Ultrasound-guided Needle Research Articles

Diagnostic yield and complications of ultrasoundguided trans-thoracic biopsies by pulmonologists: a single-centre retrospective study of lesions with pleural contact.

Introduction Ultrasound-guided trans-thoracic needle biopsy (US-TTNB) is a method of choice for the diagnostic management of peripheral lung lesions and pleural masses for pulmonologists. If complication risk factors and diagnostic yield have been well reported for CT-guided biopsies, publications for US-TTNB in this field are very scarce. Methods The primary objective of this study was to describe the diagnostic yield of US-TTNB carried out by pulmonologists defined by a definitive histopathological diagnosis Secondary objectives were to identify factors that may influence diagnostic yield and to describe complications of this procedure. Between September 2015 and December 2022, charts of consecutive patients presenting peripheral lesion with pleural contact and having undergone US-TTNB were retrospectively analyses. ROC curves were performed to assess the probability of having a contributing biopsy (definitive histology) depending on scannographic measurements and the number of punctures. Univariate and then multivariate analysis were performed to look for variables associated with complications. Results One hundred and fifty nine patients were enrolled in this study. Among them, diagnosis was obtained for 140 patients (88% success rate). The histology was in favor of a neoplastic process in 96% of cases (135/140). Analysis of the ROC curves showed that the depth of the lesion (AUC 75%; CI95% 65-85; cut-off 3.0cm), the width of the lesion (AUC 73%; CI95% 63-86; cut-off 3.9cm), the pleural contact (AUC 68%; CI95% 57-80; cut-off 3.8cm) and the number of biopsies (AUC 70%; CI95% 59-81; cut-off 3 biopsies) were the variables associated with diagnostic yield. Complications occurred for 27 patients (17%) mainly pneumothorax (6%), hemoptysis (6%), and sepsis (6%) Univariate analysis showed a significant association between pneumothorax and lesion depth (OR 0.68; 95% CI 0.65-0.92; p = 0.03) with a predicted probability > 5% for a depth < 4cm according to general linear model analysis. Univariate and multivariate analysis revealed a significant association between the number of biopsies and the risk of sepsis (OR 1.90; 95% CI 1.19-3.26; p = 0.01) with a predicted probability > 5% for more than 4 biopsies. Conclusion US-TTNB is a reliable diagnostic procedure that can be performed by pulmonologists. The depth, width, pleural contact of the lesion and the number of biopsies are key variables associated with diagnostic yield. The depth of the lesion is associated with the risk of pneumothorax, and the number of biopsies with the risk of pulmonary sepsis.

Comparison of diagnostic yield and safety of endobronchial ultrasound-guided mediastinal lymph nodal cryobiopsy and endobronchial ultrasound-guided Franseen tip needle biopsy.

In this prospective study, we evaluated the diagnostic yield and safety of two endobronchial ultrasound (EBUS) biopsy techniques - mediastinal cryobiopsy (EBUS-MCB) and Franseen tip needle biopsy (EBUS-ANB) - in patients with undiagnosed mediastinal lymphadenopathy. The study included 30 patients who underwent both EBUS-MCB and EBUS-ANB, with four biopsies taken from each patient using both methods. The results demonstrated that EBUS-MCB provided a higher diagnostic yield (96.4%) compared to EBUS-ANB (73.3%). Specimens from EBUS-MCB showed fewer artifacts and a higher density of granulomas and were adequate for ancillary studies in all cases. The most common complication observed was minor bleeding, which was more common with EBUS-MCB (36.6% versus 13.3%, p=0.04). This study demonstrates that EBUS-guided cryobiopsy has a higher diagnostic yield when compared to EBUS-guided Franseen tip needle biopsy and that both biopsy techniques have an acceptable safety profile. Larger studies comparing these two techniques are necessary to confirm the findings of the current study.

Comparing core needle biopsy and surgical excision in breast cancer diagnosis: implications for clinical practice from a retrospective cohort study.

