Ultrasound-guided Core Needle Biopsy Research Articles

Accuracy of ultrasound-guided fine-needle aspiration for small cervical lymph nodes: A retrospective review of 505 cases

PurposeThe overall diagnostic value of fine-needle aspiration (FNA) is not as excellent as that of core needle biopsy (CNB). Limited research has investigated small cervical lymph nodes inaccessible to ultrasound-guided CNB due to technical challenges associated with their small size. Therefore, this study aimed to evaluate the accuracy of ultrasound-guided FNA in determining the etiology of small cervical lymph nodes. MethodsA retrospective analysis was conducted on patients who underwent FNA between May 2018 and May 2021 at our hospital. Cytological, histopathological, and clinical follow-up data were analyzed. The diagnostic yield of FNA was assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy calculations. ResultsThis study included 505 patients, each with a small cervical lymph node under evaluation (total number of lymph nodes: 505). The average maximal diameter of the lymph nodes was 14.6 ± 6.2 mm. According to the Sydney system, the cytology results were as follows: Category I in 26 lymph nodes (5.1 %); Category II in 269 (53.3 %); Category III in 35 (6.9 %); Category IV in 17 (3.4 %); and Category V in 158 (31.3 %). We identified 212 malignant cases (203 metastases and 9 lymphomas) and 293 benign lymph nodes. FNA achieved high sensitivity (88.8 %), specificity (99.6 %), PPV (99.4 %), NPV (91.8 %), and overall accuracy (94.8 %) in determining the etiology of small cervical lymph nodes. ConclusionFNA cytology is suitable for small lesions inaccessible by CNB and provides a diagnostic basis for implementing clinically appropriate treatment measures.

Initial investigation on ultrasound-guided percutaneous biopsy of lesions in the first hepatic hilum with fusion of ultrasound and multimodal imaging cognitive guidance.

This study aims to evaluate the efficacy and safety of ultrasound-guided percutaneous biopsy of the first hepatic hilum lesion, and examine its clinical value of diagnosis and treatment. We conducted a retrospective study on patients diagnosed with the first hepatic hilum lesions at Fujian Provincial Hospital between February 2015 and October 2022. We selected patients who had lesions in the first hepatic hilum(including a 2cm surrounding area of the left/right hepatic ducts and upper-middle segment of the common bile duct) and the liver periphery(in the peripheral area of the liver, outside of the above-mentioned first hepatic porta region). These patients underwent percutaneous ultrasound-guided core needle biopsy (PUS-CNB) with cognitive fusion guidance using CT, MRI, or PET-CT. We compared the safety and efficacy of PUS-CNB in the first hepatic hilum and the liver periphery to explore the value of PUS-CNB in optimizing the clinical treatment of the first hepatic hilum lesions. The studied includes 38 cases of the first hepatic hilum cases (18 females; 20 males), 23 presented with mass-forming tumors while the remaining 15 exhibited diffuse infiltrative tumors, with an average diameter of 4.65± 2.51 cm. The percutaneous biopsy procedure, conducted under ultrasound guidance, had an average operation time of 14.55 ± 2.73 minutes, and resulted in a postoperative bleeding volume of approximately 10.79 ± 2.79 ml. The diagnostic success rate was noted to be as high as 92.11% among the participants who underwent percutaneous biopsy of the first hepatic hilum. Procedural complications, such as bleeding, bile leakage, intestinal perforation, infection or needle tract seeding, did not occur during or after the biopsy procedure. Affected by biopsy results, 5 altered their clinical treatment plans accordingly, 24patients received non-surgical treatment, 9 underwent surgical treatment, 5 underwent radiofrequency ablation for the lesions. The study comprised a total of 112 cases for percutaneous biopsy of the liver periphery. The safety and effectiveness of the two biopsy techniques were comparable, with diagnostic success rates of 92.11% VS. 94.34%, respectively (p = 0.61). Cognitive fusion of ultrasound and multi-modal imaging for the first hepatic hilum lesion puncture biopsy is a safe and effective diagnostic procedure, with better diagnostic rate, may improve clinical value of diagnosis and treatment of various diseases.

