Ultrasound-guided Aspiration Biopsy Research Articles

Endobronchial spread of tuberculosis after endobronchial ultrasound-guided transbronchial needle aspiration and intranodal forceps biopsy.

Endobronchial spread of tuberculosis after endobronchial ultrasound-guided transbronchial needle aspiration and intranodal forceps biopsy.

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial.

Simple SummaryPulmonologist-performed US-NAB of “superficial” metastatic lesions is safe and has an excellent diagnostic yield for both tissue diagnosis and molecular profiling regardless of the use of rapid on-site evaluation. These findings have important implications for costs, hospital resource allocation, and the globally widespread utilization of US-NAB.Background and Objective: Studies which evaluated the role of an ultrasound-guided needle aspiration biopsy (US-NAB) of metastases from lung cancer located in “superficial” organs/tissues are scant, and none of them assessed the possible impact of rapid on-site evaluation (ROSE) on diagnostic accuracy and safety outcomes. Methods: Consecutive patients with suspected superficial metastases from lung cancer were randomized 1:1 to US-NAB without (US-NAB group) or with ROSE (ROSE group). The diagnostic yield for a tissue diagnosis was the primary outcome. Secondary outcomes included the diagnostic yield for cancer genotyping, the diagnostic yield for PD-L1 testing, and safety. Results: During the study period, 136 patients were randomized to receive an US-NAB with (n = 68) or without ROSE (n = 68). We found no significant differences between the ROSE group and the US-NAB group in terms of the diagnostic yields for tissue diagnosis (94.1% vs. 97%, respectively; p = 0.68), cancer genotyping (88% vs. 91.8%, respectively; p = 0.56), and PD-L1 testing (93.5% vs. 90.6%, respectively; p = 0.60). Compared to the diagnostic US-NAB procedures, the non-diagnostic procedures were characterized by less common use of a cutting needle (66.6% vs. 96.9%, respectively; p = 0.0004) and less common retrieval of a tissue core (37.5% vs. 98.5%; p = 0.0001). Only one adverse event (vasovagal syncope) was recorded. Conclusion: US-NAB of superficial metastases is safe and has an excellent diagnostic success regardless of the availability of ROSE. These findings provide a strong rationale for using US-NAB as the first-step method for tissue acquisition whenever a suspected superficial metastatic lesion is identified in patients with suspected lung cancer.

Usefulness of Adding Maspin Staining to p53 Staining for EUS-FNA Specimens of Pancreatic Ductal Adenocarcinoma.

Background: Endoscopic ultrasound-guided puncture aspiration biopsy (EUS-FNA) of pancreatic ductal adenocarcinoma (PDAC) is highly diagnostic, but it is difficult to distinguish from benign disease. Our objective was to determine the usefulness of maspin staining, in addition to conventional p53 staining, in the diagnosis of PDAC by EUS-FNA. Methods: Of the patients who underwent EUS-FNA and were diagnosed with PDAC, we retrospectively identified 90 cases in which both maspin and p53 staining were performed. In addition, we identified 28 cases of benign pancreatic disease diagnosed using EUS-FNA and these were selected as a control group. For analysis of EUS-FNA specimens, Cohen’s Kappa (κ) coefficient and the prevalence and bias adjusted Kappa statistic (PABAK) were applied to assess the significance of sensitivity and specificity, comparing p53, maspin, p53+maspin. Results: The sensitivity and specificity of p53 staining were 48.9% and 100%. The κ coefficient was 0.31 (95%CI 0.18–0.44) (p < 0.01) and the PABAK coefficient was 0.22 (95%CI 0.03–0.40). The results for maspin staining were 88.9% and 92.9%. The κ coefficient was 0.72 (95%CI 0.54–0.90) (p < 0.01) and the PABAK coefficient was 0.78 (95%CI 0.64–0.88). The results for the combination of maspin and p53 staining were 94.4% and 92.2%. The κ coefficient was 0.82 (95%CI 0.64–1.00) (p < 0.01) and the PABAK coefficient was 0.86 (95%CI 0.74–0.94). Conclusion: Adding maspin staining to p53 staining showed high sensitivity and specificity. Our results demonstrated the usefulness of their combined use that might contribute to the improvement of tissue diagnostic performance of PDAC by EUS-FNA.

