Fig 1. A 51-year-old woman with a metastatic lymph node in the right axilla. (A) The mediolateral oblique view of mammography shows an enlarged high density lymph node in the right axilla without mass or microcalcifications in the right breast. (B) Ultrasonography revealed a 1.48 × 0.71 cm sized hypoechoic lymph node in the right axilla, showing loss of a fatty hilum. (C) The ultrasound guided 14-gauge automated core biopsy was performed at the axilla lymph node, and the real time visualization of the needle was achievable. (D) A large needle (14-gauge) lymph node specimen (H&E stain, × 20) shows the cores of metastatic carcinoma occupying almost the entire biopsied lymph node tissue. (E) Photomicrograph shows clusters of infiltrating metastatic carcinoma cells on the right side of view (H&E, × 400).
The first less obvious but still key point relates to the issue of the adequacy of tissue sampling for small, sub- centimeter, but highly suspicious (i.e., BI-RADS category 4 or 5) ultrasound lesions . There is always an inher- ent degree of uncertainty that exists within one ’ s mind when using the spring-loaded 14-gauge core biopsy technique secondary to concerns about positional over- shooting or undershooting that may occur with the tis- sue acquisition chamber when firing the spring-loaded 14-gauge core biopsy device when attempting to target any such small, subcentimeter ultrasound lesion. In con- trast, approaching such small, subcentimeter ultrasound lesions by the 8-gauge vacuum-assisted biopsy technique allows for more representative and even potentially complete tissue sampling of any given small, subcenti- meter region of interest in a more precise and directed fashion. This line of reasoning was utilized in the cur- rently reported series in which 39.2% (58/148) of breast carcinomas diagnosed by the 8-gauge vacuum-assisted biopsy technique were less than 1 cm in size, while only 4.9% (19/386) of breast carcinomas diagnosed by the spring-loaded 14-gauge core biopsy technique were less than 1 cm in size (P < 0.001). Such an approach may be highly advantageous for helping to potentially minimize
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Background: Since introducing stereotactic core biopsy (SCB) on breast le- sions in Denmark, no national follow-up of the procedure has been executed. Purpose: To evaluate performance of SCB in Danish mammography screen- ing. 3 areas were selected for evaluation: diagnostic value of SCB, performance of the Danish 7-tier mamma-radiological classifications system, DKBI-RADS, and diagnostic delay for SCB-diagnosis. Materials & Methods: Danish retro- spective national cohort study including 2195 screening patients undergoing SCB. Study period: 01.01.2010 to 30.09.2012. Patients were identified from The Danish National Patient Register. Pathology-data were obtained from the Danish Pathology Database. Radiological-data according to DKBI-RADS were recorded. Diagnostic delay from clinical mammography until diagnosis was registered. Results: 173 SCBs indicated cancer; all operated with 3 cases final- ized as benign. 1296 cases were determined benign with diagnostic surgery in 81 cases of which 31 were concluded pre-malignant/malignant. Correlation between DKBI-RADS and pathology diagnosis: 329 of 485 DKBI-RADS3, 227 of 450 DKBI-RADS4 were benign. 4 of 16 DKBI-RADS5 were benign. The diag- nostic value of pre-malignant/malignant SCB related to results from surgery showed 94.4% sensitivity and a positive predictive value of 93.9%. Median di- agnostic-time of single-biopsy was 13 days. Conclusion: The performance of SCB in Denmark is comparable to international studies regarding the diagnostic value of malignant SCB. The study indicates that DKBI-RADS classifications are not used consistently regarding micro-calcifications selected in screen- How to cite this paper: Redsted, S.,
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K Taylor, P Britton, L Sonoda, M Wallis, R Sinnatamby Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge, UK Breast Cancer Research 2009, 11(Suppl 2):P1 (doi: 10.1186/bcr2371) Introduction Fibroadenomas (FAs) present as common breast lesions in young women, often necessitating core biopsy/fine needle aspira- tion. Our unit protocol has been to biopsy suspected FAs in women aged 20 years and over. Literature suggests there is a case for safe non-biopsy in the under 25s. We wanted to establish whether it would be safe practice to stop biopsying FAs in women <30 years of age. Methods A theoretical incidence of a benign presentation of breast cancer in our unit was established using national statistics and Stavros criteria . Using this, an imaging criteria-based protocol for non- biopsy of FAs was devised, which we retrospectively tested against our departmental practice over the period 2000 to 2008 in women <30 years of age.
