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Rheumatology International Oct 2023For knee osteoarthritis and related conditions, analysis of biomarkers hold promise to improve early diagnosis and/or offer patient-specific treatment. To compare... (Review)
Review
For knee osteoarthritis and related conditions, analysis of biomarkers hold promise to improve early diagnosis and/or offer patient-specific treatment. To compare biomarker analyses, reliable, high-quality biopsies are needed. The aim of this work is to summarize the literature on the current best practices of biopsy of the synovium and synovial fluid arthrocentesis. Therefore, PubMed, Embase and Web of Science were systematically searched for articles that applied, demonstrated, or evaluated synovial biopsies or arthrocentesis. Expert recommendations and applications were summarized, and evidence for superiority of techniques was evaluated. Thirty-one studies were identified for inclusion. For arthrocentesis, the superolateral approach in a supine position, with a 0°-30° knee flexion was generally recommended. 18-gage needles, mechanical compression and ultrasound-guidance were found to give superior results. For blind and image-guided synovial biopsy techniques, superolateral and infrapatellar approaches were recommended. Single-handed tools were preconized, including Parker-Pearson needles and forceps. Sample quantity ranged approximately from 2 to 20. Suggestions were compiled for arthrocentesis regarding approach portal and patient position. Further evidence regarding needle size, ultrasound-guidance and mechanical compression were found. More comparative studies are needed before evidence-based protocols can be developed.
Topics: Humans; Arthrocentesis; Synovial Fluid; Knee Joint; Biopsy; Synovial Membrane
PubMed: 36513849
DOI: 10.1007/s00296-022-05256-4 -
Journal of the American Academy of... Dec 2015Animal-type melanoma is a rare subtype of melanoma with heavily pigmented dermal epithelioid and spindled melanocytes. Its classification as a subtype of melanoma versus... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Animal-type melanoma is a rare subtype of melanoma with heavily pigmented dermal epithelioid and spindled melanocytes. Its classification as a subtype of melanoma versus a borderline melanocytic tumor is debated.
OBJECTIVES
Our primary objective was to characterize the demographics, clinical presentation, histopathology, management, and outcomes of patients with animal-type melanoma.
METHODS
We performed a systematic review and meta-analysis of the English-language literature on animal-type melanoma.
RESULTS
We identified 190 cases of animal-type melanoma. They occurred equally in men and women, with Caucasians (53.7%) most commonly affected. The median Breslow depth was 3.8 mm; ulceration was reported present in 15.8%; and dermal mitoses greater than or equal to 1/mm(2) was reported in 27.4%. The most common initial management was wide local excision with sentinel lymph node biopsy (55.7%). In all, 78 patients underwent sentinel lymph node biopsy with 41.0% positivity rate. A total of 32 patients underwent completion lymph node dissection with 34.4% positivity rate. Locoregional recurrence was reported in 15 patients, recurrence with distant metastases in 6 patients, and death in 5 patients.
LIMITATIONS
Data were obtained from small studies with limited follow-up. There is no universally accepted definition of animal-type melanoma.
CONCLUSION
Prospective studies with complete staging information and molecular profiling may allow further characterization of this tumor.
Topics: Biopsy, Needle; Female; Humans; Immunohistochemistry; Incidence; Male; Melanocytes; Melanoma; Prognosis; Prospective Studies; Rare Diseases; Risk Assessment; Skin Neoplasms
PubMed: 26412164
DOI: 10.1016/j.jaad.2015.08.016 -
Radiology Sep 2011To use meta-analysis to determine the complication rate and diagnostic accuracy of image-guided percutaneous needle biopsy of the spleen. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To use meta-analysis to determine the complication rate and diagnostic accuracy of image-guided percutaneous needle biopsy of the spleen.
MATERIALS AND METHODS
Several electronic databases were searched through July 2010 without language restrictions. Two reviewers independently selected studies that met the inclusion criteria for the diagnostic accuracy and complication rate arms of the study. Study data were independently extracted by the two reviewers. The primary 2 × 2 data were investigated with a random-effects meta-analysis of sensitivity and specificity. The complication rate data were investigated with a random-effects meta-analysis; sensitivity analysis of complication rate, excluding needles larger than 18 gauge, was performed.
RESULTS
Four studies met the inclusion criteria for the diagnostic accuracy arm (639 patients), and nine met the inclusion criteria for the complication rate arm (741 patients). The meta-analysis showed a pooled sensitivity of 87.0% (95% confidence interval [CI]: 80.7%, 91.4%) and specificity of 96.4% (95% CI: 81.4%, 99.4%). The pooled major complication rate was 2.2% (95% CI: 0.8%, 5.6%). Sensitivity analysis with the removal of biopsies performed with needles larger than 18 gauge showed a major complication rate of 1.3% (95% CI: 0.6%, 2.5%). The most commonly encountered complications were hemorrhage followed by pain.
