Tru-cut Needle Research Articles

P72 The Use of Endoscopic Ultrasound in the Diagnosis of Mediastinal Lymphadenopathy: A Comparison of Trucut Biopsy Versus Fine Needle Aspiration

BackgroundEndoscopic ultrasound guided fine needle aspiration is a commonly used tool in the diagnosis of mediastinal lymphadenopathy. However, less is known of the value of additional trucut biopsy. This retrospective...

Renal malakoplakia presenting as a renal mass in a 55-year-old man: a case report

IntroductionMalakoplakia is an uncommon chronic inflammatory condition that has a gross and microscopic appearance resembling that of xanthogranulomatous pyelonephritis. It is characterized by distinctive Michaelis-Gutmann bodies. Malakoplakia can affect any organ system but genitourinary tract involvement is the most common, particularly in immunocompromised individuals. Very rare cases have been reported to present as a unifocal lesion mimicking a renal tumor.Case presentationWe report a case of renal malakoplakia in a 55-year-old Iranian man with a past history of recurrent urinary tract infections who presented with left flank pain. An ultrasound study showed a large solid left renal mass, and he underwent a left radical nephrectomy with a clinical diagnosis of a renal tumor. Pathology slides revealed the diffuse infiltration of sheets of Periodic Acid Schiff-positive histiocytes in his renal parenchyma; these cells showed strong immunoreactivity for CD 68. The final diagnosis was renal malakoplakia.ConclusionRenal malakoplakia must be kept in mind for patients presenting with a renal mass and a history of long-term recurrent renal infections or renal failure. The large, rapidly growing nodules of malakoplakia may mimic renal cell carcinoma in imaging studies. In these cases, a true cut needle biopsy may help the correct diagnosis and prevent unnecessary surgery.

Diagnostic value of ultrasound guided biopsy in patients with malignant pleural effusion

Aim of workTo study the diagnostic value of ultrasound guided biopsy in patients with malignant pleural effusion. Patients and methodsThis study involved 40 patients with malignant pleural effusion of indeterminate aetiology. All patients had a contrast CT chest performed and were divided into 3 Groups according to their radiologic appearance: GROUP 1: 10 patients having pleural effusion only. GROUP 2: 15 patients having pleural effusion and pleural thickening. GROUP 3: 15 patients having pleural effusion and pleural mass lesions. All 3 groups of patients underwent ultrasound examination in the Radiology department. In patients of Groups 2 and 3, ultrasound fluid aspiration and ultrasound guided core biopsy of the pleura were attempted. Patients of all 3 Groups performed Medical thoracoscopy in the interventional pulmonology unit. ResultsIn Group 1 patients, US guided biopsy was contraindicated and could not be performed due to absence of pleural thickness, nodulation or masses. Thoracoscopy was performed in them all with a sensitivity reaching 90%. In Group 2, a malignant aetiology was reached in 5/10 cases whom had adequate tissue retrieval (sensitivity 50%). In Group 3, 12/15 patients were diagnosed by US guided biopsy (sensitivity 80%). The mean sensitivity of US guided biopsy in both Groups was 65%. Thoracoscopy was then performed successfully in all of patients in Groups 2 and 3 with a diagnostic sensitivity of 100% each. The mean diagnostic sensitivity of thoracoscopy for all 3 Groups was 96.7%. ConclusionThe US guided pleural biopsy with a Tru-cut needle is simple, safe and well tolerated. It is especially useful for patients with pleural tumour, thickened pleura, small amounts of pleural effusion or loculated pleural effusion.

