Tru-cut Needle Biopsy Research Articles

The role of percutaneous ultrasound-guided true-cut needle biopsy in patients with sheet-like pleural thickening

Background Pleural biopsy for histological confirmation is the standard diagnostic procedure for pleural diseases. Aim To identify the role of percutaneous ultrasound (US)-guided true-cut needle biopsy in patients with sheet-like pleural thickening. Patients and methods A prospective interventional simple controlled trial was conducted on 60 patients with computed tomographic evidence of pleural thickening. Percutaneous US-guided pleural biopsies using a true-cut needle were performed for pathological tissue characterization; complications were recorded. Results All patients were diagnosed, with only five (8%) patients found to have self-limiting pneumothorax, with no need for a chest tube. Fifty-three percent of patients had a histopathological diagnosis of mesothelioma, 14% had a histopathological result of adenocarcinoma, whereas 33% had chronic fibrosing pleuritis. Conclusion The US-guided procedure has a major advantage as it is being real time, rapid, available bedside, and well tolerated, and no serious complications were observed in good case selection and procedure.

The complementary role of digital rectal examination and prostate specific antigen for prostate cancer detection as seen Dar Es Salaam -Tanzania

Background: Prostate cancer (PCA) is a significant public health problem. It is the most common malignancy and the second most common cause of cancer deaths among American men. In most of African countries its incidence is said to be unknown, probably because of poor quality of the medical care systems and registries which may have a substantial impact on the completeness and accuracy of the reported incidence rates. Digital rectal examination (DRE), PSA, Trans Rectal Ultrasound and needle biopsy remain standard tools for diagnosis of Prostate carcinoma worldwide. This study aimed to establish the diagnostic value of DRE and PSA among males suspected to have PCA at two Hospitals Dar es Salaam.Methods: This was a cross sectional study which involved males suspected for PCA recruited by convenient sampling at Muhimbili national Hospital and Tumaini hospital. Data was collected by using structured questions. Each participating patient gave an informed consent. DRE findings and PSA values were sought from patient’s notes. Histopathology results were sought from Central Pathology Laboratory. Analysis was done with the aid of SPSS version 20 software.Results: Three hundred and seventy-three patients were enrolled in the study with mean age 70.72 years and range from 45 to 102 years with a peak age of 61-70 years. The sensitivity, specificity and positive predictive value of DRE was 76.8%, 82.3% and 0.82 respectively; while for PSA respective values were 100%,29% and 0.47. Combination of DRE and PSA had a positive predictive value of 0.87making diagnosis accuracy of 87% when the two tests were combined.Conclusion: Digital rectal examination and Prostate Specific Antigen provide good detection rate of prostate cancer when these two tests combined. In our study the diagnostic accuracy of DRE combined with PSA was 0.87. So as per WHO recommendations, these two tests should be used together since they complement each other if Trucut needle biopsy cannot be performed for any reason(s).Keywords: Digital Rectal examination, prostate specific Antigen, prostate cancer

Histopathology and elastography discordance in evaluation of breast lesions with acoustic radiation force impulse elastography.

PurposeIt is known that, besides its benefits, ultrasound (US) elastography may show discordance findings, leading to biopsy, so this technique has some limitations. The purpose of the present study was to compare histopathological results and shear wave velocity (SWV) values in patients, to reveal discordance findings, and to investigate its statistical significance in making the decision for biopsy with SWV values.Material and methodsA total of 190 patients presenting with breast lesions were included in the study. The mean age of the patients was 39.87 ± 13.56 years. All morphological features of lesions were evaluated by B-mode US. The mean SWV values were measured using the region of interest (ROI) through all lesions with ARFI elastography. An ultrasound-guided Tru-Cut needle biopsy was performed, and histopathologic data were obtained.ResultsThe SWV values of false positive benign lesions, such as: granulomatous mastitis, sclerosing adenosis, chronic inflammation, fat necrosis, fibrotic breast tissue, and scar tissue, were as high as the SWV values of malignant lesions. Sensitivity was found as 91.6% and specificity as 40.9% for SWV values in ARFI US.ConclusionsOur results showed that breast lesions showed false positivity (59.1%) and false negativity (8.3%) in ARFI US. Elastography is useful and sensitive in the evaluation of breast lesions, but some benign lesions may mimic malignant lesions; thus, this information should not be underestimated in biopsy decision-making for elastography users.