Preoperative ultrasound-guided core needle biopsy (CNB) is currently the standard procedure for managing breast illnesses. However, the differences in outcomes between CNB and surgical excision (SE) have not been thoroughly assessed. This study aimed to explore the disparities in pathological outcomes between these two procedures, using a large sample dataset. This retrospective study consecutively included patients who underwent CNB and SE at Shenzhen People's Hospital from May 2016 to June 2023. Immunohistochemistry (IHC) was utilized to determine the status of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor-2 (HER2), and Ki-67. Patients presenting with HER2 IHC 2+ underwent additional fluorescence in situ hybridization (FISH) examination. The cutoff value for high Ki-67 expression was established at 14%. Molecular subtypes were classified into four groups (Luminal A, Luminal B, Triple-negative, and HER2-positive) and five groups [Luminal A, Luminal B+ (HER2-positive), Luminal B- (HER2-negative), Triple-negative, and HER2-positive], based on different criteria. A total of 4,209 patients were included in this study. Post-surgical confirmation revealed 2,410 cases as benign and 1,799 as malignant. Among the malignant cases, 334 were excluded due to either not having undergone direct surgery or having incomplete IHC results. The remaining 1,465 cases underwent IHC testing. CNB demonstrated a 97% concordance rate (CR) in diagnosing benign cases. The CRs for diagnosing invasive breast cancer (IBC) and carcinoma in situ (CIS) were 92% and 54%, respectively. ER, PgR, HER2, and Ki-67 exhibited CRs of 94%, 91%, 98%, and 84%, respectively. In the four-group classification, the overall diagnostic CR was 82%, with CRs for Luminal A, Luminal B, HER2-positive, and triple-negative breast cancer (TNBC) being 84%, 82%, 78%, and 85%, respectively. Under the five-group classification, the overall diagnostic CR was also 82%, with CRs for Luminal A, Luminal B+, Luminal B-, HER2-positive, and TNBC being 86%, 85%, 94%, 88%, and 92%, respectively. This study demonstrates that CNB is highly accurate in differentiating benign from malignant breast lesions, particularly showing significant consistency in the diagnosis of molecular subtypes, providing a reliable reference for clinical diagnosis.

Molecular mechanisms impact on fluoroquinolone resistance among E.coli from enteric carriage monitoring before prostate biopsy and earliest description of qnrB81

Fluoroquinolone-resistant (FQs-R) microorganisms causing infectious complications after ultrasound-guided needle biopsy of the prostate (TRUS-BP) have become an important challenge in healthcare settings globally, questioning the continued utility of FQ as the preferred prophylactic agent. This study aimed to characterize molecular mechanisms of resistance on FQs-R E. coli isolated from the enteric microbiota of patients undergoing (TRUS-BP) and to highlight their impact on Minimum Inhibitory Concentrations (MICs). From February 2016 to December 2018, the incidence of rectal carriage of Qs-FQs resistant Enterobacterales detected from rectal swabs of patients before undergoing (TRUS-BP) was 61.06% (80/131) all related to E. coli species. Based on the MICs range of Qs (24–256 mg/L) and FQs (0.24–128 mg/L) breakpoint by EUCAST, we categorized these E. coli isolates into three resistance profiles (I, II, and III) associated with the patterns of chromosomal mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC and the plasmid-mediated quinolone resistance encoding genes (PMQRs) detected by PCR-based assay and sequencing; MICs increase in an escalation step according to the co-occurrence of multiple molecular mechanisms. The mutation of the gyrA gene was the most frequent on codons (Ser83Leu/Thr/Tyr/Trp and Asp87Asn); mutation on the parC gene was the least on codons (Ser80Iso/Leu and Glu84 Val/Gly/Lys). PMQRs genes (4 qnrB ,7 qnrS, and one aac(6’)-Ib-cr) were determined within 15% of the isolates. Allelic variation allows us to report earliest the qnrB81 determinant in an E. coli isolate. Among isolates (35%) belonged to the notorious ST131 lineage. The phylogenetic group showed a predominance of B2 group (51, 25%), however (PFGE) revealed a high level of clonal variability. Worrying incidence of FQs-R E. coli isolates in the rectal flora of our local population showed the potential to cause post-infection. FQ resistance is a complex interplay between mutations in the QRDRs and PMQR determinants that impact MICs. The importance of intestinal microbiota as a reservoir of resistant strains and pandemic clones encourages driving mitigation challenges to characterize molecular mechanisms of antimicrobial resistance to adapt prophylactic therapy, control infection, and ensure epidemiological monitoring.

