Yield Of Biopsy Research Articles

Impact of a multidisciplinary approach to ultrasound- guided thyroid fine-needle aspiration biopsy at Tygerberg Hospital, Cape Town, South Africa: A retrospective audit

Background. Thyroid nodules are common and mostly benign. Inadequate sampling generally occurs in 13 - 17% of thyroid fine-needle aspiration biopsies (FNABs), but the proportion was found to be as high as 45% on evaluating 100 ultrasound (US)-guided FNABs in a previous unpublished audit at Tygerberg Hospital, Cape Town, South Africa (SA). Objectives. Primary aim: To determine the diagnostic yield of US-guided thyroid biopsy after implementing changes to existing practices, involving the creation of a specialised clinic and applying protocols for referral and FNAB. Secondary aim: To compare the results with other centres in SA. Methods. A retrospective audit of 178 thyroid biopsies was conducted. All US-guided thyroid biopsies performed in the specialised clinic between January 2017 and July 2018 were included. Data were analysed using descriptive statistics. Results. The 178 nodules were biopsied in 159 patients. The mean age was 53.7 years, with a gender ratio of 9.6:1 (female/male). A reduction in non-diagnostic biopsies was noted compared with the historical cohort (45% v. 32.6%). Sixty-one nodules (34.3%) had previously been biopsied with inadequate cytology results. When repeat biopsies were excluded, only 16.2% (n=19) were classified as insufficient. Conclusions. These findings illustrate the importance of the multidisciplinary approach and standardisation of the US-guided biopsy procedure and the value of consistency and quality control in a health system. While nodular thyroid disease is common and FNAB is relatively simple, early referral to a central specialised unit to minimise the incidence of inadequate FNAB should be considered.

Cardiac involvement in sarcoidosis: Evolving concepts in diagnosis and treatment

Clinically evident cardiac involvement has been noted in at least 2 to 7% of patients with sarcoidosis, but occult involvement is much higher (> 20%). Cardiac Sarcoidosis (CS) is often not recognized as an antemortem, as sudden death may be the presenting feature. Cardiac involvement may occur at any point during the course of sarcoidosis and may occur in the absence of pulmonary or systemic involvement. Sarcoidosis can involve any part of the heart. The prognosis of CS is related to the extent and site(s) of involvement. Most deaths due to CS are due to arrhythmias or conduction defects, but granulomatous infiltration of the myocardium may cause progressive and ultimately lethal cardiomyopathy. The definitive diagnosis of isolated CS is difficult and the yield of Endomyocardial Biopsies (EMB) is low. Treatment of CS is often warranted even in the absence of histologic proof. Radionuclide scans are integral to the diagnosis. Gadolinium-enhanced cardiac magnetic imaging scans and 18Fluorodeoxyglucose (18FDG)-Positron Emission Tomography (PET) are the key imaging modalities to diagnose CS. The prognosis of CS is variable, but mortality rates of untreated CS are high. Randomized therapeutic trials have not been done, but corticosteroids (alone or combined with additional immunosuppressive agents) are the mainstay of therapy. Additionally, anti-arrhythmic agents and therapy for heart failure are often required. Because of the potential for sudden cardiac death, an Implantable Cardioverter-Defibrillator (ICD) should be placed in any patient with CS and serious ventricular arrhythmias or heart block and should be considered for cardiomyopathy. Cardiac transplantation is a viable option for patients with end-stage CS refractory to medical therapy.

Concepts in Musculoskeletal Bone and Soft Tissue Biopsy.

Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.

Diagnostic yield of CT-guided lung biopsies: how can we limit negative sampling?

