Yield Of Biopsy Research Articles

PATH-16. Noninvasive diagnosis of gliomas through CSF cfDNA sequencing in pediatric and adolescent and young adult (AYA) patients

Abstract PURPOSE: A subset of pediatric, adolescent and young adult (AYA) gliomas are located in the brainstem, eloquent locations, or present with diffuse/leptomeningeal disease, and are associated with high risk and low yield of biopsy. At the same time, accurate molecular diagnosis is necessary to direct optimal therapy. In such cases, analysis of cell free DNA (cfDNA) form cerebral spinal fluid (CSF) may represent a diagnostic alternative to biopsy. METHODS: We investigated the utility of CSF cfDNA sequencing through a stepwise approach, using clinically validated, targeted molecular assays. Testing was performed using a broad hybrid capture next generation sequencing assay (MSK-IMPACT) and subsequent targeted digital droplet PCR in a subset of cases. RESULTS: We analyzed 17 CSF samples from 17 pediatric (n=6) and AYA (n=11) glioma patients with primary or recurrent disease. Thirteen had tumors located within the brainstem, and four had leptomeningeal involvement. Somatic alterations were detected in 12/17 samples (71%). In 3/4 patients with leptomeningeal involvement, cfDNA testing revealed a BRAF fusion consistent with the diagnosis of diffuse leptomeningeal glioneuronal tumor (DLGNT). Among the 13 patients with brainstem involvement, four had somatic H3 K27M mutations, three had IDH mutations, and one had TP53 and ATRX mutations; five patients had no detectable mutations. CONCLUSION: In our analysis, we found that established glioma hotspot mutations were able to be detected within the CSF. We propose that in patients for whom tissue biopsy is high risk, not feasible, or tissue was nondiagnostic, CSF cfDNA sequencing has a substantial diagnostic yield and should be considered as a valuable novel diagnostic tool. Ongoing research is aiming to further increase the sensitivity of cfDNA testing, especially in patients with very low levels of CSF cfDNA.

The Role of Sural Nerve Biopsy in the Diagnosis of Vasculitis.

The diagnostic yield of sural nerve biopsy (SNB) in vasculitis is uncertain. Our aim was to document relevant characteristics of patients undergoing SNB in the investigation of vasculitis; determine the diagnostic yield; relate positive biopsy findings to patient demographic, laboratory, and clinical variables; and to calculate the rate of surgical complications. Patients with suspected vasculitis that underwent SNB as part of diagnostic evaluation at academic medical centers in Sweden and the United Kingdom were identified by searching local pathology databases and clinic registers. A structured review of medical case records and pathology reports was conducted. Histological findings were categorized as definite, probable, or no vasculitis in accordance with the 2015 Brighton Collaboration reinterpretation and update of the Peripheral Nerve Society guidelines for vasculitic neuropathy. Definite and probable findings were considered positive for vasculitis. Ninety-one patients that underwent SNB were identified (45% female). Forty (44%) patients showed histological evidence of vasculitis: 14 definite and 26 probable. A concomitant muscle biopsy conducted in 10 patients did not contribute to the diagnostic yield. Positive antineutrophil cytoplasmic antibody test, organ involvement other than the nervous system, and a longer biopsy sample were associated with a positive biopsy. The reported surgical complication rate was 15%. SNB of sufficient length is a useful procedure to confirm a diagnosis of vasculitis.

Abstract No. 318 Fluoroscopy-guided versus CT-guided bone marrow aspiration and biopsies: comparison of patient radiation exposure, biopsy yield and cost

To compare the radiation exposure for patients, diagnostic sampling adequacy and procedural time and facility costs between fluoroscopy-guided versus CT-guided bone marrow aspirations and biopsies (BMB)

Abstract No. 225 Comparison of diagnostic yield and safety of percutaneous transluminal endoscopic and fluoroscopic-guided biliary biopsies in interventional radiology

Abstract No. 225 Comparison of diagnostic yield and safety of percutaneous transluminal endoscopic and fluoroscopic-guided biliary biopsies in interventional radiology

Abstract No. 569 Yield of transthoracic core biopsy of subsolid lesions and influencing factors

Abstract No. 569 Yield of transthoracic core biopsy of subsolid lesions and influencing factors

Bone Biopsy in Suspected Nonvertebral Osteomyelitis: Counterpoint-Limited Yield and Clinical Utility of Image-Guided Percutaneous Needle Biopsy.

