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PloS One 2023Nitrous oxide (N2O) with rapid analgesic effect is often used to relieve pain induced by diagnostic procedures. This review was conducted to evaluate the efficacy and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nitrous oxide (N2O) with rapid analgesic effect is often used to relieve pain induced by diagnostic procedures. This review was conducted to evaluate the efficacy and safety of N2O in patients undergoing puncture biopsy.
METHODS
We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus and the ClinicalTrials.gov up to March, 2022. Randomized controlled trials (RCTs) were included if they investigated the effect of N2O in adults undergoing puncture biopsy. The primary outcome was pain score. Secondary outcomes included anxiety score, patient satisfaction and side effects.
RESULTS
Twelve RCTs with 1070 patients were included in the qualitative review, of which eleven RCTs were included in the meta-analysis. Pooled analysis suggested that compared with the controls (placebo, lidocaine and midazolam), N2O had better analgesic effect (MD -1.12, 95% CI -2.12 to -0.13, P = 0.03; I2 = 94%). In addition, N2O significantly alleviated patient anxiety (MD = -1.79, 95% CI -2.41 to -1.18, P<0.00001; I2 = 0%) and improved patient satisfaction (MD 1.81, 95% CI 0.11 to 3.50, P = 0.04; I2 = 92%). There was no significant difference regrading the risk of nausea (RR 2.56; 95% CI 0.70 to 9.31, P = 0.15; I2 = 0%), headache (RR 0.62, 95% CI 0.17 to 2.33, P = 0.48; I2 = 46%), dizziness (RR 1.80, 95% CI 0.63 to 5.13, P = 0.27; I2 = 0%) or euphoria (RR 2.67, 95% CI 0.81 to 8.79, P = 0.11; I2 = 8%) between the N2O group and the control group.
CONCLUSION
The present review suggested that N2O might be effective for pain management in patients undergoing puncture biopsy.
Topics: Humans; Adult; Nitrous Oxide; Randomized Controlled Trials as Topic; Pain; Analgesics; Biopsy, Needle
PubMed: 37279243
DOI: 10.1371/journal.pone.0286713 -
Archives of Pathology & Laboratory... Apr 2022The diagnosis of classic Hodgkin lymphoma (CHL) traditionally requires surgical tissue biopsy because of the paucity of diagnostic Hodgkin and Reed-Sternberg cells....
CONTEXT.—
The diagnosis of classic Hodgkin lymphoma (CHL) traditionally requires surgical tissue biopsy because of the paucity of diagnostic Hodgkin and Reed-Sternberg cells. Diagnosis can be challenging in small core needle and cytologic biopsies, which are increasingly used because of reduced costs and minimal invasiveness. Flow cytometric (FC) identification of Hodgkin and Reed-Sternberg cells is possible, but FC test efficacy is not well studied outside of validation settings, especially in small specimens.
OBJECTIVE.—
To assess the testing efficacy of FC performed on small biopsy and cytology specimens for the diagnosis of CHL.
DESIGN.—
We reviewed 131 patients with CHL and 459 patients without CHL during a 3-year period who underwent a small biopsy procedure, including core biopsy and/or cytology evaluation, with concurrent routine clinical FC testing for CHL, assessing performance of FC in small specimens.
RESULTS.—
Evaluating testing efficacy, sensitivity was 95.4% and specificity was 98.2%, whereas positive and negative predictive values were 92.2% and 99.0%, respectively. Although there were more false-positive results than compared with published validation studies, expert review identified distinct diagnostic pitfalls; awareness of these may improve testing efficacy.
CONCLUSIONS.—
Although FC diagnosis of CHL was historically considered unfeasible, our findings in a real-world clinical setting suggest that FC adds diagnostic value to small biopsy evaluation, reducing time to treatment, costs, and invasive excisional procedures.
Topics: Biopsy; Biopsy, Large-Core Needle; Flow Cytometry; Hodgkin Disease; Humans; Immunophenotyping; Reed-Sternberg Cells
PubMed: 34293084
DOI: 10.5858/arpa.2020-0795-OA -
Journal of Cancer Research and... Aug 2023The purpose of this study was to assess computed tomography (CT)-guided puncture biopsy of pulmonary nodules at a high risk of bleeding. First, a coaxial trocar...
