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Operative Neurosurgery (Hagerstown, Md.) Sep 2021Accurate stereotactic biopsies of brain tumors are imperative for diagnosis and tailoring of the therapy. Repetitive needle insertions enhance risks of brain lesioning,...
BACKGROUND
Accurate stereotactic biopsies of brain tumors are imperative for diagnosis and tailoring of the therapy. Repetitive needle insertions enhance risks of brain lesioning, hemorrhage, and complications due to prolonged procedure.
OBJECTIVE
To investigate clinical benefits of a combined 5-aminolaevulinic acid (5-ALA) fluorescence and laser Doppler flowmetry system for the detection of malignant brain tumor and blood vessels in stereotactic biopsies.
METHODS
Planning of targets and trajectories was followed by optical measurements in 20 patients, using the Leksell Stereotactic System and a manual insertion device. Fluorescence spectra, microvascular blood flow, and tissue grayness were recorded each millimeter along the paths. Biopsies were taken at preplanned positions. The diagnoses were compared with the fluorescence signals. The recordings were plotted against measurement positions and compared. Sites indicating a risk of hemorrhage were counted as well as the time for the procedures.
RESULTS
Signals were recorded along 28 trajectories, and 78 biopsies were collected. The final diagnosis showed 17 glioblastomas, 2 lymphomas, and 1 astrocytoma grade III. Fluorescence was seen along 23 of the paths with 4 having the peak of 5-ALA fluorescence 3 mm or more from the precalculated target. There was increased microcirculation in 40 of 905 measured positions. The measurement time for each trajectory was 5 to 10 min.
CONCLUSION
The probe provided direct feedback of increased blood flow along the trajectory and of malignant tissue in the vicinity of the target. The method can increase the precision and the safety of the biopsy procedure and reduce time.
Topics: Biopsy; Brain; Brain Neoplasms; Deep Brain Stimulation; Humans; Laser-Doppler Flowmetry
PubMed: 34192763
DOI: 10.1093/ons/opab216 -
Acta Radiologica Open Apr 2015Fibroadenomas (FAs) are the most common tumors of the breast clinically and pathologically in adolescent and young women but may be discovered at any age. With...
BACKGROUND
Fibroadenomas (FAs) are the most common tumors of the breast clinically and pathologically in adolescent and young women but may be discovered at any age. With increasing use of core biopsy rather than excision for diagnosis, it is now commonplace to follow these lesions with imaging.
PURPOSE
To assess the incidence of epithelial abnormalities (atypia, in situ or invasive, ductal or lobular malignancies) in FAs diagnosed by core biopsy and to re-evaluate the management paradigm for any growing FA.
MATERIAL AND METHODS
A retrospective review of the senior author's pathology results over 19 years identified 2062 nodular FAs (biopsied by ultrasound or stereotactic guidance). Eighty-three core biopsied FAs were identified which subsequently enlarged.
RESULTS
Twelve of 2062 of core biopsied nodules demonstrated atypia, in situ, or invasive malignancy (ductal or lobular) within or adjacent to the FA (0.58%). Eighty-three FAs enlarged and underwent either surgical excision (n = 65), repeat core biopsy (n = 9), or imaging follow-up (n = 9). The incidence of atypia, in situ or invasive malignancy was 0/83 (0%). Two enlarging FAs were subsequently surgically diagnosed as benign phyllodes tumors (PT).
CONCLUSION
Malignancy in or adjacent to a core biopsied FA is rare. The risk of cancer in a growing FA is even rarer; none were present in our series. FAs with abnormal epithelial abnormalities require excision. Otherwise, FAs without epithelial abnormality diagnosed by core biopsy need no specific follow-up considering the negligible incidence of conversion to malignancy. The breast interventionalist must know how to manage discordant pathology results.
PubMed: 25922691
DOI: 10.1177/2047981615572273 -
Journal of Neurology Jan 2021To evaluate the diagnostic accuracy and safety of extended stereotactic brain biopsy (ESBB) in a single center cohort with suspected primary angiitis of the central...
OBJECTIVE
To evaluate the diagnostic accuracy and safety of extended stereotactic brain biopsy (ESBB) in a single center cohort with suspected primary angiitis of the central nervous system (PACNS).
METHODS
A standardized stereotactic biopsy targeting MRI-positive lesions and collecting samples from the meninges and the cortex as well as from the white matter was performed in 23 patients with clinically suspected PACNS between 2010 and 2017. The relationship between biopsy yield and clinical characteristics, cerebrospinal fluid parameters, MR-imaging, time point of biopsy and exact localization of biopsy as well as number of tissue samples were examined.