Bone Biopsy in Suspected Nonvertebral Osteomyelitis: Counterpoint-Limited Yield and Clinical Utility of Image-Guided Percutaneous Needle Biopsy.

Effects of positive endomyocardial biopsy on the survival and the outcomes of catheter ablation of ventricular tachycardia in patients with cardiac sarcoidosis

Abstract Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Heart center of Leipzig Background Cardiac sarcoidosis (CS) is frequently unrecognized cause of non-ischemic cardiomyopathy associated ventricular tachycardia (VT), who eventually require VT ablations because of refractory VTs; however, the reported long-term outcomes after VT ablation are conflicting. Because of the low diagnostic yield of the endomyocardial biopsy (EMB), diagnosis of CS is often based on clinical and imaging criteria, which can lead to misdiagnosing. Purpose and objectives The purpose of this study was to identity whether patients with histologically-proven CS (EMB+) have different patient, procedural characteristics and outcomes after VT ablation as compared to those in whom the diagnosis was based on clinical criteria only (EMB-). Methods Between 2015-2021, 153 patients with suspected CS were evaluated according to a specified protocol including CMR, 18FDG-PET, EMB, bronchoscopy and EBUS biopsy, and serum markers. Those who fulfilled the latest criteria for CS of the Japanese Circulation Society (JCS) were divided into 2 groups: EMB (+) CS proven by myocardial biopsy, and EMB (-) CS fulfilling the clinical criteria for CS. The following endpoints were defined: 1) VT recurrence after ablation; and 2) the composite endpoint of death, heart transplantation or LVAD implantation. Results We identified 76 patients fulfilling the JCS criteria for CS (mean age 50 ± 10.6 years, 38% female, EMB (+) 35.5%). The leading symptoms were as follows: sustained VT in 23 (30%), high-grade AV block in 23 (30%), heart failure in 18 (24%), and other in 12 pts (16%). EMB (+) and the EMB (-) patients had similar clinical characteristics except for the imaging findings. EMB (+) patients exhibit LGE in CMR in 96% vs. 73% in EMB (-); P=0.024, whereas 18FDG-PET showed abnormal myocardial activity in 91% in the EMB (+) vs. 65% in the EMB (-); P=0.028. The primary composite endpoint was reached in 7.4% in EMB (+) group and in 12.2 % in EMB (-) group; P = 0.7. VT ablation was performed in 15 cases: 9 ablations (33%) in EMB (+) vs. 6 ablations (12%) in EMB (-); P=0.037. At the end of the procedure, all inducible VTs were successfully ablated in 100% of the EMB (-) patients vs. 56% in EMB (+) patients; P=0.1. VT recurrence was 78% in EMB (+) group vs. 67% in EMB (-); P = 0.6. The only procedural difference between the groups was the presence of vast RV low-voltage areas in 67% of the EMB (+) vs. 0% in EMB (-); P = 0.028. Conclusions Patients with CS and positive EMB exhibit more often LGE in CMR, abnormal 18FDG-PET activity and required more frequently VT ablation. The procedural characteristics between both groups were similar, except for the frequently observed RV low-voltage areas in most EMB (+) patients, whereas the RV was not affected in any of the EMB (-) patients. In spite of these differences, the VT recurrence rates and the survival seemed not to be affected by the histological evidence of CS in EMB.