The histologic diagnosis and the management of cystic neutrophilic granulomatous mastitis: a case report

BackgroundCystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment.Case presentationA 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement.ConclusionCystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation.

Feasibility, efficacy, and safety of core needle biopsy as a first-line method for cervical lymphadenopathy.

This study aimed to determine the feasibility, diagnostic efficacy, and safety of ultrasound-guided core needle biopsy (CNB) as a first-line biopsy method for cervical lymphadenopathy of non-thyroid origin. This retrospective cohort study included consecutive patients with cervical lymphadenopathy in whom US-guided CNB was used as the first-line biopsy method for cervical lymph nodes (LNs) of presumed non-thyroid origin. The coaxial CNB technique was routinely used, while the tilting and hydrodissection CNB techniques were selectively employed for small high-risk LNs. The primary endpoint of this study was the diagnostic efficacy of CNB, evaluated by the rate of inconclusive results (nondiagnostic and indeterminate) and diagnostic accuracy (criterion 1: malignant results; criterion 2: malignant or indeterminate result). The secondary outcomes included the feasibility and safety of CNB, assessed based on the technical success rate and complication rate, respectively. The rates of nondiagnostic, indeterminate, and inconclusive results were 0.7%, 3.4%, and 4.1%, respectively. The sensitivity, specificity, and accuracy of CNB for malignant LNs were 96.2%, 100%, and 97.8%, respectively, with criterion 1, and these values were all 99.8% with criterion 2. The technical success rate of CNB was 99.3%. There were no major complications and 7 cases (0.6%) of minor complications (asymptomatic hematomas). CNB was technically feasible, effective, and safe as a first-line biopsy method for cervical lymphadenopathy of non-thyroid origin with high diagnostic accuracy for malignant nodal disease. Question The role of US-guided CNB as a first-line biopsy method for cervical LNs has not yet been verified and established. Findings US-guided CNB, as a first-line method, demonstrated a high technical success rate and diagnostic accuracy for malignant nodes, with few minor complications. Clinical relevance US-guided CNB can be used as an effective first-line biopsy method for cervical lymphadenopathy and will enable accurate diagnosis of malignant LNs.

Ultrasound-Guided Needling Combined With High- or Low-Energy Extracorporeal Shock Wave Therapy Versus Needling Alone for Calcified Rotator Cuff: A Retrospective Study.