Objectives:To investigate whether lesion imaging features may condition the outcome of CT-guided lung biopsy (CTLB) and to develop a scoring system of biopsy outcome prediction.Methods:This is a single center retrospective study on 319 CTLBs that were performed in 319 patients (167 males/152 females, mean age 68 ± 12.2). Uni- and multivariate analysis were performed aiming to assess the imaging features that are likely to be correlated to a negative biopsy outcome and patients were stratified in groups accordingly.Results:Technical success was 100%. 78% of the biopsies (250/319) led to a concrete histology report (218 malignant/32 benign). The remaining lesions led to concrete histology at a second attempt that occurred on a later time. Multivariate analysis revealed increased risk of inconclusive result for nodules with low fludeoxyglucose uptake [odds ration (OR) = 2.64, 95% confidence interval (CI) 1.4–4.97; p = 0.003], for nodules with diameter smaller than 18 mm (OR = 2.03, 95% CI 1.14–3.62; p = 0.017) and for nodules that are located in one of the lung bases (OR = 1.96, 95% CI 1.06–3.62; p = 0.033). Three different groups of patients were identified accordingly with low (<30%), medium (30–50%) and high (>50%) probability of obtaining an inconclusive biopsy sample.Conclusion:This study confirms that percutaneous CT-guided biopsy in nodules that are either small in diameter or present low positron emission tomography-fludeoxyglucose uptake or are in one of the lung bases may lead to inconclusive histology. This information should be factored when planning percutaneous biopsies of such nodules in terms of patient informed consent and biopsy strategy.Advances in knowledge:Inconclusive histology after lung biopsy may be subject to factors irrelevant to technical success. Lung biopsy histology outcomes may be predicted and avoided after adequate planning.

Intraoperative electromagnetic navigation bronchoscopy (IENB) to localize peripheral lung lesions: A new technique in the pediatric oncology population

BackgroundThe utility, diagnostic yield and accuracy of lung biopsies in pediatric oncology patients are variable. Here we describe our preliminary results using intraoperative electromagnetic navigation bronchoscopy (IENB) for peripheral lung lesions to increase the surgical yield and accuracy in pediatric oncology patients. MethodsFrom May 2018 until October 2020 all surgical lung biopsies on pediatric oncology patients were performed using IENB technology. IENB and tattooing with methylene blue dye, Indocyanine green dye or both followed by Video-assisted Thoracoscopic Surgery (VATS) was performed in the same setting. Data were collected retrospectively. Data points included diagnosis, technical success, pathologic diagnosis and alteration in treatment management and complications. ResultsA total of 10 biopsy procedures were performed on 8 patients during the study. The youngest patient was 7 years old. All had successful IENB with tattooing. All biopsies were diagnostic. No procedures were converted to open. There were no technical failures or procedure complications. One patient had a total of 11 biopsies, 6 from the right lung and 5 from the left, performed at 2 separate procedures. Another had 2 biopsies, one from the right lung and one from the left performed at the same operation. In 7 of the 8 patients treatment changes were made based on results of their biopsy. ConclusionHere we present the first described experience of IENB and tattooing of peripheral lung lesions in the pediatric population. We have shown that IENB for peripheral lung lesion localization is a safe and effective technique in pediatric oncology.

Safety and Diagnostic Yield of Radial Probe Endobronchial Ultrasound-Guided Biopsy for Peripheral Lung Lesions in Patients with Idiopathic Pulmonary Fibrosis: A Multicenter Cross-Sectional Study

Background: Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used for diagnosis of peripheral lung lesions (PLLs). To date, there have been no reports regarding the clinical outcomes of RP-EBUS-TBLB for PLLs in patients with idiopathic pulmonary fibrosis (IPF). Objectives: This study was performed between October 2017 and December 2019 to identify the safety and diagnostic performance of RP-EBUS-TBLB in IPF patients. Methods: Patients were divided into the usual interstitial pneumonia (UIP) group (n = 39, 4%), the probable UIP group (n = 12, 1%), and the noninterstitial lung disease (non-ILD) group (n = 903, 95%). Results: The diagnostic yield was significantly lower in the UIP group than in the non-ILD group (62% vs. 76%; p = 0.042), but there were no significant differences between the UIP and probable UIP groups (62% vs. 83%; p = 0.293) or the probable UIP and non-ILD groups (83% vs. 76%; p = 0.741). Multivariate logistic analysis showed that the mean diameter of PLLs, positive bronchus sign on CT, and “within the lesion” status on EBUS were independently associated with success of the procedure. Especially, the presence of the UIP pattern on CT (OR, 0.385; 95% CI: 0.172–0.863; p = 0.020) was independently associated with failed diagnosis. Among patients with UIP, “within the lesion” status on EBUS (OR, 25.432; 95% CI: 2.321–278.666; p = 0.008) was shown to be a factor contributing to a successful diagnosis. Overall, there were no significant differences in complication rates among the 3 study groups. Conclusion: RP-EBUS-TBLB can be performed safely with an acceptable diagnostic yield, even in patients with IPF.