Percutaneous ultrasound-guided core needle biopsy for the diagnosis of cardiac tumors: Optimizing the treatment strategy for patients with intermural and pericardial cardiac tumors.

ObjectiveThe aims of this study are to investigate the clinical value and practical safety of ultrasound-guided percutaneous core needle biopsy on diagnosing cardiac tumor and to discuss the treatment strategy for cardiac intermural and pericardial tumors.MethodsThe clinical data were retrospectively collected for patients with intermural and pericardial cardiac tumors. The patients were divided into groups of surgical resection, surgical resection after obtaining pathological tissue by PUS-CNB, and/or radiotherapy according to the treatment modality. Ultrasound-guided aspiration biopsy was divided into cardiac tumor biopsy and extracardiac lesion biopsy according to patient conditions. The surgical time was recorded, and the safety and clinical application value of PUS-CNB for the diagnosis of cardiac tumors were evaluated in terms of complications and satisfaction with pathological sampling.ResultsA total of 18 patient cases were collected, and PUS-CNB of cardiac tumors was performed in 8 cases, with sampling times averaging 15.6 ± 3.0 min. Four cases of cardiac tumors combined with extracardiac tumors were biopsied, with puncture times averaging 13.0 ± 2.9 min. All 12 biopsied patients had no postoperative complications. Except for 1 failed biopsy, the biopsies were successful and the pathological results were consistent with the clinical diagnosis with a satisfaction rate of 91.7%. Except for two cases of surgical resection, the rest were considered for conservative treatment. Surgical resection and/or biopsy were performed in six cases, and two cases were aggravated after surgery. The final pathology of all 17 cardiac tumors was malignant.ConclusionPUS-CNB is safe and effective, providing a simple and undemanding method for accurate diagnosis of cardiac intermural and pericardial tumors while avoiding unnecessary open-heart surgery.

First case of lung cancer with pneumoconiosis and endobronchial leiomyoma complicating the diagnosis

BackgroundIn the treatment of lung cancer, the presence or absence of mediastinal lymph node involvement has a significant bearing on the indication for surgery. In addition, if a tumor is found in the trachea during preoperative scrutiny of lung cancer, the possibility of intratracheal metastasis should be considered, since this kind of metastasis is a contraindication for surgery. In the present study, we experienced a case of lung cancer associated with pneumoconiosis and a rare intratracheal leiomyoma. In this case, preoperative staging was difficult, but endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and intratracheal tumor biopsy were helpful in determining the treatment strategy.Case presentationA 65-year-old man was referred to our hospital for evaluation of abnormal chest X-ray shadows. Sputum cytology indicated squamous cell carcinoma. PET-CT scan showed fluorodeoxyglucose uptake in a right upper lobe mass and the hilar, mediastinal and right supraclavicular lymph nodes, and bronchoscopy revealed a protuberant lesion in the left bronchus. Hence, EBUS-TBNA for the mediastinal lymph nodes and simultaneous evaluation of the protuberant lesion in the left bronchus were performed. The bronchial tumor was histopathologically diagnosed as leiomyoma. Since mediastinal lymph node biopsy showed no malignant cells, a right upper lobectomy and a right S6 segmentectomy were performed. Postoperative pathological evaluation of the dissected lymph nodes revealed pneumoconiosis but no metastasis. He was, thus, diagnosed with squamous cell lung carcinoma (pT2bN0M0, pStage IIA).ConclusionsWe report a patient with lung cancer and coexistence of a rare endobronchial leiomyoma and pneumoconiosis, who underwent surgery after preoperative evaluation using EBUS-TBNA.

Suitability of endobronchial ultrasound-guided transbronchial needle aspiration samples for programmed death ligand-1 testing in non-small cell lung cancer, the Bristol experience.

