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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 -
Journal of Vascular and Interventional... Apr 2023To compare the diagnostic yield and accuracy of both image-guided core-needle biopsy (CNB) and fine-needle biopsy and evaluate the benefit of performing fine-needle... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare the diagnostic yield and accuracy of both image-guided core-needle biopsy (CNB) and fine-needle biopsy and evaluate the benefit of performing fine-needle biopsy in addition to CNB in patients with suspected benign and malignant bone tumors.
MATERIALS AND METHODS
A systematic search was performed on March 10, 2021, to determine whether fine-needle aspiration (FNA) plays any role when performed alone or in combination with CNB. The included studies were aggregated for the pooled estimates of diagnostic yield and histologic accuracy of image-guided percutaneous needle biopsy of bone tumors. Twenty-nine studies published between 1996 and 2021 were included.
RESULTS
When all patients with bone tumors were included, the rates of diagnostic yield and accuracy of FNA and CNB were 88.5% and 82.5% and 91.4% and 92.7%, respectively; the rates of both the methods combined were 96.5% and 94.1%, respectively; and for the lytic subgroup, the rates of diagnostic yield and accuracy of CNB and both the methods combined were 94.3% and 100% and 98.9% and 90.4%, respectively. A P value of <.05 was considered statistically significant.
CONCLUSION
The present meta-analysis showed that core biopsy alone outperformed fine-needle biopsy alone in all categories of benign and malignant tumors. Additionally, the diagnostic yield was improved when FNA was used in addition to CNB for lytic bone lesions.
Topics: Humans; Image-Guided Biopsy; Biopsy, Large-Core Needle; Biopsy, Fine-Needle; Bone Neoplasms; Retrospective Studies; Sensitivity and Specificity
PubMed: 36587804
DOI: 10.1016/j.jvir.2022.12.467 -
American Journal of Kidney Diseases :... Jul 2012Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described.
STUDY DESIGN
Meta-analysis of randomized controlled trials and prospective or retrospective observational studies.
SETTING & POPULATION
Adults undergoing native kidney biopsy in an inpatient or outpatient setting.
SELECTION CRITERIA FOR STUDIES
MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more.
INTERVENTION
Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance.
OUTCOMES
Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes.
RESULTS
34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant.
LIMITATIONS
Publication bias, few randomized controlled trials, and missing data.
CONCLUSIONS
Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications.
Topics: Adult; Biopsy, Needle; Creatinine; Equipment Design; Hematuria; Humans; Kidney; Needles; Risk Factors; Ultrasonography
PubMed: 22537423
DOI: 10.1053/j.ajkd.2012.02.330 -
Surgical Endoscopy Oct 2021Endoscopic ultrasonography (EUS)-guided liver biopsy is a novel technique to obtain adequate liver samples for diagnosis of liver parenchymal diseases. There are studies... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Endoscopic ultrasonography (EUS)-guided liver biopsy is a novel technique to obtain adequate liver samples for diagnosis of liver parenchymal diseases. There are studies that have evaluated the feasibility and safety of EUS-guided parenchymal liver biopsy (EUS-LB), however, factors that can influence specimen quality are yet to be determined. Our aim was to determine the diagnostic accuracy of EUS-LB and evaluate factors associated with specimen quality.
METHODS
We performed a detailed search of PubMed/MEDLINE and Web of Science™ databases to identify studies in which results of EUS-guided liver parenchymal biopsies were reported published up to July 2020. A random effects model was used to estimate pooled values (mean ± SE) for total specimen length (TSL) and complete portal tracts (CPT). Subgroup analyses were applied to find out the procedural factors associated with better specimen quality using Cochran's Q test. A total of 10 meta-analyses were done focusing on international studies. Total of 1326 patients who underwent EUS-LB. EUS-LBs performed for suspicion of parenchymal liver disease. Pooled mean values for TSL and CPT with subgroup analyses.