Rotator cuff calcific tendinitis is a common shoulder joint disorder. Nonsurgical treatment methods, including multiple needling and extracorporeal shock wave therapy (ESWT), can effectively treat calcific tendinitis. To evaluate the clinical results and radiological outcomes of treatment with ultrasound-guided needling (UGN) alone versus UGN with high-energy ESWT (UGN-H) or UGN with low-energy ESWT (UGN-L) in patients with calcific tendinitis of the rotator cuff. Cohort study; Level of evidence, 3. Outpatient records for patients with calcific tendinitis of the rotator cuff were evaluated retrospectively. Patients were grouped into those treated with UGN-H, UGN-L, or controls with UGN alone. The visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) scores, Constant-Murley scores, and radiographic evaluation to assess calcification size were available before treatment and at 3, 6, and 12 months after the first treatment. Post event pairwise analysis to analyze score differences between treatment groups was used. Overall, 130 patients were included for analysis (42 UGN-H, 44 UGN-L, and 44 with UGN alone). At 3 months, the VAS scores were UGN-H (4.13 ± 0.84; P < .001) and UGN-L (4.47 ± 1.01; P < .001) which were significantly better than UGN alone (5.35 ± 1.00) in terms of the VAS score; however, the difference was not significant between UGN-H and UGN-L. These differences persisted at months 6 and 12 (6 months: UGN-H, 2.66 ± 1.00; P < .001; UGN-L, 3.16 ± 1.05; P = .033; 12 months: UGN-H, 1.93 ± 0.43; P < .001; UGN-L, 2.04 ± 0.46; P < .001). The results of the ASES and Constant-Murley scores were similar to those of the VAS score. In terms of radiographic outcome, follow-up at months 3, 6, and 12 revealed that UGN-H and UGN-L were superior to UGN alone at removing calcification (median 95% CI; 3 months: UGN-H, 1.4 mm2 [1.08, 7.25 mm2); P = .002; UGN-L, 5.79 mm2 (1.17, 7.85 mm2]; P = .041; 6 months: UGN-H, 0.91 mm2 [0, 1.15 mm2); P < .001; UGN-L, 1.13 mm2 [0.84, 5.10 mm2]; P < .001; 12 months: UGN-H, 0 mm2 [0, 0 mm2]; P < .001; UGN-L, 0 mm2 (0, 4.33 mm2]; P = .023). There was no significant difference between UGN-H and UGN-L at the month 3 follow-up, but the month 6 and 12 follow-ups revealed that UGN-H was more effective at removing calcification compared with UGN-L. The study demonstrated that, for pain relief and recovery of shoulder joint function, UGN + ESWT was significantly superior to UGN alone. No significant difference was observed between different energy levels of ESWT. UGN + ESWT was significantly superior to UGN alone on radiographic evaluation. Furthermore, UGN-H performed better radiographically with reducing calcifications compared with UGN-L at 12 months.

A Clinicopathologic Study of 1598 Ultrasound-Guided Needle Prostate Biopsies and Trends in Prostate Cancer Over a 14-Year Period

BackgroundProstate cancer manifests in various forms, ranging from occult and localized to metastatic disease. Analyzing prostate biopsies offers insights into histopathological characteristics, enhancing disease understanding and management. MethodsThis 14-year study reviewed ultrasound-guided needle prostate biopsies, collecting data via questionnaires and medical records, focusing on Gleason group, tumor involvement percentage, and predicted cancer stage. A comparative analysis across 2 distinct 7-year intervals was conducted. Statistical analyses included the Kolmogorov–Smirnov test, chi-square test, Fisher's exact test, and Analysis of Covariance, all performed using SPSS software. ResultsAmong 1,598 biopsies, 624 cases of adenocarcinoma were identified. Malignancy incidence significantly correlated positively with age, prostate-specific antigen (PSA), and PSA density (PSAD), and inversely with prostate volume and the free-to-total PSA ratio (%fPSA). Notably, 30.8% of malignancies were classified as Gleason groups 4 or 5, displaying significantly higher PSA levels. Patients with prior transurethral resection of the prostate exhibited increased malignancy rates and higher Gleason groups. Diagnostic accuracy, measured by Area Under the Curve, was 0.719 for PSA, 0.730 for %fPSA, and 0.817 for PSAD. The later phase of the study showed higher cancer detection, lower PSA levels, and a greater incidence of higher Gleason groups despite a lower predicted stage. ConclusionThe prevalence of higher Gleason groups was similar to other studies. PSAD demonstrated greater diagnostic reliability than PSA alone. Additionally, higher malignancy rates and Gleason groups were observed in patients with prior transurethral resection of the prostate. The increase in cancer detection rates during the second period likely indicates improved biopsy candidate selection.