Recent Advances in Systematic and Targeted Prostate Biopsies.

Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.

Preoperative MRI in breast cancer: effect of breast density on biopsy rate and yield.

Preoperative breast MRI is used to evaluate for additional cancer and extent of disease for newly diagnosed breast cancer, yet benefits and harms of preoperative MRI are not well-documented. We examined whether preoperative MRI yields additional biopsy and cancer detection by extent of breast density. We followed women in the Breast Cancer Surveillance Consortium with an incident breast cancer diagnosed from 2005 to 2017. We quantified breast biopsies and cancers detected within 6months of diagnosis by preoperative breast MRI receipt, overall and by breast density, accounting for MRI selection bias using inverse probability weighted logistic regression. Among 19,324 women with newly diagnosed breast cancer, 28% had preoperative MRI, 11% additional biopsy, and 5% additional cancer detected. Four times as many women with preoperative MRI underwent additional biopsy compared to women without MRI (22.6% v. 5.1%). Additional biopsy rates with preoperative MRI increased with increasing breast density (27.4% for extremely dense compared to 16.2% for almost entirely fatty breasts). Rates of additional cancer detection were almost four times higher for women with v. without MRI (9.9% v. 2.6%). Conditional on additional biopsy, age-adjusted rates of additional cancer detection were lowest among women with extremely dense breasts, regardless of imaging modality (with MRI: 35.0%; 95% CI 27.0-43.0%; without MRI: 45.1%; 95% CI 32.6-57.5%). For women with dense breasts, preoperative MRI was associated with much higher biopsy rates, without concomitant higher cancer detection. Preoperative MRI may be considered for some women, but selecting women based on breast density is not supported by evidence. ClinicalTrials.gov: NCT02980848; registered 2017.

Factors affecting diagnostic yield in stereotactic biopsy for brain lesions: a 5-year single-center series.

The objective of this study is to determine the factors that are associated with the diagnostic yield of stereotactic brain biopsy. A retrospective analysis was performed on 50 consecutive patients who underwent stereotactic brain biopsies in a single institute from 2014 to 2019. Variables including age, gender, lesion topography and characteristics, biopsy methods, and surgeon's experience were analyzed along with diagnostic rate. This study included 31 male and 19 female patients with a mean age of 48.4 (range: 1-76). Of these, 25 underwent frameless brain-suite stereotactic biopsies, 15 were frameless Portable Brain-lab® stereotactic biopsies and 10 were frame-based CRW® stereotactic biopsies. There was no statistical difference between the diagnostic yield of the three methods. The diagnostic yield in our series was 76%. Age, gender, and biopsy methods had no impact on diagnostic yield. Periventricular and pineal lesion biopsies were significantly associated with negative diagnostic yield (p = 0.01) whereas larger lesions were significantly associated with a positive yield (p = 0.01) with the mean volume of lesions in the positive yield group (13.6cc) being higher than the negative yield group (7cc). The diagnostic yields seen between senior and junior neurosurgeons in the biopsy procedure were 95% and 63%, respectively (p = 0.02). Anatomical location of the lesion, volume of the lesion, and experience of the surgeon have significant impacts on the diagnostic yield in stereotactic brain biopsy. There was no statistical difference between the diagnostic yield of the three methods, age, gender, and depth of lesion.