RESULTS
Twenty-three studies with a total of 1326 patients were included in our meta-analysis. Overall pooled mean TSL and CPT were 45.3 ± 4.6 mm and 15.8 ± 1.5, respectively. In subgroup analysis, core biopsy needles proved to better in terms of CPT than fine-needle aspiration needles (18.4 vs 10.99, p = 0.003). FNB with slow-pull or suction technique provided a similar TSL (44.3 vs 53.9 mm, p = 0.40), however, slow-pull technique was better in terms of CPT (30 vs 14.6, p < 0.001). Heterogeneity was present among the studies. Another limitation is the low number randomized control trials.
CONCLUSION
EUS-guided parenchymal liver biopsy is a good alternative to other methods of liver sampling. Using FNB needles with a slow-pull technique can provide better results.
Topics: Biopsy, Large-Core Needle; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Image-Guided Biopsy; Liver; Prospective Studies
PubMed: 33052529
DOI: 10.1007/s00464-020-08053-x -
Annals of Internal Medicine Feb 2010Most women undergoing breast biopsy are found not to have cancer. (Comparative Study)
Comparative Study Review
BACKGROUND
Most women undergoing breast biopsy are found not to have cancer.
PURPOSE
To compare the accuracy and harms of different breast biopsy methods in average-risk women suspected of having breast cancer.
DATA SOURCES
Databases, including MEDLINE and EMBASE, searched from 1990 to September 2009.
STUDY SELECTION
Studies that compared core-needle biopsy diagnoses with open surgical diagnoses or clinical follow-up.
DATA EXTRACTION
Data were abstracted by 1 of 3 researchers and verified by the primary investigator.
DATA SYNTHESIS
33 studies of stereotactic automated gun biopsy; 22 studies of stereotactic-guided, vacuum-assisted biopsy; 16 studies of ultrasonography-guided, automated gun biopsy; 7 studies of ultrasonography-guided, vacuum-assisted biopsy; and 5 studies of freehand automated gun biopsy met the inclusion criteria. Low-strength evidence showed that core-needle biopsies conducted under stereotactic guidance with vacuum assistance distinguished between malignant and benign lesions with an accuracy similar to that of open surgical biopsy. Ultrasonography-guided biopsies were also very accurate. The risk for severe complications is lower with core-needle biopsy than with open surgical procedures (<1% vs. 2% to 10%). Moderate-strength evidence showed that women in whom breast cancer was initially diagnosed by core-needle biopsy were more likely than women with cancer initially diagnosed by open surgical biopsy to be treated with a single surgical procedure (random-effects odds ratio, 13.7 [95% CI, 5.5 to 34.6]).
LIMITATION
The strength of evidence was rated low for accuracy outcomes because the studies did not report important details required to assess the risk for bias.
CONCLUSION
Stereotactic- and ultrasonography-guided core-needle biopsy procedures seem to be almost as accurate as open surgical biopsy, with lower complication rates.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Biopsy; Biopsy, Needle; Breast; Breast Neoplasms; Evidence-Based Medicine; Female; Humans; Risk; Sensitivity and Specificity; Stereotaxic Techniques; Ultrasonography, Mammary; Vacuum
PubMed: 20008742
DOI: 10.7326/0003-4819-152-1-201001050-00190 -
Urologia Internationalis 2012To systematically evaluate the risk of antiplatelet drugs (APs) on bleeding complications in urological surgery. (Comparative Study)
Comparative Study Meta-Analysis Review
Risk of bleeding complications after preoperative antiplatelet withdrawal versus continuing antiplatelet drugs during transurethral resection of the prostate and prostate puncture biopsy: a systematic review and meta-analysis.
OBJECTIVE
To systematically evaluate the risk of antiplatelet drugs (APs) on bleeding complications in urological surgery.
