三种睾丸活检取材方法的比较研究

本文对睾丸切开、睾丸钳穿剌及Tru-Cut针穿剌三种活检取材方法进行了组织学、取材过程、术后并发症及经济性比较,发现三种取材方法对曲细精管均无明显的人为损害,针穿刺法对间质组织有一定程度破坏。针穿剌法对机体损伤最小、病人痛苦最轻、简便、经济、易推广。钳穿剌法除术后疼痛持续时间与切开法相同外,也较切开法有上述优点。作者认为在钳穿刺及Tlu-Cut针穿刺可替代传统的睾丸切开活检法,其中Tru—Cut针穿刺活检法较适于普通(及小儿)睾丸活检,钳穿刺法较适于科研应用。     

Testicular needle biopsy: Is it a safe and adequate method?

We aimed to investigate if testicular needle biopsy is adequate and safe for the examination of testis. Needle biopsies were performed on 21 testes of 5 patients with advanced prostate cancer and 11 patients with cryptorchidism before orchiectomy. Biopsies were done with the prostatic tru-cut needle. After needle biopsy, the tract and puncture sites were explored and an incisional biopsy was performed on each testis. Both needle specimens and open biopsy specimens were fixed in Bouin's solution and sent for histologic examination. There were small haematomas in two testes and moderate haemorrhage between tunica vaginalis layers in another. The tissues obtained by needle biopsy were sufficient except for two specimens and diagnostic accuracy was perfect. Nevertheless, measurement of the seminiferous tubules of the lamina propria could not be achieved in many cases.     

Needle biopsy in the diagnosis of testicular leukemia in children

Aggressive chemotherapy in patients with acute lymphoblastic leukemia has resulted in a marked upsurge in patient survival. In the course of their management, testicular biopsy and rebiopsy have an important role. We evaluated the histological findings in 50 sets of open wedge and simultaneous needle core biopsy specimens from 44 testes of children with acute lymphoblastic leukemia to determine the accuracy of the needle biopsy technique in the evaluation of testis involvement in acute lymphoblastic leukemia. We conclude that needle biopsy of the testis in acute lymphoblastic leukemia is highly accurate and correlates well with the conventional open wedge biopsy, and it may have a role in the management of children with acute lymphoblastic leukemia.     

Yield and efficacy of biopty gun testis needle biopsy

OBJECTIVES: To assess whether a preliminary skin incision enhances diagnostic yield of percutaneous testis biopsy and to further evaluate the clinical efficacy of this procedure. METHODS: A total of 45 men (67 testes) underwent testicular biopsy with two passes of a Biopty gun spring-loaded needle. Twenty-seven biopsies were performed without a preliminary skin incision (group 1), and 40 were performed after a small scrotal incision (group 2). In 56 testes, needle biopsy histopathologic diagnosis was compared with that of open biopsy or orchiectomy specimens from the same patient. Needle and surgical specimens were fixed in Bouin's solution and sent separately for independent, blinded, histologic interpretation. RESULTS: Complications of the procedure were negligible. In all 67 needle biopsies, specimen quality was adequate for histopathologic interpretation. The mean number of seminiferous tubules obtained from needle biopsy was 28% higher among patients having a preliminary skin incision (25.9) compared with those without (18.7, P = 0.023). Correlation between needle and open histopathologic diagnosis was excellent (55 of 56, 98%). CONCLUSIONS: A preliminary skin incision made before needle biopsy increases the diagnostic yield of percutaneous testis biopsy. Percutaneous testis biopsy using the Biopty gun needle provides equal diagnostic information when compared with open testis biopsy or orchiectomy specimens. The concomitant reduction in morbidity and cost make this an attractive diagnostic procedure.     

Use of fine needle aspiration cytology for the diagnosis of testicular relapse in patients with acute lymphoblastic leukemia

The testis frequently is the site of relapse in male patients with acute lymphoblastic leukemia. While many patients with testicular involvement by acute lymphoblastic leukemia have enlarged or firm testes, clinical examination alone is insufficient to establish or exclude the diagnosis completely. Open biopsy generally has been used to document the presence of acute lymphoblastic leukemia. However, this procedure requires general anesthesia and hospitalization. We studied 11 patients with a history and/or physical findings suspicious for testicular acute lymphoblastic leukemia relapse to determine the efficacy of fine needle aspiration cytology in the evaluation of the testes for leukemic infiltration. Of the 11 patients fine needle aspiration cytology correctly identified all 5 patients with histologically proved testicular acute lymphoblastic leukemia, it was negative in 5 with no histological evidence of leukemia and it demonstrated rare atypical cells that were not evident on subsequent histological examination in 1. No adverse effects were encountered in this series. Fine needle aspiration cytology appears to be a safe, reproducible alternative to open biopsy in the evaluation of patients for testicular relapse of acute lymphoblastic leukemia.     