Pulmonologist-Performed Ultrasound-Guided Fine-Needle Aspiration of Lung Lesions

Background and objective: Lung cancer is increasingly common, and accurate diagnosis is important for personalized treatment. Ultrasound-guided percutaneous fine-needle aspiration (FNA) is a useful method to obtain a specimen for a histological diagnosis of peripheral lung lesions. The aim of this study is to evaluate the diagnostic accuracy and complication rate of the procedure performed by pulmonologists. The result is compared with that of ultrasound-guided core needle biopsy performed by radiologists. Methods: We retrospectively evaluated the diagnostic accuracy and complication rates of pulmonologist-performed ultrasound-guided FNAs of lung lesions in the period of 1 August 2019 to 30 June 2021 (pulmonologist group) and radiologist-performed ultrasound-guided core needle biopsies (CNBs) of lung lesions in the period of 1 January 2010 to 31 December 2014 (radiologist group). A logistic regression analysis was used to identify independent influence factors associated with diagnostic accuracy in the pulmonologist group and in the combination of both groups. Results: In a 23-month period, pulmonologists in a tertiary center performed 113 episodes of ultrasound-guided fine-needle aspiration for peripheral lung lesions. The diagnostic accuracy and complication rates were 80.4% and 5.3%, respectively, compared to 86.8% and 7.4% in a historical cohort consisting of 68 episodes of ultrasound-guided core needle biopsies performed by radiologists in the same hospital. Lung lesions located in the upper lobe were predictive of successful diagnoses. Conclusions: An ultrasound-guided fine-needle aspiration by a pulmonologist is an easily accessible and reliable method to obtain specimens for histological diagnoses.

Baseline breast tissue characteristics determine the effect of tamoxifen on mammographic density change.

Tamoxifen prevents recurrence of breast cancer and is also approved for preventive, risk-reducing, therapy. Tamoxifen alters the breast tissue composition and decreases the mammographic density. We aimed to test if baseline breast tissue composition influences tamoxifen-associated density change. This biopsy-based study included 83 participants randomised to 6 months daily intake of placebo, 20, 10, 5, 2.5, or 1 mg tamoxifen. The study is nested within the double-blinded tamoxifen dose-determination trial Karolinska Mammography Project for Risk Prediction of Breast Cancer Intervention (KARISMA) Study. Ultrasound-guided core-needle breast biopsies were collected at baseline before starting treatment. Biopsies were quantified for epithelial, stromal, and adipose distributions, and epithelial and stromal expression of proliferation marker Ki67, oestrogen receptor (ER) and progesterone receptor (PR). Mammographic density was measured using STRATUS. We found that greater mammographic density at baseline was positively associated with stromal area and inversely associated with adipose area and stromal expression of ER. Premenopausal women had greater mammographic density and epithelial tissue, and expressed more epithelial Ki67, PR, and stromal PR, compared to postmenopausal women. In women treated with tamoxifen (1-20 mg), greater density decrease was associated with higher baseline density, epithelial Ki67, and stromal PR. Women who responded to tamoxifen with a density decrease had on average 17% higher baseline density and a 2.2-fold higher PR expression compared to non-responders. Our results indicate that features in the normal breast tissue before tamoxifen exposure influences the tamoxifen-associated density decrease, and that the age-associated difference in density change may be related to age-dependant differences in expression of Ki67 and PR.

Three-year survival of breast cancer patients attending a one-stop breast care clinic nested within a primary care health facility in sub-Saharan Africa-Zambia.

In Zambia, women with breast symptoms travel through multiple levels of the healthcare system before obtaining a definitive diagnosis. To eradicate this critical barrier to care, we nested a novel breast specialty service platform inside a large public-sector primary healthcare facility in Lusaka, Zambia to offer clinical breast examination, breast ultrasound, and ultrasound-guided core needle biopsy in a one-stop format, tightly linked to referral for treatment. The objective of the study was to determine the life expectancy and survival outcomes of a prospective cohort of women diagnosed with breast cancer who were attended to and followed up at the clinic. The effect of breast cancer stage on prognosis was determined by estimating stage-specific crude survival using the Kaplan-Meier method. Survival analysis was used to estimate mean lifespan according to age and stage at diagnosis. We enrolled 302 women with histologically confirmed breast cancer. The overall 3-year survival was 73%. An increase in patients presenting with early breast cancer and improvements in their survival were observed. Women with early-stage breast cancer had a lifespan similar to the general population, while loss of life expectancy was significant at more advanced stages of disease. Our findings suggest that implementing efficient breast care services at the primary care level can avert a substantial proportion of breast cancer-related deaths. The mitigating factor appears to be stage of disease at the time of diagnosis, the cause of which is multifactorial, with the most influential being delays in the referral process.