CONCLUSION
Image-guided percutaneous biopsy of the spleen demonstrates high diagnostic accuracy and a major complication rate, for needles 18 gauge or smaller, that is similar to that reported for the liver and kidney. This technique should be considered a favorable alternative to splenectomy.
Topics: Diagnostic Imaging; Hemorrhage; Humans; Incidence; Pain; Postoperative Complications; Risk Assessment; Risk Factors; Spleen; Surgery, Computer-Assisted
PubMed: 21693659
DOI: 10.1148/radiol.11110333 -
Journal of Hepatology Aug 2007Transjugular liver biopsy (TJLB) is considered an inferior biopsy, used when percutaneous liver biopsy (PLB) is contraindicated. According to recent literature,... (Review)
Review
Transjugular liver biopsy (TJLB) is considered an inferior biopsy, used when percutaneous liver biopsy (PLB) is contraindicated. According to recent literature, specimens with 6 complete portal tracts (CPTs) are needed for histological diagnosis of chronic liver disease but 11 CPTs to reliably stage and grade. Mean CPT number in PLB series is 7.5; more passes increase complications. Sixty-four series reporting 7649 TJLBs were evaluated for quality of specimen and safety. Major indications were coagulation disorders and/or ascites. Success rate was 96.8%. Fragmentation rate was 34.3%, not correlating with length or diagnostic adequacy. With a mean of 2.7 passes, mean CPT number was 6.8. Histological diagnosis was achieved in 96.1% of TJLBs, correlating with length (p=0.007) and CPT number (p=0.04). Tru-Cut specimens had a mean CPT number of 7.5 and, compared to Menghini specimens, were longer (p<0.008), less fragmented (p<0.001) and more diagnostic (p<0.001). Thinner needles (>16-G) provided significantly longer and less fragmented specimens. Minor and major complication rates were 6.5% and 0.56%, respectively, and increased in children, but not with additional passes. In adults, mortality was 0.09% (haemorrhage 0.06%; ventricular arrhythmia 0.03%). TJLB is safe, providing specimens qualitatively comparable to PLB, and may improve further using > or = 18-G Tru-Cut needle and >3 passes.
Topics: Biopsy, Needle; Humans; Jugular Veins; Liver
PubMed: 17561303
DOI: 10.1016/j.jhep.2007.05.001 -
AJNR. American Journal of Neuroradiology Jul 2017Sonography-guided fine-needle aspiration leads to relatively frequent cases of indeterminate cytology for the diagnosis of thyroid nodules. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sonography-guided fine-needle aspiration leads to relatively frequent cases of indeterminate cytology for the diagnosis of thyroid nodules.
PURPOSE
Our aim was to evaluate the efficacy and safety of core needle biopsy for the examination of thyroid nodules with initially indeterminate results on fine-needle aspiration.
DATA SOURCES
A computerized search of the MEDLINE and Embase databases was performed to identify relevant original articles.
STUDY SELECTION
Studies investigating the use of core needle biopsy for thyroid nodules with initially indeterminate results on previous fine-needle aspiration were eligible for inclusion.
DATA ANALYSIS
The pooled proportions for nondiagnostic results, inconclusive results, malignancy on core needle biopsy, the ability of core needle biopsy to diagnose malignancy, and the related complications of the procedure were analyzed.
DATA SYNTHESIS
The meta-analytic pooling was based on a random-effects model. Nine eligible studies, involving 2240 patients with 2245 thyroid nodules, were included. The pooled proportion for nondiagnostic results was 1.8% (95% CI, 0.4%-3.2%), and the pooled proportion for inconclusive results was 25.1% (95% CI, 15.4%-34.9%). The pooled proportion for malignancy was 18.9% (95% CI, 8.4%-29.5%). With regard to the diagnostic performance for malignancy, the sensitivity of core needle biopsy varied, ranging from 44.7% to 85.0%, but the specificity was 100% in all cases. No major complications of core needle biopsy were observed.
LIMITATIONS
The relatively small number of included studies and retrospective nature were limitations.
CONCLUSIONS
Core needle biopsy has low nondiagnostic result rates and high specificity for the diagnosis of malignancy. It is a safe diagnostic technique with a higher diagnostic yield, especially when molecular testing is not available or fine-needle aspiration did not yield enough cells for molecular testing.
