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Seminars in Diagnostic Pathology Nov 2022In the late 20 century, pathologist-performed palpation-guided fine-needle aspiration (PG-FNA) of superficial masses was popularized in the United States. It brought... (Review)
Review
In the late 20 century, pathologist-performed palpation-guided fine-needle aspiration (PG-FNA) of superficial masses was popularized in the United States. It brought pathologists out of the laboratory to see patients and the hope of decreasing the need for surgical biopsy for diagnostic purposes. This first iteration of minimally invasive tissue sampling could be informally called FNA 1.0. FNA 1.0 had shortcomings, such as detection of invasion in breast cancer, precise subtyping of lymphomas, aspiration of fibrous lesions, and diagnosis of sarcomas. The early 21 century brought new hope. Ultrasound-guidance became commonly used to guide FNA of both palpable and non-palpable masses. Ultrasound-guided core-needle biopsy was available to complement FNA in select cases. Flow cytometry, immunohistochemistry, fluorescent in-situ hybridization, and genomic studies could be done on cell block and core biopsy specimens. These advances in minimally invasive tissue diagnosis could be informally called FNA 2.0. In particular, pathologist-performed ultrasound-guided core-needle biopsy can overcome many of the criticisms and shortcomings of FNA. As pathologists were once leaders in palpation-guided fine-needle aspiration, they now have the opportunity to add pathologist-performed ultrasound-guided core-needle biopsy to their skill set and emerge once again as leaders in minimally invasive tissue diagnosis. This will bring pathology to the next level.
Topics: Humans; Female; Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Breast Neoplasms; Pathologists; Ultrasonography, Interventional
PubMed: 35752516
DOI: 10.1053/j.semdp.2022.06.011 -
The British Journal of Oral &... Apr 2016Although fine-needle aspiration cytology (FNAC) and core needle biopsy are essential diagnostic investigations of lumps in the head and neck, seeding along the needle... (Review)
Review
Although fine-needle aspiration cytology (FNAC) and core needle biopsy are essential diagnostic investigations of lumps in the head and neck, seeding along the needle track has long been a concern, and various factors have been implicated. We therefore searched the Medline database for relevant English language papers published between 1970 and 2014, excluding those on the thyroid and parathyroid, and systematically reviewed them to assess the risk. In the 610 articles reviewed we found only 7 reports of seeding (5 after FNAC and 2 after core needle biopsy). Tumours were found between 3 months and 3 years after the procedure in 4 cases, and in 3, tumour cells were found along the needle track between 0 and 33 days after the procedure. The needles varied in size from 18 - 22 gauge (G) and there were 3 to 4 passes. Four cases occurred after investigation of a mass in the salivary glands, and 3 after assessment of a cervical lymph node. Disease was benign in one and malignant in 6. Seeding along the needle track after FNAC or core needle biopsy of a lump in the head and neck is rarely reported, and an accurate estimate of its incidence is difficult to ascertain. Crude estimates suggest 0.00012% and 0.0011% after FNA and core needle biopsy, respectively. A distinction should be made between seeding that is seen shortly after the procedure and the development of tumour along the needle track.
Topics: Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Biopsy, Needle; Head and Neck Neoplasms; Humans; Neck; Neoplasm Seeding
PubMed: 26837638
DOI: 10.1016/j.bjoms.2016.01.004 -
IEEE Transactions on Ultrasonics,... Feb 2017Bone biopsy is an invasive clinical procedure, where a bone sample is recovered for analysis during the diagnosis of a medical condition. When the architecture of the...
Bone biopsy is an invasive clinical procedure, where a bone sample is recovered for analysis during the diagnosis of a medical condition. When the architecture of the bone tissue is required to be preserved, a core-needle biopsy is taken. Although this procedure is performed while the patient is under local anaesthesia, the patient can still experience significant discomfort. Additionally, large haematoma can be induced in the soft tissue surrounding the biopsy site due to the large axial and rotational forces, which are applied through the needle to penetrate bone. It is well documented that power ultrasonic surgical devices offer the advantages of low cutting force, high accuracy, and preservation of soft tissues. This paper reports a study of the design, analysis, and test of two novel power ultrasonic needles for bone biopsy that operate using different configurations to penetrate bone. The first utilizes micrometric vibrations generated at the distil tip of a full-wavelength resonant ultrasonic device, while the second utilizes an ultrasonic-sonic approach, where vibrational energy generated by a resonant ultrasonic horn is transferred to a needle via the chaotic motion of a free-mass. It is shown that the dynamic behavior of the devices identified through experimental techniques closely match the behavior calculated through numerical and finite-element analysis methods, demonstrating that they are effective design tools for these devices. Both devices were able to recover trabecular bone from the metaphysis of an ovine femur, and the biopsy samples were found to be comparable to a sample extracted using a conventional biopsy needle. Furthermore, the resonant needle device was also able to extract a cortical bone sample from the central diaphysis, which is the strongest part of the bone, and the biopsy was found to be superior to the sample recovered by a conventional bone biopsy needle.