Digital single-operator cholangioscopy in diagnostic and therapeutic bilio-pancreatic diseases: A prospective, multicenter study

Background and aimDigital single-operator cholangioscopy (D-SOC) is an endoscopic procedure that is increasingly used for the management of bilio-pancreatic diseases.We aimed to investigate the efficacy and safety of D-SOC for diagnostic and therapeutic indications. MethodsThis is a multicenter, prospective study(January 2016-June 2019) across eighteen tertiary centers. The primary outcome was procedural success of D-SOC. Secondary outcomes were: D-SOC visual assessment and diagnostic yield of SpyBite biopsy in cases of biliary strictures, stone clearance rate in cases of difficult biliary stones, rate of adverse events(AEs) for all indications. ResultsD-SOC was performed in 369 patients (201(54,5%) diagnostic and 168(45,5%)therapeutic). Overall, procedural success rate was achieved in 360(97,6%) patients.The sensitivity, specificity, PPV, NPV and accuracy in biliary strictures were: 88,5%, 77,3%, 83,3%, 84,1% and 83,6% for D-SOC visual impression; 80,2%, 92,6%, 95,1%, 72,5% and 84,7% for the SpyBite biopsy, respectively.For difficult biliary stones, complete duct clearance was obtained in 92,1% patients (82,1% in a single session). Overall, AEs occurred in 37(10%) cases.The grade of AEs was mild or moderate for all cases, except one which was fatal. ConclusionD-SOC is effective for diagnostic and therapeutic indications.Most of the AEs were minor and managed conservatively, even though a fatal event has happened that is not negligible and should be considered before using D-SOC.

Targeted detection of cancer at the cellular level during biopsy by near-infrared confocal laser endomicroscopy

Suspicious nodules detected by radiography are often investigated by biopsy, but the diagnostic yield of biopsies of small nodules is poor. Here we report a method—NIR-nCLE—to detect cancer at the cellular level in real-time during biopsy. This technology integrates a cancer-targeted near-infrared (NIR) tracer with a needle-based confocal laser endomicroscopy (nCLE) system modified to detect NIR signal. We develop and test NIR-nCLE in preclinical models of pulmonary nodule biopsy including human specimens. We find that the technology has the resolution to identify a single cancer cell among normal fibroblast cells when co-cultured at a ratio of 1:1000, and can detect cancer cells in human tumors less than 2 cm in diameter. The NIR-nCLE technology rapidly delivers images that permit accurate discrimination between tumor and normal tissue by non-experts. This proof-of-concept study analyzes pulmonary nodules as a test case, but the results may be generalizable to other malignancies.

Tissue diagnosis necessary for small endoscopic ultrasound-suspected gastric gastrointestinal stromal tumors 2cm or less in size: A prospective study focusing on the endoscopic incisional biopsy.

The small endoscopic ultrasound (EUS)-suspected gastric gastrointestinal stromal tumors (GISTs), gastric subepithelial tumors at the muscularis propria layer on EUS, are detected frequently. Bite-on-bite forceps biopsy and EUS-guided tissue sampling yield variable results. This study aimed to analyze clinicopathologic features of the small EUS-suspected gastric GISTs 2cm or less in size and to evaluate the efficacy and safety of the endoscopic incisional biopsy (EIB) for these small tumors. This prospective study investigated 70 patients with small EUS-suspected gastric GISTs 2cm or less in size in two stages. Firstly, 30 patients were recruited for the efficacy and safety evaluation of the EIB. Secondly, 40 patients were randomly assigned to receive either EIB or the bite-on-bite biopsy for comparison of the diagnostic yield, procedure time, and adverse event rate. Combining two study stages, leiomyoma (74%) was diagnosed histologically to outnumber GIST (26%) with a diagnostic rate of 94% for patients receiving EIB. KIT exon 11 mutations (50%) and PDGFRA exon 12 mutations (16%) were detected in the small gastric GISTs. In the direct comparison, the diagnostic yield of EIB and the bite-on-bite biopsy was 85% and 50%, respectively (P=0.018). There was no statistically significant difference of the mean procedure time or adverse event rate between these two groups. Leiomyoma is more common than expected among these small tumors. Tissue diagnosis with an effective and safe sampling technique, such as EIB, is necessary for making further clinical decisions.