Topics: Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Humans; Reproducibility of Results; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography, Interventional
PubMed: 28473343
DOI: 10.3174/ajnr.A5182 -
European Radiology Sep 2018To identify the complication rate associated with US-guided core needle biopsy (CNB) of thyroid lesions using a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To identify the complication rate associated with US-guided core needle biopsy (CNB) of thyroid lesions using a systematic review and meta-analysis.
METHODS
Ovid-MEDLINE and EMBASE databases were searched for studies on US-guided CNB of thyroid lesions from 1 January 1994-13 December 2016. A review of 393 potential papers identified 39 eligible papers including 14,818 patients. The pooled proportions of complications were assessed using random-effects modelling. Subgroup analysis was performed. Among-study heterogeneity was explored using χ statistic for pooled estimates and inconsistency index I. Quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies.
RESULTS
The pooled proportion of overall complications after CNB of thyroid lesions was 1.11% (95% CI: 0.64-1.51, I: 87.2%). The pooled proportion of major complications (0.06% [95% CI: 0.02-0.10], I: 0.0%) was much lower than that of minor complications (1.08%[95% CI: 0.63-1.53], I: 93.17%). Subgroup analysis revealed no significant differences between studies on Asian versus non-Asian groups (p=0.7769), radiologist versus non-radiologist groups (p=0.8607), nodule size <20 mm versus nodule size ≥20 mm (p=0.1591) groups, CNB versus CNB-plus-FNA groups (p=0.9281) and studies performed before and after 2012 (p=0.6251). The overall quality of the included studies was moderate with all of the studies satisfying five or more of the eight total domains.
CONCLUSION
Various complications can occur after US-guided CNB of thyroid lesions. However, the procedure is safe, with a low complication rate.
KEY POINTS
• Various complications occurred after CNB of thyroid lesions, but the pooled complication rate was low (1.11%, I = 87.2%). • The pooled proportion of major complications (0.06%) was much lower than that of minor complications (1.08%). • There was no significant differences between studies on Asian vs. non-Asian groups, radiologist vs. non-radiologist groups, nodule size <20 mm vs. nodule size ≥20 mm groups, CNB vs. CNB-plus-FNA groups, or studies performed before 2012 vs. after 2012.
Topics: Aneurysm, False; Asian People; Biopsy, Large-Core Needle; Hematoma; Humans; Image-Guided Biopsy; Neck; Radiologists; Thyroid Nodule; Ultrasonography; Voice Disorders
PubMed: 29589112
DOI: 10.1007/s00330-018-5367-5 -
European Urology Jun 2013The optimal initial prostate biopsy core number is still an issue with many unanswered questions and significant controversy. (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The optimal initial prostate biopsy core number is still an issue with many unanswered questions and significant controversy.
OBJECTIVE
To compare diagnostic values of initial saturation prostate biopsy scheme and extended scheme with respect to prostate-specific antigen (PSA) levels, prostate volume (PV), and PSA density (PSAD).
EVIDENCE ACQUISITION
Electronic databases including Medline, Web of Knowledge, and the Cochrane Library were searched through November 1, 2012. Experts were consulted, and references from relevant articles were scanned. The meta-analysis was conducted with RevMan 5.1, according to the PRISMA guidelines. Mantel-Haenszel estimates were calculated and pooled under a fixed or random effect model, with data expressed as risk difference (RD) and 95% confidence interval (CI).
EVIDENCE SYNTHESIS
We analyzed eight trials with a total of 11997 participants who underwent transrectal ultrasound guided prostate biopsies for the first time and met inclusion criteria. Studies consisted of one paired design study, two randomized clinical trials, and five nonrandomized studies. Saturation biopsy scheme showed a significant advantage in prostate cancer (PCa) detection over an extended scheme (RD: 0.04; 95% CI, 0.01-0.08; p=0.02). In addition, subgroup analyses found a saturation protocol to be superior to an extended protocol in the detection of PCa in men with PSA <10 ng/ml (RD: 0.04; 95% CI, 0.01-0.07; p=0.002), PV >40 ml (RD: 0.05; 95%CI, 0.01-0.09; p=0.02), or PSAD <0.25 ng/ml per gram (RD: 0.04; 95% CI, 0.00-0.09; p=0.04).
CONCLUSIONS
The existing evidence indicates that an initial saturation biopsy scheme is more efficient than an extended scheme for PCa detection, especially for those men with lower PSA levels, higher PV, or lower PSAD, without increasing complications and the amount of insignificant cancer.