Desmoid abdominal tumour: a clinical case report and brief literature review

Desmoid tumours are unique mesenchymal neoplasm. They are able to spread to proximal tissues but tend not to metastasize. Our case presents a 66-year-old female referred for evaluation of the prominent, palpable mass located into the left abdomen. Imaging studies revealed a tumour up to 22 cm, extending below the diaphragm to the retroperitoneal and intra-abdominal cavity. Contrast enhanced ultrasound showed strong inhomogeneous arterial hyper-enhancement followed by persistent enhancement in a venous phase. Histology obtained with tru-cut needle biopsy established desmoid tumour, with overall proliferating activity (Ki-67 expression) of 20%. The lesion had been identified as sporadic and ‘unresectable’. During the patient’s follow-up a slow but continuous elevation of serum creatinine was registered eventually led to anuria, requiring emergent haemodialysis. The non-obstructing nephropathy is an unusual complication of the disease course, therefore we briefly reviewed the published data on abdominal desmoid tumours and critically analysed the relation with kidney injury.

Multiple Primary Malignancies: Metastatic Renal with Early Breast and Endometrial Cancers: A Case Report

Double primary malignancies could be divided into two categories, depending on the interval between tumor diagnoses. A secondary malignancy could be defined as a new cancer that has occurred as a result of previous treatment with radiation or chemotherapy. Second primary malignancy can occur at any age but it’s commonly at old age. A 46 premenopausal female patient presented to our outpatient clinic complaining from a mass in her right breast, routine metastatic work-up for distant metastasis declared multiple hepatic metastases, RT renal mass, and bone metastases. Palliative radiotherapy to tender and weight bearing sites followed by 4 cycles of systemic chemotherapy FEC regimen were received. Tru-cut needle biopsy from renal mass detected renal cell carcinoma of clear cell type, the patient started sunitinib and tamoxifen with bisphosphonate (Zoledronic acid), assessment of the response revealed reduction of the size and number of HFLs, and the size of renal mass, so the patient was decided to do cytoreductive nephrectomy and then continued on TAM and sunitinib. Collectively, due to the rising incidence of multiple primary malignancies, further studies should be done not only for better clinical evaluation and treatments but also for accurate determination of possible causes, pathogenesis, effective managements and screening programs.

Tru-Cut Needle Biopsy verses Fine Needle Aspiration Cytology (FNAC) for Early Diagnosis of Breast Carcinoma in High Risk Women

Tru-Cut Needle Biopsy verses Fine Needle Aspiration Cytology (FNAC) for Early Diagnosis of Breast Carcinoma in High Risk Women

Fine needle aspiration cytology versus trucut biopsy in the diagnosis of breast cancer: a comparative study

Background: Most diseases of the breast present as a palpable mass. The majority of breast lesions are not malignant, and most benign lesions do not progress to cancer; however, the accuracy of diagnosis can be increased by a combination of preoperative tests like physical examination, mammography, fine-needle aspiration cytology (FNAC), and Trucut needle biopsy (TGNB) or core needle biopsy (CNB). FNAC has grown in popularity and became the first initial used procedure after history taking and clinical examination for diagnosis of solid and cystic breast lumps. This study was designated to investigate the accuracy of FNAC in comparison to TCNB for diagnosis of breast masses, Design: Retrospective Study.Methods: In this study, 62 patients having breast lumps were studied during the period from January 2014 to January 2017 in terms of FNAC and Trucut Biopsy and were compared with tissue diagnosis. Variables like age, marital status, duration, size, menstrual status and site were analyzed using statistical analysis.Results: Out of 62 patients with breast lump, 32 were diagnosed with Benign Breast lesions, and 30 with malignant lesions. Sensitivity of FNAC and TRUCUT biopsy were 84.34% and 97.1% respectively. TRUCUT was more accurate when compared to FNAC.Conclusions: Both FNAC and Core Needle Biopsy are complimentary to each other and are useful in diagnosis of breast lesions.