Topics: Animals; Biopsy, Needle; Bone and Bones; Equipment Design; Finite Element Analysis; Humans; Needles; Sheep; Ultrasonic Surgical Procedures
PubMed: 28114012
DOI: 10.1109/TUFFC.2016.2633286 -
The Journal of Thoracic and... May 2020
Topics: Biopsy, Needle; Endosonography
PubMed: 31926699
DOI: 10.1016/j.jtcvs.2019.11.075 -
Journal of Neuro-oncology Aug 2021Stereotactic needle biopsy remains the cornerstone for tissue diagnosis for tumors located in regions of the brain that are difficult to access through open surgery. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Stereotactic needle biopsy remains the cornerstone for tissue diagnosis for tumors located in regions of the brain that are difficult to access through open surgery.
OBJECTIVE
We perform a meta-analysis of the literature to examine the relation between number of samples taken during biopsy and diagnostic yield, morbidity and mortality.
METHODS
We identified 2416 patients from 28 cohorts in studies published in PubMed database that studied stereotactic needle biopsies for tumor indications. Meta-analysis by proportions and meta-regression analyses were performed.
RESULTS
On meta-analysis, the morbidity profile of the published needle biopsy studies clustered into three groups: studies that performed < 3 samples (n = 8), 3-6 samples (n = 13), and > 6 samples during biopsy (n = 7). Pooled estimates for biopsy related morbidity were 4.3%, 16.3%, and 17% for studies reporting < 3, 3-6, and > 6 biopsy samples, respectively. While these morbidity estimates significantly differed (p < 0.001), the diagnostic yields reported for studies performing < 3 biopsies, 3-6 samples, and > 6 samples were comparable. Pooled estimates of diagnostic yield for these three groups were 90.4%, 93.8%, and 88.1%, respectively. Mortality did not significantly differ between studies reporting differing number of samples taken during biopsy.
CONCLUSIONS
Our meta-analysis suggests that morbidity risk in needle biopsy is non-linearly associated with the number of samples taken. There was no association between the number of biopsies taken, and diagnostic yield or mortality.
Topics: Biopsy, Needle; Brain Neoplasms; Humans; Stereotaxic Techniques; Treatment Outcome
PubMed: 34251602
DOI: 10.1007/s11060-021-03785-9 -
Der Pathologe Jul 2016The current grading of prostate cancer is based on the classification system of the International Society of Urological Pathology (ISUP) following a consensus conference... (Review)
Review
The current grading of prostate cancer is based on the classification system of the International Society of Urological Pathology (ISUP) following a consensus conference in Chicago in 2014. The foundations are based on the frequently modified grading system of Gleason. This article presents a brief description of the development to the current ISUP grading system.
Topics: Adenocarcinoma; Biopsy, Needle; Guideline Adherence; Humans; Male; Neoplasm Grading; Prognosis; Prostate; Prostatic Neoplasms; Transurethral Resection of Prostate
PubMed: 27393141
DOI: 10.1007/s00292-016-0185-5 -
Asia-Pacific Journal of Clinical... Oct 2022This study aimed to assess the efficacy of image-guided percutaneous needle biopsy in patients with suspected cancer of unknown primary. (Observational Study)
Observational Study
AIM
This study aimed to assess the efficacy of image-guided percutaneous needle biopsy in patients with suspected cancer of unknown primary.
METHODS
We conducted a retrospective observational study. Among 291 patients with suspected cancer of unknown primary who were referred to our institution between April 2011 and March 2014, 89 who underwent image-guided percutaneous needle biopsy and 27 who underwent surgical biopsy were defined as the image-guided percutaneous needle biopsy group and the surgical group, respectively. Patient backgrounds, diagnostic yields, promptness of biopsy, general anesthesia rates, and severe complication rates were compared between the two groups.
RESULTS
There was no significant difference in the patient backgrounds of the two groups. The diagnostic yields were 98.9% (95% confidence interval, 93.9%-99.8%) in the image-guided percutaneous needle biopsy group and 100% (95% confidence interval, 87.5%-100%) in the surgical biopsy group (no significant difference; p = 1.0). The mean time to biopsy was significantly shorter (6.5 days vs. 21.3 days; p < .0001) and general anesthesia was used in significantly fewer patients (0% vs. 40.7%; p < .0001) in the image-guided percutaneous needle biopsy group. There was no significant difference in the rate of serious complications between the two groups (p = 1.0).
CONCLUSION
As a biopsy procedure for patients with suspected cancer of unknown primary, image-guided percutaneous needle biopsy is equally diagnostic and safe for surgical biopsy and might be preferable to surgical biopsy in terms of promptness and not requiring general anesthesia.
Topics: Biopsy, Large-Core Needle; Biopsy, Needle; Humans; Image-Guided Biopsy; Neoplasms, Unknown Primary; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35238156
DOI: 10.1111/ajco.13762 -
Digestive Diseases (Basel, Switzerland) 2023A variety of liver disorders are associated with characteristic histopathological findings that help in their diagnosis and treatment. However, percutaneous liver biopsy...