MP33-20 UTILITY OF ADDITIONAL TARGETED AND SYSTEMIC BIOPSIES IN THE PRESENCE OF AN INDEX PI-RADS 5 LESION

You have accessJournal of UrologyCME1 May 2022MP33-20 UTILITY OF ADDITIONAL TARGETED AND SYSTEMIC BIOPSIES IN THE PRESENCE OF AN INDEX PI-RADS 5 LESION Ahmad Alzubaidi, Michael Maidaa, Mohammad Said, Grant Owens, Max Yudovich, R. Scott Grant, Thomas F. Stringer, Chad Tracy, and Jay D. Raman Ahmad AlzubaidiAhmad Alzubaidi More articles by this author , Michael MaidaaMichael Maidaa More articles by this author , Mohammad SaidMohammad Said More articles by this author , Grant OwensGrant Owens More articles by this author , Max YudovichMax Yudovich More articles by this author , R. Scott GrantR. Scott Grant More articles by this author , Thomas F. StringerThomas F. Stringer More articles by this author , Chad TracyChad Tracy More articles by this author , and Jay D. RamanJay D. Raman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatic mpMRI targeted biopsy is increasingly utilized for the diagnosis of prostate cancer (CaP). Traditionally, systematic biopsy (SB) and targeted biopsies are performed for all index and non-index lesions. The diagnostic yield of additional biopsies is not clearly defined. We evaluate the utility of additional biopsies of non-index and SB in patients with a PI-RADS 5 index lesion to detect clinically significant cancer (CSC). METHODS: Records of 1029 patients undergoing transrectal mpMRI targeted biopsy across 4 medical centers were reviewed. Those with a PI-RADS 5 index lesion were included. Pathology obtained from the index PI-RADS 5 lesion was then compared to SB pathology, and that of the other PI-RADS lesions to evaluate for pathologic upgrade from benign or clinically insignificant cancer (CIC) to clinically significant cancer (CSC) (Grade Group≥2). RESULTS: We identified 326 Index PI-RADS 5 lesions in patients. 191 (59%) targeted PI-RADS 5 biopsies had CSC, while 135 (41%) noted CIC or benign pathology. Figure summarizes pathologic findings in these respective subgroups. Of the 191 CSC lesions, SB further upgraded 40 patients (21%). Of the 135 CIC or benign lesions, SB upgraded 22 (16%) to CSC. 119 patients had ≥2 lesions; biopsy of non-index lesions showed an upgrade in only 15 (13%) patients, while 104 patients (87%) showed no change or downgraded Grade group. CONCLUSIONS: When performing MRI targeted biopsy of an index PI-RADS 5 lesion, additional biopsies of non-index lesions offers minimal additional clinical value and could potentially be omitted. However, SB potentially identifies significant malignancies whereby 37% upgraded to CSC or higher Grade group Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e577 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Alzubaidi More articles by this author Michael Maidaa More articles by this author Mohammad Said More articles by this author Grant Owens More articles by this author Max Yudovich More articles by this author R. Scott Grant More articles by this author Thomas F. Stringer More articles by this author Chad Tracy More articles by this author Jay D. Raman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Manual route modification using an oblique method following automatic virtual bronchoscopic navigation.