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compared these two devices for lung biopsy under computed tomography guidance.8 Therefore, the aim of the present study was to compare the accuracy of ultrasound guided breast biopsy performed with these two different core biopsy needles with histology of excised lesions as the gold standard. The semi-automated needle used in this study was available in Malaysia circa 2000 and the automated needle had been available in Malaysia circa 1995. The authors aimed to describe the yield obtained from both types of needles, that is, whether a diagnostic or just a descriptive report was possible. The authors also aimed to ascertain sample adequacy for histological evaluation as well as to determine the occurrence of fragmentation of the samples and whether a definite diagnosis could be made from fragmented samples. Lastly, the authors wanted to determine if the yield from semi- automated and automated core biopsy needles were affected by the tumour size and type.
Methods: A full-core end-cut 16G biopsy device and a standard side-notch 16G needle were used to take biopsies of unclear liver lesions. Patients were randomized in two groups of 16 patients each. The primary endpoint of this prospective study was the core length measured using a dedicated microscope imaging software. Secondary endpoints were the quality of the specimen rated by an independent pathologist unaware of the device (scale from 1 to 5; with 1 as best and 5 as worst), the core diameter (determined by the microscopic imaging software) and presence of fragmentation (evaluated by the pathologist).
The biopsy procedures were performed on a 64-MDCT scanner (Brilliance 64-Philips). A posterior paraspinal approach was feasible in all patients. First, a guide spinal needle of 25G was placed for local anesthesia using CT-fluoroscopy without IV contrast injection. Next, the fine spinal needle was removed and tru-cut needle bi- opsy was placed approximately near the lesion away from the expected site of aorta, IVC, ureter and renal ves- sels. Then 50 ml of non-ionic contrast medium (ioversol, Optiray 350) at a flow rate of 3 - 4 ml/sec were admi- nistered intravenously. Imaging was performed at late arterial phase (30 - 40 seconds delay). The CT acquisition parameters were 200 mAs, 120 kVp, 512 × 512 matrix, 1.172 pitch, 64 × 0.625 mm section collimation, 4 mm slice thickness. In lesions at or below the level of renal pelvis, delayed contrast-enhanced CT scan was done for delineation of the ureters.
BM biopsy, since its introduction by Ghedini  has achieved significant importance in the field of medicine, and hematology and oncology in particular. It is now routinely used in the investigations, diagnosis and management of various haematological as well as non-haematological malignant conditions. The Jamshidi needle, which popularized the technique of bone marrow core biopsy in the 60’s, had one major problem: its inability to consistently retain the biopsy specimens within the lumen of the needle at each and every attempt of usage. The Jamshidi needle had this problem because it did not have a core retention feature. Because of this the operator had to resort to some extraneous movements with the needle such as rocking, sculling or gyratory movements or change in the direction of the tip of the needle to capture and secure a solid core sample.
For proper orientation, our pathologist measured the weight and dimensions of the entire external surface using India ink, silver nitrate, and color ink. They fixed the specimens over- night in 10% neutral formalin and clarified the glands with and without basal cell layer using mixture of CK 903. When it was negative stains in the previous method, they usually performed P504S/AMACR immunostaining and modification of diag- nosis ambiguous lesion using P63/AMACR immunostaining. Biochemical recurrence (BCR) was evaluated according to biopsy core numbers (systematic 12-core biopsy with no cancer-suspicious lesions vs 13- or more-core biopsy with cancer-suspicious lesions) and index tumor location (index tumors in systematic 12-core biopsy vs index tumors in addi- tional cores). BCR was defined as a PSA value ≥ 0.2 ng/mL on two consecutive measurements following RP. 14
Complications and Study Limitations The main objections to core biopsy of the parotid gland are the risk of facial nerve injury and tumor seeding along the needle tract. Before the report about the sufficiency of 18-gauge needles was pub- lished (12), 14- or 16-gauge needles were used more frequently in our institute. From our experience, the use of 14- or 16-gauge needles with up to five passes allowed us to obtain larger core samples for immu- nohistochemistry without sequela or facial nerve in- jury. Of 53 patients, only one patient (2%) who had a Warthin tumor had hemorrhage after three passes with a 16-gauge needle. The hemorrhage was proba- bly related to the cystic components of the tumor, which occurs in 67–93% of cases (8, 9). However, no sequela was observed after surgical removal of the Warthin tumor. In this series, there was no infection, facial nerve palsy, or recurrence due to seeding of cancer at the needle tract.
