US-guided Core Needle Biopsy Research Articles

Primary muscle lymphoma in an elderly patient: Ultrasound and magnetic resonance imaging findings

Muscle lymphoma is a rarely seen disorder and it constitutes 0.1% to 1.4% of all extranodal lymphomas. It may be seen as the intramuscular involvement of disseminated disease, as an extension from adjacent bone or lymph nodes or as primary extranodal lymphoma. An 83-year-old female patient presented with the complaint of pain and swelling at her right calf. Ultrasound (US) examination of the region demonstrated a hypoechoic appearance of the affected muscle and subcutaneous tissue. Magnetic resonance imaging of the right calf demonstrated the long segmental involvement of the flexor digitorumlongus muscle and the adjacent subcutaneous tissue with the increased T2 signal, vivid enhancement, and diffusion restriction. US-guided core needle biopsy of the muscle was performed and histopathological evaluation demonstrated a B cell lymphoma. Further imaging workup with computed tomography for staging purpose revealed no other organ/system or nodal involvement. The patient was diagnosed with primary muscle lymphoma and received chemotherapeutic drugs.

1900P - Real-world prospective data of small biopsy samples for tumor PD-L1 expression in non-small cell lung cancer

Background: PD-1 antibody has been effective in patients with PD-L1-positive advanced NSCLC. However, surgically resected specimens or core-needle biopsy samples were used to estimate drug potency in past clinical trials. Methods: The aim is to prospectively investigate small sample reliability for NSCLC to determine the PD-L1 expression status. We prospectively enrolled patients who underwent diagnostic biopsy by any procedures (bronchoscopy, CT/US-guided core-needle) from 2017.3 to 2018.3. Pathologically confirmed NSCLC PD-L1 expression was evaluated in our institution using companion diagnostic PD-L1 IHC. We evaluated: 1) the total number of tumor cells and sample size; 2) compared PD-L1 expression for each procedure using tumor proportion score: TPS (50%≦, 1∼49%, <1%), 3) the concordance rate of PD-L1 expression status by biopsy and surgical materials. Results: 137 cases of PD-L1 expression were evaluated. 112 cases were sampled by bronchoscopy (98 TBBs using BF-1T260/P260F in 23/75 cases, 20 TBNAs), and 25 cases of CT or US-guided core-needle biopsy. The TPS (50%≦ / 1∼49% / <1% / undiagnosed) for total cases was 31/29/37/3% respectively which was similar to the past report. In histological subtype, TPS for adenocarcinoma (n = 82) were 28/27/43/2% and squamous cell carcinoma (n = 49) were 35/35/27/4% respectively. TPS for TBBs using BF-P260F (thin bronchoscopy) were 20/33/43/4% and TBBs using BF-1T260 (normal bronchoscopy) were 48/22/30/0%. TPS for TBNAs were 50/25/25/0% and CT or US-guided sample showed 37/21/37/5%. Four cases were not able to be diagnosed for TPS because we couldn’t obtain enough tumor cells (less than 100 tumor cells) for diagnosis of TPS. The concordance rate of PD-L1 expression status by biopsy and surgical materials was 83.3% for comparison of 24 cases. Conclusions: Utilizing smaller samples to evaluate PD-L1 expression, the frequencies of TPS were comparable to past clinical trials which used larger samples for evaluating TPS. In this study, the larger samples showed higher PD-L1 expression than smaller samples due to their containing more squamous cell carcinoma cases or advanced stage. The concordance rate of PD-L1 expression for surgically resected tissue and biopsy sample was relatively good in our institution. Clinical trial identification: UMIN000027030. Legal entity responsible for the study: Kei Morikawa. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications.

