Stereotactic Needle Biopsy Research Articles

Use of intraoperative fluorescein sodium fluorescence to improve the accuracy of tissue diagnosis during stereotactic needle biopsy of high-grade gliomas

Stereotactic needle biopsy is valuable for tissue diagnosis of suspected high-grade gliomas, but limited by a sampling error that can lead to inappropriate grading of the tumor or failure to provide diagnosis. Increasing the number of biopsy attempts can increase morbidity. The authors designed a protocol to increase safety and efficiency of the procedure. Six consecutive patients with suspected high-grade gliomas who were not candidates for cytoreductive surgery underwent fluorescein-guided stereotactic needle biopsy. All received an injection of 3 mg/kg fluorescein sodium during anesthesia induction. Samples were obtained and observed under a microscope-integrated fluorescent module. If the initial specimens were fluorescent, the procedure was complete if the pathologist confirmed diagnostic tissue. Additional specimens were obtained only at the pathologist's request. An independent neuropathologist later analyzed and graded samples for diagnostic value, tumor, and necrosis. This information was correlated to the degree of intraoperative fluorescent signal in biopsy samples. During six biopsy procedures, 26 specimens were obtained: 15 (58 %) fluorescent and 11 (42 %) nonfluorescent. All fluorescent specimens contained diagnostic tissue appropriate for tumor grading. Of 11 nonfluorescent specimens, four (36 %) did not contain tumor, three (27 %) contained minor hypercellularity or gliosis, and four (36 %) contained tumor with a high proportion of necrosis. All six tumors were diagnosed as glioblastoma multiforme. The sensitivity and specificity for fluorescein fluorescence was 79 % and 100 %, respectively. Fluorescein fluorescence may improve diagnostic accuracy and expedite stereotactic biopsy procedures.

Development and Evaluation of a Prediction Model for Underestimated Invasive Breast Cancer in Women with Ductal Carcinoma In Situ at Stereotactic Large Core Needle Biopsy

BackgroundWe aimed to develop a multivariable model for prediction of underestimated invasiveness in women with ductal carcinoma in situ at stereotactic large core needle biopsy, that can be used to select patients for sentinel node biopsy at primary surgery.MethodsFrom the literature, we selected potential preoperative predictors of underestimated invasive breast cancer. Data of patients with nonpalpable breast lesions who were diagnosed with ductal carcinoma in situ at stereotactic large core needle biopsy, drawn from the prospective COBRA (Core Biopsy after RAdiological localization) and COBRA2000 cohort studies, were used to fit the multivariable model and assess its overall performance, discrimination, and calibration.Results348 women with large core needle biopsy-proven ductal carcinoma in situ were available for analysis. In 100 (28.7%) patients invasive carcinoma was found at subsequent surgery. Nine predictors were included in the model. In the multivariable analysis, the predictors with the strongest association were lesion size (OR 1.12 per cm, 95% CI 0.98-1.28), number of cores retrieved at biopsy (OR per core 0.87, 95% CI 0.75-1.01), presence of lobular cancerization (OR 5.29, 95% CI 1.25-26.77), and microinvasion (OR 3.75, 95% CI 1.42-9.87). The overall performance of the multivariable model was poor with an explained variation of 9% (Nagelkerke’s R 2), mediocre discrimination with area under the receiver operating characteristic curve of 0.66 (95% confidence interval 0.58-0.73), and fairly good calibration.ConclusionThe evaluation of our multivariable prediction model in a large, clinically representative study population proves that routine clinical and pathological variables are not suitable to select patients with large core needle biopsy-proven ductal carcinoma in situ for sentinel node biopsy during primary surgery.