Treatment for non-small cell lung cancer (NSCLC) is now personalised using molecular mutation testing. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy suitability for anaplastic lymphoma kinase (ALK) and epidermal growth factor receptor (EGFR) mutation testing is established. Less is currently known about EBUS-TBNA suitability for PD-L1 (programmed death ligand-1) testing. To assess EBUS-TBNA biopsy adequacy for ALK, EGFR and PD-L1 testing, we conducted a prospective study of 279 consecutive NSCLC patients referred to a tertiary EBUS-TBNA centre in South West England. One hundred eight-four (62.6%) patients were found to have adenocarcinoma, 83 (28.2%) had squamous cell carcinoma, and 27 (9.2%) were identified as NSCLC-not otherwise specified. EGFR testing was successful in 166 of 168 patients (98.8%), ALK testing in all 115 and PD-L1 testing in 43 of 49 patients (88.2%). Previous EGFR and ALK testing did not affect biopsy PD-L1 testing success. PD-L1 testing failures occurred in three of five (60.0%) of 22G needle biopsies, one of five (20.0%) of 21G needle biopsies and two of 39 (5.1%) of 19G needle biopsies, P=.016. EBUS-TBNA biopsies are mostly suitable for PD-L1 testing. Larger needle size may improve PD-L1 (but not EGFR and ALK) testing success but requires further study in a controlled trial.

Endobronchial and/or Endoesophageal Bronchoscopic Ultrasound-Guided Fine Needle Aspiration in the Diagnosis of Mediastinal and Hilar Diseases of Unknown Etiologies

<i>Introduction:</i> Diagnosis of mediastinal and hilar lesions represents a problematic issue for long ago, not only due to various structures that occupy this space but also difficult accessibility to such lesions. Mediastinal endosonography – guided FNA is emerged as a new minimally invasive modality for diagnosis of such lesions. <i>Objectives: </i>to evaluate the role of endobronchial and/ or endoesophageal -bronchoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal and hilar diseases of unknown etiologies. <i>Methods:</i> This Prospective observational study was carried out at Tanta University Educational Hospital and Kobri Elkobba Military Hospitals; from December 2017 to December 2019 on thirty patients (19 males; 11 females, age range 17-82 years) presented with undiagnosed mediastinal and or hilar lesions. All patients were subjected to clinical examination, radiological assessment including Chest-X-Ray, CT Chest. Laboratory investigations: CBC, blood urea, serum creatinine and coagulation profile. Twenty-six patients were subjected only to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsies and four patients were subjected to endoscopic ultrasound using EBUS scope-guided fine- needle aspiration (EUS-B-FNA) after EBUS-TBNA, using Pentax Endobronchial ultrasound and a fine needle (22- Gauge). The procedure was done under local anesthesia and conscious sedation ROSE technique was applied for some cases. <i>Results:</i> Definitive diagnosis was reached in twenty-nine cases, achieving diagnostic yield (96.67%). Malignant lesions were the predominant category; twenty (66.67%), while nine (30%) were diagnosed as benign lesions and one (3.33%) case remained un diagnosed. Also, immunohistochemistry played an important role to reach definitive diagnosis in six cases without further sampling. About (12/30; 40%) of patients were passed without any complications while the others recorded controlled complications without any serious events. <i>Conclusion: </i>EBUS and EUS-B-FNA are minimally invasive, complementary and cost effective procedures with high diagnostic yield for mediastinal and hilar lesions. Addition of immunohistochemistry raises diagnostic value of this procedure.