The aim of this study was to assess diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) in lesions that manifest as mammographic BI-RADS 4 and 5 microcalcifications, in the setting of conjoined use of mammography, US, and MRI. Patients with mammographic BI-RADS 4 or 5 microcalcifications, without additional findings, were included in this prospective study. All patients subsequently underwent breast US and MRI. Histopathologic diagnosis, obtained by US-guided core-needle biopsy or surgical excision, served as a reference standard. Diagnostic accuracies of US and MRI were calculated, and positive predictive value for different MRI BI-RADS imaging features were determined. The study group consisted of 113 women with 125 areas of suspicious microcalcifications. MRI reached sensitivity, specificity, positive predictive value 3 (PPV3), and negative predictive value (NPV) of 100%, 70.1%, 67.6%, and 100%, respectively. Statistically significant differences in MRI morphologic features and kinetic enhancement curves were observed between malignant and benign microcalcifications. Sensitivity, specificity, PPV3, and NPV for US were: 85.4%, 66.2%, 61.2%, and 87.9%. There was statistically significant difference in presentation of malignant and benign microcalcifications at US. In the setting of conjoined use of mammography, US, and MRI, MRI can reliably exclude malignancy in suspicious microcalcifications. Thus, negative MRI findings may influence the decision to biopsy the microcalcifications.

Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters

PurposeTo investigate the most effective cutoff values for shear-wave elastography (SWE) for differentiating benign and malignant breast lesions and to evaluate the diagnostic performance of quantitative and qualitative SWE in combination with B-mode ultrasound (US). Methods209 breast lesions from 200 patients were evaluated with B-mode US and SWE. Pathologic results determined by US-guided core needle biopsy or surgical excisions were used as a reference standard. Qualitative (four-color pattern) and quantitative analyses (Emean, Emax, SD, and E ratio) were performed. The cut-off values were defined using Youden's index. The diagnostic performance of B-mode US and combination of B-mode US with four-color pattern or quantitative parameters were compared. ResultsOf the 209 breast lesions, 102 were benign and 107 were malignant. All qualitative and quantitative SWE parameters had significantly higher specificity, positive predictive value (PPV), and accuracy compared to B-mode US (p < 0.001). The optimal cutoff values for the Emax, Emean, SD and E ratio were 145.7 kPa, 89.1 kPa, 11.9, and 3.84, respectively. The optimal cutoff for color pattern was between 3 and 4. Combined B-mode US and Emax had the highest improvement, from 17.65% to 98.04% for specificity and from 58.85% to 82.78% for accuracy, with a decrease in sensitivity compared with B-mode. ConclusionQuantitative and qualitative SWE combined with B-mode US improved the accuracy to differentiate benign from malignant lesions. Emax (cutoff, 145.7 kPa) appeared to be the most discriminatory parameter.

Complications following ultrasound-guided core needle biopsy of thyroid nodules: a systematic review and meta-analysis.

To identify the complication rate associated with US-guided core needle biopsy (CNB) of thyroid lesions using a systematic review and meta-analysis. Ovid-MEDLINE and EMBASE databases were searched for studies on US-guided CNB of thyroid lesions from 1 January 1994-13 December 2016. A review of 393 potential papers identified 39 eligible papers including 14,818 patients. The pooled proportions of complications were assessed using random-effects modelling. Subgroup analysis was performed. Among-study heterogeneity was explored using χ2 statistic for pooled estimates and inconsistency index I2. Quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies. The pooled proportion of overall complications after CNB of thyroid lesions was 1.11% (95% CI: 0.64-1.51, I2: 87.2%). The pooled proportion of major complications (0.06% [95% CI: 0.02-0.10], I2: 0.0%) was much lower than that of minor complications (1.08%[95% CI: 0.63-1.53], I2: 93.17%). Subgroup analysis revealed no significant differences between studies on Asian versus non-Asian groups (p=0.7769), radiologist versus non-radiologist groups (p=0.8607), nodule size <20 mm versus nodule size ≥20 mm (p=0.1591) groups, CNB versus CNB-plus-FNA groups (p=0.9281) and studies performed before and after 2012 (p=0.6251). The overall quality of the included studies was moderate with all of the studies satisfying five or more of the eight total domains. Various complications can occur after US-guided CNB of thyroid lesions. However, the procedure is safe, with a low complication rate. • Various complications occurred after CNB of thyroid lesions, but the pooled complication rate was low (1.11%, I 2 = 87.2%). • The pooled proportion of major complications (0.06%) was much lower than that of minor complications (1.08%). • There was no significant differences between studies on Asian vs. non-Asian groups, radiologist vs. non-radiologist groups, nodule size <20 mm vs. nodule size ≥20 mm groups, CNB vs. CNB-plus-FNA groups, or studies performed before 2012 vs. after 2012.