Prostate Biopsy Quality Is Independent of Needle Size: A Randomized Single-Center Prospective Study

Objective: To evaluate sample quality, prostate cancer detection rate and biopsy morbidity in transrectal ultrasound (TRUS)-guided prostate biopsy (PBx) using 16- or 18-gauge Tru-Cut needles. Patients and Methods: Patients undergoing TRUS PBx were consecutively randomized with a 1:1 ratio into two study arms: group A (16-gauge needle) and group B (18-gauge needle). Core fragmentation and small specimen length (<10 mm) rate were the sample quality criteria. Three consecutive visual analog scale tests for pain and the Clavien surgical classification complications grading for rectal bleeding were used to evaluate TRUS PBx morbidity. Results: Overall, 250 patients were evaluated. No statistically significant difference between 16- and 18-gauge biopsy needles was recorded for cancer detection rate (29.6 vs. 30.4%, p = 0.890), core fragmentation rate (5 vs. 7%, p = 0.425) and shorter specimen (2 vs. 2%, p = 0.309). Pain control was similar in the two groups during the biopsy, 30 min after biopsy and the evening of the same day. Very small or absent bleeding was the more frequent complication observed in each group. Conclusion: Prostate detection rate and sample quality were not influenced by needle size. A 16-gauge needle biopsy does not increase TRUS PBx morbidity.

Abstract 3672: Preclinical assessment of MET modulation by a VEGFR inhibitor/MET inhibitor combination that shows additive antitumor efficacy

Abstract Background: Suppression of VEGFR signaling promotes activation of the MET signaling pathway, which may compensate for the VEGFR blockade, potentially leading to cellular invasion and metastasis. These findings have led to the hypothesis that VEGFR inhibitors will be more effective when combined with MET inhibitors in the clinic. This hypothesis is currently being tested in a clinical trial of Pazopanib with Tivantinib (ARQ197) at the NCI. We have replicated this trial in a xenograft model to evaluate the pharmacodynamic (PD) response of MET and HIF-1α using newly developed and validated quantitative assays and relate the biomarker response to anti-tumor efficacy. Methods: Ectopic SNU5 (human gastric cancer cell line) xenografts were staged to 200 mm3 in athymic nude mice and treated for 8 days with vehicle, Pazopanib (100 mg/kg/day, QD), Tivantinib (200 mg/kg/day, QD), and combinations of Pazopanib (QD) with two dose levels of Tivantinib (200 mg/kg/day QD and 400 mg/kg/day BID). Trucut needle biopsies (18Ga) were collected at 4 hours and 24 hours after Tivantinib administration on Day 8 and processed according to procedures developed to minimize analyte degradation. Tumor lysates were evaluated for MET, pY1235MET, pY1356MET, and HIF-1α using ELISA assays. Tumor volumes were measured at baseline and on Day 8. Results: PD-biomarker analysis in biopsy specimens revealed that treatment with Tivantinib alone did not significantly change MET, pY1235MET, and pY1356MET levels. Pazopanib treatment did not significantly increase total MET levels, but significantly increased pY1235MET and pY1356 MET at 4 hours after the Day 8 dose. The Pazopanib-induced activation of pY1235MET and pY1356MET was prevented by Tivantinib (p&amp;lt;0.05) in combination (BID schedule). Analysis of intratumoral levels of HIF-1α is currently underway. Compared to the vehicle treated group, single agent Tivantinib and Pazopanib inhibited tumor growth measured on Day 8 by 19% (p&amp;lt;0.05) and 20% (p&amp;lt;0.05), respectively, whereas the combination of Pazopanib and Tivantinib achieved 38-46% inhibition of tumor growth (p&amp;lt;0.05). The combination regimen was more effective when Tivantinib was administered BID than QD. Conclusions: The combination of Pazopanib with Tivantinib exhibited additive anti-tumor activity that was greater than either agent alone. Enhanced efficacy of combination therapy was associated with Tivantinib block of Pazopanib-induced activation of MET. These results confirm the hypothesis underlying clinical trials of combinations of VEGFR with MET inhibitors. The study is being expanded with additional xenograft models and treatment schedules to confirm and further examine the generality of these findings. Funded by NCI Contract #HHSN261200800001E. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3672. doi:1538-7445.AM2012-3672

Best Practices in Endoscopic Ultrasound–Guided Fine-Needle Aspiration

Over the past 2 decades, endoscopic ultrasound-guided fine-needle aspiration has evolved to become an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. The technique is useful for biopsy of mucosal and submucosal lesions in which prior endoscopic biopsies have been nondiagnostic; to sample peri-intestinal structures such as lymph nodes; and to sample masses in the pancreas, liver, adrenal glands, gallbladder, and bile duct. Also, with the advent of neoadjuvant therapies for diseases such as pancreatic cancer, most patients require a tissue diagnosis before initiating treatment. This review provides a perspective on technical issues that are key for best practices in endoscopic ultrasound-guided fine-needle aspiration.