Pulmonary Amyloidosis in a Patient With Newly Diagnosed Rheumatoid Arthritis

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Amyloidosis is a term used to describe a group of protein folding disorders. One form of systemic amyloidosis is amyloid A-type (AA). It is known to occur in chronic inflammatory conditions, including rheumatoid arthritis (RA). The prevalence of secondary amyloidosis in patients with RA ranges from 5-78% with only a small portion of cases with biopsy proven pulmonary amyloidosis.1,2 Here we present a patient with newly diagnosed RA found to have pulmonary amyloidosis. CASE PRESENTATION: Patient is a 76 year old woman with a past medical history of asthma, hypertension, hypothyroidism, and recurrent sinusitis who presented with complaints of swelling and joint pain bilaterally in her hands, shoulders, hips, and knees of 3-4 weeks duration. She reported difficulty rising from a chair as well as lifting her arms above shoulder level. Additionally, the patient complained of a minimally productive cough with clear sputum of 2-3 weeks duration. Review of systems was positive for fatigue, weakness, dry eyes, dry mouth, and joint pain. Physical exam was notable for pain on passive ROM and decreased ROM of bilateral upper extremities; there was no tenderness to palpation over her hands. Lab work up demonstrated positive rheumatoid factor, ANA, Smith, RNP, CCP, and SSA/RO. An x-ray of the hands demonstrated normal joint spaces bilaterally and no evidence of erosive changes. A chest x-ray demonstrated multiple pulmonary nodules in both lungs. Chest CT with IV contrast demonstrated diffuse pulmonary mass lesions without cavitations. Biopsy of a peripheral lung nodule demonstrated eosinophilic material consistent with amyloid. Congo red stain confirmed the presence of amyloid. A work up for amyloidosis showed normal urine protein, normal kappa/lambda ratio, and SPEP with no monoclonal spike. The patient was started on hydroxychloroquine 200 mg BID and prednisone 20mg daily with significant improvement in swelling and joint pain. DISCUSSION: Secondary amyloidosis occurs after several years in an inflammatory state. Deposition of the precursor protein, serum amyloid A, most commonly occurs in the kidneys and gastrointestinal tract.3 Pulmonary amyloidosis is an exceedingly rare finding in RA. CONCLUSIONS: Although AA amyloidosis has become less common due to advances in the treatment of RA, clinicians should include pulmonary amyloidosis in the differential when patients with RA present with pulmonary nodules. Reference #1: Barile L, Ariza R, Muci H, et al. Tru-cut needle biopsy of subcutaneous fat in the diagnosis of secondary amyloidosis in rheumatoid arthritis. Archives of Medical Research. 1993; 189-192. Reference #2: Kobayashi H, Tada S, Fuchigami T, et al. Secondary amyloidosis in patients with rheumatoid arthritis: diagnostic and prognostic value of gastroduodenal biopsy. British Journal of Rheumatology. 1996; 44-49. Reference #3: Lachmann HJ, Goodman HJB, Gilbertson JA, et al. Natural History and Outcome in Systemic AA Amyloidosis. New England Journal of Medicine. 2007: 2361-2371. DISCLOSURE: The following authors have nothing to disclose: Hooman Saberinia, Richa Bhardwaj, Justin Goralnik, Prashant Grover No Product/Research Disclosure Information

Histopathological differentiation and incidence of soft tissue tumors: study of 140 cases