MEDIASTINAL LYMPHADENOPATHY AS METASTATIC MANIFESTATION OF RENAL CELL CARCINOMA

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Renal cell carcinoma (RCC) is one of the common malignancies diagnosed in United States.(1) Since early 1990s, its incidence has risen and thought to be attributed to the increased prevalence of risk factors such as smoking, obesity and hypertension.(2) With the advent and frequent utilization of imaging such as ultrasonography and computed tomography (CT), mortality related to RCC has declined.(1) Lung is a common site for metastatic dissemination due to invasiveness of RCC into nearby vascular structures. We present an unusual case of RCC with lymphatic metastasis to lungs, contrary to the known mechanism of vascular metastasis. CASE PRESENTATION: 57-year-old female, current smoker of 25 pack years, presents to the hospital with complaints of recurrent painful hematuria after failing outpatient management for presumed nephrolithiasis. CT abdomen showed a 9.7 cm mass in superior pole of left kidney with involvement of the adjacent adrenal gland. A subsequent chest CT showed a 1.1 cm right lower lobe sub-pleural nodule, 1.1 cm right paratracheal lymphadenopathy, and 1.47 cm subcarinal lymphadenopathy (Figure 1). Patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy of station 11R with pathology consistent with renal cell carcinoma. Patient was referred for nephrectomy followed by oncologic evaluation for further management with chemotherapeutic and possible immunological therapy. DISCUSSION: The incidence of pulmonary metastasis in RCC is approximately 50-60%.(3) Although commonly presenting as solitary or multiple nodules, pleural, lymphatics, or embolic phenomenon have been reported.(3) Interestingly, RCC can present with hilar or mediastinal lymphadenopathy. In cases where extensive pulmonary metastasis is present, RCC can be discovered during EBUS-TBNA, as noted in our case. (5) In our case, patient had positive lymph node for malignancy associated with the sub-pleural based nodule. It is possible that the lymphadenopathy was an indirect seeding after metastasis to right lower lobe nodule, or direct seeding into mediastinal and hilar lymph nodes. The presence of the right lower lobe nodule makes direct lymph node seeding less likely. CONCLUSIONS: In patients who present with hematuria with incidental findings of lymphadenopathy, it is worth considering RCC as a plausible diagnosis due to various pulmonary manifestations related to RCC. Reference #1: Chow, W., Dong, L., and Devesa, S. (2010). Epidemiology and risk factors for kidney cancer. Nature Reviews Urology. 2010; 7(5): 245-257. Kabaria, T., Klaassen, Z., and Terris, M. (2016). Renal cell carcinoma: links and risks. Int J Nephrol Renovasc Dis. 2016; 9: 45-52. Reference #2: Motzer, R., Bander, N., and Nanus, D. (1996). Renal-cell carcinoma. N Engl J Med 1996. 335(12): 865-875. Agarwal, A., Sahni, S., Iftikhar, A., and Talwar, S. (2015). Pulmonary manifestations of renal cell carcinoma. Respiratory Medicine 109: 1505-1508. Reference #3: Val-Bernal, J., Martino, M., Romay, F., and Yllera, E. (2018). Endobrnchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal metastases of clear cell renal cell carcinoma. Pathology Research and Practice. 2018; vol 214 (7): 949-956. DISCLOSURES: No relevant relationships by Kushagra Gupta, source=Web Response No relevant relationships by Anthony Loschner, source=Web Response No relevant relationships by Elizabeth McCaskey, source=Web Response No relevant relationships by Toribiong Uchel, source=Web Response

Diagnostic Value of Transbronchial Ultrasound-guided Needle Aspiration Biopsy in the Diagnosis of Small Cell Lung Cancer and Non-small Cell Lung Cancer

背景与目的纤维支气管镜腔内超声引导针吸活检术（endobronchial ultrasound guided transbronchial needle aspiration, EBUS-TBNA）作为近年来发展的新技术，具有操作简单、创伤小、准确率和安全性高及可重复性等优点，已成为进行肺癌诊断和纵隔分期的新标准。由于小细胞肺癌（small cell lung cancer, SCLC）和非小细胞肺癌（non-small cell lung cancer, NSCLC）的生物学特性以及治疗方案的不同，因此，在早期能诊断并鉴别的病理类型，对于肺癌的分期、治疗及预后均有很重要意义。本文探讨EBUS-TBNA在诊断SCLC和NSCLC中的准确率及敏感性。方法回顾性分析2012年1月-2018年12月首都医科大学宣武医院胸外科进行142例经支气管内超声引导针吸活检术患者的临床资料，选取最终确诊85例SCLC和NSCLC患者，比较两组差异。结果最终经免疫组化病理明确SCLC 45例，其中经EBUS-TBNA明确诊断为SCLC 42例，诊断准确率、敏感度分别为93.3%（42/45）、100.0%（42/42）。经细胞学检查明确诊断22例，诊断准确率为48.9%（22/45）；经病理明确诊断NSCLC 40例，其中经EBUS-TBNA明确诊断为NSCLC 35例，诊断准确率、敏感度分别为87.5%（35/40）、100.0%（35/35）。经细胞学检查明确诊断11例，诊断准确率为27.5%（11/40）；EBUS-TBNA在SCLC组的诊断准确率明显高于NSCLC组，且有统计学意义（P < 0.05）。结论EBUS-TBNA用于诊断SCLC较NSCLC的准确率高。EBUS-TBNA作为微创技术，可协助SCLC早期诊断，及时治疗。