Breast lesions diagnosed by ultrasound-guided core needle biopsy: Can shearwave elastography predict histologic upgrade after surgery or vaccuum assisted excision?

PurposeTo compare breast stiffness based on shear-wave elastography (SWE) quantitative parameters with histopathologic results diagnosed by ultrasound (US)-guided core needle biopsy (CNB) to determine their association with upgrade rates after surgical excision or follow-up US as well as clinico-radiologic differences between upgrade and non-upgrade groups. Materials and methodsThis retrospective study enrolled 225 breast lesions from 225 patients, including 159 benign lesions, 38 high risk lesions and 28 ductal carcinoma in situ (DCIS) diagnosed by US-guided CNB. Quantitative SWE parameters of breast lesions were measured before CNB and compared according to histopathologic results (benign, high risk and DCIS) and lesion size (<20 mm and >20 mm). Clinico-radiologic and pathologic factors were compared between upgrade and non-upgrade groups after surgical excision or follow-up US. ResultsAfter surgical excision or follow-up US after more than one year, 29 lesions were upgraded for an overall upgrade rate of 12.9% (29/225). There were significant differences between upgrade and non-upgrade groups in age, mammographic category, US category, and sonographic features, including shape, margin, orientation, imaging-histologic correlation and E ratio. Patients with lesion upgrade were much older and had lesions characterized by significantly higher mammographic and US category (>4b), irregular shape, nonparallel orientation, microlobulated or angular margin, calcification in a mass, larger size on US (>20 mm) and greater imaging-histologic discordance. Multivariate analysis showed only mean and minimum elasticity values displayed a borderline association with histologic underestimation. ConclusionUpgrade of breast lesions diagnosed by US-guided CNB can be predicted using Emean and Emin among quantitative SWE parameters.

Role of ultrasound in diagnosis and management of inflammatory breast diseases

Introduction Inflammatory breast diseases are frequently encountered clinical complaints, and they range from benign to malignant forms, namely inflammatory breast carcinoma (IBC). It is crucial to differentiate IBC from other types of mastitis because there are major differences in its prognosis and treatment. Ultrasound (US) is one of the main diagnostic tools for discriminating benign and malignant mastitis. US-guided aspiration and core needle biopsy are the mainstay in diagnosis and management of inflammatory breast diseases. Materials and methods The study is a prospective study that included 48 patients referred to the Radiology Department, Women’s Imaging Unit from the ‘Surgical Breast Clinic’, and surgical outpatient’s clinics and wards in the period between January 2016 and July 2016. US examination was performed for all the cases by 8–12 MHz linear array transducer. Full field digital mammography was performed for 33/48 patients. US-guided core biopsies of the breast were performed in indicated cases. Drainage under US guidance and cytological assessment was performed also in certain cases. Results In all, 36/48 (75%) cases were finally diagnosed as benign mastitis, and 12/48 (25%) cases were finally diagnosed as malignant. Within the examined group, 40/48 (83.3%) cases underwent short-term first look follow-up US study after a course of antibiotic therapy: seven/40 (17.5%) patients showed complete resolution of the symptoms and the diagnosis of simple infectious mastitis was confirmed, whereas 33/40 (82.5%) patients showed no response to treatment. Conclusion US plays a specific role in diagnostic approach and management of inflammatory breast diseases. It is essential to discriminate benign from malignant etiologies as there are major differences in their prognosis and treatment options.

Transvaginal Ultrasound-Guided Core Needle Biopsy of Pelvic Masses.