Tu1555 Impact of Needle Type and Gauge on the Performance of Endoscopic Ultrasound-Guided Sampling: A Meta-Analysis

Impact of Needle Type and Gauge on the Performance of Endoscopic Ultrasound-Guided Sampling: A Meta-Analysis Young Oh*, Jeffrey L. Jackson Medical College of Wisconsin, Milwaukee, WI; Clement J. Zablocki VA Medical Center, Milwaukee, WI Background: There has been discordant data in the literature regarding which type and size of needle used for endoscopic ultrasound (EUS)-guided sampling has superior performance characteristics. AIM: The aim of this study was to comprehensively review and summarize the available literature on the performance of EUS-guided sampling based on the type and size of needle (19 gauge Trucut as well as 19, 22, and 25 gauge fine needle aspiration [FNA] needles) as well as sampling location. Methods: Published manuscripts until September 2011 regarding the use of EUS FNA or Trucut needles were identified in PubMed using relevant search terms. A review of the references from retrieved articles and abstracts from gastrointestinal meetings was also performed. Only studies that were published in English and compared two or more needles were included. Two reviewers independently reviewed each study for suitability to be included in the analysis. Data was pooled using a random effects model with variance based on exact binomial methods. Accuracy, sensitivity and specificity with 95% confidence intervals were calculated. Results: Forty-one articles and abstracts that included 3905 patients were identified that met the inclusion criteria. The combination of the Trucut needle and 22 gauge needle if necessary yielded the highest accuracy (0.95, 95% CI 0.93-0.97, p 0.03) and the 22 gauge needle alone yielded the lowest accuracy (0.76, 95% CI 0.72-0.80, p 0.001). A trend toward higher accuracies with the 25 gauge needle was observed, which did not reach statistical significance. The sensitivity using the Trucut needle was statistically worse than others (0.68, 95% CI 0.60-0.78, p 0.001) and no significant differences in specificity were observed with any of the needles. There appeared to be no differences by specific site of biopsy. Conclusions: The use of the Trucut needle in combination with the 22 gauge needle if necessary yielded the highest accuracy. For the use of single needles, a trend toward the highest accuracy was observed with the 25 gauge needle but this did not reach statistical significance.

Sa1537 Prospective Randomized Trial Comparing 19-G Tru-Cut Needle (TCB) and New 19-G Core Histology Needle (CHN) for Endoscopic Ultrasound (EUS) Guided Liver Biopsy in a Porcine Model

Histologic biopsy specimen is important for evaluating/staging liver disease. Non-operative liver tissue acquisition is usually obtained by percutaneous or transvascular routes. However, these have technical limitations and procedure-related complications. EUS-guided Trucut biopsy (TCB) has been proposed as an alternative because it may provide sufficient histologic diagnosis after a limited number of passes under real-time visualization. However, TCB also has been limited given the low core yield, need for multiple passes, and difficulty with angulation.

Breast Conserving Surgery In Early Breast Cancer Evidence Based Review

Surgical treatment of breast cancer has changed significantly in the past century from mastectomy to breast conserving procedures, including reconstructive procedures. The diagnostic armamentarium has been made easy by introducing Fine-needle aspirations & Trucut needle biopsies with conventional technique to image guided procedures, which help in diagnosis and prognostification for planning multimodality treatment. The preferred method of treatment for many women with early breast cancer is conservative surgical therapy (principally lumpectomy and axillary dissection) followed by breast irradiation. Sentinel node biopsy though not the standard of care one can still practice it & offer the technique to the select subtype of population. All these patients have to complete the treatment with radiation &adjuvant chemo, hormone therapy including target therapy. Keywords : breast cancer , conservative treatment, reconstruction, adjuvant therapy