Background: The incidence of soft tissue tumors, especially the frequency of benign tumors relative to malignant ones, is never determined accurately. The fact that many benign tumors, such as lipomas and hemangiomas, do not undergo biopsy makes direct application of data from most hospital series invalid for the general population. Histologic grade represents the most important Prognostic factor for all soft tissue sarcomas, strongly associated with the advent of metastasis and patients survival. Objectives: the objective of the study was to find occurrence of soft tissue tumor and analyse various type and sub types of soft tissue tumors. Methodology: a prospective study carried out at tertiary care teaching hospital. The operated specimens or biopsy material of soft tissue tumors received were studied in detailed by department of Histopathology. Histological diagnosis was achieved either by performing incisional or trucut needle biopsy and/or reviewing the slides when patient underwent biopsy elsewhere. Observations: The incidence were high in the age group of 31 to 40 years (36 cases, 25%), followed by 21 to 30 years (24 Cases, 17.1%) and 41 to 50 (21 Cases, 15%) years. However the malignant tumor incidence was high at age of 51 to 60 years of age. Region wise involvement shows soft tissue tumors were found in head and neck region (29.2%), followed by genital region (25.7%) and upper limb (15.8%). Type wise distribution was lipomatous (28.5%), followed by smooth muscle tumor (21.5%), peripheral nerve sheath tumor (17.9%), Tumor of blood and lymph vessels (17.1%), Conclusion: benign soft tissue tumor are much common than the malignant tumors. Among benign tumors lipomatous tumors are common followed by smooth muscle tumor and other tumors.

Abstract 767: Breast cancer in sub-Saharan Africa: a histopathologic review from a tertiary hospital in Northern Nigeria

Abstract Introduction: Breast cancer is the commonest cancer in women world-wide, however, there are discrepancies in the incidence among different geographical regions. The highest incidence rate is in North American, Northern and Western European, while the lowest rate is found among Asian and sub-Sahara African women. Breast cancer is undoubtedly heterogeneous in terms of its presentation, morphology and molecular profiles. Studies from the developing countries suggested that there are differences between the biology of BC in the developing and developed countries. Methods: This is a retrospective histopathologic review of breast cancer cases between 1st January 2003 and 31st December 2015 from the Ahmadu Bello University Teaching Hospital Zaria - Nigeria. Results: A total of 784 breast cancer cases were seen during the study period and majority of the cases (99.4%) were females. The prevalence of breast cancer was found to be 12.6%. Triple-negative breast cancers (TNBC) constitute 67.7% of cases. The mean age was 45.8 ±12.0 years and the youngest patient was 18 years while the oldest was 90 years. Out of the 784 cases, 208 were mastectomies while the remaining were incisional, trucut needle and excisional biopsies. Infiltrating ductal carcinoma NST was the most common histologic variant seen (94.7%) and most of these cases (59.1%) were Grade II tumors. The Nottingham Prognostic Index (NPI) shows that 91.4% of the cases have NPI Score of ≥3.5 with attendant poor 5-year survival rate. Conclusion: This study found that breast cancer is common and affects mostly women in fifth decade of life. There is a high TNBC among the population studied and therefore androgen receptor profile and genomic studies may be useful to determine the course of therapy. Note: This abstract was not presented at the meeting. Citation Format: Saad A. Ahmed, Balarabe Kabir, Nasiru Abubakar. Breast cancer in sub-Saharan Africa: a histopathologic review from a tertiary hospital in Northern Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 767. doi:10.1158/1538-7445.AM2017-767

The Initial Experience of Trans-Rectal Ultrasound and Biopsy in Diagnosis of Carcinoma Prostate In Gezira Hospital For Renal Disease And Surgery (GHRDS)

