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Archivio Italiano Di Urologia,... Dec 2014We performed an analysis of the literature about the optimal prostate biopsy (PBX) scheme in the repeated setting (Review)
Review
PURPOSE
We performed an analysis of the literature about the optimal prostate biopsy (PBX) scheme in the repeated setting
METHODS
We performed a clinical and critical literature review by searching Medline Database from January 2005 up to January 2014. Electronic searches were limited to the English language. The keywords were: prostate cancer, prostate biopsy, transrectal ultrasound, transperineal prostate biopsy.
RESULTS
The recommended approach in repeated setting is still the extended scheme (EPBx) (12 cores). An approach with more than 12 cores according to the clinical characteristics of the patients may optimize cancer detection. Saturation PBx (> 20 cores) clearly improves cancer detection if clinical suspicion persists after previous negative biopsy. Nevertheless international guidelines do not strongly recommended SPBx in all situations of repeated setting. EPBx or SPBX may be, in the future, substituted by multiparametric MRI-targeted biopsies.
CONCLUSIONS
Since the scenario in which a PBx is changing, the issue about the number and location of the cores in PBx is still a matter of debate in repeated setting. At present, EPBx are still the gold standard even if SPBx seems to be necessary in many cases. However, random PBx does not represent the approach of the future, but rather imaging targeted biopsy.
Topics: Biopsy; Humans; Male; Prostate; Prostatic Neoplasms
PubMed: 25641460
DOI: 10.4081/aiua.2014.4.311 -
Canadian Association of Radiologists... Nov 2019Although medical factors such as hypertension and coagulopathy have been identified that are associated with hemorrhage after renal biopsy, little is known about the...
INTRODUCTION
Although medical factors such as hypertension and coagulopathy have been identified that are associated with hemorrhage after renal biopsy, little is known about the role of technical factors. The purpose of our study was to examine the effects of biopsy needle direction on renal biopsy specimen adequacy and bleeding complications.
METHODS
Two hundred and forty-two patients who had undergone ultrasound-guided renal biopsies were included. A printout of the ultrasound picture taken at the time of the biopsy was used to measure the biopsy angle ("angle of attack" [AOA]) and to determine if the biopsy needle was aimed at the upper or lower pole and if the medulla was targeted or avoided.
RESULTS
Of the 3 groups of biopsy angle, an AOA of between 50°-70° yielded the most glomeruli per core (P = .001) and the fewest inadequate specimens (4% vs 15% for > 70°, and 9% for < 50°, P = .038). Biopsy directed at a pole vs an interpolar region resulted in fewer inadequate specimens (8% vs 23%, P = .005), while biopsies that were medulla-avoiding resulted in fewer inadequate specimens (5% vs 16%, P = .004) and markedly reduced bleeding complications (12% vs 46%, P < .001) compared to biopsies where the medulla was entered.
DISCUSSION
An AOA of approximately 60°, aiming at the poles, and avoiding the medulla were each associated with fewer inadequate biopsies and bleeding complications. While biopsy of the medulla is necessary for some diagnoses, the increased bleeding risk emphasizes the need for communication between nephrologist, pathologist, and radiologist.
Topics: Adult; Biopsy, Needle; Female; Hemorrhage; Humans; Image-Guided Biopsy; Kidney Diseases; Male; Middle Aged; Retrospective Studies; Ultrasonography, Interventional
PubMed: 30928202
DOI: 10.1016/j.carj.2018.11.006 -
Urology Journal Nov 2022Prostate biopsies are associated with infectious complications and approximately 80% are either benign or clinically insignificant prostate cancer. Our aim is to develop...
PURPOSE
Prostate biopsies are associated with infectious complications and approximately 80% are either benign or clinically insignificant prostate cancer. Our aim is to develop and independently validate prediction model to avoid unnecessary prostate biopsies by predicting clinically significant prostate cancer (csPCa) Materials and Methods: Retrospective analysis of single-center cohort (Mount Sinai Hospital, NY) of 1632 men who underwent systematic or combined systematic and Magnetic Resonance Imaging (MRI)/ultrasound fusion targeted prostate biopsy between 2014-2020. External cohort (University of Miami) included 622 men that underwent biopsy. Outcome for predicting csPCa was defined as International Society of Urologic Pathology (ISUP) Gleason grade ≥ 2 on biopsy. Multivariable logistic regression analysis was performed to build nomogram using coefficients of logit function. Nomogram validation was performed in external cohort by plotting receiver operating characteristics (ROC). We also plotted decision curve analysis (DCA) and compared nomogram-predicted probabilities with actual rates of csPCa probabilities in external cohort.