Role of Image-Guided Biopsy in Nonpalpable Breast Lesions: A Study in the Sub-Himalayan Region of North India

Background Nonpalpable breast lesions pose a challenge in their early diagnosis. Image-guided biopsy is preferred in these cases so that a pathological diagnosis of breast carcinoma is reached timely for a better prognosis as the disease has an increased chance of successful outcome with early identification and treatment. Objective The study aims at evaluating the role of stereotactic core needle biopsy (CNB) and percutaneous ultrasound-guided core needle biopsy (US-CNB) in diagnosing suspicious nonpalpable breast lesions. Methods Our study included 35 patients with nonpalpable breast lesions and having a Breast Imaging Reporting and Data System (BI-RADS) risk assessment category IV or V on mammography or sonography. These 35 lesions were subjected to percutaneous image-guided (stereotactic or US) biopsy for histopathological analysis. Results Out of a total of 35 cases, 17 were pathologically malignant (48.6%), with the most common subtype being invasive ductal carcinoma (82.3%). Twenty-nine cases underwent US-CNB, 16 (55.1%) of which were malignant and 13 (44.8%) were benign on histopathological evaluation (HPE). The remaining six cases, which on mammography showed no mass but suspicious malignant calcification only, were subjected to stereotactic CNB, out of which one (16.6%) was malignant and five (83.3%) were benign on HPE. Hence, the lesions visible on sonography were more likely to be malignant. Conclusion Sonography and mammography play a complimentary role in detecting breast carcinoma. Percutaneous biopsy under image guidance can be used as an accurate diagnostic alternative to open surgical excisional biopsy to avoid diagnostic delay.

Examining the false-negative rate of a negative axillary node ultrasound-guided core needle biopsy in breast cancer patients undergoing upfront surgery

BackgroundAxillary assessment in breast cancer is key to determining an upfront surgery or neoadjuvant chemotherapy (NAC) approach. We investigated the false-negative rate (FNR) of axillary-node ultrasound-guided core-needle biopsy (US-CNBx) and the surgical management of pN ​+ ​patients. MethodsThis single-institution study from 2010 to 2020 included patients with benign findings on US-CNBx and upfront surgery. Statistical analyses were performed via t-tests and chi-squared tests. Results95 axillae met inclusion, 23 were pN+, resulting in a US-CNBx FNR of 24.2 ​%. pN ​+ ​patients more frequently had cT2-T3 tumors vs pN0 patients (43.5 ​% vs 27.8 ​%, p ​= ​0.03). Of the 23 ​pN ​+ ​patients, 9 underwent breast-conserving surgery (BCS) and 14 underwent mastectomy. In those with BCS, 7 had 1–2 positive nodes, 2 had ≥3 nodes; 3 received an ALND. In those with mastectomies, 12 had 1–2 positive nodes, 2 had ≥3 positive nodes; 6 received an ALND. ConclusionIn this cohort, US-CNBx had a FNR of 24.2 ​%. pN ​+ ​patients had a greater frequency of cT2–cT3 tumors, therefore clinicians should be cognizant of potential occult nodal disease despite negative CNBx when deciding management.

Pleomorphic Lobular Carcinoma In Situ Composed of Signet-Ring Cells Mimicking Ductal Carcinoma In Situ with A Papillary Pattern: A Case Report.

While some forms of invasive or in situ carcinoma of the breast may be partly composed of signet-ring cells, signet-ring cells rarely become a prominent feature of pleomorphic lobular carcinoma in situ (LCIS). We report a rare example of pleomorphic LCIS composed predominantly of signet-ring cells with a papillary pattern mimicking ductal carcinoma in situ (DCIS). A 58-year-old woman presented with a mass in the left breast detected by ultrasonography. Fourteen years previously, the patient underwent right breast-conserving surgery for invasive breast carcinoma of no special type. Ultrasonography revealed an irregular parallel, angular hypoechoic mass measuring 1.5 cm in the left breast. An ultrasound-guided core needle core biopsy was conducted. Microscopically, the lesion was composed of epithelial cells supported by a fibrovascular stroma. The majority (> 70%) of the lesional cells between the fibrovascular stalks showed signet-ring cell features. Some of the nuclei of the signet-ring cells showed intermediate-grade atypia. A mucicarmine stain showed intracytoplasmic mucin in the signet-ring cells. Immunohistochemistry for E-cadherin was negative in the tumor cells. After surgical excision, the final diagnosis was a pleomorphic LCIS. To our knowledge, there have been no previous reports of pleomorphic LCIS consisting primarily of signet-ring cells with a papillary pattern.