<p><strong>Background</strong>: Prostate cancer prevalent cancer in males above sixty-five worldwide, this lead to the introduction of screening of the PSA and using of the transrectal ultrasound scanning, and sextant biopsy of the prostate.</p><p><strong>Objectives</strong>: To compare the accuracy of the Transrectal Ultrasound guided biopsy (TRUS/BX) in the diagnosis of prostate cancer in Gezira Hospital for Renal Diseases and Surgery (GHRDS), with specific considerations to the digital rectal examination (DRE) findings and prostate specific antigen (PSA) level. .</p><p><strong>Materials and Methods</strong>: This is a prospective, descriptive small-scale hospital based study. A total of 297 patients with clinically symptomatic enlarged prostate underwent transrectal ultrasound guided true cut needle biopsy of the prostate were studied in (GHRDS) in the period from June2006 to June2009. </p><p><strong>Results</strong>: The majority 188 (63.3%) of patients were between 50-70 years of age. Abnormal digital rectal examination (DRE) like obliteration of the median sulcus, and fixed mucosa revealed higher incidence of carcinoma prostate (CaP) with a significant value (p= 0.0000). PSA level showed significant relation (p= 0.0001) with the diagnosis of carcinoma prostate. Transrectal U/S findings well correlated to the histopathological results, where abnormal findings (like hypo-echoic lesions or calcifications and cysts) showed higher incidence of malignancy in 46 patients constitute 52.8% of the abnormal U/S findings.</p><p><strong>Conclusions and recommendations</strong>: PSA level is highly sensitive but less specific in detection of prostate cancer. Normal DRE doesn’t exclude prostate cancer, fixed mucosa and obliterated median sulcus has the highest predictors of cancer prostate in DRE. Presence of calcifications and cyst on trans-rectal ultrasound has the highest liability for cancer prostate in compare to the other ultrasonic findings. </p><p><strong>Key words: </strong>Prostate cancer, DRE, PSA level, TRUS/ BX (Transrectal ultra sound biopsy), sextant biopsy.</p>

A Comparative Evaluation of Fine Needle Aspiration Cytology, Trucut Needle Biopsy & Imprint Cytology and Histopathology in Breast lumps

A Comparative Evaluation of Fine Needle Aspiration Cytology, Trucut Needle Biopsy & Imprint Cytology and Histopathology in Breast lumps

Utility of Tru-Cut Biopsy of Breast Lesions - An Experience in a Regional Cancer Center of a Developing Country.

Tru-cut Needle Biopsy (TCB) is an integral part of triple assessment of breast cancer, which includes clinical assessment, mammography and TCB or Core Needle Biopsy (CNB). The technique is reliable, simple, and reproducible, and inexpensive, which can be adapted even for low-income group of patients and in developing countries. This study was done to establish the efficacy of TCB of palpable breast lesions in a developing country where mammography is not possible in all cases. A retrospective analysis of 892 TCBs was done in AH Regional Cancer Centre, Cuttack, Odisha, India where TCBs were performed in patients presenting to outpatient department with palpable breast lesions. The H&E stained sections were interpreted by pathologists of the same centre. Diagnosis was classified into different categories. Immunohistochemistry (IHC) for Estrogen Receptor (ER), Progesterone Receptor (PR) and Her-2/neu was done and interpreted by Allred scoring system. A total 892 TCBs were analysed with 23 repeat TCBs. There were 13 (1.4%) male patients. A total of 747 cases (83.6%) were diagnosed as malignant, including 735 carcinomas, nine malignant phyllodes tumour, two angiosarcoma and one case of Non-Hodgkin' Lymphoma (NHL). It was possible to diagnose special histological types such as lobular carcinoma, metaplastic carcinoma and mucinous carcinoma on TCB. A total of 21 cases were diagnosed as carcinoma on repeat biopsy. Eight of the 735 TCBs diagnosed as carcinoma were bilateral breast cancers, hence actual number of carcinoma cases were 727. IHC was done successfully on the paraffin blocks in 260 cases. In this series out of 727 patients of carcinomas 30% were in young, i.e., below 40 years of age, including four cases of carcinoma below 20 years. There were no false positive case in this study giving a specificity of 100% and sensitivity was 97%. TCBs are well tolerated by patients, can be done in OPDs and reduce cost. It is possible to give histological diagnosis of carcinoma, lymphoma, phyllodes tumour and sarcomas on TCBs. The paraffin blocks of TCBs can be used for IHC study which helps the oncologists for preoperative adjuvant therapy.