Application of Raman Spectroscopy to Identify Microcalcifications and Underlying Breast Lesions at Stereotactic Core Needle Biopsy

Microcalcifications are a feature of diagnostic significance on a mammogram and a target for stereotactic breast needle biopsy. Here, we report development of a Raman spectroscopy technique to simultaneously identify microcalcification status and diagnose the underlying breast lesion, in real-time, during stereotactic core needle biopsy procedures. Raman spectra were obtained ex vivo from 146 tissue sites from fresh stereotactic breast needle biopsy tissue cores from 33 patients, including 50 normal tissue sites, 77 lesions with microcalcifications, and 19 lesions without microcalcifications, using a compact clinical system. The Raman spectra were modeled on the basis of the breast tissue components, and a support vector machine framework was used to develop a single-step diagnostic algorithm to distinguish normal tissue, fibrocystic change (FCC), fibroadenoma, and breast cancer, in the absence and presence of microcalcifications. This algorithm was subjected to leave-one-site-out cross-validation, yielding a positive predictive value, negative predictive value, sensitivity, and specificity of 100%, 95.6%, 62.5%, and 100% for diagnosis of breast cancer (with or without microcalcifications) and an overall accuracy of 82.2% for classification into specific categories of normal tissue, FCC, fibroadenoma, or breast cancer (with and without microcalcifications). Notably, the majority of breast cancers diagnosed are ductal carcinoma in situ (DCIS), the most common lesion associated with microcalcifications, which could not be diagnosed using previous Raman algorithm(s). Our study shows the potential of Raman spectroscopy to concomitantly detect microcalcifications and diagnose associated lesions, including DCIS, and thus provide real-time feedback to radiologists during such biopsy procedures, reducing nondiagnostic and false-negative biopsies.

Flat Ductal Intraepithelial Neoplasia 1A Diagnosed at Stereotactic Core Needle Biopsy: Is Excisional Biopsy Indicated?

This study correlates ductal intraepithelial neoplasia (DIN) 1A diagnosed at stereotactic spring core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) with the subsequent surgical histologic results or long-term follow-up imaging findings to predict the likelihood of upgrade to ductal carcinoma in situ (DCIS) or invasive carcinoma. Stereotactic imaging-guided CNBs and VABs were performed principally for assessment of microcalcifications seen on mammography. DIN 1A diagnoses made at CNB or VAB were correlated with subsequent excisional biopsy results or imaging follow-up. Patients were included only if there was no concomitant CNB or VAB diagnosis of DIN 1B, atypical lobular hyperplasia, lobular carcinoma in situ or DCIS, papillary lesion, or invasive carcinoma. Surgical biopsy results were obtained for 239 patients. Upgrade was defined as a diagnosis of DCIS or invasive carcinoma at surgery. Patients who did not undergo surgical excision were followed with imaging. An upgrade rate of 4.2% (10 lesions in 239 patients) is reported. The remaining samples (229/239) had a surgical diagnosis of DIN 1A or DIN 1B, lobular carcinoma in situ, or a benign finding with no atypia. The upgrade rate of DIN 1A diagnosed at CNB or VAB was 4.2%. These results indicate it may be reasonable to avert immediate surgery in favor of short-term imaging follow-up.

Diagnostic power of diffuse reflectance spectroscopy for targeted detection of breast lesions with microcalcifications

Microcalcifications geographically target the location of abnormalities within the breast and are of critical importance in breast cancer diagnosis. However, despite stereotactic guidance, core needle biopsy fails to retrieve microcalcifications in up to 15% of patients. Here, we introduce an approach based on diffuse reflectance spectroscopy for detection of microcalcifications that focuses on variations in optical absorption stemming from the calcified clusters and the associated cross-linking molecules. In this study, diffuse reflectance spectra are acquired ex vivo from 203 sites in fresh biopsy tissue cores from 23 patients undergoing stereotactic breast needle biopsies. By correlating the spectra with the corresponding radiographic and histologic assessment, we have developed a support vector machine-derived decision algorithm, which shows high diagnostic power (positive predictive value and negative predictive value of 97% and 88%, respectively) for diagnosis of lesions with microcalcifications. We further show that these results are robust and not due to any spurious correlations. We attribute our findings to the presence of proteins (such as elastin), and desmosine and isodesmosine cross-linkers in the microcalcifications. It is important to note that the performance of the diffuse reflectance decision algorithm is comparable to one derived from the corresponding Raman spectra, and the considerably higher intensity of the reflectance signal enables the detection of the targeted lesions in a fraction of the spectral acquisition time. Our findings create a unique landscape for spectroscopic validation of breast core needle biopsy for detection of microcalcifications that can substantially improve the likelihood of an adequate, diagnostic biopsy in the first attempt.