Ultrasound guided core needle biopsy results after marking suspicious lesions on mammography with a fine needle

Amaç
 Mamografi ile meme kanseri taramasının artışı memede saptanan nonpalpabl lezyonların oranını arttırmaktadır. Sadece mamografi ile görülebilen kuşkulu lezyonların tanısında stereotaktik vakum aspirasyon biyopsi (VAB) tercih edilen ilk yöntemdir. Ancak vakum biyopsi ünitesi ve vakum iğnesinin yüksek maliyetli olması nedeniyle bu yönteme erişim sınırlıdır. 
 Bu çalışmada VAB’ ye alternatif olarak mamografide izlenen kuşkulu lezyonun ince iğne ile işaretlenmesi ardından, bu iğne kılavuzluğunda US eşliğinde yapılan kalın iğne biyopsi sonuçlarının değerlendirilmesi amaçlanmıştır. 
 Gereç ve Yöntem
 Ocak 2021-Nisan 2022 tarihleri arasında, sadece mamografide izlenebilen ve kuşkulu kategoride olan lezyonlara, mamografide ince iğne ile işaretleme ardından, US rehberliğinde iğnenin bulunduğu alana kalın iğne biyopsi yapılan hastalar retrospektif olarak taranmıştır. Hastaların mamografi bulguları, lezyonun BI-RADS kategorisi, biyopsi örnekleme sayısı, spesmen mamografisi, biyopsi patoloji sonuçları, varsa cerrahi eksizyon patoloji sonuçları değerlendirilmiştir. 
 Bulgular
 Biyopsi yapılan toplam 43 hastanın 39’unda sadece kuşkulu mikrokalsifikasyon, 3’ ünde sadece asimetri ve distorsiyon, 1 ‘inde mikrokalsifikasyon ve eşlik eden asimetri izlenmekteydi. Kalın iğne biyopsi histopatoloji sonuçlarında %58 benign, %9 atipili benign ve %33 malign tanı saptandı. 15 hastada cerrahi eksizyon ile lezyon çıkarıldı, radyoloji patoloji uyumu olan diğer hastalar takibe alındı. 43 hastanın %39.5’i malign, %60.5’i benign gruptaydı. Mamografide yerleştirilen ince iğnenin kılavuzluğunda yapılan, kalın iğne biyopsi işleminin tanısal doğruluğuna bakıldığında; sensitivite %76.5, spesifite %100 olarak saptandı. 
 Sonuç
 Mamografide saptanan kuşkulu mikrokalsifikasyonlar erken evre meme kanserinin tanısında önemli belirteçlerdir. Kuşkulu lezyonların tanısında mamografide yerleştirilen ince iğnenin rehberliğinde yapılan trucut biyopsi yüksek tanısal doğruluğa sahip, açık cerrahi biyopsi ve VAB’ ye alternatif olarak kullanılabilecek minimal invaziv bir yöntemdir.

Core Needle Biopsies as an Alternative Source for Ex Vivo Expanded TIL for Adoptive Cell Therapy in Triple-Negative Breast Cancer.

Adoptive transfer of ex vivo expanded tumor-infiltrating lymphocytes (TILs) have produced long-term response in metastatic cancers. TILs have traditionally been expanded from surgically resected specimens. Ultrasound-guided core needle biopsy (CNB) is an alternative method that avoids the morbidity of surgery and have added benefits which may include patients not amenable to surgery as well as the potential to produce TILs from multiple lesions in the same patient. We assessed the ability to produce and expand TILs from primary triple-negative breast cancer tumors from CNB (n=7) and demonstrate comparable expansion, phenotype and cytokine secretion after phorbol myristate acetate-ionomycin stimulation to TILs expanded from surgery (n=6). T cell Receptor clonality and diversity were also comparable between the two cohorts throughout the TIL culture. CNB is a safe and feasible method to obtain tumor tissue for TIL generation in patients with triple-negative breast cancer.