S563 Diagnostic Yield of Upper and Lower Endoscopic Biopsies for Evaluation of Suspected Acute Gastrointestinal Graft-Versus-Host Disease

S563 Diagnostic Yield of Upper and Lower Endoscopic Biopsies for Evaluation of Suspected Acute Gastrointestinal Graft-Versus-Host Disease

SC313 - Predictors of diagnostic yield of percutaneous renal tumor biopsies in a single center experience

SC313 - Predictors of diagnostic yield of percutaneous renal tumor biopsies in a single center experience

S1126 Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Two Center Experience

S1126 Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Two Center Experience

An Audit on the Use of Brain Biopsies for Non-neoplastic Brain Diseases

Introduction: In cases where a brain tumour is suspected, brain biopsies are the gold standard method for confirming the diagnosis. Brain biopsies are not frequently performed in non-neoplastic diseases as they tend to be regarded as an investigation of last resort. The role of brain biopsies, and their impact on subsequent clinical care, in non-neoplastic brain disorders is not well-defined. Methods: This is a retrospective analysis of brain biopsies for non-neoplastic brain diseases performed at a single tertiary neuroscience centre over a ten-year period, from 2008 to 2018. Cases were identified from neuropathology reports. The charts were reviewed where pre-operative clinical information and investigation results were documented and post-biopsy clinical outcome as well as management changes were also recorded. Data analysis was performed using the frequencies tool and Fisher-exact test via SPSS software. Results: Twenty cases were identified from pathology reports. 60% of biopsies (n = 12) were pathologically diagnostic. In those who had clinical management following biopsy recorded, clinical management was altered in 84% (n = 16) of patients. Of those with clinical outcome recorded: 62% (n = 8) had a documented clinical improvement; 15% (n = 2) returning to pre-disease baseline while 46% (n = 6) of patients improved without returning to pre-disease baseline. Complications occurred in 5% of patients (n = 1), a lower respiratory tract infection. Discussion: In comparison with previous papers, the diagnostic yield of biopsies in this study is high. This could be attributable to extensive investigations, particularly neuroimaging resulting in targeted biopsies. Clinical improvements were seen in higher rates compared to previous research and complication rates were low. Conclusion: This study shows that brain biopsies are useful in the investigation of non-neoplastic neurological disease and can have a high diagnostic yield. Clinical outcome was, for the majority, positive with a significant proportion of the patients improving. Complications were rare and did not have an adverse effect on patient outcomes. Our findings support the inclusion of brain biopsies as part of the diagnostic algorithm for non-neoplastic neurological conditions of unknown aetiology.

Diagnosis Yield and Safety of Surgical Biopsy in Interstitial Lung Diseases: A Prospective Study

BackgroundSurgical lung biopsy is essential in the diagnostic algorithm of interstitial lung disease (ILD) of unknown cause. Safety concerns have been recently reiterated. This study prospectively assessed the yield of diagnosis and safety of video-assisted thoracoscopic surgical lung biopsy (VATS-LB) for ILD diagnosis. MethodsThis prospective study, conducted in 6 ILD-referral Paris hospitals, included 103 patients with ILD. VATS-LB was proposed after initial multidisciplinary discussion. A final diagnosis was made after the procedure, during a second multidisciplinary discussion. The main outcome was to determine the final diagnoses and their proportion after VATS-LB. Other outcomes were the percentage of change in diagnosis and treatment propositions after VATS-LB and adverse events during 3 months after the operation, postoperative pulmonary function, quality of life, and pain. ResultsA definite diagnosis was reached in 87 patients (84.4%), and 16 remained unclassifiable (15.6%). After VATS-LB, the hypothesized diagnosis changed in 65 patients (63.1%) and treatment changed in 41 patients (39.8%). One patient died of acute exacerbation. In-hospital complications were predicted by a shorter preoperative 6-minute walking test distance and by forced vital capacity lower than 77%. Postoperative quality of life was not modified at 3 months, whereas forced vital capacity decreased slightly. Postoperative neuropathic pain was revealed in 5% of patients at 1 month and in 2% at 3 months. ConclusionsVATS-LB dramatically changed preoperative hypothetical diagnoses and treatment in ILD of unknown cause, with good patient survival in ILD referral centers.