Asymmetries: Comparison Between Full Field Digital Mammography and Digital Breast Tomosyntesis

INTRODUCTION: Breast Tomosynthesis (DBT) is a procedure developed from digital mammography unit to enable the acquisition of a three-dimensional (3D) volume of thinsection data. The slice examination of breasts can reduce or even eliminate tissue overlap. The purpose of this study was to evaluate if breast tomosynthesis can help to differentiate the assymetries from the overlapping tissues. MATERIALS AND METHODS: A total of 48 cases of asymmetries were referred to perform stereotactic guided core needle biopsy or vacuum assisted biopsy. Each case was analyzed with full field digital mammography(FFDM) and with digital breast tomosynthesis (DBT) previously to the procedure. The study included 47 women (age range 34-78 years, mean age 44, 3 years;) and all the lesions were sampled. The histopathologic results were compared with those obtained with FFDM and DBT. RESULTS: of the 48 cases of asymmetries, 19 (39, 58%) did not change with DBT and 27 (60, 41%) attenuated or disappeared. Among the 19 lesions, the stereotactic guided biopsy diagnosed 8 cases of breast cancer (4 invasive ductal carcinoma, 3 invasive lobular carcinoma, 1 ductal carcinoma in situ), 1 of lobular neoplasia, 1 atypical ductal hyperplasia, 6 of fibroadenoma and 3 cases of normal breast tissue. There were no cases of breast cancer or atypical hyperplasia in those images that attenuated or disappeared with DBT. In this study the biopsy could be avoided in 60, 41% of the cases of asymmetries with the performance of the DBT. DISCUSSION: These results indicate that DBT can be useful in the differentiation between the asymmetries and the overlapping tissues, allowing a decrease in the number of unnecessary biopsies in these cases.

Precision of Raman Spectroscopy Measurements in Detection of Microcalcifications in Breast Needle Biopsies

Microcalcifications are an early mammographic sign of breast cancer and a target for stereotactic breast needle biopsy. We developed Raman spectroscopy decision algorithms to detect breast microcalcifications, based on fit coefficients (FC) derived by modeling tissue Raman spectra as a linear combination of the Raman spectra of 9 chemical and morphologic components of breast tissue. However, little or no information is available on the precision of such measurements and its effect on the ability of Raman spectroscopy to make predictions for breast microcalcification detection. Here we report the precision, that is, the closeness of agreement between replicate Raman spectral measurements--and the model FC derived from them--obtained ex vivo from fresh breast biopsies from patients undergoing stereotactic breast needle biopsy, using a compact clinical Raman system. The coefficients of variation of the model FC averaged 0.03 for normal breast tissue sites, 0.12 for breast lesions without, and 0.22 for breast lesions with microcalcifications. Imprecision in the FC resulted in diagnostic discordance among replicates only for line-sitters, that is, tissue sites with FC values near the decision line or plane. The source of this imprecision and their implications for the use of Raman spectroscopy for guidance of stereotactic breast biopsies for microcalcifications are also discussed. In summary, we conclude that the precision of Raman spectroscopy measurements in breast tissue obtained using our compact clinical system is more than adequate to make accurate and repeatable predictions of microcalcifications in breast tissue using decision algorithms based on model FC. This provides strong evidence of the potential of Raman spectroscopy guidance of stereotactic breast needle biopsies for microcalcifications.

