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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 -
Current Medical Research and Opinion Feb 2023(1) To find strategies to improve diagnostic performance of ultrasound-guided biopsy of intermediate and high suspicion thyroid nodules with macrocalcifications. (2) To...
OBJECTIVES
(1) To find strategies to improve diagnostic performance of ultrasound-guided biopsy of intermediate and high suspicion thyroid nodules with macrocalcifications. (2) To find malignancy rates of nodules with macrocalcification.
MATERIALS AND METHODS
From 2018 to 2022, fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) were retrospectively evaluated. Macrocalcifications were categorized into three types: intra-nodular, rim and entirely calcified. Diagnostic performance was compared between biopsy modes (FNAB vs. CNB) and FNAB techniques (to-and-fro vs. whirling). Multivariate logistic regression was performed to determine features associated with performance of FNAB. Malignancy rates were calculated according to macrocalcification types.
RESULTS
A total of 114 procedures (87 FNAB and 27 CNB) in 89 nodules per 86 patients (mean age, 64 years; 76 women) were performed. Overall, CNB performed better than FNAB (unsatisfactory rate: 3.7% vs. 33.3%, = .005). For macrocalcification thicker than 2 mm, whirling FNAB technique demonstrated a comparable unsatisfactory rate with statistical trends toward significance (to-and-fro: 69.2% vs. whirling: 27.8%, = .055). The entirely calcified nodule was associated with poor performance of FNAB (adjusted odds ratio 4.46 [95% CI: 1.19-16.67], = .027). Overall malignancy was 22.5%, higher in intra-nodular macrocalcification than rim and entirely calcified types (68.4% vs. 21.1% vs. 10.5%, = .025).
CONCLUSION
For the entirely calcified type, CNB should be considered first to improve diagnosis. For other types, FNAB can be performed, and whirling technique may be an alternative technique in thicker macrocalcification. Malignancy in intermediate and high suspicion nodules with macrocalcification have non-negligible rates.
Topics: Humans; Female; Middle Aged; Thyroid Nodule; Thyroid Neoplasms; Retrospective Studies; Biopsy, Fine-Needle; Ultrasonography; Biopsy, Large-Core Needle; Sensitivity and Specificity
PubMed: 36369696
DOI: 10.1080/03007995.2022.2146404 -
Techniques in Vascular and... Sep 2021Image-guided lung needle biopsy allows for minimally invasive diagnosis of lung pathology. In the setting of suspected malignancy, the biopsy not only confirms the... (Review)
Review
Image-guided lung needle biopsy allows for minimally invasive diagnosis of lung pathology. In the setting of suspected malignancy, the biopsy not only confirms the diagnosis but also allows for molecular profiling, a requisite for tailored systemic therapy. Needle biopsy can also characterize non-neoplastic entities such as infections not responding to treatment and other inflammatory processes. A successful and safe lung needle biopsy starts with lesion and patient selection and careful pre-procedural evaluation. Here we review the indications and contraindications, diagnostic alternatives, approach planning and sequential procedural steps with the goal of maximizing both yield and patient safety. We discuss technical tips for preventing complications such as pleural anesthesia, the saline seal, the blood patch, the banana bend, hydro dissection, and the rapid needle out/patient rollover maneuver. We also review how to manage complications, avoid non-diagnostic biopsies, and provide recommendations for post-procedural observation and imaging follow-up.
Topics: Biopsy, Needle; Humans; Image-Guided Biopsy; Lung; Lung Neoplasms; Retrospective Studies
PubMed: 34861971
DOI: 10.1016/j.tvir.2021.100770 -
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 -
Journal of the American Society of... 2023Fine-needle aspiration (FNA) and small tissue biopsy of chordoma have been reported in several small series, but no large series exists. We undertook an examination of...
INTRODUCTION
Fine-needle aspiration (FNA) and small tissue biopsy of chordoma have been reported in several small series, but no large series exists. We undertook an examination of 47 cases (with concurrent core needle biopsy in a subset) to analyze diagnostic accuracy, cytomorphology, and immunohistochemistry.
MATERIALS AND METHODS
Our cytopathology files were searched for examples of chordoma with histopathologic verification. FNA biopsy smears and core needle were performed using standard techniques.
RESULTS
Forty-seven cases of chordoma were retrieved from 44 patients [M:F; 1.8:1; age range 5-81 years; mean age 55 years]. Twenty-seven presented with primary, 10 with locally recurrent, and 7 with metastatic tumors. Two aspirates were from the appendicular skeleton, 2 from the trunk, 1 from neck lymph node, and 42 aspirates (89%) from axial and peri-axial skeleton and surrounding soft tissues. Four were cytologic touch imprints while the remainder were FNA biopsy specimens. Specific cytologic diagnoses were chordoma/consistent with chordoma (44 cases, 94%), suspicious for chordoma (2), and malignant neoplasm (1). Along with a single case of benign notochordal tumor misdiagnosed as chordoma, our diagnostic accuracy was 91%. Concurrent tissue biopsy was performed in 51% of cases. Immunohistochemical staining of tumor in 29 (62%) cases showed expression of brachyury in 23 of 24 (96%) instances. Cytopathology consisted of cellular smears populated by large cells possessing enormous amounts of vacuolated and non-vacuolated cytoplasm with an abundant background myxoid/chondromyxoid stroma.
CONCLUSIONS
FNA and small tissue biopsy specimens show a very high degree of diagnostic accuracy in recognition of chordoma.
Topics: Humans; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Chordoma; Biopsy, Large-Core Needle; Immunohistochemistry; Bone and Bones
PubMed: 36270910
DOI: 10.1016/j.jasc.2022.09.005 -
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 -
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 -
Gastrointestinal Endoscopy Dec 2019
Topics: Biopsy, Large-Core Needle; Digestive System Abnormalities; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Needles; Network Meta-Analysis
PubMed: 31759416
DOI: 10.1016/j.gie.2019.08.017