Renal Mass Biopsy

Kidney cancer accounts for 2% of cancer related deaths. Historically, a patient with a solid renal mass would undergo surgery without biopsy given the previously low diagnostic yield of biopsy and the fear of tumor seeding. This led to a high rate of resection for benign masses. With the rising incidence of renal masses discovered on imaging, improvements in biopsy technique and advancements in pathologic evaluation of biopsy samples of renal masses, renal mass biopsy now plays an important role in selected patients with renal masses. Coaxial core needle biopsy is the preferred technique with a low rate of complications and a high diagnostic yield. This article will discuss indications, methods, utility, limitations and complications of renal mass biopsy.

Correlation of Imprint and Crush cytology with Bronchoscopic biopsy in the diagnosis of Bronchogenic carcinoma

Introduction: Lung carcinoma is the most common cancer with 2.1 million (11.6%) newly diagnosed cases in 2018. Over the years, many cytotechniques have been developed but their combination with histology is still an area of controversy. Imprint and crush cytology are considered simple, rapid and cost effective for a low resource setting in the early diagnosis and management of lung cancer. Here, we aimed to assess the diagnostic accuracy of imprint and crush cytology and compare them with histopathology. Method: A prospective study was conducted from May 2017 to April 2018 at the Pulmonary medicine unit and Department of Pathology at National Academy of Medical Sciences (NAMS), Bir Hospital. A total of 53 patients were enrolled in the study who showed visible mass on bronchoscopy. Three to five bits of tissue were obtained, imprint and crush smear were prepared from them and the tissue were then sent for histopathological examination. The level of significance selected was p &lt; 0.005. Results: The most common age group affected was 60-69 years. 91% cases were smokers, with a male predominance. The most common location of endobronchial growth was left upper lobe. 43 cases were malignant in biopsy. The sensitivity, specificity, accuracy and positive predictive value of imprint cytology was 71.05%, 87.50%, 73.91% and 96.43% respectively while that for crush cytology was 74.36%, 75%, 74.47% and 93.55% respectively. The diagnostic yield of imprint, crush smear and forceps biopsy were 52.8%, 58.4% and 81.1% respectively. Squamous cell carcinoma was the most common carcinoma in this study. Conclusion: Imprint and crush cytology yield additional information that can be complementary to endobronchial biopsy. They are convenient, do not burden the patients and thus can be carried out wherever possible during bronchoscopy.

Clinical and Epidemiological Features of Tuberculous Pleural Effusion in Alicante, Spain

We aimed to (1) evaluate the incidence of tuberculous pleural effusion (TPE) over 25 years in our centre; (2) measure the yield of different diagnostic techniques; (3) compare TPE features between immigrant and native patients. Retrospective study of patients who underwent diagnostic thoracentesis and pleural biopsy in our hospital between 1995 and 2020. TPE was diagnosed in 71 patients (65% natives, 35% immigrants). Onset was acute in 35%, subacute in 26% and prolonged in 39%. Radiological features were atypical in 42%. Thoracentesis specimens were lymphocyte-predominant in 84.5% of patients, with elevated adenosine deaminase in 75% of patients. Diagnostic yield of pleural biopsy was 78%. Compared with native patients, more immigrants had previous contact with TB (54% vs. 17%, p = 0.001), prior TB (21% vs. 4%, p < 0.02) and atypical radiological features (58% vs. 34%, p < 0.03). TPE incidence was six times higher in the immigrant population (6.7 vs. 1.1 per 100,000 person-years, p < 0.001). TPE has an acute onset and sometimes atypical radiological features. Pleural biopsy has the highest diagnostic yield. Reactivation, prior contact with TB, atypical radiological features, complications, and positive microbiology results are more common in immigrant patients.