Treatment efficiency of thyroid benign nodules by ultrasound-guided radiofrequency ablation

Objective To explore the effectiveness and safety of ultrasound-guided radiofrequency ablation (RFA) in treatment of thyroid benign nodules. Methods We analyze 573 patients with thyroid benign nodules from June 2014 to September 2017 treated by RFA at Department Ⅱof Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University. Among these patients, there were 75 males and 498 females, with a median age of 45 years old. All patients were diagnosed as thyroid benign nodules by ultrasound-guided fine needle aspiration biopsy before RFA. A total of 750 benign tumors were treated. To evaluate the thyroid function of the patients before RFA and 3 months after it, and to observe the changes of thyroid benign nodules by ultrasound at 3, 6, 12 months after RFA. The paired t-test was used to compare the measurement data with normal distribution, and Wilcoxon's signed rank test was used to compare the measurement data with non-normal distribution. To calculate the volume change and reduction rate of thyroid benign nodules. Results RFA was successfully completed in all patients, the volume reduction rate was 67%(48%, 83%) in the 3rd month after RFA, in the 6th month was 81%(67%, 91%), in the 12th month was 89%(80%, 95%). Eighteen patients felt pain during RFA, but the pain was alleviated after stopping ablation. Three patients′ tone decreased, but recovered in a week. Hoarseness occurred in 6 patients and recovered in 3 months. Three patients had neck hemorrhage, which was managed with simple compression of the neck. Conclusions RFA is an effective and safe treatment for thyroid benign nodules and has obvious advantages such as less invasiveness, having no influence in thyroid functions. It is clinically prospective for application. Key words: Retrospective studies; Thyroid neoplasms; Biopsy, needle; Radiofrequency ablation; Ultrasound guided

Small lung tumor biopsy samples are feasible for high quality targeted next generation sequencing.

Next‐generation sequencing (NGS) has been implemented in clinical oncology to analyze multiple genes and to guide therapy. In patients with advanced lung cancer, small biopsies such as computed tomography‐guided needle biopsy (CTNB), endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and transbronchial biopsy (TBB) are less invasive and are preferable to resection to make a pathological diagnosis. However, the quality of DNA/RNA and NGS from small lung tumor biopsy samples is unknown. Between April 2017 and March 2018, 107 consecutive samples were obtained from thoracic tumors or metastatic sites for targeted NGS analysis. Fifteen samples were obtained through CTNB, 11 through EBUS‐TBNA, 11 through TBB and 70 through surgical resection. All samples were formalin‐fixed and paraffin‐embedded. DNA and RNA quality was measured using the ddCq method and the percentage of RNA fragments above 200 nucleotides (DV200), respectively. Our custommade probes were designed to capture exon sequences of 464 cancer‐related genes and transcripts of 463 genes. DNA and RNA yield from the 3 biopsy methods were similar, and less than the yield obtained from resected samples. The quality of DNA and RNA was similar across all methods. Overall, 12 of 15 CTNB samples (80%), all 11 EBUS‐TBNA samples, and 9 of 11 TBB samples (82%) underwent successful NGS assays from DNA. NGS analysis from RNA was successful in all 12 CTNB samples, 9 of 11 EBUS‐TBNA samples (82%), and 8 of 11 TBB samples (73%). CTNB, EBUS‐TBNA and TBB mostly resulted in adequate DNA and RNA quality and enabled high‐quality targeted NGS analysis.

Primary malignant mixed mullerian tumor of the peritoneum: a case report

Malignant mixed mullerian tumor (MMMT) occurs rarely extragenital sites and generally originates from female genital tracts such as the uterus. Here, we report a patient with a primary MMMT of the peritoneum in a 64-year-old woman, who experienced a discontinuous epigastric pain and an abdominal distention for 3 months. An ultrasound-guided fine needle aspiration biopsy (FNA) was executed and indicated a highly malignant soft tissue sarcoma. And after that, the patient received a tumor resection (cytoreductive surgery) and postoperative chemotherapy. The postoperative immunohistochemical analysis revealed a MMMT in peritoneum. Up to now, the patient has survived for 5 months.