Diagnosis of pleural tuberculosis in the era of thoracoscopic surgery

Background Before thoracoscopic surgery, diagnosing tuberculous (TB) pleurisy was a medical challenge. Thoracoscopy is the most accurate but expensive method for TB pleurisy diagnosis. TB is common in low-income countries, where financial limitations prevent the use of thoracoscopy, motivating the search for a cheaper alternative. Patients and methods A prospective study was done from January 2019 to January 2023 to evaluate diagnostic methods for patients with exudative pleural effusions (PE) of unknown etiologies. The demographic, radiological, procedural, and histological data of exudative PE patients were analyzed. All patients were examined for adenosine deaminase (ADA) and lymphocyte/neutrophil ratio in pleural fluid. Ultrasound-guided Abrams needle biopsy and video-assisted thoracoscopic surgery pleural biopsies were obtained, and histopathological results were assessed. Results Of 250 patients with PE, 161 (64%) had TB PE, 72 (28.8%) had malignant PE, and 17 (6.8%) had idiopathic PE. Sensitivity of ADA (≥40 U/l) was 88%, lymphocyte/neutrophil ratio (≥0.75) was 86.1%, and their overall sensitivity was 91%. They had 93.2, 86.3, and 100% specificity, respectively. For ultrasound-guided Abrams needle biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 66, 46.5, and 78.4%, respectively. All were 100% specific. For thoracoscopic biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 100, 86.6, and 100%, respectively. All were 100% specific. The assay sensitivity of pleural fluid and tissue Xpert Mycobacterium tuberculosis/rifampin resistance was 12.5 and 49.7%, respectively. Both were 100% specific. Combining ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and an ultrasound-guided Abrams needle biopsy yielded 92.4% sensitivity and 100% specificity. Conclusion Combining pleural fluid ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and ultrasound-guided Abrams needle biopsy can accurately detect TB PE in high-TB populations. It may be an affordable alternative to thoracoscopy in countries with limited resources.

Assessment of ultrasound-guided tru-cut needle pleural biopsy in the diagnosis of unexplained exudative pleural effusion compared to medical thoracoscopy

Background Ultrasound-guided needle biopsy (USGNB) allows for precise and immediate viewing of pleural lesions, effusions, and needle placement without ionizing radiation. This study aimed to assess the efficacy of US-guided tru-cut needle pleural biopsy in diagnosing unexplained exudative pleural effusion compared to medical thoracoscopy (MT), focusing on safety, accuracy, time, and cost of the treatment. Patients and methods This observational cross-sectional research was conducted on 40 patients over 18 years old, of both sexes, with unexplained exudative pleural effusion. The patients were randomly separated into two equal groups. The girst group is USGNB and the second group is MT. Results Group II exhibited substantially greater costs, sedation levels, procedure duration, biopsy site discomfort, surgical emphysema, lung expansion failure, and psychological distress compared to group I (P&lt;0.05). There was no notable disparity between the two groups regarding radiological detection of pleural effusion, pleural fluid properties, procedural observations, histological results, and diagnostic effectiveness. The duration of hospitalization was considerably shorter in group I compared to group II, assessed from the day of the operation to the day of release (P=0.001). Conclusion USGNB is an important tool in the diagnosis of pleural effusion after failure of pleural fluid analysis, which is performed by a chest physician is an accurate, safer, lower in cost, and shorter in duration with fewer complications compared with MT.

274 - Comparative Study of Ultrasound-Guided Dry Needling vs. Exercise Intervention for Managing Pelvic Pain and Improving Bladder Neck Motility in Myofascial Pelvic Pain Syndrome: A Prospective Cohort Study

274 - Comparative Study of Ultrasound-Guided Dry Needling vs. Exercise Intervention for Managing Pelvic Pain and Improving Bladder Neck Motility in Myofascial Pelvic Pain Syndrome: A Prospective Cohort Study

Ultrasound-guided core needle biopsy of deep fascia: A cadaveric study evaluating feasibility, accuracy and reliability.