RESULTS
Of 1632 men, 43% showed csPCa on biopsy. PSA density, prior negative biopsy, and Prostate Imaging and Reporting Data System (PI-RADS) scores 3, 4, and 5 were significant predictors for csPCa. ROC for prediction of csPCa was 0.88 in external cohort. There was agreement between predicted and actual rate of csPCa in external cohort. DCA demonstrated net benefit using the model. Using the prediction model at threshold of 30, 35% of biopsies and 46% of diagnosed indolent PCa could be avoided, while missing 5% of csPCa.
CONCLUSION
Using our prediction model can help reduce unnecessary prostate biopsies with minimal impact on csPCa detection rates.
Topics: Male; Humans; Prostate; Prostatic Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Biopsy; Image-Guided Biopsy
PubMed: 34978065
DOI: 10.22037/uj.v18i.6852 -
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 -
Cleveland Clinic Journal of Medicine Mar 2005Clinical imaging and serologic testing are increasingly replacing biopsy for diagnosing hepatic diseases. However, more biopsies are being done to stage and grade... (Review)
Review
Clinical imaging and serologic testing are increasingly replacing biopsy for diagnosing hepatic diseases. However, more biopsies are being done to stage and grade hepatitis C and fatty liver disease, to diagnose space-occupying lesions (typically with fine-needle aspiration biopsy), and to assess response to therapy. If biopsy is planned, it is important to evaluate its indications and risks and, if other physicians are involved, who is responsible for what.
Topics: Biopsy; Fatty Liver; Hemochromatosis; Hepatitis B; Hepatitis C; Humans; Liver; Liver Diseases
PubMed: 15825800
DOI: 10.3949/ccjm.72.3.199 -
Journal of the American Society of... Oct 2022Semiquantitative visual inspection for glomerulosclerosis, interstitial fibrosis, and arteriosclerosis is often used to assess chronic changes in native kidney biopsies....
BACKGROUND
Semiquantitative visual inspection for glomerulosclerosis, interstitial fibrosis, and arteriosclerosis is often used to assess chronic changes in native kidney biopsies. Morphometric evaluation of these and other chronic changes may improve the prognostic assessment.
METHODS
We studied a historical cohort of patients who underwent a native kidney biopsy between 1993 and 2015 and were followed through 2021 for ESKD and for progressive CKD (defined as experiencing 50% eGFR decline, temporary dialysis, or ESKD). Pathologist scores for the percentages of globally sclerosed glomeruli (GSG), interstitial fibrosis and tubular atrophy (IFTA), and arteriosclerosis (luminal stenosis) were available. We scanned biopsy sections into high-resolution images to trace microstructures. Morphometry measures were percentage of GSG; percentage of glomerulosclerosis (percentage of GSG, ischemic-appearing glomeruli, or segmentally sclerosed glomeruli); percentage of IFTA; IFTA foci density; percentage of artery luminal stenosis; arteriolar hyalinosis counts; and measures of nephron size. Models assessed risk of ESKD or progressive CKD with biopsy measures adjusted for age, hypertension, diabetes, body mass index, eGFR, and proteinuria.
RESULTS
Of 353 patients (followed for a median 7.5 years), 75 developed ESKD and 139 experienced progressive CKD events. Visually estimated scores by pathologists versus morphometry measures for percentages of GSG, IFTA, and luminal stenosis did not substantively differ in predicting outcomes. However, adding percentage of glomerulosclerosis, IFTA foci density, and arteriolar hyalinosis improved outcome prediction. A 10-point score using percentage of glomerulosclerosis, percentage of IFTA, IFTA foci density, and any arteriolar hyalinosis outperformed a 10-point score based on percentages of GSG, IFTA, and luminal stenosis >50% in discriminating risk of ESKD or progressive CKD.
