-
Computers in Biology and Medicine Aug 2019Planning and practice of surgical procedures can be improved through the use of modelling. This study provides an insight into the biopsy needle (i.e. hollow cannula)...
Planning and practice of surgical procedures can be improved through the use of modelling. This study provides an insight into the biopsy needle (i.e. hollow cannula) and needle-tissue interactions using a modelling approach, thus enabling the optimization of needle-tip designs not only for training but also for the planning of surgical procedures. Simulations of needle insertion into agar gel were performed using a Coupled Eulerian-Lagrangian (CEL) based finite element (FE) analysis, adapted for large deformation and tissue fracture. The experimental work covers needle insertion into 3% agar gel using a needle with a beveled tip of various angles, to assess the validity of the simulation. The simulated needle deflection and insertion force for two needles (i.e. Needle 1 with 18° bevel angle and Needle 2 with 27° bevel angle) were compared with corresponding experimental results. The contact stress (i.e. contact pressure) on the needles from the agar gel during the insertion of the needles were also studied. Observations indicate that varying the needle bevel angle from 27° to 18° results in a decrease of the peak force (i.e. puncture force) and an increase in needle deflection. Quantitatively, the percentage errors between the experimental data and the FE model for the total insertion force along the z-direction (i.e. Z Force) for Needle 1 and 2 were 4% and 4.8% (p > 0.05), respectively. Similarly, needle deflection percentage errors along the x-z plane were 5.7% and 10% respectively. Therefore, the forces and needle deflection values predicted by the simulation are a close approximation of the experimental model, validating the Coupled Eulerian-Lagrangian based FE model. Thus, providing an experimentally validated model for biopsy and cytology needle design in silico that has the potential to replace the current build and break approach of needle design used by manufacturers.
Topics: Biopsy, Needle; Equipment Design; Finite Element Analysis; Gels; Humans; Models, Biological; Needles; Phantoms, Imaging; Reproducibility of Results
PubMed: 31279981
DOI: 10.1016/j.compbiomed.2019.103337 -
Ultrasound Quarterly Mar 2024Percutaneous core-needle biopsy (PCNB) plays a growing and essential role in many medical specialties. Proper and effective use of various PCNB devices requires basic... (Review)
Review
Percutaneous core-needle biopsy (PCNB) plays a growing and essential role in many medical specialties. Proper and effective use of various PCNB devices requires basic understanding of how they function. Current literature lacks a detailed overview and illustration of needle function and design differences, a potentially valuable reference for users ranging from early trainees to experts who are less familiar with certain devices. This pictorial aims to provide such an overview, using diagrams and magnified photographs to illustrate the intricate components of these devices. Following a brief historical review of biopsy needle technology for context, we emphasize distinctions in design between 2 major classes of PCNB devices (side- and end-cutting devices), focusing on practical implications for how each device is most effectively used. We believe a nuanced understanding of biopsy device function sheds light on certain lingering ambiguities in biopsy practice, such as the optimal needle gauge in organ biopsy, the benefits and risks associated with coaxial technique, the impact of needle selection and technique on bleeding, and the risk of unsuccessful sampling. In a subsequent pictorial, we will draw on the concepts presented here to illustrate examples of biopsy needle failure and how unrecognized needle failure can be an important and often preventable cause of increased biopsy risk and lower tissue yield.
Topics: Humans; Biopsy, Large-Core Needle; Needles; Biopsy; Image-Guided Biopsy; Nitrobenzenes
PubMed: 37918119
DOI: 10.1097/RUQ.0000000000000664 -
Cancer Cytopathology Feb 2022Despite widespread clinical use, lymph node fine-needle aspiration cytology (LN-FNAC) lacks universal acceptance for definitively diagnosing lymphomas. This is likely...
BACKGROUND
Despite widespread clinical use, lymph node fine-needle aspiration cytology (LN-FNAC) lacks universal acceptance for definitively diagnosing lymphomas. This is likely due to reports of lower diagnostic performance, inconsistent terminology use in cytopathology diagnostic reports, and only limited data on the clinical implications of LN-FNAC diagnoses. Recently, a uniform LN-FNAC cytopathological diagnostic reporting system was proposed (the Sydney System). This study evaluated LN-FNAC diagnostic performance and risks of malignancy associated with the proposed diagnostic categories.
METHODS
LN-FNAC specimens obtained in 2018-2019, with and without concurrent core biopsy, to evaluate for suspected lymphoma were analyzed (n = 349). LN-FNAC diagnoses were compared with final diagnoses obtained via subsequent tissue biopsy and/or clinical assessment.