Over the past few decades, researchers and clinicians have dedicated significant attention to fascial tissues. Current interest focuses on their anatomical and pathophysiological features. Breakthroughs in ultrasound (US) and magnetic resonance imaging (MRI) have enhanced our ability to study the dynamics and alterations of the tissue structures. However, a microscopic perspective is also essential for a comprehensive understanding of some pathologies of the fasciae. The aim of this study was to investigate, using a cadaveric study: (1) the ease of visualization of the landmarks used for the US-guided fascial core needle biopsy (CNB); (2) the consistency and accuracy of needle placement inside fascial layers using US guidance and confirmed by histological examination; (3) inter-rater reliability. We assessed the feasibility of US-guided CNB in different topographical regions of human cadavers: the thoracolumbar fascia (TLF), fascia lata (FL), and crural fascia (CF). The results, confirmed by histological examination, revealed no significant difference in needle placements between the in-plane approaches in the long and short axes for all locations and fasciae studied (long axis: 91.88%; short axis: 96.22%); p > 0.05. US-guided core needle biopsy with the in-plane approach is feasible, consistent and reliable. It could provide most or all of high-quality fascial tissue samples required for pathological examination. It could also reveal changes in fascial pathologies, capturing the exact site of pathology thanks to US guidance, in particular in patchy diseases such as eosinophilic fasciitis.

Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial

PurposeThis study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. MethodsIn this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. ResultsAt all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). ConclusionUltrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.

EZH2 mutation is associated with the development of visceral metastasis by enhancing proliferation and invasion and inhibiting apoptosis in breast cancer cells

BackgroundThe prognosis of breast cancer patients with visceral metastasis (VM) is significantly worse than that of patients without VM. We aimed to evaluate EZH2 (enhancer of zeste homolog 2) mutation as a biomarker associated with VM.MethodsData from forty-nine patients with metastatic breast cancer (MBC) pathologically confirmed at our hospital between March 2016 and September 2018 were collected. Metastatic tissue samples were obtained via ultrasound-guided needle biopsy, and paired peripheral blood samples were also collected. Tissue and blood samples were subjected to targeted next-generation sequencing via a 247-gene panel. Stably transfected MDA-MB-231 cells expressing wild-type EZH2 (EZH2WT) or a mutant form of EZH2 (EZH2K515R) were generated. Cell proliferation, colony formation ability, migration and invasion abilities and apoptosis were assessed using CCK-8 assays, plate colony formation assays, Transwell chamber assays and flow cytometry.ResultsThe incidence of EZH2 mutations in the VM subgroup was greater than that in the non-VM subgroup in the entire cohort (n = 49, 42.3% vs. 13.0%, p = 0.024) and in the triple-negative breast cancer (TNBC) subgroup (n = 20, 50.0% vs. 10.0%, p = 0.05). Patients carrying EZH2 mutations had a significantly greater risk of developing VM than did those in the non-EZH2 mutation group in the entire cohort (HR 2.9) and in the TNBC subgroup (HR 6.45). Multivariate analysis revealed that EZH2 mutation was an independent prognostic factor for VM (HR 2.99, p = 0.009) in the entire cohort and in the TNBC subgroup (HR 10.1, p = 0.006). Data from cBioPortal also showed that patients with EZH2 mutations had a significantly greater risk of developing VM (HR 3.1), and the time to develop VM was significantly earlier in the EZH2 mutation group (31.5 months vs. 109.7 months, p = 0.008). Multivariate analysis revealed that EZH2 mutation (HR 2.73, p = 0.026) was an independent factor for VM after breast cancer surgery. There was no correlation between EZH2 mutations and BRCA1/2 mutations. Most of the patients (81.8%) in our cohort who developed VM carried the “c.1544A > G (p.K515R)” mutation. Compared with EZH2WT MDA-MB-231 cells, EZH2K515R MDA-MB-231 cells had greater colony formation rates (p < 0.01), greater migration and invasion rates (p < 0.001), and lower apoptosis rates (p < 0.01). The proportion of S + G2/M phase cells in the EZH2K515R group was significantly greater than that in the EZH2WT group.ConclusionsEZH2 mutation is associated with VM development in breast cancer patients. The EZH2K515R mutation leads to VM and a poor prognosis by enhancing proliferation and invasion and inhibiting apoptosis in breast cancer cells.