Management strategies after nondiagnostic results with frameless stereotactic needle biopsy: Retrospective review of 28 patients

Background:Although frameless stereotactic needle biopsy is an accepted procedure for the diagnosis of intracranial lesions, findings are nondiagnostic in 2–15% of patients and no recommendations yet exist to guide subsequent care. After reviewing the postoperative course after nondiagnostic biopsy of 28 patients, we developed a paradigm to guide management in the future.Methods:In reviewing the medical records of 284 frameless stereotactic needle biopsies (January 2000 to December 2006), we identified a subset of 28 patients who underwent 29 (10.2%) biopsies that did not yield a definitive diagnosis based on permanent pathologic samples. Postoperative treatment plans and clinical courses were further examined in 21 patients; 7 without follow-up were excluded.Results:Of the 21 patients, lesion location and characteristics guided the surgeon's decision to recommend further surgery or initiate empiric treatment. Soon after initial biopsy, five patients underwent a second procedure (biopsy or resection) that yielded diagnostic pathologic tissue. Of 16 patients who had empiric treatment, 7 (43.7%) subsequently had their treatment plan changed because of a lack of improvement and 5 underwent a second biopsy (4 diagnostic). Evolving clinical information precipitated treatment change in two patients. Of 10 patients who had a second surgery for better diagnostic information, the diagnostic yield was 90%.Conclusions:Considering the 90% diagnostic yield, we now recommend repeat surgery for most patients with nondiagnostic biopsies, especially for lesions considered potentially neoplastic or infectious. Empiric management, for lesions likely to be neurodegenerative, is an option but requires close follow-up examination.

Raman spectroscopy: a real-time tool for identifying microcalcifications during stereotactic breast core needle biopsies

Microcalcifications are an early mammographic sign of breast cancer and a target for stereotactic breast needle biopsy. We present here a Raman spectroscopic tool for detecting microcalcifications in breast tissue based on their chemical composition. We collected ex vivo Raman spectra from 159 tissue sites in fresh stereotactic breast needle biopsies from 33 patients, including 54 normal sites, 75 lesions with microcalcifications and 30 lesions without microcalcifications. Application of our Raman technique resulted in a positive predictive value of 97% for detecting microcalcifications. This study shows that Raman spectroscopy has the potential to detect microcalcifications during stereotactic breast core biopsies and provide real-time feedback to radiologists, thus reducing non-diagnostic and false negative biopsies.

Real-time three-dimensional transoesophageal echocardiography during stereotactic needle biopsy of complex atrioventricular nodal tumour

Comprehensive echocardiographic imaging allows the characterization of tissue abnormalities of complex cardiac tumours and can guide invasive procedures. We present a case of a cystic tumour of the atrioventricular (AV) node. These are rear, benign, primary cardiac tumour that can arise from the right atrium and the interatrial septum. It can cause variable degree of heart block and sudden death. Although these types of tumour have …

Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor

To evaluate the efficacy of intraparenchymal brain tumor biopsy using endoscopy and a navigation system (navigation-guided endoscopic biopsy) as a diagnostic tool, a case series of intraparenchymal tumor biopsies was reviewed. Navigation-guided endoscopic biopsy was applied in 9 cases, stereotactic needle biopsy in 16 cases, and open biopsy with or without navigation system in 34 cases. In all biopsy cases, 84.7% of biopsy points were sampled accurately, and 93.2% of diagnoses by biopsy were correct. Comparison of each type of biopsy showed that the resected volumes in navigation-guided endoscopic biopsy and open biopsy tended to be larger than those in stereotactic biopsy, and the mean operation time for the open biopsy procedure was the longest. To define the most applicable device or examination method to increase sampling accuracy, various factors were analyzed in 59 procedures. Navigation-guided endoscopic biopsy was the most accurate of the three types of biopsy, although the statistical difference was not significant. Older patients, histological diagnosis of high-grade glioma or malignant lymphoma, positive photodynamic diagnosis, and positive intraoperative pathology were significant factors in improving the sampling accuracy. Navigation-guided endoscopic biopsy could provide a larger sample volume within a relatively short operation time. The biopsy can be easily combined with both photodynamic diagnosis and intraoperative pathology, significantly improving the histological diagnostic yield.

