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Nephron 2020A kidney biopsy is an important tool in managing kidney diseases. Bleeding is the most significant complication. The biopsy can be performed as an inpatient or an... (Review)
Review
BACKGROUND
A kidney biopsy is an important tool in managing kidney diseases. Bleeding is the most significant complication. The biopsy can be performed as an inpatient or an outpatient procedure with a shorter post-biopsy bed rest and monitoring period. It is cost-effective, but raises some questions about patient safety. At Helsinki University Hospital, the majority of elective kidney biopsies have been performed as outpatient procedures since 2010. The aim of this study was to retrospectively evaluate the safety and risk factors of this protocol.
METHODS
We collected data from all patients undergoing an elective outpatient biopsy of a native or transplanted kidney following the outpatient protocol between January 2011 and February 2016. We recorded the data on the biopsy procedure and complications: bleeding (hematoma or macrohematuria), severe pain, death, or "other" (infection, accidental puncture of another organ). A complication was classified as major, if it required interventions such as transfusion or radiological or surgical intervention.
RESULTS
Over a 5-year period, 824 (448 native and 326 transplant kidney) patients were biopsied. In total, 94 (11.4%) had a complication, but only 4 patients (0.5%) had a major complication; no deaths were recorded. All major and 70 minor complications emerged during post-biopsy monitoring (4-6 h). Patients with complications were younger (p = 0.001), female (p < 0.001), and had lower hemoglobin (p = 0.001) than those without. Transplant biopsies were associated with fewer complications than native kidney biopsies (p= 0.002).
CONCLUSIONS
In selected patients, an outpatient kidney biopsy is a relatively safe procedure.
Topics: Adult; Ambulatory Surgical Procedures; Biopsy; Female; Humans; Kidney; Male; Middle Aged; Risk Factors
PubMed: 31578024
DOI: 10.1159/000503255 -
Current Opinion in Urology Sep 2009To review the most recent literature concerning renal mass biopsy with special consideration to three points: variation in results related to the standard used as... (Review)
Review
PURPOSE OF REVIEW
To review the most recent literature concerning renal mass biopsy with special consideration to three points: variation in results related to the standard used as comparison, biopsy in small renal masses (up to 4 cm in diameter) and the case for nondiagnostic biopsy.
RECENT FINDINGS
The overall rate of failed and indeterminate biopsies shows a trend for improvement. However, selection bias and the lack of a uniform index test for comparison preclude a definitive statement. Fine-needle aspiration may equal results of core biopsy, but its role in the diagnostic algorithm is not yet defined. In-vivo accuracy decreases in small renal masses with the same limitations exposed for the overall literature on renal mass biopsy. When nondiagnostic biopsies are considered, there is a need for standardization of the nomenclature in order to compare results. Re-biopsies or surgery after a nondiagnostic biopsy shows malignancy in up to 75% of the cases of renal cell carcinoma.
SUMMARY
There is a trend in increasing interest and accuracy on the subject of percutaneous biopsy of renal masses as well as a decreasing trend in the rate of nondiagnostic biopsies. In the small renal masses, most likely to be benign, a diagnostic percutaneous biopsy may have a definitive role. However, the higher rate of nondiagnostic results in this population calls for prospective studies with standard definitions and when possible homogenous index test to properly assess the diagnostic performance of the biopsy.
Topics: Biopsy; Humans; Kidney; Kidney Neoplasms
PubMed: 19571757
DOI: 10.1097/MOU.0b013e32832f0d5a -
The Veterinary Clinics of North... Jan 1995Biopsy is an essential part of the diagnostic workup for cancer patients. Percutaneous, endoscopic, catheter, incisional, and excisional biopsies have different... (Review)
Review
Biopsy is an essential part of the diagnostic workup for cancer patients. Percutaneous, endoscopic, catheter, incisional, and excisional biopsies have different indications, accuracy, and efficacy. Careful attention to biopsy technique will minimize complications and increase the accuracy and efficacy of the biopsy procedure. Intraoperative biopsy and microscopy can be used in selected instances to modify the surgical plan.
