Tru-cut Core Biopsy Research Articles

Tru-cut placental site trophoblastic tumor biopsy: A novel way for diagnosis. Case report

Background: A Placental Site Trophoblastic Tumor (PSTT) is a rare form of gestational trophoblastic disease and usually manifests itself with abnormal uterine bleeding and elevated β-hCG serum levels even months or years after any antecedent pregnancy event. Typically, tumors are confined into the uterus and secrete lower levels of β-hCG compared with other Gestational Trophoblastic Neoplasia (GTN). They can be detected sonographically like heterogeneous solid mass in the uterine cavity with minimal to high vascularization, but sometimes they develop into myometrium without endometrial involvement. To the best of our knowledge, uterine biopsy is the only way to make a reliable diagnosis, but for these reasons sometimes Dilation and Curettage (D&C) or hysteroscopy are not exhaustive. Their final diagnosis is histopathological and often very difficult due to their rarity, thus many times they directly present metastasis symptoms (mainly pulmonary) or paraneoplastic syndromes. Case presentation: A 37-year-old woman with the purpose of a second pregnancy, after seven weeks of amenorrhea, complained irregular bleeding and metrorrhagia. The patient underwent transvaginal ultrasound (US) and a lesion of 50 mm was found in myometrium, its echostructure was inhomogeneous and richly vascularised (CS4) with rear acoustic reinforcement. It was associated with slightly elevated serum levels of β-hCG. The patient performed a hysteroscopy with simultaneous tru-cut biopsy of the lesion under US guidance and a placental site trophoblastic tumor was diagnosed by histological examination. Conclusion: In this paper we suggest a novel method to perform the PSTT diagnosis. A tru-cut core biopsy allows a deep and precise biopsy with less invasivity and low risk of bleeding or uterine damage. Our case study shows that the employment of this novel technique can help in the diagnosis through a targeted sampling of the myometrium even in those cases in which the endometrial cavity is not involved.

An intriguing journey of encapsulated apocrine papillary carcinoma of the breast

BackgroundEncapsulated Apocrine Papillary Carcinoma (EAPC) of the breast are very rare tumors. They usually present as a cystic mass with mural nodule in women aged 44–84 years. Affected patients may be asymptomatic or complain of breast swelling, or nipple discharge. Mammographic features are nonspecific. The tumor appears as a high-density round or oval mass with circumscribed or spiculated margins on mammography. On Ultrasonography (US) a classical lesion appears as predominantly cystic mass with intracystic solid papillary projections and area of vascularity within it. Contrast Enhanced Breast MRI helps to further characterize the lesion by showing intense contrast enhancement in early phase along with washout curve. Histological features of these tumors are similar to those of classical encapsulated papillary neoplasm, in that myoepithelial cells are absent within the papillary structures and at the periphery of the cyst. They show variable degree of cytological atypia and mitotic activity. Such tumors consist of abundant granular eosinophilic cytoplasm and large nuclei with prominent nucleoli and are androgen receptor positive. However, a multidisciplinary approach is crucial for diagnosis and tissue histology is essential to suitably formulate treatment guidelines. Surgical excision is the preferred treating option for these tumors. Little consensus is available about local radiation and adjuvant therapy for the treatment of such tumors, yet they have been reported to have good prognosis.Case presentationThis rare case report describes the intriguing journey towards the diagnosis of an encapsulated intracystic apocrine papillary carcinoma in a 52-year-old premenopausal female who presented with palpable breast swelling in left breast. The patient underwent mammography, breast ultrasound and breast MRI concluding it to be a BIRADS 4A lesion. Then the patient was subjected to trucut core biopsy and finally surgical excision was performed. On Histopathology this lesion was diagnosed as encapsulated apocrine papillary carcinoma with androgen receptor positivity and triple negative hormonal status. At present patient is on regular follow-up.ConclusionsEncapsulated intracystic apocrine papillary carcinoma has a favorable prognosis with low recurrence rate and excellent long-term survival regardless of its invasive nature. Therefore, we present this rare entity to highlight the importance of radiological and histopathology findings in its diagnosis.