This study assessed the efficacy and safety of transvaginal ultrasound (US)-guided core needle biopsy (CNB) for obtaining adequate pelvic mass samples for histologic analysis and evaluated factors that may affect biopsy success. Two hundred cases underwent transvaginal US-guided CNBs for primary inoperable tumors, suspicion of metastases to the ovaries or peritoneum, recurrence, or other solid lesions in the pelvis. Biopsy samples were obtained from the pelvic cavity (67.0%), vaginal cuff or vaginal wall (17.5%), or peritoneal cake (15.5%). The potential influences of the biopsy site (pelvic cavity, vaginal cuff or vaginal wall, or peritoneal cake), vascularization, ascites, tumor size, and tumor type (inoperable, metastases, recurrence, or solid pelvic tumor) on the success of transvaginal US-guided CNB were evaluated by a univariate analysis. Adequate samples were obtained in 192 of 200 biopsies (96.0%), of which 190 yielded successful diagnoses (95.0%). The biopsy site had a significant effect on biopsy adequacy, as there was a significantly lower probability of obtaining satisfactory specimens for histologic verification from the peritoneal cake compared to pelvic tumors and the vaginal cuff or vaginal wall (P < .01). Adequacy was also affected by tumor size (P < .05) but not by vascularization, ascites, or tumor type. No complications occurred during the biopsy procedures. Transvaginal US-guided CNB is a safe and effective alternative to more invasive methods for evaluating pelvic lesions, such as laparoscopy and laparotomy.

Diagnostic accuracy and safety of US-guided core needle biopsy versus fine needle aspiration biopsy of thyroid nodules: a Meta analysis

Objective:To evaluate the efficacy and safety of core needle biopsy (CNB) and fine neon needle aspiration biopsy (FNAB) in the diagnosis of thyroid nodules.Method:The CNKI, Wanfang database, China Biomedical Literature Database (CBM), PubMed, Cochrane Library, EMBASE, Web of Science database (the deadline of February 2017) were used to search the literature on CNB and FNABCNB. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and evaluated the quality of the literature, and used RevMan 5.3 software for Meta analysis.Result:The accuracy of the CNB group was higher than that of the FNAB group(RR= 1.14, 95%CI: 1.06-1.22, P< 0.01). Meta analysis showed that the accuracy of CNB group compared with FNAB group was statistically significant the difference was statistically significant. There was no significant difference between the two groups (RR= 0.92, 95%CI:0.67-1.25, P> 0.05).Conclusion:CNB is safe and feasible in the diagnosis of thyroid nodules under the condition of mastery of puncture technique.

Effectiveness of Multimodality Imaging in Differential Diagnostics of Nonpalpable Breast Architectural Distortion

Objective:the aim of the study was to estimate the informative value of multimodality imaging in differential diagnostics of nonpalpable breast architectural distortion of different origin.Matherials and methods.We analyzed the results of multimodality examination of 307 women with nonpalpable breast architectural distortion of different origin. They underwent mammography, handheld sonography (B-mode), compressive elastosonography, Doppler angiography, automated breast volume US-scanning, US-guided core needle biopsy (n = 115; 38%) and stereotactic core needle biopsy (n = 192; 62%), pathomorphologic analysis. Results.Breast cancer were diagnosed in 221 (72%) women, benign lesions – in 86 (28%) women. Surgical treatment was performed In 254 (83%) cases and 31 (10%) breast lesions were removed with vacuum-assisted aspiration biopsy.Conclusion.Multimodality imaging with the invasive procedures gave 92.5% sensitivity, 100% specificity, 100% showed positive prognosis, 72.5% negative prognosis, 93.1% accuracy index.

The application of ultrasound in detecting lymph nodal recurrence in the treated neck of head and neck cancer patients