Virtual automatic bronchoscopic navigation (VBN) systems to determine the route to peripheral pulmonary lesions (PPLs) in lung cancer can improve diagnostic biopsy yields. However, compared with VBN, drawing manual routes using computed tomography images, especially with oblique methods, can identify more routes. The Ziostation2 VBN system combines the benefits of these 2 methods; we evaluated this performance by comparing 3 different route-determining methods.We retrospectively collected data from 50 patients with PPLs measuring <30 mm who underwent transbronchial biopsy with an ultrathin bronchoscope at the Osaka International Cancer Institute during January to December 2018. We compared automatic VBN (Ziostation2), manual route modification using an oblique method after automatic VBN, and manual navigation using a general application computed tomography viewer. Concordance between predicted and actual branching were determined. We also compared the predicted relationship between the terminal bronchi and the lesion by 2 of the methods with ultrasonographic images (radial-probe endobronchial ultrasonography [radial-EBUS]).Manual modification after automatic VBN significantly increased the rate of determining routes to the target (66%) versus with the automatic VBN alone (32%) (P < .001). Expected route bifurcations were exact matches with actual branching in 45/48 of the patients using manual modification after automatic VBN. The predicted relationship between the terminal bronchi and the lesion using manual modification after VBN matched the radial-EBUS images in 35/50 of the patients.Manual modification of routes to PPLs using an oblique method after automatic VBN predicted actual radial-EBUS route imaging and could help determine appropriate patients for bronchoscopy.

Histological Diagnostic Yield and Clinical Significance of the First Biopsy in Device-Assisted Enteroscopy in Patients with Small Bowel Diseases: A KASID Multicenter Study.

Device-assisted enteroscopy (DAE) enables the direct visualization of small bowel lesions with histological diagnosis; however, few studies have described the diagnostic performance of enteroscopic biopsy. We investigated the diagnostic performance of enteroscopic biopsy. We used a nationwide multicenter enteroscopy database to identify patients who underwent DAE with biopsy for small bowel diseases. The patients were classified into the tumor and non-tumor groups according to the final diagnosis. They were also divided into diagnostic and non-diagnostic groups based on the enteroscopic biopsy results. The clinical significance of the first biopsy and histological diagnostic yield of DAE were analyzed. Among the 112 procedures investigated, 32 (28.9%) were diagnosed with tumors, and 80 (71.7%) were diagnosed with non-tumor diseases. The overall histological diagnostic yield of DAE was 43.7%. The histological diagnostic yield was significantly higher in the tumor than in the non-tumor group (81.2% vs. 28.8%, p < 0.001). The mean number of biopsies was significantly higher in the diagnostic than in the non-diagnostic group (5.6 ± 3.3 vs. 3.7 ± 2.1, p = 0.001). In the diagnostic group, 87.7% of the cases were histologically confirmed at the first biopsy. Therefore, the first biopsy should be performed carefully.

Kidney biopsy adequacy and complications in children — does technique matter?

Kidney biopsy is part of the diagnostic workup of many children with renal disease. Traditionally, a perpendicular approach to the biopsy has been used, but more recently, some proceduralists have favoured a tangential approach. It is not clear if one technique is superior with regards to tissue adequacy or complication rates. In our centre, interventional radiologists (IR) use general anaesthetic and a tangential approach, whereas paediatric nephrologists (PN) use sedation and a perpendicular approach. We examined consecutive native kidney biopsies performed between January 2008 and December 2017 for adequacy (sufficient tissue for light and electron microscopy and immunofluorescence) and examined the electronic medical records for data regarding technique and complications. IR performed 72 (29%) of the 245 native kidney biopsies, obtaining more total glomeruli (median 39 vs 16, p < 0.001) and more glomeruli per tissue core (median 13 vs 8, p < 0.001) than PN. No differences in specimen adequacy were observed between the two groups (79% IR vs 81% PN, p = 0.75) and a diagnosis could be made in 99% and 94% respectively (p = 0.1). A statistically lower rate of peri-nephric haematoma (28% vs 42%, p = 0.04) was detected in the IR group, but there were no significant differences in other complications. One patient required a blood transfusion (PN) and another required surgical intervention for a perinephric haematoma (IR).Conclusion: IR obtained larger samples and number of glomeruli, but the overall adequacy for native kidney biopsies was good using both perpendicular and tangential techniques, with low rates of significant complications.What is Known:• Kidney biopsy is integral to the diagnostic work-up of many children with kidney disease.• Kidney biopsy is a safe procedure with well-established complications in a minority of children.What is New:• Interventional radiologists had higher biopsy yield than paediatric nephrologists, possibly due to the tangential approach.• Biopsy adequacy rates are high using both techniques and provided a diagnosis in over 95% of cases.