CONTEXT
The purpose of this study was to assess computed tomography (CT)-guided puncture biopsy of pulmonary nodules at a high risk of bleeding. First, a coaxial trocar technique was used to radiofrequency ablate small blood vessels in the puncture area, followed by a biopsy of the pulmonary nodule.
AIM
This study aimed to evaluate the effectiveness and safety of this procedure.
METHODS
In this retrospective research, we assessed the relevant data of 45 patients who had undergone needle biopsy of pulmonary nodules at a high risk of bleeding. Twenty-five of these patients had CT-guided coaxial radiofrequency ablation (RFA)-assisted biopsy (group A). The remaining 20 had undergone conventional CT-guided needle biopsy (group B). We equated the technical success rate and the incidence of complications such as bleeding, pneumothorax, and pain in the two groups of needle biopsies.
RESULTS
Both groups had a 100% success rate with puncture biopsy. The incidences of pneumothorax in groups A and B were 10% (2/20) and 24% (6/25), respectively; this difference is not significant (P > 0.050). The rates of bleeding in groups A and B were 10% (2/20) and 44% (11/25), respectively, and the rates of pain were 30% (6/20) and 60% (15/25), both of which were statistically significant (P = 0.030; P = 0.045, respectively).
CONCLUSIONS
CT-guided coaxial trocar technique for RFA-assisted biopsy of pulmonary nodules at a high risk of bleeding is effective and safe and can significantly reduce the risk of biopsy-induced pulmonary hemorrhage.
Topics: Humans; Pneumothorax; Retrospective Studies; Hemorrhage; Image-Guided Biopsy; Multiple Pulmonary Nodules; Pain; Radiofrequency Ablation
PubMed: 37675725
DOI: 10.4103/jcrt.jcrt_2193_22 -
International Braz J Urol : Official... 2020To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive...
OBJECTIVES
To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofloxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofloxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated.
RESULTS
Mean age was 62.38 ± 7.30 (47-75), and the mean prostate volume was 43.17 ± 15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the fi rst biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively).
CONCLUSIONS
Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.
Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Biopsy, Needle; Ciprofloxacin; Drug Combinations; Enema; Humans; Male; Middle Aged; Ornidazole; Prostate; Prostatitis; Reproducibility of Results; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Ultrasonography, Interventional
PubMed: 31851459
DOI: 10.1590/S1677-5538.IBJU.2019.0257 -
The British Journal of Radiology Sep 2021To determine biopsy device failures, causative factors, complications and sample quality of the 16G end-cut Biopince and side-notch Bard needles.
A real-world study evaluating ultrasound-guided percutaneous non-targeted liver biopsy needle failures and pathology sample-quality assessment in both end-cut and side-notch needles.
OBJECTIVES
To determine biopsy device failures, causative factors, complications and sample quality of the 16G end-cut Biopince and side-notch Bard needles.
METHODS
All ultrasound-guided non-targeted liver biopsies between 01/01/2016 and 31/12/2018 were included. Operator, device, number of failures, complications and repeat biopsies were recorded. Histopathology samples were reviewed for all cases of needle failure and a group with no failures, and graded "yes/no" for the presence of steatosis, inflammation and fibrosis. The pathology slides from these cases were reviewed to assess biopsy sample quality (length and portal tract number). The failure and no-failure groups were compared in terms of device type/histology, and sample quality was compared between the needle types.
RESULTS
1004 patients were included. 93.8% ( = 942) required one needle pass to obtain a sample and 6.2% ( = 62) required >1 pass due to needle failure. Total of 76 needle failures, more with end-cut than side-notch needles (8.7% 2.9%) ( < 0.001). No needle failures resulted in complication. The presence of liver fibrosis was associated with fewer needle failures ( = 0.036). The major complication rate was 0.4% (4/1044). A biopsy with >10 portal tracts was obtained in 90.2% of specimens > 20 mm long, compared with 66% of 16-20 mm biopsies and 21% of <16 mm biopsies. The target of >10 portal tracts was achieved in 10/26 (38.5%) of side-notch biopsies and 64/90 (71.1%) of end-cut biopsies ( = 0.004).
