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SA Journal of Radiology 2022Stereotactic breast biopsies have become the gold standard for tissue diagnosis in non-palpable, sonographically occult breast abnormalities seen on mammogram. Only...
BACKGROUND
Stereotactic breast biopsies have become the gold standard for tissue diagnosis in non-palpable, sonographically occult breast abnormalities seen on mammogram. Only limited data exist in South Africa on the correlation between imaging findings and stereotactic biopsy histology.
OBJECTIVES
To describe the mammographic findings and histological diagnosis in patients who underwent stereotactic breast biopsy at a referral hospital. In addition, to evaluate the proportion of malignancy in each Breast Imaging Reporting and Data System (BI-RADS) category.
METHOD
A retrospective review of stereotactic breast biopsies was performed. Imaging characteristics (including BI-RADS category) and histological diagnosis were recorded. Using histopathology, cases were classified as benign, high-risk or malignant.
RESULTS
A total of 131 biopsies, from 123 patients, were included in the study. Most biopsies were performed on asymptomatic patients (79.3%, 104/131). The majority were categorised as BI-RADS 4 and demonstrated calcifications. Histology revealed a malignant diagnosis in 40 (30.5%) patients, a high-risk lesion in 8 (6.1%) patients and a benign diagnosis in 83 (63.4%) patients. There was a stepwise increase in the proportion of malignancy from BI-RADS category 3 to 5. When compared with surgical histology, the stereotactic biopsies demonstrated an overall ductal carcinoma in situ (DCIS) underestimation rate of 10.3%.
CONCLUSION
Despite resource restrictions, stereotactic breast biopsies performed in a South African context produce radiological-pathological concordance in keeping with BI-RADS guidelines, as well as with local and international studies.
PubMed: 36093214
DOI: 10.4102/sajr.v26i1.2463 -
The British Journal of Radiology Apr 2022Contrast-enhanced spectral mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and...
OBJECTIVE
Contrast-enhanced spectral mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI-guided biopsy.
METHODS AND MATERIALS
An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally, this would have necessitated an MRI-guided breast biopsy, but was performed under CESM guidance.
RESULTS
A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer.
CONCLUSION
CESM-guided breast biopsy is a new technique that can be successfully used as an alternative to MRI-guided breast biopsy.
ADVANCES IN KNOWLEDGE
CESM-guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.
Topics: Breast Neoplasms; Contrast Media; Female; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Mammography; Sensitivity and Specificity
PubMed: 35015574
DOI: 10.1259/bjr.20211287 -
Journal of Thoracic Oncology : Official... Apr 2019Stereotactic body radiation therapy (SBRT) is a promising curative treatment for early-stage NSCLC. It is unclear if survival outcomes for SBRT are influenced by a lack... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Stereotactic body radiation therapy (SBRT) is a promising curative treatment for early-stage NSCLC. It is unclear if survival outcomes for SBRT are influenced by a lack of pathological confirmation of malignancy and staging of disease in these patients. In this systematic review and meta-analysis, we assess survival outcomes after SBRT in studies with patients with clinically diagnosed versus biopsy-proven early-stage NSCLC.
METHODS
The main databases were searched for trials and cohort studies without restrictions to publication status or language. Two independent researchers performed the screening and selection of eligible studies. Outcomes were overall survival, cancer-specific survival, and disease-free survival. The inverse variance method and the random effects method for meta-analysis were used to assess pooled survival estimates.
RESULTS
A total of 11,195 nonduplicate records were identified by the original search strategy. After screening by title and abstract, 1051 potentially eligible records were identified. A total of 43 articles were included. The comparative studies showed lower 3-year overall survival and lower 2-year and 5-year cancer-specific survival for biopsy-proven disease compared to clinical disease. However, 5-year overall survival was the same for both groups. For the pooled estimates, 3-year disease-free survival and 2-year cancer-specific survival were lower for biopsied disease.
CONCLUSIONS
Results of this systematic review and meta-analysis show a discrepancy in oncological outcomes for patients undergoing SBRT for suspected early-stage NSCLC in whom there is pathologic conformation of malignancy and those who there is only a clinical diagnose of NSCLC. These results emphasize the importance of obtaining pathologic proof of malignancy.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Radiosurgery; Survival Analysis
PubMed: 30721798
DOI: 10.1016/j.jtho.2018.12.035 -
World Neurosurgery Jun 2022The ClearPoint SmartFrame Array (ClearPoint Neuro, Inc., Solana Beach, CA) system consists of a magnetic resonance imaging compatible frame supported by a customized...
BACKGROUND
The ClearPoint SmartFrame Array (ClearPoint Neuro, Inc., Solana Beach, CA) system consists of a magnetic resonance imaging compatible frame supported by a customized neuro navigation software. This system received U.S. Food and Drug Administrationclearance for clinical use in January 2021. Our objective was to report initial safety data and user experience of SmartFrame Array-supported stereotactic procedures.