CONCLUSION
Morphometric characterization of glomerulosclerosis, IFTA, and arteriolar hyalinosis on kidney biopsy improves prediction of long-term kidney outcomes.
Topics: Humans; Prognosis; Constriction, Pathologic; Kidney; Biopsy; Renal Insufficiency, Chronic; Fibrosis
PubMed: 35922132
DOI: 10.1681/ASN.2022030234 -
Brazilian Journal of Otorhinolaryngology 2019In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the...
INTRODUCTION
In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated.
OBJECTIVES
The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated.
METHODS
The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology.
RESULTS
The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p<0.001).
CONCLUSION
In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.
Topics: Adolescent; Adult; Aged; Biopsy; Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Retrospective Studies; Young Adult
PubMed: 29807812
DOI: 10.1016/j.bjorl.2018.04.006 -
BMJ Open May 2023Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of...
INTRODUCTION
Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of postbiopsy infection is increasing due to increasing antibiotic resistance of rectal flora. Single-centre studies suggest that a clean, percutaneous transperineal approach to prostate biopsy may have a lower risk of infection. To date, there is no high-level evidence comparing transperineal versus transrectal prostate biopsy. We hypothesise that transperineal versus transrectal prostate biopsy under local anaesthesia has a significantly lower risk of infection, similar pain/discomfort levels and comparable detection of non-low-grade prostate cancer.
METHODS AND ANALYSIS
We will perform a multicentre, prospective randomised clinical trial to compare transperineal versus transrectal prostate biopsy for elevated prostate-specific antigen in the first biopsy, prior negative biopsy and active surveillance biopsy setting. Prostate MRI will be performed prior to biopsy, and targeted biopsy will be conducted for suspicious MRI lesions in addition to systematic biopsy (12 cores). Approximately 1700 men will be recruited and randomised in a 1:1 ratio to transperineal versus transrectal biopsy. A streamlined design to collect data and to determine trial eligibility along with the two-stage consent process will be used to facilitate subject recruitment and retention. The primary outcome is postbiopsy infection, and secondary outcomes include other adverse events (bleeding, urinary retention), pain/discomfort/anxiety and critically, detection of non-low-grade (grade group ≥2) prostate cancer.
ETHICS AND DISSEMINATION
The Institutional Review Board of the Biomedical Research Alliance of New York approved the research protocol (protocol number #18-02-365, approved 20 April 2020). The results of the trial will be presented at scientific conferences and published in peer-reviewed medical journals.
TRIAL REGISTRATION NUMBER
NCT04815876.
Topics: Male; Humans; Prostate; Prospective Studies; Biopsy; Prostatic Neoplasms; Rectum; Image-Guided Biopsy; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 37208135
DOI: 10.1136/bmjopen-2022-071191 -
Acta Clinica Croatica Oct 2022All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on...
INTRODUCTION
All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted biopsies should lower prostate cancer biopsy undergrading and overgrading.
GOALS
To determine the incidence of prostate cancer biopsy undergrading in patients who underwent a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy.
MATERIALS AND METHODS
We identified the patients from our database who underwent a radical prostatectomy at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified. Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer. The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We compared the biopsy results with the final pathological results, and searched for undergrading or overgrading in the biopsies compared to the final histological report.
RESULTS
The undergrading was found in 17,7% (N=11) cases in the non-mpMRI group and in 12,0% (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the final specimen report. The charasteristics of patients are listed in Table 1.
DISCUSSION AND CONCLUSION
In our cohort, the patients who underwent a mpMRI targeted biopsy had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate. Since different areas of the tumor have different areas of differentiation, only a low-grade part of the tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate than the analysis of prostate cores obtained by biopsy.
Topics: Male; Humans; Prostate; Image-Guided Biopsy; Prostatic Neoplasms; Prostatectomy; Neoplasm Grading; Magnetic Resonance Imaging
PubMed: 36938557
DOI: 10.20471/acc.2022.61.s3.4 -
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