CONCLUSION
Ultrasound-guided liver biopsy is safe and sample quality is consistently good when a core >20 mm long is obtained. The end-cut biopsy device generated reliably good quality biopsy samples; however, the needle failure rate was significantly higher than the side-cut needle.
ADVANCES IN KNOWLEDGE
Ultrasound-guided liver biopsy specimen quality is consistently good when a core >20 mm long is obtained which can be achieved with a single pass using the 16G Biopince end-cut needle, although the needle failure rate is significantly higher than the 16G Max-Core Bard side-notch needle.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Needle; Equipment Design; Equipment Failure; Female; Humans; Image-Guided Biopsy; Liver; Male; Middle Aged; Reproducibility of Results; Ultrasonography, Interventional; Young Adult
PubMed: 34289324
DOI: 10.1259/bjr.20210475 -
IEEE Transactions on Bio-medical... May 2021To obtain definitive cancer diagnosis for suspicious lesions, accurate needle deployment and adequate tissue sampling in needle biopsy are essential. However, the...
OBJECTIVE
To obtain definitive cancer diagnosis for suspicious lesions, accurate needle deployment and adequate tissue sampling in needle biopsy are essential. However, the single-bevel needles in current biopsy devices often induce deflection during insertion, potentially causing lesion missampling/undersampling and cancer misdiagnosis. This study aims to reveal the biopsy needle design criteria enabling both low deflection and adequate tissue sampling.
METHODS
A novel model capable of predicting needle deflection and tissue deformation was first established to understand needle-tissue interaction with different needle tip geometries. Experiments of needle deflection and ex-vivo tissue biopsy were conducted for model validation.
RESULTS
The developed model showed a reasonably good prediction on the correlation of needle tip type vs. the resultant needle deflection and tissue sampling length. A new multi-bevel needle with the tissue separation point below the needle groove face has demonstrated to be an effective design with an 87% reduction in deflection magnitude and equivalently long tissue sampling length compared to the current single-bevel needle.
CONCLUSION
This study has revealed two critical design criteria for biopsy needles: 1) multiple bevel faces at the needle tip can generate forces to balance bending moments during insertion to enable a low needle deflection and 2) the tissue separation point should be below the needle groove face to ensure long tissue sampling length.
SIGNIFICANCE
The developed methodologies and findings in this study serve as proof-of-concept and can be utilized to investigate various biopsy procedures to improve cancer diagnostic accuracy as well as other procedures requiring accurate needle insertion.
Topics: Biopsy, Needle; Equipment Design; Needles; Neoplasms
PubMed: 33507862
DOI: 10.1109/TBME.2021.3054922 -
European Radiology Apr 2021To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a...
OBJECTIVES
To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis.
METHODS
We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed.
RESULTS
The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048-0.128%; I = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029-34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103-91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725-14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149-9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309-20.447; p = 0.019).
CONCLUSION
The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB.
KEY POINTS
• The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.
Topics: Biopsy, Needle; Embolism, Air; Humans; Incidence; Lung; Prognosis; Risk Factors; Tomography, X-Ray Computed
PubMed: 33051730
DOI: 10.1007/s00330-020-07372-w -
BMC Cancer Apr 2021Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now...
BACKGROUND
Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications.
MATERIALS AND METHODS
In total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC.
RESULTS
The overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05).
CONCLUSION
Higher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Large-Core Needle; Female; Humans; Image-Guided Biopsy; Lung; Lung Diseases; Male; Middle Aged; Propensity Score; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography; Young Adult
PubMed: 33836683
DOI: 10.1186/s12885-021-08126-7 -
La Radiologia Medica Jun 2023Digital Breast Tomosynthesis (DBT) is a cutting-edge technology introduced in recent years as an in-depth analysis of breast cancer diagnostics. Compared with 2D...