The role of ultrasound-guided transthoracic Tru-Cut core biopsy in the diagnosis peripheral thorax lesion

BackgroundThe nature of opaque lesions such as effusions, atelectasis, masses, and consolidations can be clarified by sonography. This study investigated the sensitivity and accuracy of ultrasound-guided percutaneous core needle biopsy in different thoracic tumors (lung, pleural, chest wall, and mediastinal).ResultsSixty patients underwent ultrasound-guided percutaneous transthoracic core biopsy of peripheral thoracic masses with a Tru-Cut needle with a big bore. Twenty masses were in the lung, seventeen lesions were in the pleura, ten masses were in the mediastinum, eleven were enlarged palpable lymph nodes, and two masses were in chest wall. The sensitivity, PPV, and accuracy for detection of chest tumors in the chest wall, mediastinum, lung, and pleura were 100% for all, and in LN 88.9, 100, and 90.9%, respectively. The overall diagnostic performance of sonar-guided Tru-Cut needle biopsy in diagnosis was 97.78% sensitivity, 98.18% accuracy, and 100% PPV.ConclusionTru-Cut needle percutaneous transthoracic core biopsy is a convenient and sensitive process in obtaining samples under ultrasound guidance for exact histological diagnosis of thoracic tumors. The diagnostic efficiency is high, and the technique can also be used in outpatients, which is relatively simple.Trial registrationNCT, NCT04741958 Registered 5 February 2021, retrospectively registered,

The “Jist” of It: Transgastric EUS-Guided Diagnosis of Small Bowel GIST Masquerading as a Peripancreatic Lymph Node

Purpose: A 76 y/o female with a history of coronary artery disease had an episode of mild pancreatitis managed conservatively. There was no biliary, toxic, or dyslipidemic etiology, and she denied jaundice, weight loss, diabetes, or steatorrhea. After a second episode 8 months later, a CT scan was acquired, revealing a cystic lesion in the body of the pancreas. She was therefore referred for EUS. This showed a 17×8 mm anechoic lesion in the body of the pancreas with a thin wall and no septae. There was no associated mass, internal debris, or chronic pancreatitis, and both the common bile duct and pancreatic ducts were normal; FNA was performed. Incidentally noted was a 24×11 mm peripancreatic solid lesion resembling a lymph node (see image). A transgastric approach was then undertaken for both FNA and Trucut core biopsy. The FNA of the cystic lesion stained positive for mucin, fluid CEA was 1637 ng/mL, and the cytology was negative, all consistent with a mucinous cystadenoma (MCA). The FNA of the peripancreatic mass was unrevealing, but the core biopsy had foci of spindle cells that stained positive for c-kit, strongly suggesting GIST. The patient underwent an enucleation of the cystic lesion and a resection of a submucosal lesion in the fourth portion of the duodenum. Surgical pathology confirmed pancreatic MCA and small bowel GIST. In retrospect, the patient denied any bleeding or obstructive symptoms; review of the prior CT also failed to demonstrate any small bowel lesion. This case highlights the discovery of a small bowel GIST found incidentally on endosonography due to the serendipitous location of the distal duodenal tumor immediately adjacent to the greater curvature of the stomach. GISTs are relatively uncommon, with a prevalence of about 15/million, only 20% of which are found in the small bowel. The rate of malignancy is usually low, but in small bowel GIST, about 50% of lesions are malignant. They are classically subepithelial with central umbilication and positive immunohistochemistry for c-kit. The therapy for these tumors is resection if not metastatic; otherwise, tyrosine kinase inhibitors can be used.[figure1]Figure

A Method of Assessing the Adequacy of Trucut Biopsy Specimens Obtained with a 19-Gauge Trucut Core Biopsy Needle

To develop a simple and accurate method of evaluating trucut biopsy (TCB) specimen.We performed 40 ex vivo TCBs of surgical specimens under direct visual guidance with the Quick-Core needle (Wilson-Cook, Winston-Salem, North Carolina, U.S.A). Touch preparations were made using 4 methods. Slides were stained with a modified Wright-Giemsa stain, and biopsies were processed for histology. Slides were blindly classified as malignant, suspicious, atypical, benign or inadequate. The ease of the 4 touch preparation methods was compared.There were 20 TCBs of benign tissue and 20 of malignant tissue. Cytologic interpretation could be made in 34 of 40 cases and was correct in 25 of 34 cases. Touching the biopsy to a glass slide was significantly easier than the 3 other methods tested.Touch preparations can be made easily with TCB samples and can provide information about specimen adequacy and diagnosis.

Management of soft tissue sarcoma.

A total of 485 patients with a proven or suspected diagnosis of soft tissue sarcoma were referred over a 3-year period. Of these, 61 were referred for opinion only and 424 for definitive treatment. Overall there were 223 patients with primary soft tissue sarcoma and 84 with recurrent sarcoma, 84 with benign soft tissue tumours and 22 with non-soft tissue sarcoma malignancy; 11 patients were referred with known metastatic disease. The commonest benign tumours mimicking soft tissue sarcoma were fibromatosis and benign intermuscular or intramuscular lipoma. The malignant tumours suspected clinically of being soft tissue sarcoma were bone tumours, lymphoma and metastatic carcinoma. Of the 172 patients with primary soft tissue sarcoma referred with a proven diagnosis this had been established by excision biopsy in 94 and open incision biopsy in 48. By contrast, of those undiagnosed at referral, 44 of 51 patients with soft tissue sarcoma had the diagnosis made by Tru-cut core biopsy. Amputation was performed in four of 165 patients with primary extremity soft tissue sarcoma and in five of 54 with recurrent extremity sarcoma, giving an overall amputation rate of 4 per cent. It is proposed that the amputation rate for extremity soft tissue sarcoma can be reduced by the use of reconstructive procedures, particularly myocutaneous flaps to the proximal limbs and limb girdles, and free vascularized flaps to sites distal to the midthigh and midarm.