From a retrospective review of the pathologic data base of our institution between June 2013 and December 2013, 102 patients with 105 cytologically inconclusive nodules underwent US- guided thyroid biopsy. We excluded 9 nodules because ⬍ 3 core biopsy specimens had been obtained (mean, 1.9 cores). Of these 9 nodules, 5 were located near the common carotid artery. The remaining 4 nodules were relatively small (mean, 0.9 cm; range, 0.8 –1.2 cm) and deeply located in the thyroid gland. We also excluded 36 nodules of 34 patients because they were not followed up after benign results on US-guided CNB. Finally, 60 thyroid nodules of 59 patients were included in this study. The Bethesda Categories on the initial FNA were I (nondiagnostic) in 45% (27/ 60) or III (atypia of undetermined significance/follicular lesion of undetermined significance [AUS/FLUS]) in 55%, 33/60). We ret- rospectively reviewed the medical records for information includ- ing age, sex, pathologic findings, ultrasonographic findings, and follow-up and surgical results.
Once anesthetized, patients were placed in the dorsal litho- tomy position and prepped and draped in the standard surgical fashion. Aerated lidocaine gel was injected into the urethra and a penile clamp was placed. A BK Medical (Peabody, MA) Fal- con, Model 2101 ultrasound machine with a 7.5 MHz Model 8658 (BK Medical) probe was inserted into the rectum and stabilized using a RTP 6000 brachytherapy stabilizer and STP 110 precision stepper (North American Scientific, Pittsburgh, PA). The prostate volume was measured via a height-times- width-times-length technique and recorded in the chart. The appropriate transperineal biopsy guide was chosen based on the volume of the prostate (Figure 1) which indicates the number of positive cores and their location. Glands measuring less than 30 mL underwent a 24-core biopsy. Glands measuring 30–45 mL underwent a 36-core biopsy, and glands measur- ing greater than 45 mL underwent a 48-core biopsy. Biopsy samples were taken using an 18-gauge Bard Biopsy Systems (Tempe, AZ) Max-Core ® disposable core biopsy instrument.
With the improvement of ultrasound resolution and contrast, microcalcifications contrasting with background hypoechoic areas or duct-like structures can now be detected by ultrasound . It is very important to classify non-mass lesions visible using ultrasound because these lesions are more histologically heterogeneous than mass lesions, and usually include more DCIS and non-palpable lesions . In the present study, there was a significant difference in the agreement between mass and non-mass lesions for 18G CNB. This indicates that for smaller caliber CNB performed on non-mass lesions, especially 18G, the diagnosis value is lower than biopsies using a larger core needle or vacuum-assisted CNB .
Due to advancements in modern imaging during the last years, nowadays more than 70% of kidney tumours are de- tected incidentally . In most of the cases appropriate treat- ment can be initiated on the basis of cross-sectional imaging modalities without further investigations because of the mass showing certain signs of malignancy or coming up with pub- lished imaging criteria of benign lesions like cysts or fat- containing angiomyolipoma . If it is not possible to make a reliable diagnosis, percutaneous biopsy should be taken into account to avoid unnecessary surgery.
Normal coagulation screening tests, including pro- thrombin time (PT), platelet count, and partial thrombo- plastin time (PTT), were performed before biopsy . If the results were confirmed to be normal, CNB would be performed to the patients. The routine US was car- ried out to investigate the shape, echo, size, and blood supply of the masses, and the relationships among the masses, surrounding organs, and great vessels, besides the medium length of the lesions, were recorded and compared between the two groups. All the biopsies were performed by well-experienced radiologists. The local anesthesia was administered using 2% lidocaine. Under the real-time supervision of US, the needle was inserted at the edge of the mass and the biopsy gun was instant- aneously excited to collect at least three times in differ- ent parts of the mass (one needle in the center and two needles at the periphery of the mass). Intact tissue strips with a length of more than 0.5 cm were considered to be satisfactory samples.