A case of intramuscular lumbar myxoma: Uncertainty in the preoperative diagnosis of a spinal soft tissue tumour

We report an uncommon case of a 76-year-old woman who presented with lower back pain, an intermittent L5 radiculopathy and a right palpable paraspinal mass. Imaging studies revealed a 7-cm lumbar paraspinal pseudo-cystic soft tissue tumour developed in the paravertebral musculature, without a clear radiological diagnosis. Gross total surgical resection was performed, resulting in complete resolution of pain. Histopathological studies revealed an intramuscular (IM) myxoma.With a low positive predictive value of radiological work-up and a poor yield of percutaneous biopsies, surgery remains the mainstay treatment for these rare soft tissue tumours of the lumbar spine. Intramuscular myxomas show excellent postoperative results.

Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations.

(1) Background: The aim of this study was to conduct a prospective analysis on the diagnostic accuracy of transthoracic ultrasound-guided percutaneous needle biopsy (TUS-PNB) for the histological assessment of peripheral lung lesions and to assess the performance of transthoracic ultrasound (TUS) examination vs. chest CT (gold standard) in the differentiation between malignant and benign peripheral lung lesions. (2) Methods: A total of 961 consecutive patients with subpleural pulmonary lesions were enrolled. All the patients received a CT scan with contrast; 762 patients underwent TUS-PTNB for suspicion of malignancy, and the remaining 199 enrolled patients underwent only TUS examination as a part of routine follow-up for known non-malignant subpleural consolidations. (3) Results: Among the 762 TUS-guided biopsies, there were 627 (82.28%) malignant lesions, 82 (10.76%) benign lesions, and 53 (6.96%) indeterminate lesions. The overall diagnostic accuracy was 93.04%. The rates of pneumothorax not requiring chest-tube insertion and self-limited hemoptysis were 0.79 and 0.26%, respectively. Patients were divided into two groups based on the benign or malignant nature of the subpleural consolidations. On TUS, both malignant and benign lesions showed mostly irregular margins and a hypoechoic pattern, but no differences were assessed in terms of sonographic margins and pattern between the two groups. There was poor agreement between TUS and chest CT in assessing air bronchograms and necrotic areas. The only finding in the detection of which TUS showed superiority compared to chest-CT was pleural effusion. (4) Conclusions: TUS-PNB was confirmed to be an effective and safe diagnostic method for peripheral pulmonary consolidation, but their sonographic pattern did not allow to rule out a malignant nature. A pre-operative evaluation on CT images, combined with the possibility of performing additional immunohistochemical and cytological investigations and the experience of the medical staff, may improve the diagnostic yield of TUS-guided biopsies.

PERIPHERAL LYMPH NODE EXCISIONAL BIOPSY IN CHILDREN: YIELD IN A TERTIARY CARE CENTRE

AIM: To study the pediatric patients in a developing country undergoing peripheral lymph node excision biopsy in terms of demographics and histopathological ndings and evaluate the diagnostic yield of peripheral Lymph node excision biopsy in children. MATERIALS AND METHODS: A retrospective study of 402 patients was done of the children undergoing peripheral lymph node st st excision biopsy in a tertiary care center from 1 January 2013 to 31 December 2018 (6 years). Demographics, histopathological ndings and yields were studied. RESULTS: Out of the 402 patients, 218 (54.2%) were males and 184(45.8%) were females. Male to female ratio 1.18: 1. Maximum patients belonged to the age group of 4-6years (26.87%) followed by the age group of 2-4years of age (22.89%). Most common group of nodes excised were cervical (77.9%) followed by axillary and inguinal lymph nodes (9.2%) each. The most common etiology was reactive lymphoid hyperplasia (63.18%) in our study followed by tuberculous lymphadenitis(31.84%). Specic ndings were seen in 35.58% and non-specic ndings were seen in 64.42% patients. Malignancy was seen in 8 patients (2%). CONCLUSION: Peripheral Lymphadenopathy in pediatric population is always a diagnostic challenge. While FNAC tends to be investigation of choice for adults, in a developing country with limited resources and high prevalence of tuberculosis, peripheral lymph node biopsy is the gold standard with a good diagnostic yield and should always be considered for patients with persistent lymphadenopathy. Clinical significance: The study highlights the importance of excision biopsy in peripheral lymphadenopathy in children in a developing nation with limited resources and high prevalence of infectious diseases.