Yield of Routine First Week Biopsy After Heart Transplantation

<h3>Purpose</h3> Routine endomyocardial biopsies (rEMB) are performed for early detection of allograft rejection, from 1 week to one year after heart transplantation (HT). The optimal frequency of rEMB is unclear in the current era of immunosuppressive agents. Our aim was to investigate the yield of the first rEMB performed a week post HT. <h3>Methods</h3> A single center retrospective analysis on consecutive adult patients undergoing HT between 01/2014 to 09/2021 all had rEMB performed one week after HT. rEMB with International Society for Heart and Lung Transplantation (ISHLT) grade 1R/1B or more was considered as acute cellular rejection (ACR). <h3>Results</h3> A total of 260 patients were included, in 37 (14%) rEMB performed at a median of 7 days [IQR 2] after HT showed ACR. Of these patients, mean age was 51±17, 25 (74%) were males, 14 (38%) had an ISHLT grade 1R/1B rejection, 13 (35%) 1R/2, 9 (24%) 2R/3A and 1 (3%) 3R/4. Only 3 of these 37 patients had none of the following high risk clinical factors: Pre HT panel reactive antibodies class I/II > 20% (n = 12), echocardiogram at EMB day showing left ventricular ejection fraction < 40% (n = 2), continuous sub-therapeutic tacrolimus levels (n = 19), need for mechanical circulatory support during the first week after HT or for vasopressors support until the day of rEMB (n = 6). Two of these 3 patients had 1R/1b rejection with normal echocardiograms at the day of EMB and no change in their immunosuppression was made, while a third patient with 2R/3A ACR, had moderate-severe right ventricular dysfunction on echocardiogram and 6/7 days of sub-therapeutic tacrolimus levels. <h3>Conclusion</h3> The great majority of patients with ACR diagnosed on first week rEMB had at least one high-risk clinical feature suggesting the need for EMB. No patients without any clinical risk factor had 2R rejection or worse. Routine surveillance EMB one week after HT should not be performed absent clinical signs or risk factors for rejection.

Unilateral vs Bilateral Lower Lobe Surveillance Transbronchial Biopsies in Patients with Bilateral Lung Transplant Patients

<h3>Purpose</h3> Transbronchial biopsies are routinely performed in surveillance of subclinical rejection after lung transplantation. Sensitivity of transbronchial biopsies can be increased by sampling lower lobes and multiple lobes. Due to the inherent risks of the procedure, biopsies are usually limited to one lung. It is not known if sampling bilateral lower lobes improves diagnostic sensitivity for ACR or affects the outcomes. At our institution, one of the transplant pulmonologist routinely biopsies both the lower lobes hence, this provided us with an opportunity to study and compare the diagnostic yield of biopsies of unilateral vs bilateral lower lobes. <h3>Methods</h3> Retrospective analysis of charts was performed on 83 patients transplanted with lungs bilaterally over 3.5 years. Details of surveillance transbronchial biopsies at 1, 3, 6, 9 (Optional) and 12 months after transplantation were collected for analysis. <h3>Results</h3> 83 lung transplant recipients studied over 3.5 years with a total of 427 transbronchial biopsies. Out of these, 116 procedures were performed bilaterally and 195 procedures were performed unilaterally. Among the 116 patients biopsied bilaterally, 2 samples were inadequate and 25 patients (21.73%) had evidence of ACR including minimal (A1) in 31 samples and A2 rejection in 1 sample. Only 6 out of 25 patients had evidence of ACR in both the lower lobes and 4 out of those procedures were performed in the same patient at different times. Only one of these patient with A2 rejection and another with persistent A1 rejection were treated with pulsed dose steroids for ACR. Among the 195 samples obtained unilaterally, 1 sample was inadequate and 30 biopsy specimens had evidence of ACR (15.38%) including minimal (A1) ACR in 24 samples and mild (A2) rejection in 6 samples. All patients with A2 rejection were treated with pulsed dose steroids for ACR. There were no reported episodes of life threatening hemoptysis or pneumothorax associated any of the above procedures. <h3>Conclusion</h3> In bilateral lung transplant recipients, bilateral lower lobe surveillance transbronchial biopsies may increase the yield for detection of ACR. Detection of ACR simultaneously in both the lower lobes is rare. Unilateral ACR was minimal in most of the biopsies and did not alter the management. Bilateral lower lobe biopsies was not associated with increased risk of pneumothorax