Early detection of neck lymph node (LN) recurrence is paramount in improving the prognosis of treated head and neck cancer patients. Ultrasound (US) with US-guided fine needle aspiration (FNA) and core needle biopsy (CNB) have been shown to have great accuracy for LN diagnoses in the untreated neck. However, in the treated neck with fibrosis, their roles are not clarified. Here, we retrospectively review 153 treated head and neck cancer patients who had received US and US-guided FNA/CNB. In multivariate logistic regression analyses, size (short-axis diameter >0.8 cm) (odds ratio (OR) 4.19, P = 0.007), round shape (short/long axis ratio >0.5) (OR 3.44, P = 0.03), heterogeneous internal echo (OR 3.92, P = 0.009) and irregular margin (OR 7.32, P < 0.001) are effective US features in predicting recurrent LNs in the treated neck. However, hypoechogenicity (OR 2.38, P = 0.289) and chaotic/absent vascular pattern (OR 3.04, P = 0.33) are ineffective. US-guided FNA (sensitivity/specificity: 95.24%/97.92%) is effective in the treated neck, though with high non-diagnostic rate (29.69%). US-guided CNB (sensitivity/specificity: 84.62%/100%) is also effective, though with low negative predictive value (62.5%). Overall, US with US-guided FNA/CNB are still effective diagnostic tools for neck nodal recurrence surveillance.

Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience.

PurposeThis study assessed the outcomes of ultrasound (US)-guided core needle biopsies (CNBs) of breast lesions with at least 2 years of follow-up to determine the false-negative rate and to evaluate the diagnostic accuracy of CNB.MethodsWe retrospectively analyzed 13,254 consecutive US-guided 14-gauge CNBs for breast lesions. We excluded biopsies if non-malignant biopsy result was not confirmed by surgical excision or US-guided vacuum-assisted biopsy, or fewer than 2 years of follow-up data were available. A total of 4,186 biopsies were excluded, and 9,068 breast masses from 7,039 women were included. The pathologic findings from each CNB were assessed using the standard diagnostic reference, defined based on the results of surgical excision, vacuum-assisted biopsy, or at least 2 years of long-term imaging follow-up. The false-negative rate and underestimation rate were calculated.ResultsOf the 9,068 CNBs, benign pathology was found in 64.2%, high-risk results in 3.5%, and malignant results in 32.3%. Of the 5,821 benign CNBs, an additional malignancy was found at excision in 63 lesions, leading to a false-negative rate of 2.0% (63 of 3,067). The underestimation rate was 33.6% (111 of 330) for ductal carcinoma in situ and 24.5% (79 of 322) for high-risk results at surgical excision. Most false-negative diagnoses (84.1%, 53 of 63) were recognized through imaging-histology correlations, and immediate rebiopsies were performed. Ten malignancies (15.9%, 10 of 63) had delayed diagnoses and showed progression in follow-up US imaging.ConclusionUS-guided 14-gauge CNB provided optimal diagnostic information. Imaging-histology correlations and appropriate imaging follow-up should be performed to avoid delayed diagnoses.

Ultrasound-Guided Core Needle Biopsy for Head and Neck Mass Lesions in Patients Undergoing Antiplatelet or Anticoagulation Therapy: A Preliminary Report

We compared the complications and diagnostic adequacy of ultrasound (US)-guided core needle biopsy (CNB) for head and neck mass lesions between patients who did and did not receive antiplatelet/anticoagulation therapy. This study was designed as a prospective case study including 146 consecutive patients who underwent US-guided CNB for head and neck mass lesions. Of these, 32 patients were undergoing antiplatelet/anticoagulation therapy involving aspirin, clopidogrel, cilostazol, and warfarin. None of the patients had clinical bleeding/hematoma in either group. Subclinical bleeding/hematoma recognized only by a US examination was not significantly different between the groups (P = .229). No other complications were noticed. The rate of unsatisfactory sampling was also not different between the groups (P > .999). Furthermore, when patients receiving aspirin (n = 18) were reclassified into the no-antiplatelet/anticoagulation therapy group, there was still no significant difference in the incidences of complications compared with the patients receiving clopidogrel, cilostazol, or warfarin (n = 14). Our study suggests that US-guided CNB is safe and provides good diagnostic results without necessitating the discontinuation of antiplatelet/anticoagulation therapy in patients with head and neck mass lesions. However, as this was a preliminary study, the cohort was relatively small. Larger studies are needed to confirm our findings.

Efficacy and safety of percutaneous ultrasound guided radiofrequency ablation for treating cervical metastatic lymph nodes from papillary thyroid carcinoma.