Diagnostic yield of combined ultrasound-guided fine needle aspiration and core needle biopsy versus either technique alone in peripheral lung and pleural lesions

IntroductionUltrasound (US) has become an integral tool for chest assessment as it provides crucial information on pleural pathologies and peripherally located lung lesions.AimTo assess the diagnostic yield of combined fine needle aspiration (FNAB) and core needle biopsy (CNB) versus each technique ultrasound-guided in peripheral lung and pleural lesions.MethodologyThe present study enrolled 30 patients presenting to Alexandria Main University Hospital, with CT scans showing undiagnosed peripheral lung or parietal pleural lesions with or without effusion. A full ultrasound chest assessment was done covering 12 regions. Assessment of the lesion of interest, vascularity was assessed via color Doppler, locating the safest entry site. Real-time US-guided FNAB was done using a spinal needle 22 gauge. Then real-time US-guided CNB using 18 gauge Trucut needle in the same setting. Duration and complications of each procedure were reported. In FNAB, three smears were prepared, fixed in alcohol, and stained with hematoxylin and eosin stain. The remaining sample was fixed in formalin and centrifuged to prepare cell blocks. On the other hand, Trucut needle biopsy specimens were fixed in formalin and processed as paraffin-embedded blocks. Immunohistochemical staining was done. The results were classified into four categories (inadequate, negative, suspicious, and positive for malignancy.ResultsThe diagnostic yield of combined techniques was 96.7% versus 63.3% using FNAB and 96.7% using CNB. The sensitivity of FNAB was 86% while CNB was 95%. The specificity and positive predictive value of both methods were 100%. The negative predictive value of FNAB was 57% versus 80% for CNB in peripheral lung lesions. Duration of US-guided CNB was statistically significantly longer than that of FNAB in both peripheral lung and pleural lesions. No major complications were reported using either technique.ConclusionCombined FNAB and CNB were not superior to CNB alone regarding diagnostic yield but were superior to FNAB. Ultrasound-guided CNB has a superior diagnostic yield over FNAB, with no statistically significant difference regarding associated complications, both techniques are safe. FNAB provided sufficient material for ancillary molecular testing.

Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report.

We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks.

Contrast-enhanced ultrasound guided core needle biopsy for soft tissue tumors: Accuracy and applicability

ObjectiveTo evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) guided core needle biopsy (CNB) in diagnosing soft tissue tumors (STTs) and to identify the conventional ultrasonography (US) features of STTs that are recommended for CEUS-guided CNB. Materials and methodsA retrospective study was conducted on 123 patients with surgically confirmed STTs. Before surgeries, all subjects underwent CNB under the guidance of US or CEUS. The histopathological results of surgical specimens were considered as the gold standards. A successful biopsy diagnosis was defined as the pathological subtypes obtained by biopsy consistent with the gold standard. The diagnostic yields were compared between the US and CEUS groups, and the diagnostic yields based on various conventional US features of STTs were also compared between the two groups. ResultsSixty-seven cases underwent US-guided CNB and fifty-six cases underwent CEUS-guided CNB. The clinical, biopsy, and conventional US characteristics revealed no significant difference between the two groups. The diagnostic yield of the CEUS group was statistically higher than that of the US group (p = 0.011). In the CEUS group, more STTs with the anechoic areas were identified after CEUS examination (p = 0.031). Furthermore, the diagnostic yields based on the conventional US features of STTs, including deep fascia layer (p = 0.010), a maximum diameter ≥5 cm (p = 0.037), rough margin (p = 0.016), heterogeneous echotexture (p = 0.017), and absence of anechoic area (p = 0.013), were significantly different between the two groups, and the CEUS group exhibited higher diagnostic yields. ConclusionCEUS-guided CNB was found to be an efficient method for STTs diagnosis. It is particularly recommended for STTs with the following conventional US features, including location in deep fascia layer, a maximum diameter ≥5 cm, rough margin, heterogeneous echotexture, or absence of anechoic area.

Accuracy of Tumor Bed Biopsy for Predicting Pathologic Complete Response After Chemotherapy Among Women With Breast Cancer: Complete Responders in the Breast Study.