Impact of rapid on-site evaluation combined with endobronchial ultrasound and virtual bronchoscopic navigation in diagnosing peripheral lung lesions

BackgroundTo investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs).MethodsBetween January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in expected consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, based on the calculation of expected diagnostic yield of R-EBUS biopsy and drop out, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed.ResultsIn the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, respectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, respectively, and the average expense was 643.44 ± 706.56 US.$ (4093.15 ± 4494.67 yuan ¥). In the controls, the positive rate of brushing and biopsy were 44%, 74%, respectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, respectively. And the average expense during diagnosis was 1009.27 ± 713.89 US.$ (6420.28 ± 4541.33 yuan ¥). There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤ 2 cm in diameter was significant.ConclusionIn combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.

Diagnostic Yield and Complication Rate of Stereotactic Biopsies in Precision Medicine of Gliomas

BackgroundAn integrated diagnosis consisting of histology and molecular markers is the basis of the current WHO classification system of gliomas. In patients with suspected newly diagnosed or recurrent glioma, stereotactic biopsy is an alternative in cases in which microsurgical resection is deemed to not be safely feasible or indicated. In this retrospective study, we aimed to analyze both the diagnostic yield and the safety of a standardized biopsy technique.Material and MethodsThe institutional database was screened for frame-based biopsy procedures (January 2016 until March 2021). Only patients with a suspected diagnosis of glioma based on imaging were included. All tumors were classified according to the current WHO grading system. The clinical parameters, procedural complications, histology, and molecular signature of the tissues obtained were assessed.ResultsBetween January 2016 and March 2021, 1,214 patients underwent a stereotactic biopsy: 617 (50.8%) for a newly diagnosed lesion and 597 (49.2%) for a suspected recurrence. The median age was 56.9 years (range 5 months−94.4 years). Magnetic resonance imaging (MRI)-guidance was used in 99.3% of cases and additional positron emission tomography (PET)-guidance in 34.3% of cases. In total, stereotactic serial biopsy provided an integrated diagnosis in 96.3% of all procedures. The most frequent diagnoses were isocitrate dehydrogenase (IDH) wildtype glioblastoma (n = 596; 49.2%), oligodendroglioma grade 2 (n = 109; 9%), astrocytoma grade 3 (n = 108; 8.9%), oligodendroglioma grade 3 (n = 76; 6.3%), and astrocytoma grade 2 (n = 66; 5.4%). A detailed determination was successful for IDH 1/2 mutation in 99.4% of cases, for 1p/19q codeletion in 97.4% of cases, for TERT mutation in 98.9% of cases, and for MGMT promoter methylation in 99.1% of cases. Next-generation sequencing was evaluable in 64/67 (95.5%) of cases and DNA methylome analysis in 41/44 (93.2%) of cases. Thirteen (1.1%) cases showed glial tumors that could not be further specified. Seventy-three tumors were different non-glioma entities, e.g., of infectious or inflammatory nature. Seventy-five out of 597 suspected recurrences turned out to be post-therapeutic changes only. The rate of post-procedural complications with clinical symptoms of the Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or higher was 1.2% in overall patients and 2.6% in the subgroup of brainstem biopsies. There was no fatal outcome in the entire series.ConclusionImage-guided stereotactic serial biopsy enables obtaining reliable histopathological and molecular diagnoses with a very low complication rate even in tumors with critical localization. Thus, in patients not undergoing microsurgical resection, this is a valuable tool for precision medicine of patients with glioma.