Topics: Biopsy, Large-Core Needle; Humans; Image-Guided Biopsy; Kallikreins; Male; Organ Size; Prostate-Specific Antigen; Prostatic Neoplasms; Ultrasonography
PubMed: 23414775
DOI: 10.1016/j.eururo.2013.01.035 -
Journal of the American Society of... 2020The workup of musculoskeletal (MSK) lesions utilizes a range of diagnostic tests including incisional biopsy, core needle biopsy, and fine-needle aspiration (FNA). FNA... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The workup of musculoskeletal (MSK) lesions utilizes a range of diagnostic tests including incisional biopsy, core needle biopsy, and fine-needle aspiration (FNA). FNA is the most cost-effective and least invasive biopsy method, but variation in its reported diagnostic performance has constrained its use for MSK lesions. Herein, we undertake a meta-analysis to clarify the diagnostic performance of FNA for bone and soft tissue lesions.
MATERIALS AND METHODS
A systematic search was run in MEDLINE, EMBASE, and CINAHL. Included studies were aggregated for pooled estimates of adequacy, accuracy, and sensitivity/specificity for all MSK lesions as well as bone and soft tissue independently. Analysis of heterogeneity and risk of bias were assessed across studies. Covariate subgroup analyses were attempted to investigate potential influences on diagnostic accuracy.
RESULTS
Twenty-five articles met inclusion criteria, representing 4604 FNAs. Adequacy was 92.3% (range: 59.2%-98.0%, S = 9.4%), and sensitivity/specificity for the nature (malignant or benign) of the lesion was 95.6% (95% CI: 94.5%-96.5%) and 96.9% (95% CI: 95.9%-97.7%). FNA was 75.8% accurate (range: 42.5%-99.3%, S = 17.3%) for definitive diagnosis. FNA provides higher accuracy for benign versus malignant nature in bone lesions but achieves a definitive diagnosis more frequently in soft tissue lesions.
CONCLUSIONS
The results of this meta-analysis support the expanded use of FNA in the diagnostic workup of bone and soft tissue lesions, particularly in light of a sensitivity and specificity comparable to incisional and core needle biopsy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Bone Neoplasms; Bone and Bones; Child; Child, Preschool; Data Accuracy; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Sensitivity and Specificity; Soft Tissue Neoplasms; Young Adult
PubMed: 32622858
DOI: 10.1016/j.jasc.2020.05.012 -
Respiratory Care Mar 2012To perform a systematic review and meta-analysis of prospectively conducted studies to define diagnostic performance of endobronchial ultrasound-guided transbronchial... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review and meta-analysis of prospectively conducted studies to define diagnostic performance of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNB) in mediastinal and hilar lymphadenopathy.
METHODS
A comprehensive search was performed using the Embase, Ovid Medline, Ovid Medline In-Process and Other Non-Indexed Citations, All Evidence Based Medicine Reviews-Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CCTR), Health Technology Assessment (HTA), and SCOPUS databases, in the second week of November 2010. Studies were selected in 2 phases by 2 reviewers, independently. Data extraction from each study was performed using a standardized data extraction form. Quality assessment of study methodology was done using a checklist that was developed based on a Quality Assessment of Diagnostic Accuracy Studies tool and the nature of the test. Using the 2 × 2 tables, we computed the sensitivity, specificity, and likelihood ratios.
RESULTS
The 14 studies included for quantitative data synthesis had a pooled cohort of 1,658 patients, from 8 different countries. The EBUS-TBNB had excellent pooled specificity of 100% (95% CI 0.90-1.00) and a positive likelihood ratio of 5.1 (95% CI 2.7-9.7). The pooled sensitivity was 0.92 (95% CI 0.91-0.93), and the pooled negative likelihood ratio was 0.13 (95% CI 0.09-0.19). The sensitivity of this intervention was not dependent on rapid on-site evaluation use or size of needle used. The pooled diagnostic odds ratio was 62.7 (95% CI 25.7-153.0). Only one major complication was reported, which resulted in early termination of the procedure.
CONCLUSIONS
Evidence of moderate quality confirms the high diagnostic performance of EBUS-TBNB for mediastinal and hilar lymphadenopathy, both in malignant and non-malignant conditions. Available evidence also demonstrates the safety of this procedure.
Topics: Biopsy, Needle; Endosonography; Humans; Lymphatic Diseases; Mediastinal Diseases; Prospective Studies; Sensitivity and Specificity
PubMed: 22004665
DOI: 10.4187/respcare.01274 -
Investigative and Clinical Urology Mar 2016Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%-3% in contemporary series. Historically,... (Review)
Review
PURPOSE
Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%-3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy.
MATERIALS AND METHODS
A systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria.
RESULTS
Effective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel.
CONCLUSIONS
The scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice.
Topics: Antibiotic Prophylaxis; Biopsy, Needle; Cross Infection; Disinfection; Humans; Male; Needles; Prostate; Prostatic Neoplasms; Sepsis
PubMed: 26981590
DOI: 10.4111/icu.2016.57.2.94