Evaluation of triple hormonal content (ER, PR, and HER\2neu)of breast cancer specimens obtained from breast cancer patients using tru-cut biopsy

Background: Breast cancer is the commonest type of malignancy among women worldwide and in Iraq. Tru-cut needle biopsy technique provides adequate tissue for histopathological diagnosis of suspected breast lumps and assessment of hormonal receptors (estrogen, progesterone and HER2neu) prior to surgical operation.Objectives: To assess estrogen, progesterone andHER2neu expression using breast cancer tissue specimens obtained by tru-cut biopsy, to correlate the findings with clinicopathological parameters of known prognostic significance in breast cancer patients.Patients and Methods: This prospective study was held within the Main Referral Center for Early Detection of Breast Tumors/Medical City Teaching Hospital and the Iraqi National Cancer Research Center/Baghdad University from May 2012 to the end of December 2012. Sixty-two females aged 25-73 years who presented with a breast lump were involved and examined using the triple assessment technique. A triple hormonal assessment (ER, PR & Her2) of the examined biopsies obtained by tru-cut needle for patients with suspected breast cancer was performed. The results were compared with the corresponding clinical and pathological parameters.Results: Data for excisional biopsy were available for 25 cases of the total number of women presented with breast lump. All of these cases showed similar histopathological results compared to Tru-cut biopsy results. Non-significant correlation was found between expression of ER, PR and HER2neu and the age of women, family history, and the site of the lump.On the other hand, a significant relationship was displayed between HER2neu over expression and the histopathological grading and age of the breast cancer patient. Conclusion: Tru-cut needle biopsy technique should be promoted nationwide in surgical departments to provide an insight to the type of mammary carcinoma, its aggressiveness, hormone receptor content and predict response to primary therapy before mastectomy.

Tissue diagnosis of GI subepithelial tumor only through Trucut biopsy under a forward-viewing endoscope: applicability as newer diagnostic modality.

Trucut biopsy (TCB) has been proposed to overcome the limitations of endoscopic ultrasonography (EUS)-guided fine-needle aspiration for the pathologic diagnosis of upper gastrointestinal (GI) subepithelial tumor (SET); however, it can be difficult to perform because the Trucut biopsy needle is very stiff. Although technical failures have been reported with the use of TCB, recently the forward-viewing echoendoscope showed a high diagnostic accuracy. We hypothesized that TCB under a conventional forward-viewing endoscope can be applied with higher yield of tissue diagnosis. To evaluate the feasibility of TCB under a forward-looking endoscopy without cumbersome EUS guidance, we introduced a 19-gauge TCB needle into the working channel of a conventional upper endoscope in 27 patients with GI SET to make tissue diagnosis. Prospectively collected data were analyzed, including technical success rate, pathologic result, and adverse events. Twenty-seven patients with GI SET (18 esophageal tumors and nine gastric tumors) underwent TCB under a forward-looking endoscope. All procedures were performed safely without any TCB-related complications. Subsequently, histopathology examination revealed gastrointestinal stromal tumors (GISTs) in three cases and leiomyomas in 21 cases. Histologic assessment was completed in 24 out of 27 patients (88.9%) because tissue obtained from three patients, whose tumors were located in the stomach, was not sufficient for the pathologic diagnosis. TCB using a conventional forward-viewing endoscope without EUS guidance provided an excellent pathologic diagnosis of upper GI SET.

S&T-58 WHY DO SOME PATIENTS MAKE PRIMARILY CALCIUM OXALATE MONOHYDRATE VERSUS DIHYDRATE STONES?