With the advent of taxanes and targeted agents in neoadjuvant chemotherapy (NACT) for breast cancer, the rates for pathologic complete response (pCR) have been steadily increasing. Surgery in these women serves as a biopsy to confirm or negate a pCR. All newly diagnosed patients with nonmetastatic breast cancer, planned for NACT, were screened. Eligible patients with a complete or near-complete response to NACT as seen on a mammogram and ultrasound (US) were recruited. A magnetic resonance imaging was performed for these patients for documentation. US-guided core biopsies of the tumor bed (Core Bx) using a 14G needle was performed (minimum four in number), and the results were compared with the final histopathology report after surgery for standard performance parameters. This study recruited 65 women of whom 94% were node-positive, and 60% were hormone receptor-negative. The pCR rate was 41.5% and 53.8% for the whole cohort and the hormone receptor-negative subgroup, respectively. The false-negative rate (FNR) for Core Bx was 42.1% (95% CI, 26.3 to 59.2), with a negative predictive value of 59.0% (95% CI, 42.1 to 74.4). Among the hormone receptor-negative tumors, the FNR was 44.4% (95% CI, 21.5 to 69.2) with a negative predictive value of 70.4% (95% CI, 49.8 to 86.2). The Complete Responders in the Breast study results suggest that ultrasound-guided 14G core needle biopsy of the tumor bed may not be a reliable predictor of pCR in the breast. These results highlight the importance of further research into the omission of surgery in the breast after chemotherapy. This study is registered with Clinical Trials Registry of India (CTRI/2018/01/011122).

Ultrasound-Guided Needle Biopsy as an Alternative to Chamberlain's Mediastinotomy and Video-Assisted Thoracoscopic Surgery (VATS) in the Diagnosis of Anterior Mediastinal Neoformations: A Retrospective Analysis.

(1) Background: The prompt diagnosis of anterior mediastinal lesions is a challenge due to their often being categorized as malignant tumours. Ultrasound-guided Transthoracic Core Needle Biopsy (US-TCNB) is an innovative technique that is arousing increasing interest in clinical practice. However, studies in this area are still scarce. This study aims to compare the diagnostic accuracy and complication rate of US-TCNB with those of traditional surgical methods-Anterior Mediastinotomy and Video Assisted Thoracoscopic Surgery (VATS)-in patients with anterior mediastinal lesions. (2) Methods: This retrospective study involved patients evaluated between January 2011 and December 2021 who had undergone US-TCNB at the Interdepartmental Unit of Internal and Interventional Ultrasound, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy. Personal data, diagnostic questions, and technical information concerning the bioptic procedure, periprocedural complications and histological reports were collected. (3) Results: Eighty-three patients were included in the analysis. Histological examination was performed in 78 cases, with an overall diagnostic accuracy of 94.0% (sensitivity 94%; specificity 100%). Only in 5 patients was a diagnosis not achieved. Complications occurred in 2 patients who were quickly identified and properly treated without need of hospitalization. The accuracy of US-TCNB was comparable to the performance of the main traditional diagnostic alternatives (95.3% for anterior mediastinotomy, and 98.4% for VATS), with a much lower complication rate (2.4% vs. 3-16%). The outpatient setting offered the additional advantage of saving resources. (4) Conclusions: a US-guided needle biopsy can be considered effective and safe, and in the near future it may become the procedure of choice for diagnosing anterior mediastinal lesions in selected patients.

Ultrasound-guided core-needle biopsy for peripheral pulmonary lesions: a systematic review and meta-analysis

To evaluate the diagnostic value and safety of ultrasound-guided core-needle biopsy for peripheral pulmonary lesions (PPLs). PubMed, EMBASE, and the Cochrane Library for relevant were searched for studies published up to June 2022. The diagnostic accuracy of US-guided percutaneous transthoracic needle biopsy (PTNB) for the diagnosis of PPLs was evaluated using pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios (PLR and NLR), and the area under the summary receiver operating characteristic curves value (SROC). The search included 12 original studies (3,830 procedures). For US-guided PTNB, the pooled sensitivity and specificity for the diagnosis of PPLs were 0.93 (95% confidence interval [CI]: 0.91-0.94) and 0.99 (95% CI: 0.96-1.00), respectively. The pooled estimates of the PLR, NLR, and DOR were 134.88 (95% CI: 24.88-731.74), 0.07 (95% CI: 0.06-0.09), and 1,814.95 (95% CI: 333.62-9,873.76), respectively. The area under the SROC curve was 0.95 (95% CI: 0.93-0.97). The overall complication rate was 3.6% (136 of 3,830), including self-limited haemoptysis and asymptomatic pneumothorax, and only six cases of pneumothorax requiring chest tube drainage and one case of severe bleeding were reported. US-guided core-needle biopsy is an excellent diagnostic tool for PPLs, with high accuracy and excellent technical performance and safety.

Diagnostic Evaluation of Solid Pancreatic Lesions: Endoscopic Ultrasound-Guided Fine Needle Aspiration Versus Percutaneous Ultrasound-Guided Core Needle Biopsy.

