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Hematology (Amsterdam, Netherlands) Dec 2021Bone marrow (BM) biopsy is the most common diagnostic procedure in hematology. Bleeding is an expected complication, and its risk is assumed to be increased in patients... (Review)
Review
BACKGROUND
Bone marrow (BM) biopsy is the most common diagnostic procedure in hematology. Bleeding is an expected complication, and its risk is assumed to be increased in patients on anticoagulants. However, the effect of anticoagulation on BM biopsy safety is unclear and guidelines are lacking robust data in this regard. As such, physicians use their clinical judgement to guide periprocedural management of anticoagulation.
OBJECTIVE
To provide the best available evidence regarding management of anticoagulation in patients who need BM biopsy.
METHODS
We reviewed and summarized available guidelines directing management of periprocedural anticoagulation for BM biopsy, and share our experience and practices with BM biopsy at our institution.
RESULTS
The incidence of significant hemorrhage after BM biopsy is very low (0.007-1.1%). BM biopsy is classified as having a low to moderate bleeding risk. Interrupting anticoagulation is not consistently recommended. Strategies exist to minimize bleeding risk for anticoagulated patients. Patients with myeloproliferative neoplasms can develop an acquired von Willebrand syndrome which increases their risk for bleeding and therefore require extra vigilance to ensure appropriate hemostasis.
CONCLUSION
Withholding anticoagulation prior to BM biopsy is not routinely recommended. Instead, assessment and optimization of bleeding risk factors should be done on a patient by patient basis.
Topics: Anticoagulants; Biopsy, Needle; Bone Marrow; Clinical Decision-Making; Disease Management; Female; Hemorrhage; Humans; Male; Practice Guidelines as Topic; Practice Patterns, Physicians'; Risk Assessment; Risk Factors
PubMed: 33594950
DOI: 10.1080/16078454.2021.1880762 -
Pathology, Research and Practice Jun 2023Thyroid cancer is the most common endocrine malignancy, with increasing incidence over the past few decades. Fine needle aspiration (FNA) biopsy is the gold standard for... (Review)
Review
Thyroid cancer is the most common endocrine malignancy, with increasing incidence over the past few decades. Fine needle aspiration (FNA) biopsy is the gold standard for preoperative diagnosis of thyroid malignancies. Nevertheless, this method renders indeterminate results in up to 30% of the cases. Therefore, these patients are often referred to unnecessary surgery to establish the diagnosis. To improve the accuracy of preoperative diagnosis, several other ways, such as ultrasonography, elastography, immunohistochemical analysis, genetic testing, and core needle biopsy, have been developed and can be used either in association with or as an alternative to FNA. This review aims to evaluate all these diagnostic tools to determine the most appropriate way of managing thyroid nodules and subsequently improve the selection of cases referred to surgery.
Topics: Humans; Thyroid Nodule; Sensitivity and Specificity; Thyroid Neoplasms; Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Retrospective Studies
PubMed: 37196471
DOI: 10.1016/j.prp.2023.154516 -
World Journal of Gastroenterology Mar 2023Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030, a high mortality rate considering the number of... (Review)
Review
Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030, a high mortality rate considering the number of cases. Surgery and chemotherapy are the main treatment options, but they are burdensome for patients. A clear histological diagnosis is needed to determine a treatment plan, and endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is a suitable technique that does not worsen the cancer-specific prognosis even for lesions at risk of needle tract seeding. With the development of personalized medicine and precision treatment, there has been an increasing demand to increase cell counts and collect specimens while preserving tissue structure, leading to the development of the fine-needle biopsy (FNB) needle. EUS-FNB is rapidly replacing EUS-guided fine-needle aspiration (FNA) as the procedure of choice for EUS-TA of pancreatic cancer. However, EUS-FNA is sometimes necessary where the FNB needle cannot penetrate small hard lesions, so it is important clinicians are familiar with both. Given these recent dev-elopments, we present an up-to-date review of the role of EUS-TA in pancreatic cancer. Particularly, technical aspects, such as needle caliber, negative pressure, and puncture methods, for obtaining an adequate specimen in EUS-TA are discussed.
Topics: Humans; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Pancreatic Neoplasms; Pancreas; Endosonography
PubMed: 37032729
DOI: 10.3748/wjg.v29.i12.1863 -
American Journal of Respiratory and... Jul 2021
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Female; Humans; Lung Neoplasms; Male; Middle Aged; Practice Guidelines as Topic; Risk Factors; Solitary Pulmonary Nodule; Thoracic Cavity; United States
PubMed: 34256009
DOI: 10.1164/rccm.2041P1 -
Medicine Aug 2021This study aimed to explore clinical significance of core needle biopsy (CNB) in pathological diagnosis of breast neoplasm.Seventy one breast neoplasm samples were...