Effectiveness and safety of minilaparoscopy-guided spleen biopsy: a retrospective series of 57 cases

Minilaparoscopy is an accepted method for liver biopsy. We report our experience with minilaparoscopy for splenic biopsy. We reviewed the records of all minilaparoscopy procedures performed from 1996 to 2004 at the University of Mainz Medical Center and from 2005 to mid-2011 at the University of Hamburg Medical Center to identify patients who underwent a minilaparoscopy-guided splenic biopsy. All procedures were performed using the previously described method (2.75-mm trocar, 2.3-mm Veress needle, 1.9-mm laparoscope) with the patient under conscious sedation (midazolam/meperidine/propofol). Splenic biopsies were performed using a second trocar with an 18-G Tru-Cut needle. Argon plasma coagulation (APC) and/or fibrin glue (FG) were used to control postbiopsy bleeding. Fifty-seven patients underwent minilaparoscopy-guided biopsy of the spleen (27 females, 30 males; median age = 41 years, range = 16-76). A specimen suitable for histopathologic evaluation was obtained in all patients. Grouped by preprocedure indication, a definitive diagnosis was obtained in 70% (7/10) of patients who had splenic mass lesions in prior imaging (3 B-NHL, 2 hemangioma, 1 tuberculosis, 1 sarcoidosis; p < 0.01) compared to 29% (10/34) in the group with unexplained fever or suspected lymphoma (3 tuberculosis, 2 B-NHL, 1 hepatosplenic T-cell lymphoma, 1 sarcoidosis, 1 Still's disease, 1 EBV, 1 Q-fever) and 0/13 with unexplained splenomegaly. Focal lesions noted at laparoscopy yielded to a histologic diagnosis in 38% (11/29) of 42 patients compared to 21% (6/28) without laparoscopic abnormality (p = 0.25). Bleeding from the biopsy site was noted in 96.5% (55/57) and was classified as brisk in 9. Control of hemorrhage was achieved in all patients (APC: 47, FG: 1, APC/FG: 7). There was no postprocedure bleeding or other complications. Splenic biopsy guided by minilaparoscopy can be performed safely. Postprocedure bleeding is readily controlled with APC with or without fibrin glue. The highest diagnostic yield is in patients with focal splenic lesions.

Detection of Prostate Cancer: Comparison of cancer detection rates of Sextant and Extended Ten-core Biopsy Protocols

To compare the cancer detection rates of sextant and ten- core biopsy protocol amongst patients being evaluated for prostate cancer. This is a prospective study involving 125 men with suspicion of prostate cancer. They all had an extended 10-core transrectal digitally-guided prostatic biopsy using Tru-Cut needle. Indications for biopsy were presence of one or more of the following: elevated Prostate Specific Antigen (PSA), abnormal Digital Rectal Examination (DRE) findings and abnormal prostate scan. Sextant biopsies were collected first, followed by four lateral biopsies in all patients. Both groups of specimen were kept and analyzsed separately by the same pathologist. The cancer detection rates of sextant and extended (combination of sextant and lateral) 10-core biopsy protocols were determined and compared. Pearson's Chi square and McNemar tests at two degrees of freedom with level of significance set at 0.05 ( P <0.005) were used to determine the statistical significance. The overall cancer detection rate of 10-core prostate biopsy was 48.8%. Of all positive biopsies, the sextant biopsy protocol detected 52 cancers (85.2%) while the lateral biopsy protocol detected 58 cases (95.1%). Three (3) cancers were detected by the sextant protocol only while the lateral protocol detected nine (9) cancers where sextant technique was negative for malignancy. Ten-core extended protocol showed a statistically significant increase of 14.8% over the traditional sextant. (P=0.046). The overall complication rate of ten-core biopsy was 26.4% and the procedure was well tolerated in most patients. We conclude that a ten-core prostate biopsy protocol significantly improves cancer detection and should be considered as the optimum biopsy protocol.