RESULTS
PACNS was confirmed in 7 of 23 patients (30.4%). Alternative diagnoses were identified in 7 patients (30%). A shorter time period between the onset or worsening of symptoms (p = 0.018) and ESBB significantly increased the diagnostic yield. We observed only minor and transient postoperative complications in 3 patients (13.0%). ESBB led to a direct change of the therapeutic regime in 13 of 23 patients (56.5%). Careful neuropathological analysis furthermore revealed that cortical samples were crucial in obtaining a diagnosis.
CONCLUSION
ESBB is a safe approach with good feasibility, even in critically ill patients, and high diagnostic accuracy in patients with suspected PACNS changing future therapies in 13 of 23 patients (56.5%). Early biopsy after symptom onset/worsening is crucial and (sub)acute MRI-lesions should be targeted with a particular need for biopsy samples from the cortical layer.
Topics: Biopsy; Brain; Cohort Studies; Humans; Magnetic Resonance Imaging; Vasculitis, Central Nervous System
PubMed: 32813052
DOI: 10.1007/s00415-020-10157-2 -
The Kobe Journal of Medical Sciences Jan 2011The safety of stereotactic biopsy (STB) was studied in this article. CT-guided STB (Brown-Roberts-Wells; BRW) was performed 58 times for 56 patients (male: 29, female:... (Review)
Review
The safety of stereotactic biopsy (STB) was studied in this article. CT-guided STB (Brown-Roberts-Wells; BRW) was performed 58 times for 56 patients (male: 29, female: 27) at Hyogo Cancer Center between 1988 and 2007. The age distribution ranged from 15 to 83 (mean: 55) years old. Histological diagnoses were established for 58 samples, with 35 cases of glioma, eight of metastatic brain tumor, nine of malignant lymphoma and leukemia, two of germ cell tumor, two of abscess, one necrosis, and one case with normal tissue. There were 3 cases (5.2%) in which an intratumoral hemorrhage with neurological deficits was occurred. They were needed surgically removal and those histological pathology revealed glioma. Concerning location of biopsy, STB for basal ganglia (putamen or globus pallidus) and thalamus were caused complication of the intratumoral hematoma after biopsy. The review of the 575 cases indicates that glioma was the relative risk factor for morbidity associated with CT-guided STB (odds ratio 5.36). The overall morbidity rate was 6.4% (37/575). We considered that tumors of the basal ganglia (putamen or globus pallidus), thalamus and glioma were risk factors of morbidity for CT-guided STB.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Brain Neoplasms; Female; Glioma; Globus Pallidus; Hematoma; Humans; Male; Middle Aged; Postoperative Complications; Putamen; Stereotaxic Techniques; Thalamus; Tomography, X-Ray Computed
PubMed: 21937861
DOI: No ID Found -
MedRxiv : the Preprint Server For... Dec 2023Glioblastoma (GBM) is a primary brain cancer with an abysmal prognosis and few effective therapies. The ability to investigate the tumor microenvironment before and...
UNLABELLED
Glioblastoma (GBM) is a primary brain cancer with an abysmal prognosis and few effective therapies. The ability to investigate the tumor microenvironment before and during treatment would greatly enhance both understanding of disease response and progression, as well as the delivery and impact of therapeutics. Stereotactic biopsies are a routine surgical procedure performed primarily for diagnostic histopathologic purposes. The role of investigative biopsies - tissue sampling for the purpose of understanding tumor microenvironmental responses to treatment using integrated multi-modal molecular analyses ('Multi-omics") has yet to be defined. Secondly, it is unknown whether comparatively small tissue samples from brain biopsies can yield sufficient information with such methods. Here we adapt stereotactic needle core biopsy tissue in two separate patients. In the first patient with recurrent GBM we performed highly resolved multi-omics analysis methods including single cell RNA sequencing, spatial-transcriptomics, metabolomics, proteomics, phosphoproteomics, T-cell clonotype analysis, and MHC Class I immunopeptidomics from biopsy tissue that was obtained from a single procedure. In a second patient we analyzed multi-regional core biopsies to decipher spatial and genomic variance. We also investigated the utility of stereotactic biopsies as a method for generating patient derived xenograft models in a separate patient cohort. Dataset integration across modalities showed good correspondence between spatial modalities, highlighted immune cell associated metabolic pathways and revealed poor correlation between RNA expression and the tumor MHC Class I immunopeptidome. In conclusion, stereotactic needle biopsy cores are of sufficient quality to generate multi-omics data, provide data rich insight into a patient's disease process and tumor immune microenvironment and can be of value in evaluating treatment responses.
ONE SENTENCE SUMMARY
Integrative multi-omics analysis of stereotactic needle core biopsies in glioblastoma.