Testicular needle biopsy in diagnosis of infertility

Testicular needle biopsies were performed on 10 patients who at the same time underwent open testicular biopsy. The tracts and puncture sites were explored on each of these patients, and an open biopsy was obtained at the puncture site simultaneously. Both needle specimen and open tissue specimen were fixed in Bouin solution and sent for histologic examination. In none of the cases was there found to be bleeding or extrusion of the testis at the puncture site. In one of the needle specimens, however, insufficient tissue was obtained for diagnosis. In the other 19 specimens, diagnostic accuracy was not compromised by the technique. The main differences appear to be fewer tubules obtained by the needle technique as well as decreased preservation of the interstitial tissue. This is a rapid, simple, and inexpensive method for testes biopsy which has proved to be both safe and diagnostically accurate.     

Comparison of fine-needle aspiration and open biopsy of testis in sperm retrieval and histopathologic diagnosis

This study aimed to compare the diagnostic value of testicular fine-needle aspiration (FNA) with open biopsy in infertile males with azoospermia or severe oligozoospermia and to evaluate the reliability of testicular sperm extraction by FNA. A total of 76 testes of 40 patients, 34 with azoospermia, four oligozoospermia and two patients who underwent orchidectomy as a result of cancer of prostate were included. Detailed clinical and laboratory examinations were performed and two semen analyses were obtained from each patient. A 20-ml 26 gauge 13-mm needle was used for FNA and smears were stained with May-Grunwald-Giemsa and Papanicolaou stain. An open biopsy was performed in each patient after FNA and the samples were stained with haematoxylen-eosin. Smears and histological stains were examined and compared under light microscopy by the same pathologist. In 69 of the 76 testes (90%) FNA cytology results agreed with the histology. In four testes, the aspirate was unsatisfactory and in three testes, spermatocytic arrest was found cytologically while subsequent biopsies revealed diffuse fibrosis. In 15 of 16 patients (93.7%) with normal and hypospermatogenesis, spermatozoa had been extracted by FNA. Spermatozoa could not be obtained after neither FNA nor open biopsy in the remaining 24 patients. Testicular FNA in infertile males is a simple, reliable and minimally invasive diagnostic tool. It is as effective as open biopsy for testicular sperm extraction and good results can be achieved in experienced hands.     

A comparison of the histopathological findings after open and percutaneous needle testicular biopsy in adult male rats

OBJECTIVE: To define the histopathological changes occurring as a result of open and percutaneous needle testicular biopsy in adult rats. MATERIALS AND METHODS: Percutaneous needle and open testicular biopsies were taken from 35 male albino rats (120-140 days old). Nine of the rats were killed 10 days after the biopsy, eight after 30 days and the other eight 60 days after the biopsy. A control group of six rats underwent orchidectomy with no preceding testicular biopsy. RESULTS: Significant tubulitis and obstructive findings were detected 10 days after needle biopsy (P < 0.05); epididymo-orchitis was frequent after open biopsy during this period. At 10-30 days after needle biopsy the mean seminiferous tubule diameters were significantly greater than in either the control group or after open biopsy (P < 0.05). The histopathological damage recovered 60 days after open and needle biopsy. CONCLUSION: Although percutaneous, a needle biopsy (as an alternative to open biopsy) causes tubulitis and frequent obstructive findings in the early period; therefore, repeat testicular procedures should be planned after these changes have resolved.     

Office-based Core Needle Biopsy of Bone and Soft Tissue Malignancies: An Accurate Alternative to Open Biopsy with Infrequent Complications

Background  

Biopsy is a critical step in the diagnosis of musculoskeletal malignancy. As an alternative to open biopsy, percutaneous core needle biopsy techniques have been developed. As many studies combine office-based, image-guided, and operative biopsies, the accuracy of office-based core needle biopsy is not well documented.     