Combining Fine-Needle Aspiration (FNA) and Fine-Needle Core Biopsy (FNCB) Using a Standard 22 Gauge EUS Needle Increases Diagnostic Yield: 2011 ACG Presidential Poster

Purpose: EUS guided needle aspiration for cytology has limitations in diagnosis of diseases such as lymphoma and stromal tumors. Core biopsies for histologic information have been traditionally performed using 19 gauge trucut needles but usage of these devices in certain anatomic locations can be challenging. There is paucity in data examining the utility of standard 22 gauge needles in obtaining core biopsies and such method as a supplement to the traditional FNA. Current study explores combining EUS FNA with FNCB to increase the diagnostic yield. Methods: EUS performed between December 2009 and November 2010 in a single community hospital setting were retrospectively reviewed, and cases which used both FNA and FNCB (with standard FNA needles rather than 19 gauge trucut needles) were selected. Cases were reviewed for procedural details, FNA cytology results, FNCB histopathology results, and confirmation of final diagnoses. FNAs were performed with 25 gauge and/or 22 gauge needles. FNCB were performed with 22 gauge needles. Results: Total of 21 cases meeting the criteria were identified. Diagnoses of the lesions sampled were as follows: lymphoma (4), pancreatic carcinoma (5), GIST (5), undifferentiated carcinoma of pancreas with giant cells (1), splenule (1), schwannoma (1), autoimmune pancreatitis (1), benign mass with mixed lymphocytes (1), gastric adenocarcinoma (1), and carcinoid tumor (1). 18/21 (85.7%) cases were accurately diagnosed with the combined method. Sensitivities of FNA, FNCB, and the combined method were 47.4%, 52.6% and 84.2%, respectively. Specificities were 100% for all methods.11 cases revealed nondiagnostic FNA cytology, of which FNCB was able to yield accurate diagnoses in 7 cases (63.6%). Conclusion: FNCB with 22 gauge EUS needles can be employed as a supplement to FNA in diagnosis with high accuracy, especially in cases where usage of traditional 19 gauge trucut needles can be technically difficult. This would be particularly useful when immediate cytological feedback is not available. More studies are needed to prospectively compare the different EUS tissue sampling methods available.

Retroperitoneal Laparoscopic Kidney Biopsy: Technical Tips for a Minimally Invasive Approach

Nowadays, ultrasound-guided percutaneous kidney biopsy (PKB) is the gold standard for renal biopsies. Nevertheless, PKB is still contraindicated by conditions such as bleeding diatheses, severe obesity, solitary kidney, uncontrolled hypertension, and previous failed attempts at PKB. In these cases, the laparoscopic approach may offer a valid and mini-invasive alternative to open biopsy. We describe our technique and report indications and outcomes of a consecutive series of retroperitoneal laparoscopic kidney biopsies (LKB). In a retrospective review of patients who underwent LKB, we examined indications, outcomes, and complications, stratified according to the Clavien classification. In all, 40 patients underwent LKB between 2001 and 2010 (mean age 58.85 years, SD 10.87). Mean serum creatinine at surgery was 3.02 mg/dL. Indications for LKB included coagulopathy (30%), polycystic kidney or multiple renal cysts (30%), solitary kidney (12.5%), and morbid obesity (10%). All the biopsies were performed with a Trucut needle. All the procedures were successful and led to pathological diagnosis. The most common pathological findings were glomerulonephritis (47.5%) and glomerulosclerosis (27.5%). All biopsies were performed in less than 1 hour. Only three complications (7.5%) were reported: two grade I and one grade IIIa according to Clavien classification. In three selected cases, we used a particular "ready-to-laparo" open surgical technique, which allowed to view a part of kidney parenchima through the 10-mm incision made for the Hasson trocar sufficient for Trucut biopsies and hemostasis under direct vision. This study shows that LKB is a safe, effective, and minimally invasive procedure that allows direct control of hemostasis and lower risks of postoperative morbidity compared with open biopsy. When PKB is contraindicated, LKB should be the first-choice alternative.

