic nerve blockade through a common paraneural sheath results in shorter onset time when compared with conventional postbifurcation injection external to the paraneural tissue. To illustrate the microscopic anatomy of the paraneural tissues, we performed histological examinations of a human leg specimen. Following institutional review board approval and written informed consent, 89 patients undergoing an ultrasound-guided popliteal block for foot or ankle surgery were included in the study. They were prospectively randomized to receive a single injection of local anesthetic at the site of bifurcation through a common paraneural sheath (group 1) or 2 separate circumferential injections of the tibial and common peroneal nerves distally to sciatic nerve bifurcation (group 2). Patients in group 1 had a 30% shorter onset time of both sensory and motor block. This was associated with a more extensive proximal and distal longitudinal spread of local anesthetic in this group. Nerve diameter and cross-sectional area remained unchanged in both groups after injection, which is consistent with extraneural injection. A greater proportion of patients in group 1 required a single needle pass for block performance. An ultrasound-guided popliteal sciatic nerve block through a common paraneural sheath at the site of sciatic nerve bifurcation is a simple, safe, and highly effective block technique. It results in consistently short onset time, while respecting the integrity of the epineurium and intraneural structures.

Reducing risk of transjugular intrahepatic portosystemic shunt using ultrasound guided single needle pass

Delayed liver laceration following transjugular intrahepatic portosystemic shunt (TIPS) is a serious and likely underdiagnosed complication. It is however an important complication following TIPS, which remains one of the most technically challenging interventional procedures performed. In addition to laceration, a number of complications regarding bleeding and perforation are well described following TIPS procedures. We feel the adoption of techniques such as ours and that of other authors described in the literature using an ultrasound-guided percutaneous transhepatic approach with a small caliber needle provides a safer and less traumatic procedure and should reduce complications of bleeding and almost completely eliminate the risk of liver laceration. Our procedure was successfully performed under conscious sedation rather than general anaesthesia further reducing the overall procedural risk to the patient.

Ultrasonography-Guided Fine-Needle Biopsy for Thyroid Nodules: An Emphasis on One-Sampling and Biopsy Techniques

The aim of this study was to assess the adequacy and efficacy of ultrasonography (US)-guided fine-needle biopsy (US-FNB) with one-sampling technique (only one specimen through a single needle pass was obtained during the US-FNB procedure on each thyroid nodule in each study patient) for the cytological diagnosis of thyroid nodules.

Ultrasonography‐guided fine‐needle aspiration cytology for thyroid nodules: An emphasis on one‐sampling and biopsy techniques

The aim of this study was to assess the adequacy and efficacy of ultrasonography (US)-guided fine-needle aspiration cytology (US-FNAC) with one-sampling technique (only one specimen through a single needle pass was obtained during the procedure on each thyroid nodule in each study patient) for the cytological diagnosis of thyroid nodules. In this study, US-FNAC techniques, including "free two-hand," "mixed sampling," "flipping-extraction," and "single-needle-pass" procedures were used to collect thyroid cells from July 2007 to June 2009. The cytopathology results and patients' complications were reviewed retrospectively. Of the 1456 thyroid-nodule samples obtained from 977 patients (1.49 per patient), the incidence of adequate and inadequate samplings was 88.5% (1289/1456) and 11.5% (167/1456), respectively. After thyroid surgery in 396 patients, 568 nodules were confirmed as 353 papillary thyroid carcinomas including one diffuse sclerosing variant, five follicular thyroid carcinomas, three medullary thyroid carcinomas, one anaplastic thyroid carcinoma, one metastatic renal cell carcinoma, two poorly differentiated carcinomas, 17 follicular adenomas, two nodular thyroiditis, two pseudonodules related to thyroiditis, and 182 cases of nodular hyperplasia. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, false-negative rate, and false-positive rate for the US-FNAC were 94.3%, 91.9%, 96.2%, 88.3%, 93.6%, 3.9%, and 2.6%, respectively. There were no significant patients' complications, but 87 patients (8.9%) reported mild pain during or after the procedure. This study showed a good adequacy and efficacy of US-FNAC for thyroid nodules despite one-sampling.

Integrated cone-beam CT and fluoroscopic navigation in treatment of head and neck vascular malformations and tumors

Background and aimAccurate direct puncture access to vascular malformations and tumors of the head and neck is critical to successful embolization treatment and avoidance of complications. The primary focus of...

Abstract P6-02-04: Breast Lesion Excision System — Intact®(B.L.E.S): A Novel Stereotactic Method of Biopsy Utilizing Radiofrequency for Suspicious Non-Palpable Mammographic Lesions

Abstract AIM: The Breast Lesion Excision System by Intact®(B.L.E.S) is a novel stereotactic, vacuum-assisted breast biopsy device that utilizes radiofrequency in order to completely excise any suspicious (BIRAD ≥4) non palpable mammographic lesion. The purpose of this clinical study is to evaluate the efficiency and success rate of the B.L.E.S system in the accurate diagnosis of any suspicious non-palpable mammographic lesions. MATERIAL AND METHODS: This study included 105 patients with suspicious non palpable mammographic lesions that visited the Breast Unit of the First Propaedeutic Surgical Clinic at Ippocration hospital from January 2008 to April 2010. The mammographic findings included suspicious microcalcifications, solid lesion and radial scars, all classified as BIRAD ≥4. The method was performed by the same surgical-radiologist team utilizing the Fisher's stereotactic table which includes a breast compression plate, incorporated digital mammography device, a robotic arm that carries the biopsy needle and a vacuum apparatus. The system is controlled by a central computer that performs the stereotactic localization. We utilize the 15mm or the 20mm tissue basket depending on the size of the lesion, trying to completely excise it with healthy margins, if possible. The procedure is performed under local anaesthesia (20ml of 2% Lydokaine) and is completed with a single needle pass. A 5-6 mm skin incision is performed and a retrieval basket is deployed to circumscribe the lesion, while radiofrequency is used to ablate the surrounding breast tissue. The basket containing the captured specimen is removed through the incision and the wound is dressed with steril strip. We routinely perform mammography on the specimen to insure the success of the biopsy and we place a titanium clip in the biopsy cavity to mark the area. RESULTS: One hundred and five patients with non palpable mammographic lesions underwent biopsy with the BLES — Intact® system. All lesions were excised completely, but not all with healthy margins especially in cases of DCIS with intraductal component. The histological findings included: Fibroadenoma: 38 (36.1 %), Invasive Ductal Breast Cancer with associated DCIS 14 (13.3 %), papilloma: 11 (10.4 %), Fibrocystic changes 11 (10.4 %), Papillary Apocrine Metaplasis 7 (6.6 %), Stromal Fibrosis: 7 (6.6%), mammary duct ectasia: 6 (5.71%), DCIS :5 (4.7%), Liponecrosis: 2 (1.9 %), Intramamary lymph node: 2 (1.9%), Invasive Ductal Carcinoma: 1 (0.95%), Invasive Ductal Carcinoma with associated lobular in situ (LCIS): 1 (0.95%). CONCLUSION: Suspicious non palpable mammographic lesions can be safely removed for histologic diagnosis utilizing the BLES — Intact® system. The method has the unique advantage of completely removing the lesion without cutting through it. This way the specimen retains its original architectural structure intact, which means even more accurate histologic diagnosis and thus lower underestimation rates. Furthermore, the BLES system alliviates all concern for possible tumor dissemination through the needle tract since it comes in no contact with the tumor and can remove the lesion with healthy margins. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-02-04.