Although TRUS-guided systematic sextant biopsy method has been accepted as the “gold” standard technique for pros- tate biopsies, there is controversy regarding the efficiency of this technique; many studies have been conducted to improve the detection rate of this procedure. Several authors claim that sampling done with sextant biopsy is not enough and suggest increasing the number of cores. Levine and colleagues demonstrated that two consecutive sets of TRUS- guided sextant biopsies of the prostate performed in a single office visit is a cost-effective biopsy strategy, as it increased the number of cancers detected by 30%. 5 In another study,
core needle biopsy in the tumor bed in the resected specimen. Our results showed that the overall accuracy was significantly improved compared to forceps biopsy (76.7% vs. 36.1%; p < 0.001). We further tested the hypothesis by in vivo core needle biopsy guided by ERUS in good responders. Although the method is able to identify additional 36.4% of patients with residual disease after ruling out patients with obvious non- pCR, the overall accuracy is far from perfect. These were not unexpected since a false-negative result was
To determine how the metabolomic profiles of these samples compared with histologic classification, we per- formed various statistical analyses of the metabolomic data. Hierarchical clustering analysis split the kidney biopsy samples into two major clusters, with one cluster containing four cancer tumor samples and one benign sample, and the other cluster containing five benign and two cancer tumor samples (Figure 6). This analysis sug- gests that disease-free tissue from the same patient may be an integral component of interpreting metabolomic data from diseased tissue. For example, based upon the metabolomic signature, the histologically benign biopsy from nephrectomy patient 1 was in the same major cluster with cancer tumor biopsies (Figure 6). Similarly, the cancer tumor samples from patients 4 and 5 were in the main cluster with five benign samples. In all three cases, the matched cancer and benign samples from each of those patients group into the same terminal cluster. In contrast, the tumor samples from patients 2, 3, and 6 do not fall into the same major cluster or terminal cluster as the matched benign samples. It is tempting to speculate that these results reflect a difference in the metabolism in the tissue biopsies that may be indicative of the stage or aggressiveness of the cancer tumor. For instance, in patient 1, although the sample appears histologically benign, the metabolomic signature in the benign biopsy may be indicative of a more aggressive cancerous state since it groups with the cancer cluster. In patients 4 and 5, the metabolomic signature for tumor samples groups with the benign cluster, indicating the signature resem- bles that of benign samples, which could indicate that the cancer was less advanced or less aggressive. Thus, distinct metabolic signature-based groupings of cancer tumor tis- sue may indicate not only early stage cancer but could distinguish a more aggressive from a less aggressive can- cer. More extensive studies with detailed histological assessments would be needed to substantiate these hypotheses.
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Among every 1,000 men who undergo screening, 100 to 120 are expected to demonstrate an elevated PSA value, and most of these men will go on to have a biopsy, resulting in over 1 million pros- tate biopsies in the United States each year (2). Tissue for histo- pathological examination is most commonly obtained by trans- rectal ultrasound (TRUS)-guided biopsy, in which an ultrasound probe and biopsy needle are placed in the rectum and tissue cores are collected by sampling through the rectum wall into the pros- tate. NCCN guidelines recommend collection of 12-core biopsies. Of those patients who undergo biopsy, one-fourth will receive a diagnosis of prostate cancer (3). While TRUS-guided prostate biopsy is generally considered a safe procedure and can be performed in the outpatient setting, about one-third of men will experience symptoms or complications related to the procedure, with approxi- mately 4% requiring hospitalization within 30 days (3).
CT/USG guided percutaneous transthoracic biopsy is a safe and effective procedure in the evaluation of undetermined pulmonary lesions and also permits successful drainage of pulmonary abscesses(Mathis G et al) 23 .According to Kardos et al and Davies et al ,this technique is particularly useful for benign lesions or tumors with pleomorphic morphological charecteristics and has better diagnostic value relative to bronchoscopic sampling in those cases where the size and location of the nodule make it inaccessible with the bronchoscopy. 4,17
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