PubMed: 38234840
DOI: 10.1101/2023.12.29.23300541 -
Diagnostic and Interventional Radiology... 2016We aimed to present our biopsy method and retrospectively evaluate the results, upgrade rate, and follow-up findings of stereotactic vacuum-assisted breast biopsy (VABB)...
PURPOSE
We aimed to present our biopsy method and retrospectively evaluate the results, upgrade rate, and follow-up findings of stereotactic vacuum-assisted breast biopsy (VABB) procedures performed in our clinic.
METHODS
Two hundred thirty-four patients with mammographically detected nonpalpable breast lesions underwent VABB using a 9 gauge biopsy probe and prone biopsy table. A total of 195 patients (median age 53 years, range 32-80 years) with 198 microcalcification-only lesions with a follow-up of at least one year were included in the study. The location of the lesion relative to the needle was determined from the postfire images, and unlike the conventional technique, tissue retrieval was predominantly performed from that location, followed by a complete 360° rotation, if needed.
RESULTS
The median core number was 8.5. Biopsy results revealed 135 benign, 24 atypical, and 39 malignant lesions. The total upgrade rate at surgery was 7.7% (6.1% for ductal carcinomas in situ and 10.5% for atypical lesions). Patients with benign lesions were followed up for a median period of 27.5 months, with no interval change. At the follow-up, scar formation was seen in 23 patients (17%); three of the scars were remarkable for resembling a malignancy.
CONCLUSION
Our biposy method is fast and practical, and it is easily tolerated by patients without compromising accuracy. Patients with a diagnosis of atypia still need to undergo a diagnostic surgical procedure and those with a malignancy need to undergo curative surgery, even if the lesion is totally excised at biopsy. VABB may leave a scar in the breast tissue, which may resemble a malignancy, albeit rarely.
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Breast; Breast Diseases; Breast Neoplasms; Calcinosis; Female; Humans; Image-Guided Biopsy; Middle Aged; Retrospective Studies; Stereotaxic Techniques
PubMed: 27306660
DOI: 10.5152/dir.2015.14522 -
Cureus Apr 2022Aim To analyze the histopathological outcome of stereotactic biopsies of newly developed suspicious calcifications at lumpectomy scar site in patients with breast...
Aim To analyze the histopathological outcome of stereotactic biopsies of newly developed suspicious calcifications at lumpectomy scar site in patients with breast conservation surgery (BCS) to determine the incidence of malignancy and the association of mammographic appearance of recurrent microcalcification and their distribution. We also determined the association of disease recurrence with the presence of calcifications in original tumor and lumpectomy resection margins with the risk of recurrence. Materials and methods This study is a retrospective review of mammograms of patients with breast cancer from 2010 to 2021 who underwent stereotactic biopsy of newly developed suspicious calcifications at scar site appreciated on annual follow-up mammogram after breast conservation surgery (BCS) with no mass on correlative ultrasound. The radiological and pathological features of the patients' primary tumor and new calcifications were obtained from the hospital's electronic patient record system. Results A total of 84 patients with breast cancer developed suspicious microcalcifications at the lumpectomy scar site detected on follow-up mammograms after BCS, and 28.6% showed malignant histopathological outcomes. All malignant cases demonstrated pleomorphic morphology. All amorphous (9.5%) and coarse heterogeneous (54.8%) calcifications were benign. The distribution pattern of recurrent malignant calcifications was grouped in 9.5%, regional in 2.4%, linear in 9.5%, and segmental in 7.1%. Calcifications in primary tumors were found in 20.2% of cases. Positive margins were found in 7.1% of these malignant cases. Statistically, there was a strong association between calcification morphology, calcification distribution, presence of calcifications on baseline mammogram, and tumor resection margins. The presence of calcifications in primary tumors and positive resection margins were identified as significant independent risk factors of malignant recurrent calcifications in the logistic regression model and marginal statistical significance in the multivariable logistic regression (MLR) model. Conclusion The interval development of pleomorphic calcifications after BCS with either linear or segmental pattern, positive resection margins, and associated calcifications in primary tumors was related to the increase in the risk of recurrence. Although amorphous and coarse heterogeneous morphology with grouped distribution showed benign outcomes, stereotactic biopsy is recommended to exclude disease recurrence in this high-risk patient population.
PubMed: 35607536
DOI: 10.7759/cureus.24318 -
The Kaohsiung Journal of Medical... Oct 2019Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpable lesions detected by mammography. Considering the diagnostic...
Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpable lesions detected by mammography. Considering the diagnostic effectiveness, a direct comparison of SVAB and open surgical biopsy (OSB) is lacking. We performed a retrospective review of 276 (33.8%) SVAB and 541 (66.2%) OSB to compare the diagnostic accuracy and the total number of procedures the patients underwent. The negative predictive values of OSB and SVAB were 99.77% and 99.61%, and their false-negative rates were 0.96% and 4.76%, respectively. SVAB, as the first-line biopsy method, obviated 92.3% of operations. All malignancies diagnosed using SVAB could be treated with single therapeutic surgery. By contrast, 48% of malignancies of OSB group received two operations. Breast Imaging Reporting and Data System (BI-RADS) category used at the study correlated well with the percentage of malignancy and can thus be used to predict biopsy results. Our study concluded that SVAB is reliable for diagnosing nonpalpable breast lesions and is the better biopsy method for categories 3 and 4A lesions, which reduces the benign surgery rate. For lesions with a higher likelihood of malignancy, BI-RADS 4B, 4C and 5, SVAB has an advantage over OSB, which lowers the total number of operations for malignancy treatment.
Topics: Adult; Aged; Biopsy; Biopsy, Needle; Breast Neoplasms; Female; Humans; Middle Aged; Retrospective Studies
PubMed: 31271510
DOI: 10.1002/kjm2.12100 -
Acta Clinica Croatica Jun 2021Robot-assisted brain tumor biopsy is becoming one of the most important innovative technologies in neurosurgical practice. The idea behind its engagement is to advance...
Robot-assisted brain tumor biopsy is becoming one of the most important innovative technologies in neurosurgical practice. The idea behind its engagement is to advance the safety and efficacy of the biopsy procedure, which is much in demand when planning the management of endocranial tumor pathology. Herein, we provide our earliest institutional experiences in utilizing this mesmerizing technology. Cranial robotic device was employed for stereotactic robot-assisted brain glioma biopsy in three consecutive patients from our series: an anaplastic isocitrate dehydrogenase (IDH) negative astrocytoma (WHO grade III) located in the right trigone region of the periventricular white matter; a low grade diffuse astrocytoma (WHO grade II) of bilateral thalamic region spreading into the right mesencephalic area; and an IDH-wildtype glioblastoma (WHO grade IV) of the right frontal lobe producing a contralateral midline shifting. Robot-assisted tumor biopsy was successfully performed to get tissue samples for histopathologic and immunohistochemical analysis. The adjacent tissue iatrogenic damage of the eloquent cortical areas was minimal, while the immediate postoperative recovery was satisfactory in all patients. In conclusion, considering the preliminary results of our early experiences, robot-assisted tumor biopsy was proven to be a feasible and accurate procedure when surgery for brain glioma was not an option. It may increase safety and precision, without expanding surgical time, being similarly effective when compared to standard stereotactic and manual biopsy. Using this method to provide accurate sampling for histopathologic and immunohistochemical analysis is a safe and easy way to determine management strategies and outcome of different types of brain glioma.
Topics: Biopsy; Brain; Brain Neoplasms; Glioblastoma; Glioma; Humans; Robotics
PubMed: 34744281
DOI: 10.20471/acc.2021.60.02.17 -
Oncology (Williston Park, N.Y.) Jun 1998Imaging-guided breast biopsy performed with large-core needles can accurately diagnose most breast pathologies, often allowing a diagnosis to be made more quickly and... (Review)
Review
Imaging-guided breast biopsy performed with large-core needles can accurately diagnose most breast pathologies, often allowing a diagnosis to be made more quickly and less expensively than with surgical biopsy. Major complications, such as hemorrhage and infection, are extremely rare, although post-biopsy ecchymosis and tenderness are not unusual. Because less tissue is removed, post-biopsy cosmetic deformity does not occur. Stereotactic biopsy is performed by triangulating the position of a breast lesion and by obtaining views angled equally off a central axis. This can be done using dedicated tables or add-on equipment. Stereotactic core biopsy has a reported accuracy of at least 90%. All lesions for which biopsy would ordinarily be recommended are amenable to stereotactic techniques, but those near the chest wall or in the axilla may be more difficult to biopsy with some equipment. Lesions characterized by calcifications are sometimes more difficult to sample. A biopsy diagnosis of ductal atypia, because of its histologic heterogeneity, requires surgical excision to exclude coexistent carcinoma, which has been found in half of women at subsequent surgical excision. A core biopsy diagnosis of ductal carcinoma in situ does not preclude the discovery of invasive carcinoma at surgery. In rare instances, the small tissue volume removed at stereotactic biopsy does not permit a final diagnosis to be made; this occurs most commonly when differentiating phyllodes tumor from fibroadenoma.
Topics: Biopsy, Needle; Breast Neoplasms; Diagnostic Imaging; Female; Humans
PubMed: 9644688
DOI: No ID Found