Ultrasound-guided percutaneous needle release of the A1 pulley and its cost in patients with stenosing tenosynovitis

Ultrasound-guided percutaneous needle release of the A1 pulley and its cost in patients with stenosing tenosynovitis

Transesophageal ultrasound-guided bronchoscopic Acquire TBNB versus Vizishot2 TBNA needles for neoplastic lesions: A retrospective study

BackgroundLung cancer is often diagnosed at an advanced stage; however, it has shown improved therapeutic efficacy with the introduction of molecularly targeted drugs and immune checkpoint inhibitors, necessitating accurate molecular diagnosis for effective treatment planning. Traditional sampling techniques, including endobronchial ultrasound-guided transbronchial needle aspiration, frequently require multiple biopsies to obtain sufficient tissues for multiplex testing, highlighting the need for more efficient methods. Therefore, we explored the diagnostic utility of endoscopic ultrasound with bronchoscope-guided fine-needle biopsy (EUS-B-FNB) versus fine-needle aspiration (EUS-B-FNA) in patients with lung cancer, focusing on tissue sample collection for molecular testing. The introduction of the Franseen needle in EUS-B-FNB, characterized by three beveled edges, allows for more tissue collection in cylinder form. MethodsWe retrospectively analyzed the data of 97 patients who underwent EUS-B-FNB or EUS-B-FNA at Hakodate Goryoukaku Hospital and evaluated diagnostic yields, safety, and nucleic acid concentrations using collected specimens. ResultsThe diagnostic yields of EUS-B-FNB and EUS-B-FNA were comparable (92.2% vs. 92.3%), with no significant differences in complications. However, EUS-B-FNB provided significantly higher DNA and RNA concentrations (DNA; 41.05 vs. 10.20 ng/mL; P < 0.0001, RNA; 36.80 vs. 11.80 ng/mL; P = 0.0009), essential for comprehensive molecular testing. ConclusionThis study highlights the potential of EUS-B-FNB for enhancing the molecular diagnosis of lung cancer by ensuring adequate tissue sample collection for multiplex testing, paving the way for personalized medicine. This technique is comparable in safety and efficacy to traditional methods while offering a substantial improvement in the quality of molecular diagnostics.

343. DIAGNOSTIC VALUE OF ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSESOPHAGEAL NEEDLE ASPIRATION (EBUS-TENA) IN LESIONS ADJACENT TO BOTH THE TRACHEA/BRONCHUS AND ESOPHAGUS

Abstract Objective To investigate the clinical diagnostic value of endobronchial ultrasound-guided transesophageal needle aspiration (EBUS-TENA) in lesions adjacent to both the trachea/bronchus and esophagus Methods The clinical data of 12 patients who underwent EBUS-TENA from February 2019 to February 2022 were collected. The operative physicians and nurses worked closely with each other and meticulously cared the patients. The vital signs changes were observed and recorded, as well as intraoperative adverse events and the acquired specimens. Results All the 12 patients underwent surgery successfully, and hair-like tissue strips were obtained in each case. There were 8 cases of central lung cancer and 4 cases of mediastinal tumor. The preoperative vital signs scores showed no significant difference with the intraoperative and postoperative scores (P&amp;gt;0.05). A few complications occurred, including 2 case of mild cough, 2 case of nausea and vomiting, with no symptoms of severe cough and dyspnea, haemorrhage, mediastinal infection, pneumothorax, mediastinal emphysema and other complications. Conclusion EBUS-TENA has significant effect in successfully obtaining pathological tissue specimens especially for lesions adjacent to both the trachea/bronchus and esophagus, improving disease positive diagnosis rate, reducing patients discomfort and the risk of surgery.