Needle core vs open biopsy for diagnosis of intermediate- and high-risk neuroblastoma in children

BackgroundOpen biopsy has been the mainstay for definitive diagnosis of neuroblastoma in pediatric patients. However, needle core biopsy may represent a faster, less invasive, and safer alternative to open biopsy in children. The purpose of this study was to compare safety and efficacy between needle core and open biopsy in the diagnosis of patients with intermediate- and high-risk neuroblastoma at our institution.MethodsWe retrospectively reviewed the medical records of children with intermediate- and high-risk neuroblastoma who underwent open or needle core biopsies from 2002 to 2010. Data collected included patient demographics, tumor size, sample adequacy for diagnosis and risk stratification (histology and cytogenetics), length of hospital stay, time to initiate chemotherapy after biopsy, need for repeat biopsy, and both intraoperative and postoperative complications. Mann-Whitney U and Fisher's exact tests were used for statistical analysis.ResultsDuring the study period, 7 patients underwent needle core primary biopsies (5 intermediate-risk primary tumors and 2 high-risk primary tumors), and 4 patients underwent needle core biopsy for metastatic tumors, whereas 21 patients had open biopsies (10, intermediate risk; 11, high risk). Median age at biopsy and median tumor size were similar in both groups. There was no significant difference in adequacy of biopsy, need for repeat biopsy, time to initiate chemotherapy, length of stay, or minor complications. The rate of major complications differed significantly between the 2 groups with 0% after needle core biopsy vs 48% after open biopsy (P = .027).ConclusionsIn children, needle core biopsy is comparable in efficacy with open biopsy in the diagnosis of intermediate- and high-risk neuroblastoma with significantly lower rates of major postoperative complications. These findings warrant a larger scale evaluation of diagnostic needle core biopsies in pediatric patients with solid tumor.     

Fine Needle Aspiration for Clinical Triage of Extremity Soft Tissue Masses

Background  

Fine needle aspiration cytology (FNAC) is a rapid and low-morbid alternative to open biopsy or needle core biopsy for soft tissue masses. Numerous reports describe its use with metastatic or recurrent lesions, but FNAC is less accepted for primary lesions.     

The usefulness of percutaneous fine-needle aspiration biopsy in infants and children

During the past 2 years percutaneous fine-needle aspiration biopsy has been employed to help establish or confirm diagnosis in 32 infants and children. A 22-gauge needle is used to aspirate the site of suspected disease. For lesions inside the chest or abdomen, the needle is guided with the help of fluoroscopy, ultrasound, or computed tomography (CT) scan. Nineteen of the 32 patients had malignant disease, including lymphoma, neuroblastoma, rhabdomyosarcoma, Ewing's sarcoma, osteosarcoma, and leukemia. In all patients with solid tumors, tissue obtained at operation confirmed the accuracy of the diagnosis. In seven children with suspiciously enlarged lymph nodes, an open biopsy was avoided when the needle aspirate was clearly benign. In four children, the early appearance of metastatic or recurrent malignancy was confirmed without the need for open biopsy. In this small series, there were no false-negative or false-positive needle aspirates, and no complications directly related to the procedure. The skill and experience of the cytopathologist is essential to the success of this technique. Percutaneous fine-needle aspiration biopsy is a safe and reliable alternative method of establishing a diagnosis in infants and children with suspected malignant disease.     

The potential value of mammographically guided fine-needle aspiration biopsy of nonpalpable breast lesions

Nonpalpable breast lesions in 20 female patients were prospectively evaluated with a new technique of fine-needle aspiration biopsy (FNAB) under mammographic guidance. The patient age range was 37-82 years (mean: 60 years), and the mammographic indications for biopsy were microcalcifications (30%), mass (30%), mass with calcifications (25%), and asymmetric density (15%). Seven (35%) patients had significant risk factors for breast cancer. Prototype coaxial 19-gauge/22-gauge and 18-gauge/20-gauge needle systems (Cook, Inc., Bloomington, IN) were used for localization and biopsy. The technique involved needle localization of the target lesion with FNAB performed through the localizing needle after radiologic confirmation of position. A localizing wire then was inserted to allow each patient to proceed directly to the operating room for a standard needle localization open biopsy. Successful localization and aspiration was possible in 18 (90%) patients. Surgical excision was performed in all 20 patients and confirmed by specimen radiography in 17 (85%). A significant concordance of 94 per cent was found between the histologic results of the open biopsy specimens and the cytologic findings of aspirated specimens. These findings suggest that mammographically guided FNAB may offer a safe, reliable, and cost-effective alternative to open biopsy of nonpalpable breast lesions. Further study of this procedure is warranted to confirm its potential in this area.     