EUS-guided fine needle aspiration and trucut needle biopsy for examination of rectal and perirectal lesions

Objective. Few studies have assessed the diagnostic efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and/or trucut biopsy (TCB) in patients with rectal and perirectal lesions. We aimed to evaluate the diagnostic utility of EUS-FNA and/or TCB in patients with rectal and perirectal lesions. We also assessed their influence on the management and clinical course of these patients. Material and methods. We performed EUS-FNA and/or TCB in 11 consecutive patients (4 men and 7 women, 33–69 years) with rectal and perirectal lesions for whom conventional diagnostic tools could not provide definitive diagnoses. Patients with definite intraluminal cancer were excluded. Results. The 11 patients underwent 12 procedures, with 9 being EUS-FNA alone and 3 being EUS-FNA and TCB. Seven patients had rectal lesions and four had perirectal lesions. Initial EUS-FNA and/or TCB established a diagnosis of malignancy in five patients and of benign lesions in four. EUS-FNA plus TCB confirmed malignant lymphoma after diagnostic failure of initial EUS-FNA in one patient. In one other patient with suspicious secondary linitis plastica, EUS-FNA could not establish a definitive diagnosis. Correct diagnoses were obtained in 10 out of 11 patients who underwent EUS-FNA and/or TCB. EUS-FNA and/or TCB changed clinical courses, which included avoidance of unnecessary surgeries, having a chance of anal sphincter-saving surgeries, and timely administration of chemotherapy. No serious complications related to the use of EUS-FNA or TCB were evident. Conclusion. EUS-FNA and/or TCB are useful in the diagnostic evaluation of and appropriate therapeutic plan in patients with rectal and perirectal lesions.

Hemostasis Effects of Direct Intraparenchymal Injection of Platelets and Fresh Frozen Plasma before Cutting Needle Biopsy in an Animal Model

Purpose To evaluate the effectiveness of direct intraparenchymal injection of platelets or fresh frozen plasma (FFP) into the needle tract before cutting needle biopsy to decrease postprocedural blood loss in pigs with normal and abnormal hemostasis. Materials and Methods A total of 12 Yorkshire-cross pigs were anesthetized and maintained on a respirator. The pigs were divided into three groups: three with normal hemostasis, five treated with warfarin anticoagulation, and four treated with aspirin. Four types of biopsies were performed in the exposed livers and kidneys with 14-gauge Tru-Cut needles. The first was a standard (ie, control) biopsy, and the other three were performed with 2 mL normal saline solution, porcine FFP, or platelet-rich porcine plasma injected into the planned needle tract. Biopsy was then performed in the same needle tract. Blood loss was measured with gauze sponges. Results Significantly decreased postbiopsy blood loss was noted after FFP and platelet injection in the livers and kidneys of all groups except the kidney biopsy group after platelet injection in pigs with normal hemostasis. There was no significant difference in blood loss between the control and saline solution control groups in any of the pigs. Conclusions Local injection of platelets or FFP significantly decreases postbiopsy blood loss in pigs with impaired hemostasis.

Comparison of 19- and 22-gauge needles in EUS-guided fine needle aspiration in patients with mediastinal masses and lymph nodes

Endoscopic ultrasound-guided fine needle aspiration is an established tissue-acquisition technique for mediastinal lesions. However, there are limitations to endoscopic ultrasound-guided fine needle aspiration of mediastinal masses in certain neoplasms and granulomatous diseases. Most studies have used 22-gauge aspiration and/or 19-gauge Tru-cut needles, and only limited data exist on larger-caliber aspiration needles. We aimed to compare prospectively the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration using 19- and 22-gauge aspiration needles in patients with mediastinal lesions of unknown origin. Using a consecutive entry design, 57 patients with mediastinal mass or lymph node, in whom previous investigations, including bronchoscopy and computed tomography-guided biopsy, had not provided a final diagnosis, underwent endoscopic ultrasound-guided fine needle aspiration biopsy using 19-gauge or 22-gauge aspiration needle. Determination of the adequacy and cytopathologic interpretation of fine needle aspiration materials were done by two pathologists blinded to the clinical condition of the patient. Fine needle aspiration specimens were placed in four categories as: (1) nondiagnostic, (2) benign, (3) granulomatous disease, and (4) malignant. Among 57 patients [35 (61.4%) with mediastinal lymph nodes and 22 (38.5%) with pulmonary masses], adequate tissue was obtained in 52 (91.2%) of the cases (with a mean of 3.3 needle passes). Correct cytopathologic diagnoses were made based on the endoscopic ultrasound-guided fine needle aspiration specimens obtained by 19- and 22-gauge needles in 96% and 92% of the samples, respectively (p>0.05). As concerns endoscopic ultrasound-guided fine needle aspiration of mediastinal masses and lymph nodes, the diagnostic sensitivity of aspirated material obtained using 19- and 22-gauge fine needle aspiration needles was found to be comparable in our study.