The aim of this study was to assess the effectiveness and safety of ultrasound guided percutaneous radiofrequency ablation (RFA) of cervical metastatic lymph nodes (LNs) from papillary thyroid carcinoma. 54 metastatic LNs confirmed by percutaneous biopsy in 33 patients with previous total thyroidectomy and radioiodine therapy were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before ablation. Follow-up consisted of conventional US, CEUS, thyroglobulin (Tg) level at 1, 3, 6, and 12 months and every 6 months thereafter. In 3 months after ablation, US-guided core needle biopsy (CNB) was performed in the center, at the edge of the ablation area to exclude recurrence. Technical success was obtained in all 54 lymph nodes (100%) without immediate or later major complications occurred. With a mean follow-up of 21 ± 4 months (range 12-24 months), there were no evidence of recurrence at ablated sites. After RFA, 33 metastatic LNs completely disappeared (33/54, 61.1%) and 21 metastatic lymph nodes remained as small scarlike lesions (21/54, 38.9%) at the last follow-up visit. The mean volume reduction ratio (VRR) was 32.7 ± 8.6% (range 21.2-59.3%), 46.8 ± 9.7% (range 33.6-68.1%), 62.5 ± 12.1% (range 42.5-95.4%), 77.1 ± 10.6% (range 54.3-100.0%), 89.2 ± 8.3% (range 68.7-100.0%) and 94.9 ± 5.3% (range 78.2-100.0%) at 1, 3, 6, 12, 18 and 24 months after RFA respectively. Significant differences in the VRR were found between every two follow-up visits (P < 0.001). At the last follow-up visit, the mean serum Tg level decreased from 10.2 ± 5.1ng/ml (range 0.8-16.2ng/ml) to 1.1 ± 0.8ng/ml (range 0.2-3.1ng/ml) (P < 0.001). Ultrasound guided percutaneous RFA for cervical metastatic LNs from papillary thyroid carcinoma is a feasible, effective and safe therapy. This procedure shows a nonsurgical therapeutic option that can eradicate the lesions with a very low complication rate.

Ultrasound-Pathology Discordant Nodules on Core-Needle Biopsy: Malignancy Risk and Management Strategy.

The reported malignancy rates of thyroid nodules that appear suspicious on ultrasound (US) but yield benign fine-needle aspiration (FNA) cytology results range from 13.6% to 56.6%. However, the malignancy risk of nodules that are discordant on US and core-needle biopsy (CNB) pathological findings has not been evaluated. This study evaluated the malignancy risk associated with thyroid nodules that are suspicious on US but yield benign CNB results. Between July 2008 and November 2011, 1309 patients with 1313 thyroid nodules underwent US-guided CNB. Among these, 166 thyroid nodules that were suspicious on US but yielded benign CNB results were retrospectively reviewed. Benign nodules were diagnosed by surgery, FNA, and/or CNB that was repeated at least twice or CNB and lesion size stability on follow-up. The malignancy risk of US-pathology discordant nodules was calculated according to recommendations by Moon et al., and a further evaluation was conducted using four different US risk systems. Factors that differentiated benign from malignant nodules were assessed using the chi-square test or Fisher's exact test. Moreover, the histological findings of US-pathology discordant nodules were analyzed. Patients with benign and malignant nodules did not differ significantly regarding clinical and demographic characteristics. Of the 166 US-pathology discordant nodules, seven (4.2%) were confirmed malignant. The malignancy risks associated with the five US risk systems ranged from 3.6% to 5.5%. Regarding suspicious US features, only the number of suspicious features was associated with malignancy (p = 0.002). Histological analysis of benign CNB specimens with suspicious US features revealed fibrosis (77.6%), thyroiditis (28.7%), calcifications (10.6%), and hemosiderin deposition (6.4%). The malignancy risk among thyroid nodules with discordant US and CNB results ranged from 3.6% to 5.5%, depending on US risk systems. However, repeated biopsy may be necessary for selected thyroid nodules with more than two suspicious US features.