Accuracy of Pulmonary Nodule Sampling Using Robotic Assisted Bronchoscopy with Shape Sensing, Fluoroscopy, and Radial Endobronchial Ultrasound (The ACCURACY Study)

Background: Despite recent advances in guided bronchoscopy, the yield of bronchoscopic biopsy of a peripheral pulmonary nodule (PPN) remains highly variable. Objective: The aim of the study was to evaluate which features of robotic assisted bronchoscopy (RAB) contribute to a successful biopsy in a cadaver model. Methods: A preclinical, prospective, single-blinded trial using a ventilated human cadaveric model assessed the successful puncture of implanted pulmonary nodules using various localization techniques with RAB. The different approaches included positioning the robotic catheter at predefined distances from the target nodule (<10 mm, 10–20 mm, 20–30 mm), bronchoscopist correction of divergence between the software virtual map and bronchoscopic view if observed, and impact of fluoroscopy and radial endobronchial ultrasound (rEBUS). The primary endpoint was a central target hit (defined as an inner 2/3 target puncture) verified by cone-beam computed tomography. Results: Thirty-eight RAB procedures were performed to target 16 PPNs. Median nodule size was 16.2 mm. All targets were located in the outer 1/3 of the lung with a bronchus sign in 31.3%. Central target hit rates were improved when the robotic catheter tip was closer to the nodule (<10 mm 68%, 10–20 mm 66%, 20–30 mm 11%, p < 0.001). Multivariable analysis confirmed the strongest predictor of a central target hit was robotic catheter distance to nodule (OR 0.89 per increase in 1 mm, p < 0.001), independent of the presence of a bronchus sign, divergence or concentric rEBUS view. Conclusions: Utilizing a RAB platform, closer proximity of the robotic catheter to the target nodule results in an increase in peripheral nodule biopsy success.

The diagnostic dilemma of an exudative pleural effusion and the emerging role of thoracoscopic pleural biopsy in these patients: A study from South India

Objectives: Pleural effusion is one of the common presentations of several several diseases in clinical practice. The pathology behind a pleural effusion is often not clear on pleural fluid analysis. In developing countries like India, empirical antitubercular treatment is started assuming exudative pleural effusion to be tuberculosis. Over some time with more emphasis on evidence-based medicine, this is not a right approach. Thoracoscopic examination and biopsy visceral are a minimally invasive procedure which is underutilized in our practice. The study was conducted to evaluate the definitive etiological diagnosis of exudative pleural effusion and to analyze the diagnostic yield of thoracoscopic biopsy in the diagnosis of exudative pleural effusion. Material and Methods: The study was conducted in the Department of Medicine and Oncology, Command Hospital Airforce, Bengaluru, India. All adult patients with exudative pleural effusion (according to light’s criteria) reporting to the hospital from January 2019 to December 2020 were included and subjected for analysis. Results: Out of a total of 100 patients who were included in the study, there was male predominance with 78 males and 22 females. Thoracoscopic biopsy remained conclusive in 100% of cases. Malignancy was the most common etiology with 48% of cases while tuberculosis was seen in 38%, 12% had inflammation, and 2 (02%) had mucormycosis. TB PCR sensitivity and specificity of TB PCR were 42% and 100%, respectively. MTB culture showed sensitivity of 11%. MTB culture of biopsy showed sensitivity of 26%. The specificity in both the methods was 100%. Conclusion: Thoracoscopy is an ideal method for the diagnosis of pleural effusion with suspected exudative pathology. It gives an accurate diagnosis and helps differentiate between tuberculosis and malignancy which are the most common etiologies in India, thereby leading to early appropriate and specific treatment in such patients. Malignancy was the most common etiology in our study.