Spring-loaded Biopsy Needle Research Articles

Percutaneous Kidney Biopsy: A Valuable Diagnostic Tool

Percutaneous kidney biopsy is a valuable diagnostic tool for the pathological evaluation of renal diseases, particularly glomerular disorders. It is crucial for guiding treatment decisions when clinical and laboratory findings are uncertain. Since its introduction in the mid-20th century, percutaneous kidney biopsy has evolved from an initial blind approach, associated with higher complication rates, to advanced methods using real-time ultrasound or computed tomography guidance and spring-loaded biopsy needles. These advancements have significantly improved tissue sampling accuracy and minimized complications, establishing percutaneous kidney biopsy as a relatively safe diagnostic procedure. Despite these improvements, the invasive nature of the procedure emphasizes the importance of careful patient selection and operator expertise. Nephrologists, as the primary operators and performers of kidney biopsy, play a pivotal role in ensuring timely and appropriate patient care.

Color Doppler Guided in Early Renal Allograft Biopsy: A Safer and Non-Inferior Technique

This study compared a novel technique for renal allograft biopsy, color Doppler ultrasound-guided biopsy (CDUS-Bx), with routine ultrasound-guided biopsy (RUS-Bx). A retrospective review was conducted on 111 patients, with 42 undergoing CDUS-Bx and 69 undergoing RUS-Bx. Urologists used an 18-gauge automatic spring-loaded biopsy needle for all procedures. CDUS-Bx tissue collection was guided by identifying renal vessels with color Doppler mode. Overall, the adequacy rate was 90.1%, with a higher number of glomeruli obtained in the CDUS-Bx group (25.6 ± 10.3 vs. 20.6 ± 11.3, P=.008). Acute tubular necrosis was the most frequent pathological diagnosis, with a higher prevalence in the CDUS-Bx group (69% vs 40.6%). T cell-mediated rejection had a lower incidence in the CDUS-Bx group (4.8% vs 21.7%), and antibody-mediated rejection was comparable between the 2 groups. The most common complication was microscopic hematuria, which was significantly less frequent in the CDUS-Bx group (48.7% vs 70.1%, P=.028), but there was no significant difference in the rate of gross hematuria between CDUS-Bx and RUS-Bx (11.9% vs 11.6%, P=.961). The number of cores was the only predictor of adequate biopsy, with a 93.2% adequacy rate after 3 cores of allograft biopsy. Multivariate analysis revealed that only the guiding type, CDUS-Bx, was associated with less microscopic hematuria (adjusted odds ratio 0.325, P=.018). Color Doppler ultrasound-guided biopsy had comparable tissue adequacy to RUS-Bx, with a lower incidence of microscopic hematuria. These findings suggest that CDUS-Bx may be a safe and effective alternative to RUS-Bx for allograft biopsy.

Benign breast papillomas without atypia diagnosed with core needle biopsy: Outcome of surgical excision and imaging follow-up

PurposeTo evaluate the surgical upgrade rate to malignancy and high-risk lesions in cases of papilloma without atypia diagnosed with imaging-guided percutaneous core needle biopsy (CNB) and to determine whether any lesion imaging features, biopsy techniques, and pathological factors can predict lesion upgrade to help guide clinical management. Materials and methodsBenign papillomas without atypia (n = 399) diagnosed with CNB were retrospectively reviewed. The surgical upgrade rate to malignancy or high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in-situ, flat epithelial atypia and atypical papilloma) was determined. Detection modality (i.e. mammography, ultrasonography (US), magnetic resonance imaging (MRI)), lesion type and size, biopsy-guidance modality (US, stereotactic, MRI), biopsy needle size (<14 G vs ≥14 G), use of vacuum assistance, and presenting symptoms were statistically analyzed. The reference standard for evaluation of upgrade was either excision or at least 24 months of imaging follow-up. Chi Square test and Fisher exact tests were performed for categorical variables, and the Mann-Whitney-U test was used for continuous variables. ResultsUltrasound was the predominant biopsy modality (78.4 %, p < 0.001). Of the 399 benign papilloma lesions in 329 women, 239 (59.9 %) were excised and 93 others were followed for at least 24 months (total of 332). Of these 332 lesions, 7 (2.1 %) were upgraded to ductal carcinoma in-situ and 41 (12.3 %) to high-risk lesions at excision. Larger lesion size (≥15 mm, p = 0.009), smaller biopsy needle size (≥14 G, p = 0.027), and use of spring-loaded biopsy device (p = 0.012) were significantly associated with upgrade to atypia. Only lesion size (≥15 mm, p = 0.02) was associated with upgrade to cancer. ConclusionUpgrade to malignancy of biopsy-proven benign papillomas without atypia at the time of surgery was sufficiently low (2.1 %) to support non-operative management. Surgery may be performed for selected cases- those with larger lesion size and those whose biopsies were performed with smaller spring-loaded biopsy needles.