METHODS
We prospectively followed the first 10 consecutive patients who underwent stereotactic procedures supported by SmartFrame Array. Clinical and procedural data were recorded and compared to data obtained from prior cases with SmartFrame XG.
RESULTS
Ten patients underwent stereotactic needle biopsy, stereotactic laser ablation (SLA), or combined biopsy/SLA procedures. For needle biopsies (n = 9), the average maximal diameter of the contrast-enhancing target lesion was 9.9 ± 2.8 mm. The radial error of stereotaxis was less than 2 mm. Definitive diagnosis was achieved in all cases. For procedures involving SLA (n = 5), 100% of the contrast-enhancing lesion was ablated. All patients were discharged home by postoperative day 2. There were no 30-day readmissions, morbidity, or mortality. The average stereotaxis time for the SmartFrame Array-aided single trajectory procedure was 80 ± 9.5 minutes, which compared favorably to that required for the earlier generation SmartFrame XG frame (111.5 ± 16.5 minutes; P < 0.01). The unique Array design supported stereotactic procedures that cannot be easily achieved with the previous SmartFrame XG frame.
CONCLUSIONS
The SmartFrame Array system offers a more rigid and compact build to enhance procedural efficiency while maintaining accuracy and safety. The design supports multi-trajectory stereotaxis, allowing novel clinical applications.
Topics: Biopsy; Biopsy, Needle; Brain Neoplasms; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Stereotaxic Techniques
PubMed: 35231619
DOI: 10.1016/j.wneu.2022.02.095 -
Journal of Cancer Research and Clinical... Sep 2021The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic...
PURPOSE
The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature.
METHODS
All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE).
RESULTS
We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1-3 were observed in 12%.
CONCLUSION
Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.
Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Female; Follow-Up Studies; Humans; Karnofsky Performance Status; Male; Middle Aged; Neoplasms; Radiation Dose Hypofractionation; Radiosurgery; Retrospective Studies; Salvage Therapy; Survival Rate; Treatment Outcome
PubMed: 33638006
DOI: 10.1007/s00432-021-03564-z -
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 -
International Journal of Molecular... Apr 2024Up to 80% of patients under immune checkpoint inhibitors (ICI) face resistance. In this context, stereotactic ablative radiotherapy (SABR) can induce an immune or... (Observational Study)
Observational Study
Up to 80% of patients under immune checkpoint inhibitors (ICI) face resistance. In this context, stereotactic ablative radiotherapy (SABR) can induce an immune or abscopal response. However, its molecular determinants remain unknown. We present early results of a translational study assessing biomarkers of response to combined ICI and SABR (I-SABR) in liquid biopsy from oligoprogressive patients in a prospective observational multicenter study. Cohort A includes metastatic patients in oligoprogression to ICI maintaining the same ICI due to clinical benefit and who receive concomitant SABR. B is a comparative group of oligometastatic patients receiving only SABR. Blood samples are extracted at baseline (T1), after the first (T2) and last (T3) fraction, two months post-SABR (T4) and at further progression (TP). Response is evaluated by iRECIST and defined by the objective response rate (ORR)-complete and partial responses. We assess peripheral blood mononuclear cells (PBMCs), circulating cell-free DNA (cfDNA) and small RNA from extracellular vesicles. Twenty-seven patients could be analyzed (cohort A: n = 19; B: n = 8). Most were males with non-small cell lung cancer and one progressing lesion. With a median follow-up of 6 months, the last ORR was 63% (26% complete and 37% partial response). A decrease in cfDNA from T2 to T3 correlated with a good response. At T2, CD8+PD1+ and CD8+PDL1+ cells were increased in non-responders and responders, respectively. At T2, 27 microRNAs were differentially expressed. These are potential biomarkers of response to I-SABR in oligoprogressive disease.
Topics: Humans; Male; Lung Neoplasms; Radiosurgery; Female; Aged; Biomarkers, Tumor; Middle Aged; Immune Checkpoint Inhibitors; Immunotherapy; Cell-Free Nucleic Acids; Prospective Studies; Carcinoma, Non-Small-Cell Lung; Aged, 80 and over; Neoplasm Metastasis; Disease Progression; Liquid Biopsy; Leukocytes, Mononuclear; Treatment Outcome
PubMed: 38674117
DOI: 10.3390/ijms25084533 -
Journal of Neurosciences in Rural... 2024Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the...
OBJECTIVES
Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by doing less in the form of STB for the patients of doubtful intracranial lesions treated over the past 5 years. We also want to highlight the technique of performing the procedure under scalp block, which can be used as a versatile tool in many clinical scenarios. Stereotactic biopsies may be planned even in rural district-level health facilities. One-time investment to procure instruments and avail existing imaging can lead to establishing definitive diagnoses in many doubtful cases. This will result in lesser cost and early establishment of treatment. Independent risk factors determining the outcome, such as deep-seated lesions, associated edema, and intraoperative hypertension, were studied. Establishing the diagnosis helped in prognosticating the disease, explaining the natural progression of symptoms, and starting adjuvant therapy. This tissue biopsy would also help secure samples for research and molecular analysis.