Topics: Animals; Biopsy; Neoplasms
PubMed: 7709562
DOI: 10.1016/s0195-5616(95)50003-8 -
Acta Neurologica Scandinavica.... 2011Nerve biopsy is most often a final step in the evaluation of patients with peripheral neuropathy. The procedure should always be expected to result in varying degree of... (Review)
Review
Nerve biopsy is most often a final step in the evaluation of patients with peripheral neuropathy. The procedure should always be expected to result in varying degree of sensory loss within the innervation area of the biopsied nerve and chronic pain in the area may also occur. Therefore appropriate informed consent must be obtained and a weighing of such side effects and benefits for the patient, particularly therapeutical consequences, should be seriously considered before the procedure is performed. The surgical procedure and the processing in the laboratory of the nerve material must hold a high standard at all levels. Nerve biopsy should not be performed before adequate clinical, electrophysiological and laboratory investigations have been performed. The choice of nerve is important, but in most instances the sural nerve is biopsied, although the superficial peroneal nerve is also an option and allows an easy access to muscle biopsy in the same procedure. Laboratories performing nerve biopsies should have the facilities and expertise to prepare and evaluate fixed and frozen sections (paraffin, cryostat and epoxy-sections) and teased fibers, and also to perform light and electron microscopy and immunohistochemistry. Although not routinely used, the option of morphometry should be available as well. We recommend that properly trained technicians start the processing procedures in the operating room and, if feasible, even in hospitals outside that of the hospital with nerve laboratory. We also prefer routine use of teased fiber analysis as this visualizes in an excellent way pathological processes like axonal degeneration, demyelination and remyelination as well as other features. Evaluation of small fiber neuropathy is rarely an indication for nerve biopsy and should be investigated with skin biopsy and visualization and quantification of intraepidermal nerve fibers. Investigation of inflammatory neuropathy, particularly to demonstrate nerve vasculitis, is the main indication of nerve biopsy.
Topics: Biopsy; Demyelinating Diseases; Humans; Nerve Fibers; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 21711259
DOI: 10.1111/j.1600-0404.2011.01546.x -
Der Unfallchirurg Jun 2014Although biopsies are a key step in the diagnosis of bone tumors, they are often still referred to as a minor intervention which can be carried out by any surgeon as an... (Review)
Review
Although biopsies are a key step in the diagnosis of bone tumors, they are often still referred to as a minor intervention which can be carried out by any surgeon as an outpatient procedure or quickly carried out between other more important tasks. A biopsy should, however, be regarded as the final part of the diagnostic procedure preceded by careful evaluation of the clinical course and analysis of the required imaging studies. Although the biopsy procedure seems technically simple to perform, an incorrectly performed biopsy can become an obstacle to correct tissue analysis (sampling error) and adequate tumor resection and may reduce the patient's chances of survival. The principles by which an adequate and safe biopsy of bone tumors should be planned and executed are reviewed and the surgical approaches to different anatomical locations are presented.
Topics: Biopsy, Large-Core Needle; Bone Neoplasms; Humans; Image-Guided Biopsy; Osteosarcoma
PubMed: 24903500
DOI: 10.1007/s00113-013-2471-5 -
Journal of General Internal Medicine Jan 1998To review three commonly performed skin biopsy procedures: shave, punch, and excision. (Review)
Review
OBJECTIVE
To review three commonly performed skin biopsy procedures: shave, punch, and excision.
DATA SOURCES
English-language articles identified through a MEDLINE search (1966-1997) using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and cross-references.
STUDY SELECTION
Articles that reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care.
DATA EXTRACTION
Information was manually extracted from all selected articles and texts; emphasis was placed on information relevant to internal medicine physicians who want to learn skin biopsy techniques.
DATA SYNTHESIS
Shave biopsies require the least experience and time but are limited to superficial, nonpigmented lesions. Punch biopsies are simple to perform, have few complications, and if small, can heal without suturing. Closing the wound with unbraided nylon on a C-17 needle will enhance the cosmetic result but requires more expertise and time. Elliptical excisions are ideal for removing large or deep lesions, provide abundant material for many studies, and can be curative for a number of conditions, but require the greatest amount of time, expertise, and office resources. Elliptical excisions can be closed with unbraided nylon using a CE-3 or FS-3 needle in thick skin or a P-3 needle on the face. All specimens should be submitted in a labeled container with a brief clinical description and working diagnosis.