Transvaginal/transrectal ultrasound-guided aspiration biopsy for diagnosis of pelvic/pelvic floor tumors in females: A retrospective analysis.

Ultrasound guidance for histological diagnosis is in real-time, convenient, and economical. The aim of this study was to determine whether transvaginal ultrasound (TVUS)- and transrectal ultrasound (TRUS)-guided aspiration biopsy allows detection of a malignant pathology of pelvic/pelvic masses. Data of 40 patients with pelvic and pelvic mass lesions by computed tomography or magnetic resonance imaging underwent TVUS- or TRUS-guided biopsy. Tissue samples obtained were assessed on suitability for histopathologic evaluation. The post-biopsy complication was monitored. All the specimens in the pelvic floor, vaginal stump, vaginal fornix, cervix, and posterior wall of the anal canal were adequate for histologic diagnosis. There were no post-biopsy complications. Transvaginal/transrectal ultrasound-guided aspiration biopsy is safe and simple. It can be used for the diagnosis and differential diagnosis of pelvic and pelvic floor lesions in women. Prospective studies are needed to test diagnostic performance across clinical scenarios.

Diagnostic value of contrast-enhanced ultrasound combined with BRAF V600E mutation for cytologically indeterminate thyroid nodules

Objective To evaluate the diagnostic efficacies of contrast-enhanced ultrasound(CEUS) combined with BRAF V600E mutation detection in ultrasound-guided fine-needle aspiration cytology of thyroid nodules with atypia of undetermined significance. Methods A total of 129 thyroid nodules underwent the examinations of CEUS and BRAF V600E mutation were analyzed retrospectively. With surgical pathology as the gold standard, ROC curve was used to investigate the diagnostic values of CEUS, BRAF V600E and the combination of the two methods. Results The sensitivity, specificity and accuracy of CEUS and BRAF V600E gene detection for thyroid nodules with atypia of undetermined significance diagnosed by ultrasound-guided fine-needle aspiration biopsy were 86.7%, 83.3%, 85.3% and 72.0%, 100%, 83.7%, respectively. The sensitivity and accuracy of CEUS were higher than those of BRAF V600E gene detection (all P<0.001), however its specificity was lower than BRAF V600E with statistically significance(P<0.001), those of the combined test of CEUS and BRAF V600E mutation analysis were 94.7%, 83.3%, 89.9%, respectively. The combination of two methods had the highest diagnostic efficacy, with statistically difference (P<0.001), and the area under the ROC curve (AUC) was higher than that for each test(0.951 vs 0.860 vs 0.901). Conclusions The combined test of CEUS and BRAF V600E mutation has a higher diagnostic efficacy for cytologically indeterminate thyroid nodules compared with CEUS or BRAF V600E mutation alone. Key words: Contrast-enhanced ultrasound; Thyroid nodule; BRAF V600E gene; Mutation; Fine needle aspiration biopsy

Simultaneous amplification and testing method for Mycobacterium tuberculosis rRNA to differentiate sputum-negative tuberculosis from sarcoidosis.

We use the simultaneous application and testing method to detect Mycobacterium tuberculosis rRNA (SAT-TB) with the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy specimens to differentiate sputum-negative tuberculosis from sarcoidosis. In the first part, we validated the SAT-TB on the bronchial or EBUS-TBNA biopsy specimens from sputum smear-positive pulmonary tuberculosis. In the second part, all EBUS-TBNA specimens for sputum smear-negative intrathoracic tuberculous lymphadenopathies or sarcoidosis were tested with the SAT-TB, acid-fast bacilli smear, and culture. In the 16 sputum-positive tuberculosis cases, 5 showed negative SAT (2 nontuberculous mycobacteria and 3 had anti-tuberculosis therapies previously); the remaining 11 were positive. Of the 41 sputum-negative tuberculosis cases in the second part, five other diseases were negative. In the remaining 36 cases, 27 sarcoidosis cases were negative; 7 in 9 with sputum-negative tuberculosis were positive (77.78%). In these 36 patients, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the SAT method were 77.78, 100, 100, 93.10, and 94.44%, respectively. The SAT distinguished sputum-negative tuberculosis from sarcoidosis significantly ( P < 0.0001) and identified cases with active M. tuberculosis as accurately as the conventional methods (κ = 0.912, P < 0.0001). We conclude that the SAT-TB may be an effective method for using biopsy specimens to differentiate sputum-negative tuberculosis from sarcoidosis.