Abstract P2-01-21: Preoperative axillary ultrasound guided needle sampling in breast cancer: Comparing the sensitivity of fine needle aspiration cytology and core needle biopsy

Abstract Background: Preoperative axillary ultrasound (US) combined with selective US-guided needle sampling (UNS) can be used to identify lymph node metastases. This can inform decisions about neoadjuvant chemotherapy and allow a patient to proceed immediately to axillary lymph node dissection (ALND) thus avoiding an extra sentinel node biopsy (SNB) procedure. We acknowledge the landmark ACOSOG Z0011 trial showing a subgroup of patients (T1-2) undergoing breast conserving surgery and whole-breast radiotherapy in which ALND can safely be omitted if they have minimal nodal disease burden. For these patients the utility of UNS may be limited if the surgeon has modified their practice according to the trial. For patients not fitting the Z0011 trial criteria, preoperative UNS remains important. Previous studies comparing the sensitivity of axillary US-guided fine needle aspiration cytology (FNA) and core needle biopsy (CNB) have been small and a meta-analysis has not shown a difference in sensitivity1. Our aim was to directly compare the sensitivity of the two techniques. Method: Patients with macrometastatic nodal involvement that were treated at a tertiary referral centre between January 2013 and December 2014 were retrospectively identified from pathology records. Preoperative UNS had been performed by one of eight Consultant Radiologists with the sampling method being according to each individual radiologist's preference. The result of the first UNS performed on each patient was compared to post-operative histopathology results. Patients who had undergone previous axillary surgery or any part of their investigations/treatment at another unit were excluded. Results: A total of 101 CNBs and 181 FNAs were performed in 282 patients. There were 78 true positive CNBs and 96 true positive FNAs. US-guided CNB was therefore more sensitive than US-guided FNA (77.2% vs. 53.0%, p=&amp;lt;0.001). Two non-diagnostic CNBs and eight non-diagnostic FNAs were performed. Five patients in the CNB group were correctly identified preoperatively as having isolated tumour cells (ITCs) or micrometastatic disease only in their axillary lymph nodes and were therefore triaged to SNB rather than ALND. A single haematoma requiring non-operative management was recorded in the CNB group. Conclusion: US-guided CNB of the axilla is more sensitive than US-guided FNA and is a safe technique in experienced hands. We also highlight the additional potential benefit (whilst accepting the possibility of sampling error) of CNB over FNA in assisting the multidisciplinary planning of axillary surgery in patients who are found to have ITCs or micrometastatic disease only during their preoperative axillary staging.

Ultrasonography and Ultrasound-Guided Intervention of Salivary Glands

An accurate diagnoses of salivary gland masse is clinically critical for optimal patients' management. A patient with sialadenitis, benign neoplasm or lymphoid hyperplasia may be treated conservatively. Patients with lymphoma may undergo chemotherapy or radiation therapy after systemic staging, while those with primary malignancy may be treated by surgery. Ultrasonography (US) has become an optimal diagnostic tool due to its non-invasiveness, non-irradiation, multi-planar capability and high portability. US-guided fine needle aspiration (USFNA) and US-guided core needle biopsy (USCNB) have also been used to increase the accuracy in diagnosing salivary gland masses. On sonograms, significant difference can be found between the benign and malignant lesions of parotid gland with respect to the shape. The benign neoplasms and lymphoid hyperplasia are more likely to have homogeneous texture, well-defined margin and round or oval shape; while the malignancies and inflammatory lesions tend to be heterogeneous with indistinct margin and irregular shape. USFNA is a well-accepted and widely used technique for the preliminary diagnosis of salivary gland masses. It is safe, fast, and well-tolerated. In the literature, on average, it has a high specificity (98%) but lower sensitivity (80%) in differentiating benign from malignant salivary gland masses. According to our reports, USFNA has a sensitivity of 71%, a specificity of 98%, and an accuracy of 94% in differentiating benign from malignant parotid masses. The corresponding figures for the USCNB are 98%, 100% and 98%, respectively. USCNB has positive and negative predictive values of 100% and 96%, respectively, in diagnosing malignancies. Thus, a positive diagnosis by FNAC is reliable, but the false-negative rate associated with FNAC may be unacceptable. Accurate diagnoses and sub-typing of lymphoma cannot be reliably made on the basis of cytology. A meta-analysis report on five studies with 277 cases published between 2002 and 2009 showed that the sensitivity of USCNB is 0.92 (95% CI, 0.77-0.98) and the specificity is 1.00 (95% CI, 0.76-1.00). It is concluded that USCNB has a high accuracy and a low (1.2%) inadequacy rate for diagnosing salivary gland masses. In this presentation, the techniques to avoid complications of USCNB will also be discussed.