CONCLUSIONS
Skin biopsies are an essential technique in the management of skin diseases and can enhance the dermatologic care rendered by internists.
Topics: Biopsy; Humans; Internal Medicine; Physicians, Family; Practice Patterns, Physicians'; Retrospective Studies; Safety; Skin
PubMed: 9462495
DOI: 10.1046/j.1525-1497.1998.00009.x -
Handbook of Clinical Neurology 2013This chapter discusses the indications for biopsying a peripheral nerve and the factors involved in justifying this decision and then deciding which nerve to take. There... (Review)
Review
This chapter discusses the indications for biopsying a peripheral nerve and the factors involved in justifying this decision and then deciding which nerve to take. There is a table summarizing some of the causes of neuropathy and attempting to relate these to the probability that nerve biopsy would be helpful in diagnosis. The surgical procedure for the nerve biopsy is described including aftercare and possible complications. The techniques involved in processing and staining the nerve are discussed. This section includes the possibilities of creating artefactual damage by mishandling or poor technique, and how to avoid these. Modification to the standard resin processing schedule to allow the teasing out of individual nerve fibers is briefly described, as are methods for measuring fiber density, fiber size and myelin thickness. There is also a brief discussion of the applications of immunohistochemistry. This is followed by a section on interpretation by light and electron microscopy in which some of the more important diagnostic features are described and illustrated, as are nonspecific morphological findings. Interpretation of teased fiber preparations is discussed. Finally, some common causes of incorrect interpretation are mentioned.
Topics: Animals; Biopsy; Humans; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 23931779
DOI: 10.1016/B978-0-444-52902-2.00009-6 -
Contraception, Fertilite, Sexualite... Jun 1993
Review
Topics: Biopsy; Curettage; Embryo Implantation; Endometrial Hyperplasia; Endometrial Neoplasms; Female; Humans; Hysteroscopy; Menstrual Cycle
PubMed: 7920934
DOI: No ID Found -
Actas Dermo-sifiliograficas Jan 2012The aim of these reviews is to describe the reasons for performing skin biopsy, to provide indications for the choice of area to be biopsied and the preparation of the... (Review)
Review
The aim of these reviews is to describe the reasons for performing skin biopsy, to provide indications for the choice of area to be biopsied and the preparation of the sample, and to summarize the various complications of dermatologic surgery. In addition, we present a guide for selecting the biopsy technique based on the suspected diagnosis and on the area to be biopsied. Finally, the various artifacts that can complicate interpretation of results are described, together with the methods used to prevent their appearance insofar as is possible. The aim of this guide is to improve the diagnostic yield of biopsies and to highlight the importance of a correct clinical-histological correlation.
Topics: Antibiotic Prophylaxis; Anticoagulants; Biopsy; Hemorrhage; Humans; Skin; Skin Diseases; Specimen Handling; Staining and Labeling
PubMed: 22459516
DOI: 10.1016/j.adengl.2011.05.005 -
European Journal of Radiology Jan 2003This paper presents current indications, contraindications, technical aspects, complications and yield of diagnosis of percutaneous lung biopsy in the setting of lung... (Review)
Review
This paper presents current indications, contraindications, technical aspects, complications and yield of diagnosis of percutaneous lung biopsy in the setting of lung cancer. Percutaneous lung biopsy should be performed each time that the therapeutic strategy can be significantly influenced, when the procedure is technically feasible and to patients for which the benefits outweigh the risks, that are pneumothorax and pulmonary haemorrhage. Factors identified as potentially favouring post-biopsy pneumothorax are numerous whereas the use of a needle size larger than 18 gauge is the major risk factor of bleeding. Although a coaxial system is highly suitable in any case, two categories of needles can be used; those providing aspiration and those for core biopsies. Both offer similar yields for the diagnosis of malignancy, but core biopsies are more efficient for the specific diagnosis of benignity and lymphoma. Technical improvements of guidance, needle design and pathological techniques may contribute to lower the size limit of the nodule to be biopsied, to decrease the complication rate and their severity and to increase the yield of diagnosis.
Topics: Biopsy, Needle; Contraindications; Humans; Lung; Lung Neoplasms; Risk Factors; Sensitivity and Specificity
PubMed: 12499065
DOI: 10.1016/s0720-048x(02)00286-3