Efficient and safe method in the diagnosis of thoracic lesions: Ultrasound-guided needle aspiration biopsy

BACKGROUND: This study aimed to investigate the diagnostic value of fine-needle aspiration biopsy (FNAB) performed under the guidance of thoracic ultrasonography (USG) for the diagnosis of thoracic lesions such as peripheral lung lesions, pleural lesions, mediastinal lesions, and chest wall or supraclavicular metastases of lung lesions. MATERIALS AND METHODS: Cases with thoracic lesions that were found eligible for biopsy by thoracic USG and underwent FNAB between January 2008 and December 2016 were included in the study. Demographical characteristics and radiological findings of the cases, lesion size as detected by USG, sonographic patterns, number of FNABs per lesion, diagnosis based on FNAB, final diagnosis of inconclusive cases and the methods used to establish the final diagnosis, and developed complications were recorded. RESULTS: FNAB was performed for peripheral lung lesion in 188 (72.6%), mediastinal mass in 23 (8.9%), chest wall metastasis of lung tumor in 23 (8.9%), supraclavicular lymph node metastasis of lung tumor in 18 (6.9%), and pleural lesion in 7 (2.7%) cases. The corresponding diagnostic accuracy was 78.7%, 78.2%, 95.6%, 94.4% and 85.7%, respectively. A diagnosis could be made in 211 (81.4%) of 259 cases (195 [92.4%] malignant and 16 [7.6%] benign). The overall diagnostic success of the procedure was 81.4%, and the success rate to diagnose malignant and benign lesions was 81.9% and 76.1%, respectively. Pneumothorax which needs pleural tube in placement was seen in five patients, with peripheral lesion as the major complication. CONCLUSION: USG-guided FNAB performed for thoracic lesions is associated with a high rate of diagnostic success (81.4%) and a low rate of major complications (1.9%).

Ultrasonography in diagnosis of breast granulomatous lobular mastitis

The findings of preoperative ultrasonography in patients with granulomatous lobular mastitis treated in Xintai People′s Hospital from December 2013 to December 2016 were retrospectively analyzed. Among 15 cases of granulomatous lobular mastitis confirmed by pathology, there were 6 cases of mass type, 5 cases of tubular type and 4 cases of mixed type diagnosed by ultrasound before operation, which were consistent to pathological diagnosis in 3, 4, 3, respectively. On the ultrasound images, the blood flow signals are more rich, the tubular and mixed type have certain specificity, and color Doppler flow imaging (CDFI) usualy can make correct diagnosis. For the atypical mass lesions, the final diagnosis can be made by ultrasound-guided needle aspiration biopsy. Key words: Granulomatous mastitis; Ultrasonography

The effect of 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration biopsies on characterisation of malignant and benign disease. The Bristol experience.

EBUS-TBNA is a recent mediastinal staging and diagnostic technique. We have previously reported superior characterisation with 21G biopsies over 22G biopsies for benign and malignant mediastinal nodes. A new 19G needle now exists but there are limited studies. We hypothesised 19G biopsies would improve both benign and malignant characterisation due to larger samples. We retrospectively analysed sequential patients referred for EBUS-TBNA with unexplained mediastinal adenopathy performed with 19G, 21G and 22G needles respectively (100 patients each). Contingency table analysis was performed. There were no complications. Sensitivity for malignancy was highest in the 19G group (95.7% versus 94.7% and 87.5%, respectively). The 19G group had higher mean lymph node size (19.4mm versus 18.6mm and 13.5mm, respectively), the highest proportion of lymphoma (9% versus 5% and 0%, respectively), the lowest proportion of NSCLC-NOS (2% versus 12% and 5%, respectively), the highest proportion of subcharacterised benign disease (89.6% versus 69.8% and 37.9%, respectively). This large single centre retrospective UK study suggests the 19G needle appears safe with the suggestion of better sensitivity for malignancy subcharacterisation of benign disease but this requires further study in adequately powered comparative controlled studies with univariate and multivariate analysis.