The main objective of the present study is to compare the safety, technical success and diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus ultrasound-guided percutaneous core-needle biopsy (US-CNB) in patients with solid pancreatic lesions. This is a retrospective study that involved all patients with a solid pancreatic lesion who underwent EUS-FNA or US-CNB between November 2019 and February 2021. Of all patients, 69 (84.1%) had inoperable malignancy, whereas 13 (15.9%) had chronic pancreatitis. Resectability status was ascertained by computed tomography. All core needle biopsies were performed by the same interventional radiologist via ultrasound guidance with an 18-gauge semi-automatic tru-cut needle. All EUS-FNA procedures were performed by the same gastroenterologist with a 27-gauge EUS-FNA needle. Technical success is defined as if the region of interest is reached and specimen taken from the pancreatic lesion. Diagnostic yield is defined as the procurement of sufficient tissue for pathological examination. Overall, 52 patients (mean age 58.5 ± 9.8years) who underwent EUS-FNA and 30 patients (60.1 ± 12.1years) who underwent US-CNB were included. Solid lesions were most commonly (61.5% in EUS-FNA and 50.0% in US-CNB groups) located in pancreatic head in both groups. Mean size of the lesions was comparable in both groups as well. The technical success was 100% in both groups. In 12 (14.6%) patients, pathology results revealed inadequate sampling (11 × in the EUS-FNA and 1 × in the US-CNB group). The diagnostic yield was significantly higher in US-CNB group than in EUS-FNA group (96.7% vs. 78.8%, respectively, p = 0.048). Of 11 patients in the EUS-FNA with inadequate sampling, pancreatic lesions were located in the pancreatic head in 7 (63.6%). No major complications were observed in neither of the groups. As a minor complication, one case of slight abdominal pain was detected in the EUS-FNA group. Based on the results of the present study, both US-CNB and EUS-FNA appeared safe; however, diagnostic yield in the US-CNB group was significantly higher.

Ultrasonography-guided core-needle biopsy of lymphadenopathies suspected of lymphoma: Analysis on diagnostic efficacy and safety of 1000 front-line biopsies in a multicenter Italian study.

The reliability and safety of front-line ultrasonography guided core needle biopsy (UG-CNB) performed with specific uniform approach have never been evaluated in a large series of patients with lymphadenopathies suspected of lymphoma. The aim of this study was to assess the overall accuracy of UG-CNB in the lymph node histological diagnosis, using a standard reference based on pathologist consensus, molecular biology, and/or surgery. We retrospectively checked the findings concerning the application of lymph node UG-CNB from four Italian clinical units that routinely utilized 16-gauge diameter modified Menghini needle under power-Doppler ultrasonographic guidance. A data schedule was sent to all centers to investigate the information regarding techniques, results, and complications of lymph node UG-CNB in untreated patients over a 12-year period. Overall, 1000 (superficial target, n=750; deep-seated target, n=250) biopsies have been evaluated in 1000 patients; other 48 biopsies (4.5%), screened in the same period, were excluded because inadequate for a confident histological diagnosis. Most patients were suffering from lymphomas (aggressive B-cell non-Hodgkin lymphoma [aBc-NHL], 309 cases; indolent B-cell [iBc]-NHL, 279 cases; Hodgkin lymphoma [HL], 212 cases; and nodal peripheral T-cell [NPTC]-NHL, 30 cases) and 100 cases from metastatic carcinoma; 70 patients had non-malignant disorders. The majority of CNB results met at least one criterion of the composite reference standard. The overall accuracy of the micro-histological sampling was 97% (95% confidence interval: 95%-98%) for the series. The sensitivity of UG-CNB for the detection of aBc-NHL was 100%, for iBc-NHL 95%, for HL 93%, and for NPTC-NHL 90%, with an overall false negative rate of 3.3%. The complication rate was low (6% for all complications); no patient suffered from biopsy-related complications of grade >2 according to the Common Terminology Criteria for Adverse Events. Lymph node UG-CNB as mini-invasive diagnostic procedure is effective with minimal risk for the patient.

The diagnostic value of BI-RADS grade 3 to 5 for breast masses is correlated with the expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2.