Study of ultrasound-guided transthoracic fine-needle aspiration and core-needle biopsy in the diagnosis of peripheral pulmonary lesions

Background Transthoracic ultrasound (TUS) is a useful diagnostic tool in peripheral pulmonary lesions. US-guided transthoracic needle biopsy has become an easy and safe procedure that provides adequate tissue samples of lesions for cytological or histopathological examination. Aim The purpose of the study was to evaluate the role of transthoracic fine-needle aspiration and core-needle biopsy under US guidance in the diagnosis of peripheral pulmonary lesions. Patients and methods The study included 30 patients with undiagnosed peripheral parenchymal lesions. Fine-needle aspiration with or without core-needle biopsy under US guidance was performed using needles of different pores and lengths, and spring-loaded biopsy needles having needle size (16–18–20 gauge) and core length (1–2 cm) for core biopsy. Results The total diagnostic yield of transthoracic lung sampling was 80%. The diagnostic yields of fine-needle aspiration, core-needle biopsy, and their combined techniques were 70%, 72.73%, and 81.82%, respectively. The sensitivity of the combined technique (94.12%) was higher than fine-needle aspiration alone (76%) and that of core-needle biopsy alone (88.24%). Conclusion TUS-guided biopsy is an easy and reliable cheap sampling method with less complication. US-guided fine-needle aspiration and core-needle biopsy can be used as complementary procedures for sampling tissue in the diagnosis of peripheral pulmonary lesions abutting the pleura.

Pilot Evaluation of a Vacuum-Assisted Biopsy Instrument for Percutaneous Renal Biopsy in Dogs

Kidney biopsies in dogs are commonly obtained using automated spring-loaded biopsy instruments. Interpretation of biopsies from dogs with glomerular disease requires examination of at least 5-10 glomeruli, with at least two biopsies usually required for full evaluation. The purpose of this study was to compare quality and interpretability of renal biopsies obtained from healthy dogs with a large-gauge, vacuum-assisted biopsy instrument versus two biopsies obtained with a spring-loaded biopsy needle. Twenty dogs were randomized into two groups, and percutaneous, ultrasound-guided renal biopsies were evaluated using standard criteria. There were no significant differences in the number of biopsies that contained renal tissue, cortex, or medulla. Biopsies obtained with either instrument contained an adequate number of glomeruli and an equivalent number of arterioles and severity of tissue compression. Differences included easier penetration of the renal capsule and collection of sufficient tissue for interpretation with only one instrument pass when using the vacuum-assisted device (vs two passes required with the spring-loaded instrument). Before use in client-owned dogs, future studies should evaluate whether these differences are clinically relevant advantages in the diagnostic evaluation of dogs with kidney disease, and determine the prevalence and severity of complications when using this larger gauge device.

The Prostate Needle Biopsy Gun: Busting a Myth

It is widely reported that a prostate biopsy gun needle advances 0.5 cm and then obtains the subsequent 1.5 cm of tissue. Based on this presumed skip area it is recommended that the needle tip must be placed 0.5 cm from the capsule before firing to obtain the capsule with the specimen. Contrary to this longstanding recommendation, in our experience we have observed that there is no such skip area. We determined the actual content of a needle core by obtaining biopsies from an apple model with clinical correlation to validate our findings. Using 3 types of spring-loaded biopsy needles we obtained 24 cores from an apple. We placed the biopsy needle tip directly adjacent to the capsule before firing the biopsy gun. Visual inspection of each biopsy core was done to confirm the presence or absence of the capsule (red apple peel). All cores had confirmed presence of the apple peel, confirming the absence of a skip area in the first 0.5 cm. Using spring-loaded biopsy guns we observed in an apple model that the capsule is obtained when the biopsy needle tip is placed directly adjacent to the capsule. Urologists placing the biopsy needle tip directly on the capsule in line with the projected trajectory will obtain the prostatic capsule in the specimen and should not withdraw the needle unless the gland depth is short enough so that there is risk of firing past the gland.

Prostate biopsy in the diagnosis of prostate cancer: Current trends and techniques

The advent of prostate specific antigen (PSA) screening and transrectal ultrasonography (TRUS) has had a significant impact on the detection of prostate cancer over the last 15 years. The mean age at diagnosis has decreased and the most common stage at diagnosis is now localized disease. TRUS guidance, spring-loaded biopsy needles, utilization of oral antibiotic prophylaxis, developments in local anesthesia, increases in the number of cores sampled and the use of site-specific containers have all made the prostate biopsy easier to perform and more accurate. The indications for an initial prostate biopsy have been strongly influenced by digital rectal examinations (DREs), PSA levels and the PSA-related parameters of velocity, density, and percent free. These parameters, along with abnormal histology, also dictate the need for a repeat biopsy. With the better, earlier, and more patient-friendly usage of the prostate biopsy, there has been a decrease in the mortality rate of prostate cancer.