METHODS
Studies were sought and included in this review if they were clinical controlled trials and involved transurethral resection of the prostate (TURP) and prostate puncture biopsy (PPB), which compared preoperative AP withdrawal (control group) with continuing APs (experimental group) and revealed bleeding complications as outcomes. A literature search was conducted of the electronic databases PubMed, Ovid, ScienceDirect and Embase for studies published between 1990 and 2012. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. There was evidence of publication bias based on Egger's test and funnel plot. Data were processed using Cochrane Review Manager 5.0 software.
RESULTS
Nine studies involving 3,145 cases met the inclusion criteria and were included in the meta-analysis. The baselines of patients' characteristics were comparable in all studies. The meta-analysis results showed that no differences were found in risk of bleeding after (1) TURP (OR 1.26, 95% CI 0.80-2.00, p = 0.32) or (2) PPB (OR 0.89, 95% CI 0.45-1.76, p = 0.73).
CONCLUSION
Preoperative APs do not raise the risk of surgical bleeding complications in prostatectomy and PPB. Because of few studies and small samples, more high-quality trials with larger samples and longer follow-ups are proposed.
Topics: Hemorrhage; Humans; Intraoperative Complications; Male; Platelet Aggregation Inhibitors; Preoperative Care; Prostate; Punctures; Risk; Transurethral Resection of Prostate
PubMed: 23154789
DOI: 10.1159/000343733 -
Gastrointestinal Endoscopy Feb 2019EUS-guided liver biopsy (LB) is an emerging technique over conventional percutaneous (PC) or transjugular (TJ) approaches. Recent studies have reported that EUS-guided... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
EUS-guided liver biopsy (LB) is an emerging technique over conventional percutaneous (PC) or transjugular (TJ) approaches. Recent studies have reported that EUS-guided LB may have a better safety profile than PC LB or TJ LB without compromising diagnostic yield, and the outcomes are varied with respect to the types of biopsy needles. We performed a systematic review and meta-analysis to estimate the diagnostic yield, specimen adequacy, and adverse events associated with EUS-guided LB.
METHODS
We conducted a comprehensive search of multiple electronic databases and conference proceedings, including PubMed, EMBASE, and Web of Science databases (from inception to June 2018) to identify studies that reported on EUS-guided LB. The primary outcome was to estimate the pooled rates of successful diagnosis made and insufficient specimen obtained. The secondary outcome was to estimate the pooled rate of adverse events. A subgroup analysis compared the outcomes based on the type of biopsy needle.
RESULTS
A total of 9 study arms with 437 patients were included. The pooled rate of successful histologic diagnoses was 93.9% (95% confidence interval [CI], 84.9-97.7), with heterogeneity I of 75.3%. The pooled rate of insufficient specimen obtained was 10.1% (95% CI, 3.5-25.8), with I = 71.6%. The pooled rate of adverse events with EUS-guided LB was 2.3% (95% CI; 1.1-4.8, I = 0). On subgroup analysis, the adverse events rate with a 19-gauge FNA needle (vs other core biopsy needles) was 0.9% (vs 2.7%, P = .28), and the rate of diagnostic yield was 95.8% (vs 92.7%, P = .59). The rate of insufficient specimen was significantly lower with an FNA needle compared with the core needle (4% vs 20%, P = .03).
CONCLUSION
With a histologic diagnosis rate of 93.9% and adverse event rate of 2.3%, EUS-guided LB appears to be both effective and safe. A 19-gauge FNA needle provides significantly better biopsy specimens and seems to have better outcomes compared with other core biopsy needles.
Topics: Biopsy, Large-Core Needle; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Image-Guided Biopsy; Liver
PubMed: 30389469
DOI: 10.1016/j.gie.2018.10.018 -
Gastrointestinal Endoscopy Apr 2023A histologic diagnosis of GI subepithelial tumors (SETs) is important because of the malignant potential of these lesions. The current modalities of choice, including... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
A histologic diagnosis of GI subepithelial tumors (SETs) is important because of the malignant potential of these lesions. The current modalities of choice, including EUS-guided FNA and biopsy (EUS-FNA/FNB) have demonstrated suboptimal diagnostic success. Single-incision with needle-knife (SINK) biopsy has emerged as an alternative diagnostic approach to increase tissue acquisition and diagnostic success. The aim of this study was to perform a systematic review and meta-analysis to evaluate the technical success, diagnostic success, and adverse events of SINK biopsy.