This study aimed to explore clinical significance of core needle biopsy (CNB) in pathological diagnosis of breast neoplasm.Seventy one breast neoplasm samples were obtained from Tongzhou Maternal and Child Health Hospital of Beijing between the years of 2006 and 2014. Forty five specimens were obtained via CNB and cases offering 26 of them received neoadjuvant chemotherapy. Pathology, histology, and immunohistochemistry results were compared between CNB specimens and excisional biopsy.Upward and downward tendencies could be observed in CNB specimens and excisional biopsy, respectively, in all items. Tumor proportion of CNB tissues was (33 + 2)/45 = 77.78%, when ductal carcinoma in situ detected by both CNB and excisional biopsy was 31/45 = 68.89%, with a consistency of (31 + 3)/45 = 75.56%. Tumor thrombus detected by both CNB and excisional biopsy was 2/45 = 4.44%. Among cases receiving neoadjuvant chemotherapy, CNB and excisional biopsy, in mitotic figure, cytological scoring and histological grading, showed a total change rate of >50% (50%-75%), while changes in duct and cellular heteromorphism were not distinct. Cases showing changes were up to 73.08%, with 8/26 = 30.77% for rise and 11/26 = 42.31% for descent.CNB could be used for preoperative diagnosis of breast neoplasm, and help to determine proper treatment regimen, thus elevating the rate of breast conserving. However, this method still has several limitations, particularly in immunohistochemical tests of human epidermal receptor protein-2. Neoadjuvant chemotherapy may influence the accuracy of CNB diagnosis.
Topics: Adult; Aged; Biopsy, Large-Core Needle; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging
PubMed: 34449464
DOI: 10.1097/MD.0000000000026970 -
Archives of Pathology & Laboratory... Mar 2020
Topics: Biopsy, Needle; Humans; Male; Prostate
PubMed: 32101055
DOI: 10.5858/arpa.2019-0558-LE -
Gastrointestinal Endoscopy Oct 2020
Topics: Biopsy, Needle; Humans; Pancreatic Cyst; Pathologists
PubMed: 32964846
DOI: 10.1016/j.gie.2020.06.020 -
Gastrointestinal Endoscopy May 2021
Topics: Biopsy, Needle; Humans; Liver; Needles; Prospective Studies
PubMed: 33691978
DOI: 10.1016/j.gie.2020.12.007 -
Pulmonology 2022Flexible bronchoscopy is a key diagnostic and therapeutic tool. New endoscopes and technologically advanced navigational modalities have been recently introduced on the... (Review)
Review
Flexible bronchoscopy is a key diagnostic and therapeutic tool. New endoscopes and technologically advanced navigational modalities have been recently introduced on the market and in clinical practice, mainly for the diagnosis of mediastinal lymph adenopathies and peripheral lung nodules. Bronchoscopic sampling tools have not changed significantly in the last three decades, with the sole exception of cryobiopsy. We carried out a non-systematic, narrative literature review aimed at summarizing the scientific evidence on the main indications/contraindications, diagnostic yield, and safety of the available bronchoscopic sampling techniques. Performance of bronchoalveolar lavage, bronchial washing, brushing, forceps biopsy, cryobiopsy and needle aspiration techniques are described, focusing on indications and diagnostic accuracy in the work-up of endobronchial lesions, peripheral pulmonary abnormalities, interstitial lung diseases, and/or hilar-mediastinal lymph adenopathies. Main factors affecting the diagnostic yield and the navigational methods are evaluated. Preliminary data on the utility of the newest sampling techniques (i.e., new needles, triple cytology needle brush, core biopsy system, and cautery-assisted transbronchial forceps biopsy) are shown. TAKE HOME MESSAGE: A deep knowledge of bronchoscopic sampling techniques is crucial in the era of technological bronchoscopy for an optimal management of respiratory diseases.
Topics: Humans; Bronchoscopy; Lung Neoplasms; Bronchoalveolar Lavage; Biopsy, Needle; Lymphadenopathy
PubMed: 32624385
DOI: 10.1016/j.pulmoe.2020.06.007 -
Clinical Journal of Gastroenterology Oct 2020Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA), though a well-established method for specimen acquisition from pancreatic neoplasm, has a limited role...
Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA), though a well-established method for specimen acquisition from pancreatic neoplasm, has a limited role for non-focal benign pancreatic diseases such as autoimmune pancreatitis (AIP) due to sample inadequacy and architectural distortion. Core biopsies through EUS-trucut biopsy (EUS-TCB) or newer generation EUS-fine needle biopsy (EUS-FNB) enable better histopathologic review through greater tissue specimen size and visualization of the histologic milieu. We systematically reviewed EUS-guided sample acquisition (FNA or core biopsy) and the role of EUS-guided needle biopsy in evaluation of AIP. EUS-guided needle biopsy provided significantly higher adequacy of specimen (96.8% vs 79.8%; p = 0.016) and higher diagnostic sensitivity (60.20% vs 42.02%; p < 0.0001) compared to EUS-FNA for AIP. More evidence is imperative in evaluating the feasibility, safety, and diagnostic utility of EUS-guided needle biopsy for AIP.
Topics: Autoimmune Pancreatitis; Biopsy, Fine-Needle; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Pancreatic Diseases; Pancreatic Neoplasms
PubMed: 32519311
DOI: 10.1007/s12328-020-01153-0