Correlation Between Simultaneous Ultrasound-Guided Fine Needle Aspiration and Core Needle Biopsy Results in Thyroid Nodules of 44 Cases

Ultrasound (US)-guided fine needle aspiration biopsy (FNA) is currently the most common diagnostic method for determining surgical cases and preventing unnecessary surgery as it is easy, reliable and cost-effective. However, current multi-center studies indicate that about 5-47% of the cases that have undergone FNA are evaluated as inadequate/indeterminate for diagnosis due to factors related to the assessor, the technique and the pathologist's experience. It is reported that using US-guided percutaneous core needle biopsy (CNB) is useful, especially in cases where diagnostic surgery is planned as the cases have been reported as ‘Inadequate for diagnosis’ or ‘Atypia with unclear in significance/ Follicular lesion with unclear in significance(AUS/FLUS) after inadequate repetitive FNA results. Using FNA and CNB together has been reported to provide higher diagnostic sensitivity than either method alone in certain studies. The aim of this study is prospective evaluation of simultaneous US-guided FNA and CNB results of 44 cases who had thyroid nodules. All cases were evaluated according to the TIRADS classification used for sonographic malignancy risk categorization and recorded together with the demographic data (age/gender). FNAs were evaluated according to the Bethesda classification. We tried to adapt the results of the evaluated CNBs descriptively to the Bethesda classification to facilitate comparison of the methods. In our study, when the inadequate and indeterminate diagnosis groups were separated, all our cases diagnosed as benign and malignant with FNA and CNB were compliant. However, the ratio of insufficiency shows a significant elevation compared to CNB in our FNA procedures (4.54% vs. 43.18%). We observed that simultaneous FNA and CNB use decreased the inadequate/ indeterminate diagnosis group significantly.

Utility and Safety of Repeat Us-Guided Core Needle Biopsy of Focal Liver Masses

Utility and Safety of Repeat Us-Guided Core Needle Biopsy of Focal Liver Masses

Percutaneous microwave ablation for benign focal liver lesions: Initial clinical results.

Benign focal liver lesions (BFLLs) have become a common disease diagnosed in the clinical setting following the advancement of imaging techniques. The aim of the present study was to evaluate the safety and clinical outcomes of percutaneous microwave (MW) ablation, guided by ultrasound (US), for the treatment of BFLLs. Between May 2005 and January 2011, 44 BFLLs (mean maximum diameter, 33.9±13.1 mm) in 37 patients (23 women and 14 men) were treated by US-guided percutaneous MW ablation with cooled-shaft antennae. The pathological diagnosis of a BFLL was confirmed in 91.9% (34/37) of patients using a US-guided core needle biopsy prior to ablation. The BFLLs in the other 3 cases were diagnosed by typical presentations on contrast-enhanced imaging, as the patients refused to undergo biopsies. Five inclusion criteria, including indeterminate diagnoses of nodules on contrast-enhanced imaging prior to pathological verification, were recommended. The median follow-up period was 27.0 months (range, 6-73 months). The mean MW ablation energy and time were 55.0±41.6 kJ (range, 13.5-207 kJ) and 1,039.9±706.2 sec (range, 270-3,450 sec) per lesion, respectively. In total, 40 nodules (90.9%) were completely ablated, and no evidence of recurrence was demonstrated on contrast-enhanced imaging follow-up. The other 4 nodules (9.1%) were partially ablated due to the proximity of adjacent vital organs. Minor complications without sequelae included local pain and transient hemoglobinuria and no major complications occurred in peri-ablation. Overall, US-guided percutaneous MW ablation is a safe, effective and minimally invasive therapy for BFLLs in selected patients who are non-surgical candidates.