METHODS
We searched multiple databases including PubMed, EMBASE, CINAHL, Cochrane, Web of Science, and Google Scholar from inception to July 2022. The primary outcomes assessed were the technical success and diagnostic success of SINK in GI SETs. The secondary outcomes assessed were adverse events and whether immunohistochemical analysis could be successfully performed on tissue samples obtained via SINK.
RESULTS
Seven studies with a total of 219 SINK biopsy procedures were included in this meta-analysis. The technical success rate was 98.1% (95% CI, 94.9%-99.3%; P = .000; I = .0%), and the diagnostic success rate was 87.9% (95% CI, 82.6%-91.7%; P = .000; I = .0%). The immunohistochemical success rate was 88.3% (95% CI, 78.7%-93.9%; P = .000; I = 3.5%). The rate of adverse events was 7.5% (95% CI, 4.3%-12.7%; P = .00; I = 7.2%), and bleeding was the most common adverse event.
CONCLUSION
SINK biopsy is a safe diagnostic procedure with a high technical and diagnostic success in patients with GI SET. Further randomized controlled trials and direct comparison studies are needed to validate these findings.
Topics: Humans; Gastrointestinal Neoplasms; Needles; Endoscopic Ultrasound-Guided Fine Needle Aspiration
PubMed: 36460089
DOI: 10.1016/j.gie.2022.11.021 -
Clinical Journal of the American... Jan 2019Kidney biopsy is an essential tool for the diagnosis and treatment of patients with kidney disease; however, because of its invasive nature, bleeding complications may... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Kidney biopsy is an essential tool for the diagnosis and treatment of patients with kidney disease; however, because of its invasive nature, bleeding complications may arise.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We performed a meta-analysis of prospective or retrospective observational studies and randomized, controlled trials in pediatric patients undergoing native or transplant kidney biopsy in an inpatient or outpatient setting in MEDLINE-indexed studies from January 1998 to November 1, 2017 to determine the proportion of patients who develop hematoma, need blood transfusion, or need an additional intervention due to a complication after kidney biopsy.
RESULTS
Twenty-three studies of 5504 biopsies met inclusion criteria. The proportion of patients developing hematoma after biopsy was between 11% (95% confidence interval, 7% to 17%) and 18% (95% confidence interval, 9% to 35%) using two analyses that included different time periods. The proportion needing blood transfusion was 0.9% (95% confidence interval, 0.5% to 1.4%). The proportion needing an additional intervention due to postbiopsy complication was 0.7% (95% confidence interval, 0.4% to 1.1%). Secondary analysis was not possible due to lack of data in the original manuscripts on laboratory values, needle gauges, number of needle passes, age of patient, or performer (attending versus trainee). Analysis with metaregression found that use of real-time ultrasound during biopsy did not modify the risk for hematoma, requirement of a blood products transfusion, or requirement of an additional procedure after biopsy. Analysis with metaregression comparing native biopsies with transplant biopsies did not reveal that biopsy type (native kidney biopsy versus transplant kidney biopsy) was associated with the need for a blood transfusion or requirement of an additional intervention after biopsy.
CONCLUSIONS
The development of perinephric hematoma after kidney biopsy is not an infrequent finding. The proportion of patients requiring blood transfusion or needing an additional intervention as a result of kidney biopsy in pediatric patients is significantly smaller.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Young Adult; Biopsy; Blood Transfusion; Hematoma; Kidney; Kidney Diseases; Postoperative Complications; Reoperation
PubMed: 30522995
DOI: 10.2215/CJN.05890518 -
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