Image-guided frameless stereotactic needle biopsy in awake patients without the use of rigid head fixation

Image-guided frameless stereotactic techniques provide an alternative to traditional head-frame fixation in the performance of fine-needle biopsies. However, these techniques still require rigid head fixation, usually in the form of a head holder. The authors report on a series of fine-needle biopsies and brain abscess aspirations in which a frameless technique was used with a patient's head supported on a horseshoe headholder. To validate this technique, they performed an in vitro accuracy study. Forty-eight patients underwent fine-needle biopsy of intracranial lesions that ranged in size from 0.9 to more than 107.7 ml; a fiducial-less, frameless, image-guided technique was used without rigid head fixation. In 1 of the 48 patients a cerebral abscess was drained. The accuracy study was performed with a skull phantom that was imaged with a CT scanner and tracked with a registration mask containing light-emitting diodes. The objective was a skin fiducial marker with a 4-mm circular target to accommodate the 2.5-mm biopsy needle. A series of 50 trials was conducted. Diagnostic tissue was obtained on the first attempt in 47 of 48 brain biopsy cases. In 2 cases small hemorrhages at the biopsy site were noted as a complication on the postoperative CT scan. One of these hemorrhages resulted in hand and arm weakness. The accuracy study demonstrated a 98% success rate of the biopsy needle passing through the 4-mm circular target using the registration mask as the registration and tracking device. This demonstrates a ± 0.75-mm tolerance on the targeting method. The accuracy study demonstrated the ability of the mask to actively track the target and allow navigation to a 4-mm-diameter circular target with a 98% success rate. The frameless, pinless, fiducial-less technique described herein will likely be another safe, fast alternative to frame-based stereotactic techniques for fine-needle biopsy that avoids the potential morbidity of rigid head-pin fixation. Furthermore, it should lend itself to other image-guided applications such as the placement of ventricular catheters for shunting or Ommaya reservoirs.

Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre

BackgroundPreviously, we reported on our single centre results regarding the diagnostic yield of stereotactic needle biopsies of brain lesions. The yield then (1996–2006) was 89.4%. In the present study, we review and evaluate our experience with intraoperative frozen-section histopathologic diagnosis on-demand in order to improve the diagnostic yield.MethodsOne hundred sixty-four consecutive frameless biopsy procedures in 160 patients (group 1, 2006–2010) were compared with the historic control group (group 2, n = 164 frameless biopsy procedures). Diagnostic yield, as well as demographics, morbidity and mortality, was compared. Statistical analysis was performed by Student's t, Mann–Whitney U, Chi-square test and backward logistic regression when appropriate.ResultsDemographics were comparable. In group 1, a non-diagnostic tissue specimen was obtained in 1.8%, compared to 11.0% in group 2 (p = 0.001). Also, both the operating time and the number of biopsies needed were decreased significantly. Procedure-related mortality decreased from 3.7% to 0.6% (p = 0.121). Multivariate analysis only proved operating time (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.000–1.025; p = 0.043), a right-sided lesion (OR, 3.183; 95% CI, 1.217–8.322; p = 0.018) and on-demand intraoperative histology (OR, 0.175; 95% CI, 0.050–0.618; p = 0.007) important factors predicting non-diagnostic biopsies.ConclusionsThe importance of a reliable pathological diagnosis as obtained by biopsy must not be underestimated. We believe that when performing stereotactic biopsy for intracranial lesions, next to minimising morbidity, one should strive for as high a positive yield as possible. In the present single centre retrospective series, we have shown that using a standardised procedure and careful on-demand intraoperative frozen-section analysis can improve the diagnostic yield of stereotactic brain biopsy procedures as compared to a historical series.