RESULTS
The mean patient age was 57.6 years, and 41% were female. LN-FNAC was the initial diagnostic test in 223 (63.9%), and it was used to evaluate for recurrence in 126 (36.1%). LN-FNAC diagnosed 202 hematological malignancies (57.9%), 23 nonhematological malignancies (6.6%), and 124 reactive processes (35.5%). Subsequent tissue biopsy was performed in 42 (12%). The risks of malignancy per diagnostic category were as follows: inadequate, 58.3%; benign, 6.4%; atypical, 69.2%; suspicious, 96.7%; and malignant, 99.3%. LN-FNAC demonstrated up to 96.3% sensitivity, 91.91% specificity, and 87.35% accuracy. Optimal specimen quality and the use of intradepartmental consultation reduced diagnostic error rates in FNA cases without concurrent core biopsy (P = .029 and P = .0002 respectively).
CONCLUSIONS
LN-FNAC is accurate and reliable for the diagnosis of lymphoma. Inadequate LN-FNAC samples should be resampled due to a significant associated risk of lymphoma. The diagnostic performance of LN-FNAC may be improved with good specimen quality and reviews by multiple pathologists. Understanding the risks of malignancy associated with LN-FNAC diagnostic categories will help to guide optimal patient management.
Topics: Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Cytological Techniques; Female; Humans; Lymph Nodes; Male; Middle Aged; Neoplasms; Sensitivity and Specificity
PubMed: 34661975
DOI: 10.1002/cncy.22523 -
Acta Chirurgiae Orthopaedicae Et... 2020PURPOSE OF THE STUDY To evaluate the results of incisional open biopsies and ultrasound-guided core needle biopsies for musculoskeletal lesions in extremity and limb...
PURPOSE OF THE STUDY To evaluate the results of incisional open biopsies and ultrasound-guided core needle biopsies for musculoskeletal lesions in extremity and limb girdle locations. MATERIAL AND METHODS In 2019, 176 open incisional biopsies were performed at our department, 113 from bone lesions and 63 from soft tissue lesions. In the period of September 2019 to February 2020, we started performing also ultrasound-guided core needle biopsies from soft tissue lesions in limited indications, namely in 23 cases. The diagnostic accuracy, complications and pain associated with the procedure were evaluated. RESULTS Of 113 open incisional biopsies of bone, 91.1% was fully representative and 6.2% non-representative with an indication for re-biopsy. In 53 cases another surgical procedure followed, which fully confirmed the diagnosis made based on the biopsy in 79.2%. In 7.5% the diagnosis slightly changed, with no therapeutic impact, in 5.7% the histological grade was changed, and in 7.5% the diagnosis was substantially modified. Complications appeared in 9.8% of cases. The procedure was associated with pain expressed by an increase in VAS score by 2.7 points. Of 63 soft tissue open incisional biopsies, 100% was fully representative. In 30 cases another surgical procedure followed, which fully confirmed the diagnosis made based on the biopsy in 96.7%, in one case the diagnosis was changed from aggressive benign lesion to a low-grade sarcoma. Complications appeared in 6.4% of cases. The procedure was associated with pain expressed by an increase in VAS score by 1.4 points. Of 23 ultrasound-guided core needle biopsies from soft tissues in limited indications, 100% was representative. In 11 cases another surgical procedure followed, which fully confirmed the diagnosis made based on the biopsy in 81.8%, in 2 cases the diagnosis was slightly changed, with no therapeutic impact or a change of histological grade. No complications were reported. The procedure was associated with minimal pain expressed by an increase in VAS score by 0.1 points. When comparing the group of soft tissue open incisional biopsies and ultrasound-guided core needle biopsies, a statistically significant less pain associated with the procedure was found in the group of core needle biopsies. CONCLUSIONS The biopsy of musculoskeletal tumors should be performed at specialty centers for treatment of these rare conditions. In that case it produces good results and is associated with a low rate of complications. Indications for open biopsy or core needle biopsy must be assessed individually. Key words: musculoskeletal tumors, bone and soft tissue sarcomas, open incisional biopsy, core needle biopsy, fine needle aspiration biopsy, ultrasound-guided core needle biopsy.