Comparison of diagnostic value between TIRADS and ultrasound patterns of ATA(2015)guidelines in the differentiation of benign and malignant thyroid nodule

To compare the diagnostic value between the thyroid imaging reporting and data system(TIRADS)and ultrasound(US)patterns of 2015 American Thyroid Association(ATA)guidelines in the differentiation of benign and malignant thyroid nodules. 639 patients in Jiangsu province who were scheduled for ultrasound-guided fine-needle aspiration biopsy or thyroidectomy were recruited for the retrospective study. All of them were categorized based on TIRADS and ultrasound patterns of ATA(2015)guidelines. The receiver operating characteristic curve was established to assess and compare the diagnostic value of the two models. Results: (1)639 patients with 847 thyroid nodules were included in this study, 510 females and 129 males. The mean age was(46.77±12.98)years old. (2)818 nodules could be classified according to TIRADS. The malignancy rates of TIRADS 2, 3, 4A, 4B, 5 were 0, 15.9%, 49.1%, 78.8% , and 100%, respectively. (3)Ultrasound patterns of ATA could be assigned to 793 nodules. The malignancy rates of nodules with very low, low, intermediate, high suspicion for malignancy were 6.2%, 10.3%, 24.9% and 70.1%, respectively. (4)Ultrasound patterns of ATA had higher specificity(77.9%)compared to TIRADS. The sensitivity and area under curve of ultrasound patterns of ATA were lower than those of TIRADS, though, not significant. Ultrasound patterns of ATA(2015)guidelines may yield higher specificity in the differential diagnosis of benign and malignant thyroid nodules, while TIRADS classification may offer a relatively higher sensitivity and area under curve. (Chin J Endocrinol Metab, 2016, 32: 999-1002) Key words: Thyroid nodule; Thyroid imaging reporting and data system; Ultrasound patterns; 2015 American Thyroid Association guidelines

The impact of Chinese guideline on the managements of patients with thyroid nodules and undergoing surgery

Objective To investigate the influence of Chinese guidelines for thyroid nodules and differentiated thyroid cancers on the diagnosis and treatment of thyroid nodule patients undergoing thyroid surgery in the PLA General Hospital. Methods A retrospective analysis was conducted on data of 2 243 thyroid nodule inpatients who were undergoing thyroid surgery and with their pathology results in 2011(before the guideline change, 1 013 patients)and in 2013(after the guideline change, 1 230 patients). The data of the changes of the baseline characteristics, diagnosis, constituent of thyroid nodule, distribution of benign thyroid nodule size were compared between 2011 and 2013. The differences of surgical managements of thyroid cancer were also studied. Results (1)A higher proportion of female patients was showed in 2013 group(75.61% vs 69.20%, P<0.01). The age of patients in 2013 group was significantly younger than that of 2011 group [(45.74±11.77 vs 47.43±11.87)years old, P<0.01]. (2)Thyroid stimulating hormone and ultrasound-guided aspiration biopsy were used more often after the guideline change(83.00% vs 65.55%, 47.95% vs 19.50% respectively, both P<0.01). And the proportion of benign nodules decreased gradually in the post-guideline period(32.20% vs 49.95%, P<0.01). The sizes of benign and malignant nodules were both showed a descending tendency [(2.487±0.861 vs 2.800±0.720)cm, (1.027±0.795 vs 1.186±0.964)cm respectively, both P<0.01]. (3)After the change of guidelines, the percentage of the options of total/near-total thyroidectomy, hemithyroidectomy with isthmusectomy, and central lymph node dissection for thyroid cancer were increased(respectively 31.29% vs 15.38%, 16.91% vs 7.69%, and 64.15% vs 50.50%, all P<0.01). Conclusion After Chinese guideline was introduced in 2012, the surgical management of thyroid nodules in our hospital had been followed more closely to the recommendations of the guidelines. (Chin J Endocrinol Metab, 2016, 32: 749-753) Key words: Thyroid nodule; Guidelines; Diagnosis; Therapy