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

In the modern era of frameless stereotaxis (FL), the role of frame-based (FB) stereotactic needle biopsy is evolving. Retrospective review of prospective database of 106 lesions in 91 consecutive patients undergoing FB stereotactic needle biopsy with a systematic "geologic core" technique by a single surgeon. Diagnostic accuracy was calculated comparing biopsy diagnosis with final pathology in 11 patients who underwent subsequent surgical resection. All instances of intra-operative bleeding through the needle were prospectively noted and compared with post-biopsy CT scan. Lesions were classified as risky for FL technique if they were (1) infratentorial or pineal, (2) within 10 mm of the circle of Willis or root of the Sylvian fissure, or (3) within 10 mm of deep cerebral veins. Diagnostic yield was 94%. Diagnostic accuracy was 91%. Of 18 lesions involving the corpus callosum, 13 (72.2%) were GBM 2 were anaplastic astrocytoma, and 1 each were found to be anaplastic oligodendroglioma, primary central nervous system lymphoma (PCNSL) and tumescent MS. Of 25 multifocal lesions, malignant primary brain tumor was diagnosed in 17 (68%) (11 GBM, 3 PCNSL, 2 anaplastic ologodendroglioma, and 1 anaplastic astrocytoma). Mortality was 0%. Three patients developed temporary neurologic deficits and one had permanent deficit. Absence of persistent blood through the biopsy needle had a negative predicative value of 98.8% for subsequent neuroimaging blood >5 mm diameter. According to our criteria, 80% of patients would have been candidates for FL biopsy. Stereotactic biopsy is an effective, safe and important technique for histologic diagnosis of brain lesions, particularly for multifocal and corpus callosum lesions. Post-biopsy CT can be safely reserved for patients who demonstrate persistent bleeding through the biopsy needle. FB stereotaxy remains an important technique for the 20% with small or deep seated lesions or when it is advantageous to avoid an incision, a burr hole or general anesthesia.

Diagnostic performance of stereotactic large core needle biopsy for nonpalpable breast lesions in routine clinical practice

The COBRA (COre Biopsy after RAdiological localization) study showed that in a controlled study setting, stereotactic large core needle biopsy (LCNB) is as reliable for diagnosing nonpalpable breast lesions as open surgical biopsy. In the present study, we evaluated the diagnostic performance of stereotactic LCNB in routine clinical practice. Between February 2000 and June 2002, data on all patients (n = 955) with nonpalpable breast lesions referred for LCNB were collected. High risk underestimate rate, ductal carcinoma in situ (DCIS) underestimate rate and sensitivity rate after 2 years were calculated. The usefulness of the COBRA guidelines in clinical practice was determined. Nine hundred five successful biopsies were performed in 874 patients. Of the high-risk lesions, 27% were found to be carcinomas on open biopsy, which is comparable to the results of the COBRA study (23%). The DCIS underestimate rate (28%) was higher than found in the COBRA study (17%). No carcinomas were missed after a follow-up period of 2 years. Ninety-six percent of patients were treated according to the COBRA guidelines. The diagnostic performance of stereotactic LCNB in patients with nonpalpable breast lesions seems to be comparable in a controlled study setting and routine clinical practice.

Application of stereotactic core needle biopsy in diagnosis of breast disease

目的 探讨乳腺微小病变行立体定位核芯针活检(SCNB)的临床应用价值.方法 采用计算机辅助乳腺三维立体定位系统、弹射式活检枪和16 G核芯针,对47例乳腺X线发现的可疑恶性病变直接行穿刺活检,记录每例的临床和X线表现(钙化、结节、结构紊乱等)、穿刺活检诊断、外科术后病理诊断或随访观察资料.比较SCNB与外科手术二者的病理诊断结果 ,统计其诊断符合率.对照分析SCNB准确性与病灶X线表现的关系,分析SCNB成败、误诊原因.结果 欲行SCNB 47例,成功完成44例,未能完成3例.31例患者随后行外科手术,SCNB诊断与术后病理符合27例,4例SCNB与术后病理不符.结论 SCNB具有准确、快速、微创等优势,可减少手术活检数量,及早确诊乳腺疾病,具有良好的临床应用前景。