INTRODUCTION AND OBJECTIVES: A major concern with transrectal biopsy (TRBx) is that the anterior portion of the prostate gland, including the anterior peripheral and transition zones is difficult to target by standard TRBx, particularly for larger glands. A recent study has assessed simulated biopsy schemes using threedimensional reconstructions of actual prostate cancer (PCa) specimens, and suggested that nearly all PCas with a tumor volume of >0.5 ml can be detected by 14-18 TRBx cores using needle with longer cutting length. The purpose of this study is to compare the detection rate of PCa using a novel Tru-Cut needle with 25 mm cutting length with that of a conventional needle with 17 mm cutting length in TRBx. METHODS: We cooperated with biopsy maker, TSK company, and developed a novel Tru-Cut biopsy needle with a 25 mm cutting length. A total of 426 patients underwent TRBx by the novel needle (group 25 mm). Complications that occurred (hematuria, urinary retention, rectal bleeding, and fever) were evaluated, and pain during biopsy was assessed using the Face scale. The biopsy tissue on the slides was scanned into a computer, and the length of the tissue was measured using the software ImageJ. The complications, pain on biopsy, tissue length, and detection rate of PCa were compared to those of 288 patients who underwent TRBx by a conventional needle with 17 mm cutting length (group 17 mm). RESULTS: Complications and values on the pain scale did not differ significantly between the groups. The length of tissue taken from the mid-portion of the prostate was significantly longer in group 25 mm than in group 17 mm (16.30 mm vs 18.53 mm, P < 0.001). The detection rate of PCa within the prostate-specific antigen (PSA) gray zone was significantly higher in group 25 mm than in group 17 mm (49.48% vs 39.77%, p1⁄40.044). CONCLUSIONS: The novel Tru-Cut biopsy needle is safe, and can be used to acquire a longer prostate tissue specimen. Use of the novel Tru-Cut needle with 25 mm cutting length in transrectal prostate biopsy significantly improved the detection rate of PCa within the PSA gray zone.

Automated tru-cut imaging-guided core needle biopsy of canine orbital neoplasia. A prospective feasibility study

The purpose of this study was to evaluate the diagnostic value of imaging-guided core needle biopsy for canine orbital mass diagnosis. A second excisional biopsy obtained during surgery or necropsy was used as the reference standard. A prospective feasibility study was conducted in 23 canine orbital masses at a single centre. A complete ophthalmic examination was always followed by orbital ultrasound and computed tomography (CT) examination of the head. All masses were sampled with the patient still on the CT table using ultrasound (US) guided automatic tru-cut device. The most suitable sampling approach to the orbit was chosen each time based on the CT image analysis. One of the following different approaches was used: trans-orbital, trans-conjunctival or trans-masseteric. In all cases, the imaging-guided biopsy provided a sufficient amount of tissue for the histopathological diagnosis, which concurred with the biopsies obtained using the excisional technique. CT examination was essential for morphological diagnosis and provided detailed topographic information that allowed us to choose the safest orbital approach for the biopsy. US guided automatic tru-cut biopsy based on CT images, performed with patient still on the CT table, resulted in a minimally invasive, relatively easy, and accurate diagnostic procedure in dogs with orbital masses.

Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis.

An increasing number of studies have been conducted on the use of endoscopic ultrasound (EUS)-guided needle sampling for upper gastrointestinal subepithelial lesions (SEL). However, reported diagnostic efficacy varies greatly. To summarize up current evidences on the diagnostic efficacy of EUS-guided needle sampling for upper GI SEL. A reproducible strategy was used to search four databases. Search results were evaluated for eligibility, and the quality of eligible studies was assessed by QUADAS-2. Pooled efficacy of EUS-guided needle sampling in upper GI SEL was calculated. Procedure-related complications, diagnostic errors, and independent factors related to a higher success rate were also recorded and analyzed. Seventeen studies, comprising 978 attempts of EUS-guided needle sampling, were included in a meta-analysis. Pooled diagnostic rate of EUS-guided needle sampling was 59.9%, with a heterogeneity I (2) of 55.2%. Subgroup analysis showed no difference in diagnostic rate among fine needle aspiration (FNA), trucut needle biopsy (TCB), and fine needle biopsy (FNB), or among 19-, 22-, and 25-G needles. Subgroup analysis and meta-regression suggested that the cell block method might be correlated with a higher diagnostic rate. Few severe complications were reported. Diagnosis errors were rare. EUS-guided needle sampling is a safe, but only moderately effective method for pathology diagnosis of upper GI SEL. Choice of FNA/TCB/FNB, or 19G/22G/25G does not seem to alter the overall diagnostic rate.

EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles

EUS-guided biopsy of the liver has a variable diagnostic accuracy and specimen adequacy. A new core biopsy needle has been developed that may improve performance. The objective of this study was to compare the diagnostic yield of a new core biopsy needle with the previous standard needle. In this cross-sectional study, consecutive patients who underwent EUS-guided core liver biopsy over a 7-year period for suspected parenchymal disease were prospectively evaluated. Between 2007 and 2011, all biopsies were performed with a 19-gauge Tru-cut biopsy needle (Quick-core [QC]), whereas a novel reverse bevel needle (PC) was used exclusively from 2011 to 2014. All specimens were examined by 1 of 3 experienced, blinded pathologists for the following: presence of visible core, aggregate specimen length, number of complete portal tracts, and specimen adequacy. A total of 75 patients (mean age 51 years, 51 female) underwent liver biopsy by using the QC (n = 45) or PC (n = 30) needle. The QC and PC groups had similar demographics, indications for EUS, indications for liver biopsy, and liver findings on EUS. Compared with those of the QC, biopsies with the PC required fewer passes (median 2 vs 3; P < .0001) but produced longer aggregate length (median 20 mm vs 9 mm; P < .0001) with more complete portal tracts (median 5 vs 2; P = .0003) and adequate specimens (P < .01). Two patients had abdominal pain after liver biopsy with the QC needle. Compared with the QC needle, EUS-guided core liver biopsy with the PC needle produced longer aggregate length, more complete portal tracts, and more adequate specimens despite fewer passes (Clinical trial registration number: NCT00586313.).

Is Prebiopsy MRI Good Enough to Avoid Prostate Biopsy? A Cohort Study Over a 1-Year Period

IntroductionPrebiopsy multiparametric magnetic resonance imaging (MRI) is increasingly used in clinical practice to detect clinically significant prostate cancer, although its role is controversial. We audited the accuracy of prebiopsy MRI for men clinically suspected to have prostate cancer who underwent initial transrectal ultrasound (TRUS) biopsy at our institution. Patients and MethodsAll patients who had a prebiopsy prostate MRI and initial TRUS prostate biopsy from January 1, 2013 to December 31, 2013 were included in the study. Prostate MRI was performed using a 1.5-T machine with T2 and diffusion weighted imaging axial phase. TRUS prostate biopsy was performed using a monoplane ultrasound machine. Systematic 12-core prostate biopsies were taken with a Tru-Cut biopsy needle from the apex, middle, and base of the left and right lobe. ResultsOne hundred seventy-three patients met the inclusion criteria; 128 (74.4%) patients had a lesion detected on MRI and 114 (66.3%) patients had a positive biopsy. The sensitivity of MRI for significant prostate cancer on TRUS biopsy of the prostate was 83.5%, specificity was 35.2%, positive predictive value was 55%, and negative predictive value was 68.9%. A positive MRI scan was significantly associated with significant prostate cancer diagnosis, and higher National Comprehensive Cancer Network (NCCN) risk classification (P ≤ .001). MRI detected 62 of 63 NCCN high-risk and 18 of 18 Gleason score 8 to 10 cases. ConclusionThe sensitivity and specificity of MRI appears insufficient to avoid TRUS biopsy in all men clinically suspected to have prostate cancer. Standardized MRI reporting and robust prospective studies are needed to define the role of prebiopsy MRI in this setting. For patients at risk of complications from biopsy, a negative MRI scan might be used to exclude high-risk disease.