MATERIALS AND METHODS
Twenty patients underwent STBs at our institution between January 2018 and December 2022. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including the diagnostic value and surgery-related complications. These patients were followed up, and their progression-free and overall survival were analyzed. The need for adjuvant treatment was noted and analyzed. All procedures were performed using Cosman Roberts Wells® stereotactic frame. Pre-procedure magnetic resonance scans were performed at the time of admission. Contrast-enhanced computerized tomography (CT) scan after frame application was performed to identify targets and calculate the coordinates. A post-procedure CT scan was done to confirm the accessibility of the targeted lesion.
RESULTS
The most common location of the tumor was a deep-seated thalamic lesion. A definitive diagnosis was established in 19 patients (95%) at the first STB. The diagnoses were glioma in 55% of cases, primary central nervous system lymphoma, tuberculosis, and demyelinating disorders in 10% of each, and a metastatic brain tumor in 1 (5%). The post-operative complications were all transient except in one patient with deterioration of motor weakness. The follow-up was noted, and modes of adjuvant treatment needed in these patients were recorded.
CONCLUSION
Stereotactic biopsy is a useful and effective method for achieving a definitive diagnosis and aiding in treating multifocal or small deep-seated lesions in or around eloquent regions.
PubMed: 38476427
DOI: 10.25259/JNRP_258_2023 -
Cureus Aug 2021Introduction We evaluate diagnostic radiology residents' perceptions of an ultrasound-guided and stereotactic breast biopsy simulator used at an academic medical...
Introduction We evaluate diagnostic radiology residents' perceptions of an ultrasound-guided and stereotactic breast biopsy simulator used at an academic medical center. This simulator is low-cost and easily reproducible. We aim to understand if this simulator improves residents' self-reported confidence in performing breast biopsy procedures on live patients. Methods Twenty-eight diagnostic radiology residents were instructed in how to perform ultrasound-guided breast biopsies and stereotactic breast biopsies using real biopsy and imaging equipment, but with tissue models in lieu of live persons. The hands-on experience was preceded by a didactic lecture. The ultrasound-guided tissue model was created with blueberries that were inserted in tofu, and the stereotactic tissue model was created by placing crushed calcium carbonate tablets into cored eggplant. Residents were asked to fill out a survey before and after participating in the simulation, where they self-reported their confidence level at performing ultrasound-guided and stereotactic breast biopsies. Results Twenty-eight diagnostic radiology residents participated in the simulation. All residents completed the pre-simulation survey and of these residents, twenty-one completed the post-simulation survey. Prior to the simulation residents reported a median confidence level of 3.5 out of 10 in performing ultrasound-guided breast biopsies, and a median confidence level of 1.0 out of 10 in performing stereotactic-guided breast biopsies. After the simulation, residents reported a median confidence level of 7.0 out of 10 in performing ultrasound-guided breast biopsies, and a median confidence level of 3.0 out of 10 in performing stereotactic-guided breast biopsies. Increases in resident confidence level were statistically significant for both biopsy types (p < 0.01). Conclusion Simulated biopsies can increase the confidence of diagnostic radiology residents that are learning to perform breast biopsies before they perform real biopsies on live patients. Providing simulation training and thereby improving resident confidence may help reduce physician error and patient harm due to poor biopsy techniques.
PubMed: 34522475
DOI: 10.7759/cureus.16815 -
Acta Neurochirurgica Jun 2024The gold standard for diagnostics in primary central nervous system lymphoma (PCNSL) is histopathological diagnosis after stereotactic biopsy. Yet, PCNSL has a... (Review)
Review
PURPOSE
The gold standard for diagnostics in primary central nervous system lymphoma (PCNSL) is histopathological diagnosis after stereotactic biopsy. Yet, PCNSL has a multidisciplinary diagnostic work up, which associated with diagnostic delay and could result in treatment delay. This article offers recommendations to neurosurgeons involved in clinical decision-making regarding (novel) diagnostics and care for patients with PCNSL with the aim to improve uniformity and timeliness of the diagnostic process for patients with PCNSL.
METHODS
We present a mini review to discuss the role of stereotactic biopsy in the context of novel developments in diagnostics for PCNSL, as well as the role for cytoreductive surgery.
RESULTS
Cerebrospinal fluid-based diagnostics are supplementary and cannot replace stereotactic biopsy-based diagnostics.
CONCLUSION
Histopathological diagnosis after stereotactic biopsy of the brain remains the gold standard for diagnosis. Additional diagnostics should not be a cause of diagnostic delay. There is currently no sufficient evidence supporting cytoreductive surgery in PCNSL, with recent studies showing contradictive data and suboptimal study designs.
Topics: Humans; Central Nervous System Neoplasms; Lymphoma; Time-to-Treatment; Delayed Diagnosis; Neurosurgeons; Biopsy; Stereotaxic Techniques; Cytoreduction Surgical Procedures; Treatment Delay
PubMed: 38858236
DOI: 10.1007/s00701-024-06138-3