Upstaging of atypical ductal hyperplasia after vacuum-assisted 11-gauge stereotactic core needle biopsy

BACKGROUND: Nonpalpable mammographic abnormalities are frequently evaluated by means of a stereotactic core needle biopsy. This technique is a very sensitive indicator of invasive cancer, but is less reliable to discriminate between ductal carcinoma in situ and atypical ductal hyperplasia (ADH). The objective of this study was to determine the correlation of the 11-gauge vacuum-assisted core needle biopsy to open biopsy when a diagnosis of ADH is obtained. HYPOTHESIS: The use of 11-gauge vacuum-assisted stereotactic core needle biopsy does not conclusively diagnose ADH. DESIGN: Retrospective analysis. SETTING: University-affiliated teaching hospital. PATIENTS: Mammographic findings were evaluated with an 11-gauge vacuum-assisted stereotactic core biopsy in 1750 patients. Seventy-seven patients were diagnosed as having ADH; of these, 65 underwent excisional biopsy. MAIN OUTCOME MEASURES: Pathological upstaging rate. RESULTS: Of the 65 patients who underwent excisional breast biopsy, 11 (17%) had their condition upstaged to a breast cancer diagnosis. These patients had presented at a later age than those who retained a benign diagnosis after excisional biopsy. The number of cores taken did not correlate with diagnostic accuracy. CONCLUSIONS: Of the 65 patients who underwent open biopsy for ADH in this series, only 83% had an accurate diagnosis. A diagnosis of ADH by stereotactic core needle biopsy should be followed by an open excisional biopsy.     

Fine needle aspiration biopsy of primary bone tumors

A review of 66 consecutive fine needle aspiration biopsies of primary bone tumors revealed that 48 (73%) were diagnostic. Twelve (18%) yielded inadequate specimens unsatisfactory for diagnosis, and five (8%) yielded specimens adequate for partial diagnosis. The only error, presumably attributable to sampling error, was an unappreciated dedifferentiated osteosarcoma arising in an otherwise typical giant cell tumor. Fine needle aspiration biopsy obviated the need for open biopsy in 24 patients and simplified surgery in an additional 24 patients by establishing the diagnosis before surgical intervention. A solitary soft tissue recurrence of a giant cell tumor has been the only local recurrence. A review of 26 consecutive patients with osteosarcoma revealed that seven tumors were diagnosed by primary open biopsy. Nineteen patients had fine needle aspiration biopsy, of which 15 were diagnostic and four required supplemental open biopsy. The elapsed time between the initial office visit and the diagnostic confirmation averaged 5 days for patients requiring open biopsy compared with 0 days for patients whose fine needle aspiration biopsy was diagnostic. The total estimated charge for fine needle aspiration biopsy of a distal femoral osteosarcoma was $1060.00 compared with $4312.25 for open biopsy. There have been no local recurrences in patients in either group. Fine needle aspiration biopsy provides an accurate, safe, efficient, well tolerated, and cost-effective method for diagnosing classic primary bone tumors, including osteosarcoma.     

The impact of image guided needle biopsy on the outcome of mammographically detected indeterminate microcalcification

A study was carried out to examine the impact of development in image guided needle biopsy on the outcome of mammographically detected indeterminate microcalcification. Between 01.04.1991 and 31.03.2001, the South East London Breast Screening Programme detected 392 cases of indeterminate microcalcificaton. Histological diagnosis was obtained using open biopsy, fine needle aspiration cytology (FNAC), 18/14 G wide bore needle core biopsy (WBNCB) and 11 G vacuum assisted core biopsy (VACB). The study period group was divided into two. Group A (between 01.04.1991 and 31.03.1996) and group B (between 01.04.1996 and 31.03.2001). There was a significant reduction in the benign open biopsy rate in group B compared to group A (25% vs. 51%) (P=0.0001). Of the malignant cases, there is a higher percentage of ductal carcinoma in situ (DCIS) in group B compared to group A (77% vs. 62%). In conclusion, the implementation of more effective methods of image guided biopsy has led to a 50% reduction in benign open biopsies for indeterminate microcalcification and to an increase in the detection of DCIS.     