Core wash cytology of breast lesions by ultrasonographically guided core needle biopsy

Previous studies demonstrated that core wash cytology by stereotactic needle biopsy was useful for the immediate diagnosis of breast lesions. The purpose of this study was to assess the accuracy of core wash cytology of breast lesions by ultrasonographically (US) guided core needle biopsy (CNB). US-guided 18-gauge CNB was performed in a series of 458 cases. Each CNB sample was washed in saline solution. Core wash cytology of the washed core material was performed on material obtained by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant, and unsatisfactory, which then were compared with the CNB results. The cytological diagnoses of the 458 cases were as follows: 106 lesions (23.1%) were benign, 28 lesions (6.1%) were atypical/indeterminate, 42 lesions (9.2%) were suspicious/probably malignant, 88 lesions (19.2%) were malignant, and 194 lesions (42.4%) were unsatisfactory. The core wash cytology had a sensitivity of 89% (141 of 158), and a specificity of 72% (76 of 106). The CNB showed 143 of 194 unsatisfactory samples (74%) to be benign, three to be high-risk, and 48 (25%) to be malignant. Unsatisfactory samples were obtained from significantly more benign than malignant lesions. In conclusion, the high rate of insufficient samples for core wash cytology of breast lesions by US-guided CNB makes its use impractical in this setting. This technique is not useful for immediate diagnosis of breast lesions by US-guided CNB.

Vacuum-assisted large-core needle biopsy (VLNB) improves the management of patients with breast microcalcifications – Analysis of 1009 cases

To evaluate the surgical management of patients who underwent VLNB for breast microcalcifications. This retrospective study compared the histological results and the surgical procedures in two groups of patients, group 1: large-core needle biopsy n=1009, and group 2: surgical biopsy n=270. After VLNB, 54% patients were not operated on after stereotactic large-core needle biopsy, 42% underwent one operation, 4% underwent two operations and 0.2% underwent three operations. No surgery was performed for 95% of benign lesions. Multiples operations were necessary in 12% of patients with malignant lesions of VLNB group compared to 45% in the surgical biopsy group. The rate of underdiagnosis of borderline lesions and ductal carcinomas in situ was 16% by the large-core biopsy technique. VLNB constitutes an alternative to surgical biopsy. This procedure avoids surgery for most benign lesions and reduces the number of surgical procedures in malignant lesions.

Optimization of Central Nervous System Stereotactic Needle and Pituitary Biopsies With HistoGel™ Tissue-Processing Medium

We have adapted a cornmercially available tissue processing cessing material, HistoGel™, for the routine processing of stereotactic brain needle biopsies and transsphenoidal pituitary gland specimens. Both of these specimen types often result in very scant tissue fragments available for diagnosis, even if they are processed in a tissue tea bag or lens paper envelope. Pituitary specimens are often a cloudy suspension in saline that defy macroscopic identification. HistoGel™ is a firm, pink gel at room temperature and a viscous liquid when heated. Needle biopsy cores can be placed in a bubble of viscous HistoGel™ on a flat surface or in a disposable tissue mold, allowed to solidify, and then processed routinely in a plastic cassette. Liquid-based specimens are centrifuged, the pellet layer resuspended in HistoGel™ in a disposable tissue nlold until solid, and then routinely processed. The extra handling, time, and effort that this preparation requires are far outweighed by the remarkable increase in the amount of tissue available for diagnostic evaluation with these irreplaceable diagnostic samples. This application demonstrates the potential that this tissue processing medium has for many diagnostic and research specimens (The J Histotechnol 30:131, 2007).Submitted March 1, 2007; accepted with revisions March 29, 2007.

Optimization of Central Nervous System Stereotactic Needle and Pituitary Biopsies With HistoGel™ Tissue-Processing Medium

Optimization of Central Nervous System Stereotactic Needle and Pituitary Biopsies With HistoGel™ Tissue-Processing Medium