Topics: Biopsy; Biopsy, Large-Core Needle; Bone Neoplasms; Extremities; Humans; Ultrasonography, Interventional
PubMed: 33408008
DOI: No ID Found -
Cytopathology : Official Journal of the... Jul 2024Although surgical biopsy remains the gold standard for the diagnosis of lymphoma, small-volume biopsies including fine-needle aspiration and core needle biopsy are... (Review)
Review
Although surgical biopsy remains the gold standard for the diagnosis of lymphoma, small-volume biopsies including fine-needle aspiration and core needle biopsy are increasingly being used as a first line diagnostic tool. Small-volume biopsies are safe, rapid and cost effective; however, diagnostic utility varies by lymphoma subtype. It is important for pathologists and clinicians to recognize both the strengths and limitations of such biopsies.
Topics: Humans; Lymphoma; Biopsy, Fine-Needle; Biopsy, Large-Core Needle
PubMed: 38462899
DOI: 10.1111/cyt.13372 -
Journal of the American College of... Oct 2022To provide recent population-based estimates of transthoracic needle biopsy (TTNB) complications and risk factors associated with these complications.
OBJECTIVE
To provide recent population-based estimates of transthoracic needle biopsy (TTNB) complications and risk factors associated with these complications.
METHODS
This retrospective cohort analysis included adults from a nationally representative longitudinal insurance claims data set who underwent TTNB in 2017 or 2018. Complications that were evaluated included pneumothorax, hemorrhage, and air embolism. Separate logistic regression models estimated the association of pneumothorax or hemorrhage with the setting of care (ie, inpatient or outpatient) and selected baseline patient demographic and clinical characteristics including age, gender, history of chronic obstructive pulmonary disease, diagnosis of pleural effusion, tobacco use, use of oral anticoagulants and antiplatelet agents, prior lung cancer screening, previous bronchoscopy within 1 year, and Elixhauser comorbidity index.
RESULTS
Among 16,971 patients who underwent TTNB, 25.8% experienced a complication within 3 days of the procedure (pneumothorax 23.3%, hemorrhage 3.6%, and air embolism 0.02%). Among patients who experienced pneumothorax, 31.9% required chest tube drainage. Among patients undergoing an outpatient TTNB (n = 12,443), 6.9% were hospitalized within 7 days. Biopsy in an inpatient setting, chronic obstructive pulmonary disease diagnosis, and prior bronchoscopy were associated with higher rates of both pneumothorax and hemorrhage. Prior lung cancer screening was associated with an increased risk of pneumothorax, and prior use of oral anticoagulants or antiplatelets was associated with higher rates of hemorrhage.
CONCLUSION
This contemporary population-based cohort study demonstrated that approximately one-quarter of patients undergoing TTNB experienced a complication. Pneumothorax was the most frequent complication, and hemorrhage and air embolism were rare. Among outpatients, complications from TTNB are an important cause of hospitalization.
Topics: Adult; Anticoagulants; Biopsy, Needle; Cohort Studies; Early Detection of Cancer; Embolism, Air; Hemorrhage; Humans; Image-Guided Biopsy; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Platelet Aggregation Inhibitors; Pneumothorax; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Risk Factors
PubMed: 35738412
DOI: 10.1016/j.jacr.2022.04.010 -
Head & Neck Oct 2020In this meta-analysis, we compared the risk of obtaining nondiagnostic results and the diagnostic accuracy for detection of salivary gland malignancy between core needle... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In this meta-analysis, we compared the risk of obtaining nondiagnostic results and the diagnostic accuracy for detection of salivary gland malignancy between core needle biopsy (CNB) and fine-needle aspiration (FNA).
METHODS
All published English-language studies comparing CNB and FNA diagnostic accuracy for salivary gland masses through December 2019 were searched. Pooled risk ratios (RRs) of nondiagnostic results, sensitivities, and specificities of CNB and FNA for salivary gland malignancy diagnosis were determined. Complication rates were compared.
RESULTS
Six studies (1924 procedures) were quantitatively analyzed. CNB yielded significantly fewer nondiagnostic results (P < .001) and had significantly higher pooled sensitivity (P < .001) and specificity (P = .002) than FNA for differentiating malignant and benign salivary gland neoplasms. Hematoma occurred in 0.3% of CNB, while no complication occurred in FNA procedures.
CONCLUSION
CNB yielded fewer nondiagnostic results and had superior diagnostic performance compared with FNA for detecting salivary gland malignancies.
Topics: Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Humans; Retrospective Studies; Salivary Gland Neoplasms; Salivary Glands; Sensitivity and Specificity
PubMed: 32671867
DOI: 10.1002/hed.26377 -
Journal of the Mechanical Behavior of... Apr 2020This study investigates the effect of needle tip geometry on the needle deflection and tissue sampling length in biopsy. Advances in medical imaging have allowed the...