INTRODUCTION
A variety of liver disorders are associated with characteristic histopathological findings that help in their diagnosis and treatment. However, percutaneous liver biopsy (PLB) is prone to limitations and complications. We evaluated all PLBs done in our hospital in a 13-year period, aiming to assess PLB's utility and complications.
METHODS
All PLBs conducted in an internal medicine department of a tertiary university hospital in Athens, Greece, during a 13-year period were reviewed. Recorded data included demographic characteristics, laboratory results acquired on biopsy day, indication for liver biopsy, and occurrence of side effects. All patients were followed for 1 month post-hospital discharge for possible PLB-related complications.
RESULTS
A total of 261 patients underwent PLB during the study period. The commonest indication of PLB was investigation of liver mass, followed by transaminasemia. PLB assisted in setting a diagnosis in 218 patients and was unhelpful in only 43, in 14 of them due to inadequate or inappropriate biopsy specimen. Complications attributable to PLB were rare, with 10 patients exhibiting pain, either at biopsy site or in the right shoulder, and 3 having bleeding episodes; no deaths were noted.
CONCLUSIONS
Our study shows that PLB is still a powerful diagnostic tool in everyday practice, provided it is used when indicated.
Topics: Humans; Liver; Biopsy; Liver Diseases; Biopsy, Needle; Digestive System Surgical Procedures
PubMed: 37611545
DOI: 10.1159/000533328 -
Seminars in Diagnostic Pathology Nov 2022Cytopathologist optimized ultrasound-guided fine needle aspiration biopsy (USGFNA) seeks to integrate all available sonographic and cytologic information into a single... (Review)
Review
Cytopathologist optimized ultrasound-guided fine needle aspiration biopsy (USGFNA) seeks to integrate all available sonographic and cytologic information into a single diagnostic report, usually ending with a final statement that the biopsy does or does not explain the clinical, sonographic and cytologic features of the nodule. The experience needed to fully realize this goal is best acquired in a dedicated USGFNA clinic. There the cytologist reviews the clinical record, available sonographic images and reports, personally performs a sonographic evaluation resulting in ACR 2017 TIRADS cancer risk assessment of each nodule, identifies the one or two nodules with TIRADS indication for biopsy, the samples the nodule(s) under sonographic guidance, creates well-crafted distortion free smears, completes the microscopic evaluation, and writes a final comprehensive report. This review draws on my personal and published experience in introducing cytopathologists to USGFNA and presents ten specific items for which a cytopathologist needs to acquire both background knowledge and technical skill to successfully introduce USGFNA into an existing pathology practice. This review is written from the perspective of the head and neck clinic but can be adapted to any site appropriate for USGFNA.
Topics: Humans; Biopsy, Fine-Needle
PubMed: 35940958
DOI: 10.1053/j.semdp.2022.06.008 -
The Journal of Thoracic and... May 2020Endoscopic ultrasound-guided biopsy techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided...
BACKGROUND
Endoscopic ultrasound-guided biopsy techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), are currently the standard of care for the assessment of mediastinal lymphadenopathy. Traditionally, passing the needle through and through vascular structures has been avoided owing to the risk of bleeding. In this study, we evaluated the safety and diagnostic accuracy of transvascular endosonographic-guided biopsies of mediastinal, hilar and lung lesions. Our hypothesis is that the approach is safe and adds to the endoscopic armamentarium, avoiding the need for surgical biopsy in specifically selected cases.
METHODS
One hundred patients who underwent transvascular EBUS- or EUS-guided biopsy between 2012 and 2018 were identified from a prospective interventional endoscopy database.
RESULTS
Biopsy was performed under EUS guidance in 65 patients and under EBUS guidance in 35 patients. The most frequent targets were the mediastinum (60 patients), lung (21 patients), and hilar lymph nodes (16 patients). The aorta was the vessel most commonly traversed (n = 57), followed by the pulmonary artery (n = 33). A median of 2 passes were performed per target (range, 1-5). The samples were adequate to make a diagnosis in 80 patients, and the endoscopic diagnosis was a malignancy in 62 patients. The overall sensitivity was 71.5%, and the accuracy was 74.5%. There were no observed intraoperative or immediate postoperative complications. A delayed complication, aortic pseudoaneurysm, was observed in 1 patient. Follow-up was completed in 84 patients, with a median duration of 12.3 ± 18 months.
CONCLUSIONS
Transvascular endosonographic-guided biopsy is an important adjunct to conventional endoscopic techniques and allows the thoracic endoscopist to obtain biopsy specimens from intrathoracic lesions that are not accessible without vascular puncture.
Topics: Adult; Aged; Aged, 80 and over; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Female; Humans; Lung Neoplasms; Lymph Nodes; Male; Mediastinal Neoplasms; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Young Adult
PubMed: 31735387
DOI: 10.1016/j.jtcvs.2019.10.017