CORE BIOPSY FOR MICROCALCIFICATIONS IN THE BREAST

Background : The conventional method of dealing with clustered mammographic microcalcification in the breast when it is of uncertain aetiology is to undertake either a short-term mammographic review or to surgically excise the abnormal area and submit it for histological examination. Stereotactic wide-bore needle biopsy (core biopsy) of microcalcifications is a suitable alternative to surgical biopsy and experience with this technique forms the basis of the present study. Methods : Percutaneous core biopsy has been used at the Wesley Breast Clinic as a means of assessing clustered calcification in 297 cases from November 1992 to October 1995. The procedure is done under local anaesthesia as an outpatient procedure using a Stereotactic attachment to a standard mammography unit. Results : A diagnosis of frank malignancy was made on core samples in 22 cases (7.4%), and in all of these malignancy was confirmed at open surgical biopsy. In a further six women in whom the core biopsy was reported as ‘suspicious of malignancy’, open surgical biopsy confirmed malignancy in three women, lobular in situ carcinoma was found in two women, and atypical ductal hyperplasia in one woman. In two instances the core sample was reported as showing atypical ductal hyperplasia and in those cases, this was confirmed at open surgical biopsy. In 265 cases (89%) the histology of the core revealed appearances of benign breast tissue. Open surgical biopsy has been undertaken in only six of these cases, but in all instances the histology has confirmed a benign process. In the two remaining cases, the procedure was considered to be technically unsatisfactory, and open surgical biopsy was recommended because of doubt about the appearance of the microcalcification. In both instances, malignancy was demonstrated. Conclusions : Core biopsy of clustered mammographic microcalcification of uncertain aetiology is recommended as a satisfactory and reliable alternative to open surgical biopsy. It is less expensive, can be done quickly, produces few complications, and does not produce subsequent mammographic distortion.     

Ultrasound-guided biopsy of nonpalpable breast masses by surgeons

Background: Recently, ultrasound (US)-guided needle biopsy has been proposed as an acceptable alternative to open biopsy in women with nonpalpable breast masses. This study evaluated the accuracy of US-guided needle biopsy of nonpalpable breast masses performed by surgeons at the time of the initial clinical examination. Methods: Ultrasound-guided aspiration and/or core biopsy (US-GAB) was performed on 103 patients presenting with a nonpalpable, new, or increasing-size mass detected on mammography. Study patients included those whose US was classified as: fibroadenoma (FA) (n=26), complex cyst (n=32), indeterminate (complex cyst versus solid; N=24), or suspect (n=21). Results: Of the 32 patients with diagnostic US of complex cyst, US-GAB confirmed 27 to be cysts. Twelve additional cysts were aspirated among the 24 indeterminate lesions. Sixteen FA were diagnosed on US-GAB; 11 of these underwent open biopsy and each was demonstrated to be a FA. Fibrocystic/benign-breast change (FBC) was diagnosed on 26 US-GAB; 15 of these underwent open biopsy, which demonstrated three FA and 12 FBC. Nine atypical lesions were diagnosed on US-GAB; six FBC, one papilloma, one FA, and one cancer were demonstrated on open biopsy. Seven cancers were diagnosed on US-GAB and all were confirmed on open biopsy. There were six insufficient specimens from US-GAB; four of these underwent open biopsy, which demonstrated two FA and two FBC. Conclusion: Ultrasound-guided aspiration and/or core biopsy performed by surgeons in conjunction with the initial clinical examination can accurately diagnose nonpalpable, mammographically detected breast masses. Results of this study were presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

Role of different methods of lung biopsy in the diagnosis of lung lesions

Bronchoscopic biopsy and percutaneous needle biopsy were retrospectively compared with open biopsy. No procedure resulted in mortality. Nonfatal complications were similar in incidence. Bronchoscopic biopsy approached the accuracy of open biopsy only when applied to infiltrates. Percutaneous needle biopsy approached the accuracy of open biopsy only when applied to nodules. Nonspecific results of either bronchoscopic biopsy or percutaneous needle biopsy were unacceptable as definitive diagnoses.     

Prospective Evaluation of Aspiration Needle,Cutting Needle,Transbronchial, and Open Lung Biopsy in Patients with Pulmonary Infiltrates

Twenty consecutive patients with pulmonary infiltrates undiagnosed by routine, noninvasive methods were entered into a prospective study designed to evaluate the diagnostic yield of four methods of lung biopsy. Percutaneous aspiration needle, cutting needle, transbronchial, and open (anterior thoracotomy) biopsy were performed synchronously on all patients. Specimens were evaluated by microbiological, virological, and pathological methods. The diagnostic yields of the four methods were as follows: aspiration needle, 29%; cutting needle, 53%; transbronchial, 59%; and open lung biopsy, 94%. Open lung biopsy was significantly better in yielding a diagnosis than aspiration needle (p < 0.001), cutting needle (p < 0.001), and transbronchial biopsy (p < 0.04).