Digital Breast Tomosynthesis (DBT) is a cutting-edge technology introduced in recent years as an in-depth analysis of breast cancer diagnostics. Compared with 2D Full-Field Digital Mammography, DBT has demonstrated greater sensitivity and specificity in detecting breast tumors. This work aims to quantitatively evaluate the impact of the systematic introduction of DBT in terms of Biopsy Rate and Positive Predictive Values for the number of biopsies performed (PPV-3). For this purpose, we collected 69,384 mammograms and 7894 biopsies, of which 6484 were Core Biopsies and 1410 were stereotactic Vacuum-assisted Breast Biopsies (VABBs), performed on female patients afferent to the Breast Unit of the Istituto Tumori "Giovanni Paolo II" of Bari from 2012 to 2021, thus, in the period before, during and after the systematic introduction of DBT. Linear regression analysis was then implemented to investigate how the Biopsy Rate had changed over the 10 year screening. The next step was to focus on VABBs, which were generally performed during in-depth examinations of mammogram detected lesions. Finally, three radiologists from the institute's Breast Unit underwent a comparative study to ascertain their performances in terms of breast cancer detection rates before and after the introduction of DBT. As a result, it was demonstrated that both the overall Biopsy Rate and the VABBs Biopsy Rate significantly decreased following the introduction of DBT, with the diagnosis of an equal number of tumors. Besides, no statistically significant differences were observed among the three operators evaluated. In conclusion, this work highlights how the systematic introduction of DBT has significantly impacted the breast cancer diagnostic procedure, by improving the diagnostic quality and thereby reducing needless biopsies, resulting in a consequent reduction in costs.
Topics: Female; Humans; Early Detection of Cancer; Retrospective Studies; Breast; Mammography; Breast Neoplasms; Image-Guided Biopsy; Biopsy, Large-Core Needle
PubMed: 37198373
DOI: 10.1007/s11547-023-01640-7 -
PloS One 2020To determine the concordance rate between core needle biopsy/vacuum-assisted biopsy (CNB/VAB) and postoperative histopathology in B3 (lesions of uncertain malignant...
PURPOSE
To determine the concordance rate between core needle biopsy/vacuum-assisted biopsy (CNB/VAB) and postoperative histopathology in B3 (lesions of uncertain malignant potential) and B5a (in situ) lesions found on mammograms or ultrasound.
MATERIAL AND METHODS
2,029 consecutive biopsies performed over 10 years for patients who underwent mammograms or ultrasounds. For CNB 14G needle and for VAB 8G/10G needles were used. In all biopsies, we identified the age, BI-RADS®, histopathological biopsy results, B-category, nuclear grade for DCIS and postoperative histopathology results in B3 and B5a cases from the biopsy.
RESULTS
The B-categories from CNB/VAB were as follows: B2 42.2 percent (n = 856), B3 4.5 percent (n = 91), B5a 5.7 percent (n = 115), and B5b 47.6 percent (n = 967). In the B3-category, 72/91 patients underwent surgical excision, with a concordance rate of 83.3 percent (n = 60/72) and a discordance rate of 16.7 percent (n = 12/72) to postoperative histopathology. From the discordant cases, 67.7 percent (n = 8/12) showed DCIS and 32.3 percent (n = 4/12) showed invasive breast cancer. The BIRADS of the discordant cases was 4b in 41.7 percent (n = 5/12) and 5 in 58.3 percent (n = 7/12). The PPVs for malignancy of B3 lesions were 0.21, with no statistical significance between subgroups. In the B5a-category, 101 of 115 patients underwent surgery in our hospital, with a concordance rate of 80.2 percent (n = 81/101) and a discordance rate of 19.8 percent (n = 20/101) to postoperative histopathology. From the discordant cases, 55 percent (n = 11/20) showed invasive breast carcinoma of no special type (NST).
CONCLUSION
Our concordance rate for B3 (83.3 percent) and B5a (80.2 percent) lesions in the biopsies to postoperative histopathology is matching to previously published literature. Surgical excision is our recommendation for lesions biopsied with a B3 category in the histopathology and a BIRADS category of (4b, 4c and 5). The PPVs for malignancy of B3 lesions showed no statistical significance between subgroups. Also, the nuclear grade of DCIS was not statistically significant in terms of upgrade into invasive breast cancer.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Biopsy, Large-Core Needle; Breast; Breast Neoplasms; Female; Humans; Mammography; Middle Aged; Postoperative Period; Retrospective Studies; Vacuum; Young Adult
PubMed: 32437426
DOI: 10.1371/journal.pone.0233574