Blood parameters in female Zandi lambs as affected by liver biopsy methodology

The aim of the present study was to investigate the normal blood parameters of Iranian fat-tailed sheep (Zandi) and their changes due to rapid liver biopsy technique with a tru-cut biopsy needle. In ten ewe lambs, blood samples were collected from jugular vein and biopsy needle was inserted through the dorsal one third of the 11th intercostal space, on the right hand side of the lambs and liver specimen was collected. Physical examinations were performed on alternate days during the experiment. Blood collection was done on both before (day1) and after (day17) the biopsy. All animals were slaughtered at day17. Values were compared using paired t test. While biopsy did not make any significant changes in mean values of body temperature, heart rate, respiratory rate, PCV, WBC, neutrophil, lymphocyte, eosinophil, monocyte, total serum protein, AST, ALT, and serum calcium (p > 0.05), it made a significant difference on the values of ALP (p < 0.001), serum inorganic phosphate (p = 0.035), and magnesium (p = 0.013). Necropsy examination revealed the points of hitting the biopsy needles on the diaphragmatic surface of the livers, surrounded by a zone of intense hyperemia. Peritoneal adhesions accompanying with typical strands of fibrous connective tissue between diaphragmatic surface of the liver and adjacent abdominal wall were found in two cases.

843 COMPARISON OF PROSTATE CANCER DETECTION RATE BETWEEN PROSTATE BIOPSY PERFORMED WITH END-FIRE SINGLE-PLANE AND DUAL-PLANE TRANSRECTAL PROBE