The breast imaging-reporting and data system (BI-RADS) grading has a great advantage in diagnosing breast diseases, but with some limitations. The study analyzed the value of ultrasound-guided core needle biopsy (CNB) in diagnosing BI-RADS grades 3, 4, and 5 breast cancer. Breast cancer patients at BI-RADS grades 3 to 5 received breast ultrasonography, ultrasound-guided CNB and immunohistochemical examination. Receiver operating characteristic (ROC) curve was made to test diagnostic efficiency of regression model. Calcification was positively correlated with expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER)-2. The areas of 4 ROC curves were 0.752, 0.805, 0.758, and 0.847, and the 95%CI was 0.660 to 0.844, 0.723 to 0.887, 0.667 to 0.849, and 0.776 to 0.918, respectively. BI-RADS grades 3 to 5 were positively correlated with expression of ER, PR and human epidermal growth factor receptor-2 (HER-2). Statistical significance existed between grade 5 and expression of ER, PR and HER-2, and between grade 4 and expression of HER-2. The study demonstrates that BI-RADS can be used as an effective evaluation method in the diagnosis of breast diseases before invasive operation, and it has higher diagnostic accuracy if combined with pathological examinations.

ULTRASONOGRAPHY‐GUIDED CORE‐NEEDLE BIOPSY OF LYMPHADENOPATHIES SUSPECTED OF LYMPHOMA: ANALYSIS OF EFFICACY AND SAFETY OF 1000 BIOPTIC PROCEDURES IN A MULTICENTER ITALIAN STUDY

Patients with clinical suspect of lymphoma require prompt and correct diagnosis through the histological examination. The aim of this study was to evaluate the reliability and safety of the front-line ultrasonography guided core needle biopsy (UG-CNB) of suspected lymphadenopathies in a large series of patients from 4 southern Italian clinical units. Inclusion criteria were: (i) lymphadenopathy power Doppler ultrasonography retrospectively assessment on recorded video clips and/or images; (ii) 16-gauge CNB with powered automatic suction and 1.6 mm needle diameter sample; (iii) availability of lymph node sections fixed in formalin and embedded in paraffin; (iv) morphological and immunohistochemical information (assessed retrospectively by haematopathologists); and (v) information of an accepted diagnostic reference standard (either the lymphadenopathy surgical resection or follow-up assessment with 2-deoxy-2[F-18] fluoro-D-glucose positron emission tomography [FDG PET]-computed tomography [CT] showing decreased FDG uptake and/or decreased size after specific antineoplastic treatment according to the histological subtype, as well as spontaneous regression for the benign conditions). We retrospectively collected the data of 1048 patients who underwent UG-CNB between 1 July 2009 and 1 January 2022 for suspected pathological lymphadenopathies. In total, out of the 1000 UG-CNBs yielding macroscopically adequate material for histological diagnosis, the 90% (n = 900) resulted in lymph-nodes positive for malignancy. Most patients were suffering from lymphomas (aggressive B-cell non-Hodgkin lymphoma [aBc-NHL], 309 cases; indolent B-cell [iBc]-NHL, 266 cases; Hodgkin lymphoma [HL], 198 cases; and nodal peripheral T-cell [NPTC]-NHL, 27 cases) and 100 cases from metastatic carcinoma; 70 patients were negative for malignancy (diagnosis of atypical lymphadenopathies mimicking lymphomas [ALML]). The remaining 3% were inconclusive at CNB: the morphologic, immunohistochemical and/or molecular investigations did not allow a final diagnosis. Keyword: imaging and early detection No conflicts of interests pertinent to the abstract.

Diagnostic Yield of Transabdominal Ultrasound-Guided Core Needle Method in Biopsies of Pancreatic Lesions.

In this study, it was aimed to contribute to the selection of the method to perform pancreatic lesion biopsies.Data of patients, who had undergone a percutaneous biopsy because of pancreatic masses in our institution in the period between January 2015 and November 2019, were evaluated retrospectively. The percutaneous biopsy method, the type of needle used in the procedure, and periprocedural complications were listed. Pathology and cytology reports in the archive were reviewed, and biopsy results were divided into 3 groups as benign, malignant, and inadequate. Of 308 patients included in the study, the diagnostic accuracy was verified in 124 patients through the assessment of surgical outcomes, results of biopsies from metastatic lesions, or follow-up findings. The verified results were classified as true-positives and true-negatives.Of a total of 308 patients included in the study, 23 underwent a fine-needle aspiration biopsy (FNAB) and 285 underwent a core needle biopsy (CNB). No statistical differences were observed in sample acquisition success and complications between the groups.Of the lesions with a confirmed pathological diagnosis, 67.74% were malignant and 32.26% were benign. The diagnosis was correct in 107 of 112 CNB patients (95.54%) and 9 of 12 FNAB patients (75.00%). When the success of the 2 methods was compared, it was found that outcomes of CNB were statistically more successful compared with those of FNAB.A transabdominal ultrasound-guided percutaneous CNB is a safe method with a high diagnostic yield to perform a biopsy of the pancreas.