A New Method to Assess the Adequacy of Trucut Core Biopsy Specimens

Aim: We sought to develop a simple touch prep method for evaluating trucut core biopsy (TCB) specimens that can be used during EUS to determine specimen adequacy and preliminary diagnoses. Methods: We performed 40 ex-vivo TCBs of fresh surgical specimens under direct visual guidance with the 19 guage Quick-Core needle (Wilson-Cook). A touch-prep was then made using one of four methods: 1) touching the biopsy lightly twice to a glass slide while keeping the specimen on the needle (“touch”), 2) pushing the biopsy 3cm along a slide while keeping the tissue on the needle (“push”), 3) dragging the specimen 3cm along the slide while keeping the tissue on the needle (“drag”), and 4) rolling the specimen 2cm along the slide after removing it from the needle with a toothpick (“roll”). Slides were stained with a Diff-Quik stain and biopsies were processed for histology. For each organ biopsied, the sequence of touch prep method was “touch”, “roll”, “push”, and “drag”. Ease of touch prep was rated on a Likert-type scale (1=easy, 5=cumbersome). Biopsy length and fragmentation were documented. Slides were blindly classified as malignant, suspicious, atypical, benign, or inadequate. Results: TCBs were taken of two normal stomachs, two ampullary adenocarcinomas, a normal pancreas, a thyroid adenoma, a uterine leiomyoma, a colon adenocarcinoma, a lung adenocarcinoma, and a lung metastasis of transitional cell carcinoma. Touch prep ease, adequacy, and accuracy are shown in the table. Cytologic interpretation could be made in 34/40 (85%) cases and was correct in 25/34 (74%) cases. Histologic interpretation could be made in 39/40 (98%) cases and was correct in 32/39 (82%) cases. Fragmentation (45% of biopsies) was not associated with a correct cytologic (p=0.7) or histologic (p=0.1) diagnosis. Biopsy length (median 10mm) was not associated with a correct cytologic (p=0.19) or histologic (p=0.96) diagnosis. Conclusions: Touch preps can be made with TCB samples and can predict specimen adequacy and diagnosis. The “touch” method was significantly easier than three other tested methods.

Estrogen-receptor-directed neoadjuvant therapy for breast cancer: Results of a randomised trial using formestane and methotrexate, mitozantrone and mitomycin C (MMM) chemotherapy

We wanted to determine whether neoadjuvant systemic chemoendocrine therapy guided by the estrogen receptor (ER) status of the primary breast cancer, followed by conventional surgery and/or radiotherapy, reduces local and distant recurrence and improves survival compared with adjuvant treatment given conventionally postoperatively. Two hundred ten patients with primary breast cancer (T1-T4, N0, N1-2) were randomised to receive treatment with neoadjuvant chemoendocrine therapy or conventional post-operative chemoendocrine therapy. Systemic therapy was based on the estrogen receptor (ER) status of the primary tumour obtained by trucut core biopsy. ER-negative patients received MMM chemotherapy (methotrexate (30 mg/m2), mitozantrone (7 mg/m2) and mitomycin (7 mg/m2) three-weekly for three months and ER-positive patients who were premenopausal received goserelin (3.75 mg monthly), and post menopausal women formestane (250 mg every two weeks) over three months. With a minimum of five years follow-up, there is no evidence of any survival benefit from the pretreatment neoadjuvant therapy regimen, with five year overall survival being 79% +/- 4.7% (neoadjuvant) and 87% +/- 3.4% (adjuvant). Similarly, there was no apparent benefit in terms of disease-free survival. There was, however, a significant reduction in the incidence of distant metastases in responders (4 of 51; 8%) compared with non-responders (17 of 49; 35%) (P < 0.01). There was a reduction in the need for surgery in responding patients with T1 and T2 tumours, since 10 of 74 (14%) had no detectable residual tumour, without any apparent increase in the risk of local or distant recurrence. In this study neoadjuvant treatment with endocrine or chemotherapy provided no obvious survival benefit to women with breast cancer. However, it does allow avoidance of surgery in some cases. Also, the patients whose tumours respond to neoadjuvant systemic therapy have a lower incidence of distant metastases after five year follow-up compared to those whose tumours fail to respond.