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 2011843 COMPARISON OF PROSTATE CANCER DETECTION RATE BETWEEN PROSTATE BIOPSY PERFORMED WITH END-FIRE SINGLE-PLANE AND DUAL-PLANE TRANSRECTAL PROBE Marco Raber, Carmen Maccagnano, Diego Angiolilli, Federico Dehò, Marco Roscigno, Antonino Saccà, Niccolò Maria Passoni, Nicola Fossati, Matteo Ferrari, Vincenzo Scattoni, Patrizio Rigatti, and Francesco Montorsi Marco RaberMarco Raber Milan, Italy More articles by this author , Carmen MaccagnanoCarmen Maccagnano Milan, Italy More articles by this author , Diego AngiolilliDiego Angiolilli Milan, Italy More articles by this author , Federico DehòFederico Dehò Milan, Italy More articles by this author , Marco RoscignoMarco Roscigno Milan, Italy More articles by this author , Antonino SaccàAntonino Saccà Milan, Italy More articles by this author , Niccolò Maria PassoniNiccolò Maria Passoni Milan, Italy More articles by this author , Nicola FossatiNicola Fossati Milan, Italy More articles by this author , Matteo FerrariMatteo Ferrari Milan, Italy More articles by this author , Vincenzo ScattoniVincenzo Scattoni Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal ultrasound-guided biopsy is the standard procedure to diagnose prostate cancer. The impact of ultrasound probe on detection rate has not been clarified yet. METHODS From January 2004 to March 2006, 800 consecutive patients were randomised by a single operator to undergo a first prostate biopsy with single-plane (400 patients, Group 1) and dual-plane ultrasound probe (400 patients, Group 2), using the same biopsy protocol. All patients received local anesthesia and antibiotic prophylaxis. Biopsies were taken with the patient in the left lateral decubitus position. A 18-gauge Tru-cut needle powered by a biopsy gun was used. In all cases, 14 core biopsy samples were taken. On each side, three prostate cores were obtained from each peripheral side and two from the apical margin and base. Two different ultrasound probes were used: the side-fire probe, and the end-fire probe (Hitachi Medical Systems). The primary end point was to evaluate whether the detection rate may differ using two different biopsy probes. RESULTS Overall prostate cancer detection rate was 36,2%. No significant difference in detection rate was found between single-plane and dual-plane untrasound transrectal probe (P=0,51). In multivariable analyses, after adjusting for prostate volume, transizion zone volume, total PSA, free PSA, percent of free PSA, DRE and TRUS results no statistical differences between the two probes were detected (all p>0.2). CONCLUSIONS Our findings suggest the use of either a single-plane end-fire or a dual-plane side-fire transrectal ustrasonographyc probe is not affecting the prostate cancer detection rate in extended biopsies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e339 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Raber Milan, Italy More articles by this author Carmen Maccagnano Milan, Italy More articles by this author Diego Angiolilli Milan, Italy More articles by this author Federico Dehò Milan, Italy More articles by this author Marco Roscigno Milan, Italy More articles by this author Antonino Saccà Milan, Italy More articles by this author Niccolò Maria Passoni Milan, Italy More articles by this author Nicola Fossati Milan, Italy More articles by this author Matteo Ferrari Milan, Italy More articles by this author Vincenzo Scattoni Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pseudoaneurysm of the Anterior Tibial Artery After a Tibial Bone True-Cut Needle Biopsy Treated by an Arterial Resection and Anastomosis

We report the case of a 38-year-old man who developed a false aneurysm of the anterior tibial artery after a true-cut needle biopsy of the shinbone. Although arterial damages are a known theoretical risk of such a procedure, to our knowledge, this is the first case to be reported. Repair was achieved by means of an arterial resection and anastomosis.

Mitochondrial alterations in children with chronic liver disease

Background Over recent years it has become apparent that the hepatocyte mitochondrion functions both as a cause and as a target of liver injury. Resultant dysfunction of mitochondria yields deficient oxidative phosphorylation, increased generation of reactive oxygen species, impairment of other metabolic pathways and activation of both necrotic and apoptotic pathways of cellular death. Methods This study was conducted on 26 children and adolescents with chronic liver disease who presented to or were following up in the Pediatric Hepatology Clinic, Children’s Hospital, Ain-Shams University. They were divided into three groups according to the aetiology of liver disease (GI = patients with Wilson’s disease (WD), GII = patients with chronic hepatitis C, GIII = patients with chronic liver disease other than Wilson’s and chronic hepatitis C). Ultrasound-guided gun liver biopsies were performed, under local anaesthesia for all the 26 patients, using a modified 18-gauge truecut needle. Two liver biopsy cores were taken from each patient. One for light and electron microscopic examinations and the other was immediately immersed in liquid nitrogen to be frozen and used for studying mitochondrial DNA deletions by PCR. Results Liver steatosis was higher in the group of patients with Wilson’s disease and other liver diseases. Electron microscopic examination of the mitochondria revealed significant mitochondrial pleomorphism in patients with Wilson’s disease and patients with chronic hepatitis C infection. Enlarged mitochondria were found to be more prevalent among patients with chronic hepatitis C infection. Three of our patients (11.53%) had mitochondrial DNA deletions. We developed a scoring system for mitochondrial affection in our patients, 7 patients (32%) were considered to have mild mitochondrial affection, 9 patients (41%) had moderate mitochondrial affection, while 6 patients (27%) had severe mitochondrial affection. Four of the studied patients had no mitochondrial affection. Conclusion Mitochondria affection is common in chronic liver disease. This mitochondrial affection might be responsible for some of the chronic liver disease manifestation such as easy fatiguability and steatosis.