This study investigates the effect of needle tip geometry on the needle deflection and tissue sampling length in biopsy. Advances in medical imaging have allowed the identification of suspicious cancerous lesions which then require needle biopsy for tissue sampling and subsequent confirmatory pathological analysis. Precise needle insertion and adequate tissue sampling are essential for accurate cancer diagnosis and individualized treatment decisions. However, the single-bevel needles in current hand-held biopsy devices often deflect significantly during needle insertion, causing variance in the targeted and actual locations of the sampled tissue. This variance can lead to inaccurate sampling and false-negative results. There is also a limited understanding of factors affecting the tissue sampling length which is a critical component of accurate cancer diagnosis. This study compares the needle deflection and tissue sampling length between the existing single-bevel and exploratory multi-bevel needle tip geometries. A coupled Eulerian-Lagrangian finite element analysis was applied to understand the needle-tissue interaction during needle insertion. The needle deflection and tissue sampling length were experimentally studied using tissue-mimicking phantoms and ex-vivo tissue, respectively. This study reveals that the tissue separation location at the needle tip affects both needle deflection and tissue sampling length. By varying the tissue separation location and creating a multi-bevel needle tip geometry, the bending moments induced by the insertion forces can be altered to reduce the needle deflection. However, the tissue separation location also affects the tissue contact inside the needle groove, potentially reducing the tissue sampling length. A multi-bevel needle tip geometry with the tissue separation point below the needle groove face may reduce the needle deflection while maintaining a long tissue sampling length. Results from this study can guide needle tip design to enable the precise needle deployment and adequate tissue sampling for the needle biopsy procedures.
Topics: Biopsy, Needle; Equipment Design; Finite Element Analysis; Needles; Phantoms, Imaging
PubMed: 32174391
DOI: 10.1016/j.jmbbm.2020.103632 -
Veterinary Surgery : VS Jul 2021Design 3D printed skull contoured brain biopsy guides (3D-SCGs) from computed tomography (CT) or T1-weighted magnetic resonance imaging (T1W MRI).
OBJECTIVE
Design 3D printed skull contoured brain biopsy guides (3D-SCGs) from computed tomography (CT) or T1-weighted magnetic resonance imaging (T1W MRI).
STUDY DESIGN
Feasibility study.
SAMPLE POPULATION
Five beagle dog cadavers and two client-owned dogs with brain tumors.
METHODS
Helical CT and T1W MRI were performed on cadavers. Planned target point was the head of the caudate nucleus. Three-dimensional-SCGs were created from CT and MRI using commercially available open-source software. Using 3D-SCGs, biopsy needles were placed into the caudate nucleus in cadavers, and CT was performed to assess needle placement accuracy, followed by histopathology. Three-dimensional-SCGs were then created and used to perform in vivo brain tumor biopsies.
RESULTS
No statistical difference was found between the planned target point and needle placement. Median needle placement error for all planned target points was 2.7 mm (range: 0.86-4.5 mm). No difference in accuracy was detected between MRI and CT-designed 3D-SCGs. Median needle placement error for the CT was 2.8 mm (range: 0.86-4.5 mm), and 2.2 mm (range: 1.7-2.7 mm) for MRI. Biopsy needles were successfully placed into the target in the two dogs with brain tumors and biopsy was successfully acquired in one dog.
CONCLUSION
Three-dimensional-SCGs designed from CT or T1W MRI allowed needle placement within 4.5 mm of the intended target in all procedures, resulting in successful biopsy in one of two live dogs.
CLINICAL SIGNIFICANCE
This feasibility study justifies further evaluation of 3D-SCGs as alternatives in facilities that do not have access to stereotactic brain biopsy.
Topics: Animals; Biopsy; Biopsy, Needle; Brain; Brain Neoplasms; Cadaver; Dog Diseases; Dogs; Feasibility Studies; Magnetic Resonance Imaging; Models, Anatomic; Printing, Three-Dimensional; Skull; Tomography, X-Ray Computed
PubMed: 33969898
DOI: 10.1111/vsu.13641 -
Cancer Cytopathology Mar 2024The risks of malignancy for cytologic categories in renal biopsy specimens differ from the risks in most other sites. There are obvious areas in which cytopathologists... (Review)
Review
The risks of malignancy for cytologic categories in renal biopsy specimens differ from the risks in most other sites. There are obvious areas in which cytopathologists can do better at classifying these cases, and the routine use of immunohistochemistry and core-needle biopsy may improve the accuracy of the classification of these specimens.
Topics: Humans; Neoplasms; Biopsy, Large-Core Needle; Nephrectomy
PubMed: 37747428
DOI: 10.1002/cncy.22759