The Usefulness of Ultrasound-Guided Core Needle Biopsy Compared to Fine Needle Aspiration in Pre-Operative Diagnosis of Cystic-Predominant Parotid Tumors

Background and Objectives Accurate preoperative prediction of final histopathologic diagnosis is essential in parotid tumor management, which also includes surgical planning. As a preoperative diagnostic examination for parotid tumors, the accuracy of ultrasound-guided fine needle aspiration (US-FNA) and ultrasound-guided core needle biopsy (US-CNB) was compared, and factors affecting the accuracy of diagnosis and adequacy of the specimen were analyzed.Subjects and Method This study was conducted as a retrospective analysis of 90 patients with parotid tumor who had undergone parotidectomy after pre-operative ultrasound-guided biopsy. We divided the study subjects into US-FNA and US-CNB groups and evaluated the diagnostic accuracy by comparing the pre-operative results with the final histopathologic diagnosis after surgery. In addition, accuracy and specimen adequacy were analyzed according to tumor components.Results The US-FNA group showed significantly higher rates of non-diagnostic results than the US-CNB group (44.0% vs. 13.8%, <i>p</i>=0.002) did. Diagnostic accuracy was also significantly higher in US-CNB than in US-FNA (95.4% vs. 64.0%, <i>p</i><0.001), and the non-diagnostic result of US-FNA was the main factor in reducing accuracy. Meanwhile, in both cysticpredominant tumors and solid-predominant tumors (94.8% vs. 75%, <i>p</i>=0.023), US-CNB showed significantly better accuracy than US-FNA (100.0% vs. 20.0%, <i>p</i>=0.010) did.Conclusion US-CNB has superiority in both sample adequacy and diagnostic accuracy compared to US-FNA in preoperative diagnosis of parotid tumors, and it seems necessary to consider its use more actively in the diagnosis of cystic-predominant tumors.

The efficiency of volumetric apparent diffusion coefficient histogram analysis in breast papillary neoplasms

Background/Aim: Papillary neoplasia encompasses both malignant and benign lesions, and core needle biopsy (CNB) is crucial in their diagnosis. Histological findings determine their management. Here we compare volumetric apparent diffusion coefficient (ADC) histogram analysis of carcinomas and benign pathologies identified by histopathology from excisional biopsies. Methods: This retrospective study included 524 patients who underwent breast magnetic resonance imaging (MRI) for a suspicious breast mass from January 2018 to October 2022. Patients with benign lesions, incompatible ultrasound-guided CNB results with papillary neoplasia, and those with MRI exams insufficient for diagnosis due to motion artifacts were excluded. After applying the exclusion criteria, the study included 48 patients (average aged 61.5 (14.8) years; range, 31 to 72 years). After excisional biopsies, 30 benign lesions and 18 carcinomas were identified. MRI was acquired at 1.5 T (Verio; Siemens Medical Solutions, Erlangen, Germany), and the b-values for diffusion-weighted imaging were calculated at 1000 s/mm2. Histogram parameters were computed. Receiver operating characteristic (ROC) curve analysis was performed to investigate diagnostic accuracy, evaluate histogram analysis performance, and determine threshold values. Results: The ADCmin, ADCmean, ADCmax, and all ADC value percentiles were significantly lower in the carcinoma group than in the benign group (P<0.001). The variance, skewness, and kurtosis were higher in the carcinoma group. ADCmax had the highest area under the curve (AUC: 0.985; cut-off 1.247 × 10-3 mm2/s; sensitivity 86%, and specificity 92%), followed by ADCmean (AUC: 0.950; cut-off 0.903 × 10-3 mm2/s; sensitivity 94%, and specificity 96%). Conclusion: Volumetric ADC histogram analysis of papillary neoplasia at higher b-values can be an imaging marker to detect carcinoma and quantitatively reveal the lesions’ diffusion characteristics.