Visual inspection of the prostate biopsy specimen: aid to diagnosis and management.

The purpose of this article is to assess if the visual inspection of the prostate biopsy specimen can be used as a guide when deciding whether to attempt to sample another core of tissue from the same area if a less than adequate specimen was obtained during the first attempt. Five hundred thirty-seven specimens from 84 patients, referred because of an increased prostate-specific antigen (PSA) level and/or a suspicious result on digital rectal examination (DRE), were sampled and prospectively graded based on the lack of formation and amount of liquid in the specimen (grade I) compared to a highly rigid, solid core (grade V). Specimens were then fixed in formalin and retrospectively compared, and the pathologic diagnosis was compared with the subjective visual grade assigned to the specimen. Receiver-operator curve techniques were used to quantify the results and to test for statistical significance. Rigid biopsy specimens were cancer, and liquid, formless specimens were benign. Most biopsy specimens were solid, with moderate consistency, and could not be diagnosed accurately by visual inspection. Diagnosis of prostate cancer, despite the use of PSA, DRE, or diagnostic endorectal ultrasound, requires biopsy for definitive confirmation. Although the use of spring-loaded biopsy needles routinely yields good-quality cores of tissue for pathologic analysis, there are many occasions when a less than optimal specimen is obtained. The question of whether a repeat biopsy in that region is indicated always arises. These data suggest that if the initial specimen is grade I or II, repeat biopsy is probably not indicated. If the initial specimen is grade IV or V, repeat biopsy is recommended.

Percutaneous liver biopsy in children: impact of ultrasonography and spring-loaded biopsy needles.

Percutaneous liver biopsy is a valued tool of pediatric hepatology. Recent advances in technology have incorporated spring-loaded biopsy needles and ultrasonography in percutaneous liver biopsy. To determine the frequency of complications after liver biopsy and whether variables such as needle selections (Jamshidi, Monopty, or ASAP) and ultrasound guidance could predict complications, medical records were retrospectively reviewed of all patients who underwent percutaneous liver biopsy during a 7-year period. Available data were collected from 123 patients who had undergone a total of 249 percutaneous liver biopsies. All patients with evidence of mild clotting abnormalities (8.83%) received platelets, cryoprecipitate, or fresh-frozen plasma. There was a 6.83% incidence of overall complications, and a 2.4% incidence of major complications. The mortality rate was 0.4%. Ultrasound localization did not diminish the risk of bleeding during biopsy. There was no significant difference in the change of hematocrit between the aspiration (Jamshidi) and spring-loaded (Monopty) needles. However, in patients less than 5 years of age, the change of hematocrit was significantly higher (P < 0.05) with the 15- or 18-gauge ASAP needle (Microvasive, Quincy, MA, U.S.A.) than with either the Jamshidi (Allegience Healthcare, Columbia, MD, U.S.A.) or Monopty (Bard Technologies, Covington, GA, U.S.A.) needles. Percutaneous liver biopsy is safe, using either aspiration or spring-loaded needles. Ultrasound guidance may not be helpful except in patients who underwent segmental liver transplantation.

Endosonography-guided fine-needle biopsy of indurated pancreatic lesions using an automated biopsy device.

We have designed and evaluated a prototype automated spring-loaded biopsy needle for endoscopic ultrasonography (EUS)-guided tissue sampling of indurated lesions in which sampling using conventional aspiration needles has failed. EUS-guided fine-needle biopsy using the new device was performed in four patients (two men, two women, mean age 65 years) with indurated pancreatic lesions that could not be penetrated with a conventional manually operated aspiration needle. The lesions were located in the head of the pancreas in two patients, in the genu in one, and in the body in one. The automatic biopsy needle allowed penetration of the pancreatic lesions in all cases. The biopsy route was transduodenal in two patients, and transgastric in the other two. The biopsies provided a core specimen for histological and cytological diagnosis in all cases. No complications occurred. The spring-loaded biopsy needle allows tissue sampling of indurated pancreatic lesions that cannot be penetrated with conventional aspiration needles. Further studies are warranted to determine whether this device can improve the results of EUS-guided fine-needle aspiration biopsy.

Percutaneous renal biopsy utilizing real time, ultrasonic guidance and a semiautomated biopsy device

Percutaneous renal biopsy is a fundamental diagnostic technique in clinical nephrology. Since its introduction in 1951 [1], there have been several descriptions of the technique with refinements of the procedure, more recently employing ultrasonic guidance [2–10]. The technique described in this paper is a biopsy method employing real-time ultrasonic guidance and a semiautomated, spring-loaded biopsy needle.