Guided versus blind liver biopsy for chronic hepatitis C: clinical benefits and costs

BACKGROUND/AIMS: Our objectives were: (1) to assess the clinical benefits and costs of performing ultrasound-guided liver biopsy with an automated needle compared to blind biopsy with a conventional Trucut needle in patients with chronic hepatitis C; (2) to compare the histological yield of automated needles with Trucut needles. METHODS: We prospectively studied 166 patients with hepatitis C virus who underwent either ultrasound-guided biopsy using automated ASAP needles or blind biopsy using conventional Trucut needles. Both groups were matched for age, sex, cirrhosis, needle gauge and operator experience. Patient tolerance, complications and histological adequacy were assessed. In a separate in vitro study, we assessed the histological adequacy of liver biopsy specimens obtained using automated and Trucut needles from 10 fresh autopsy cases. RESULTS: Ultrasound-guided biopsy caused significantly less biopsy pain (36.4% vs. 47.3%; p < 0.0001) and significantly less pain-related morbidity (1.8% vs. 7.7%, p < 0.05). Although, there was no significant difference in diagnostic yield between guided and blind biopsy (98% vs. 94%, p = 0.15), 3 blind biopsies (3.3%), including 2 which yielded extra-hepatic tissue, had to be repeated. The additional expense of performing guided liver biopsy with automated needles was 42 Irish Pounds per patient. In vitro, automated ASAP 15G needles provided liver specimens comparable to Trucut 15G needles and had the highest histopathologic score among the automated needles assessed. CONCLUSIONS: Even in the absence of major complications, ultrasound-guided liver biopsy with an automated needle in HCV patients is safer, more comfortable and only marginally more expensive than blind Trucut biopsy.     

Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses

Background and Study Aims:  The aim of this prospective study was to compare fine-needle aspiration guided by endoscopic ultrasonography (EUS-FNA) using 25-gauge and 22-gauge needles with the EUS-guided 19-gauge Trucut needle biopsy (EUS-TNB) in patients with solid pancreatic mass.
Patients and Methods:  Twenty-four consecutive patients with pancreatic mass underwent biopsies by both EUS-FNA and EUS-TNB. Three needles were compared with respect to technical success rate, tissue size obtained, overall diagnostic accuracy and accuracy for histological and cytological diagnosis.
Results:  The 25-gauge EUS-FNA was technically easier and obtained superior overall diagnostic accuracy than the 22-gauge and Trucut needles, especially in lesions of the pancreas head and uncinate process. Overall accuracy for the 25-gauge, 22-gauge and Trucut needle was 91.7%, 79.7% and 54.1%, respectively. Accuracy for cytological diagnosis irrespective the site of lesions with 25-gauge, 22-gauge and Trucut needles was 91.7%, 75.0%, and 45.8%, respectively. For uncinate masses, it was 100%, 33.3%, and 0.0%, respectively. These differences were significant. Among technically successful patients, the accuracy for histological diagnosis using the 25-gauge was significantly inferior ( P  < 0.05) to 22-gauge and Trucut needles and the rates were 45.8%, 78.9% and 83.3%.
Conclusions:  The 25-gauge FNA needle was significantly superior in terms of technical success rate and overall diagnostic accuracy, especially for the head and uncinate lesions, compared to the 22-gauge and Trucut needles and could be considered 'the best choice needle for cytological diagnosis' of solid pancreatic lesions. If histological diagnosis is required, the 22-gauge FNA needle and Trucut needle may be advantageous for use in head/uncinate and body/tail lesions, respectively.     

Usefulness of new automated cutting needle for tissue-core biopsy of lung nodules under CT fluoroscopic guidance

OBJECTIVES: The goal of our study was to evaluate the efficacy and safety of a new type of automated cutting needle for tissue-core lung biopsy under real-time CT fluoroscopic guidance. DESIGN: Observational MATERIALS AND METHODS: One hundred ten percutaneous needle tissue-core lung biopsies were performed with the Auto Surecut needle (Create Medic; Yokohama, Japan) under CT fluoroscopic guidance, and the specimens obtained underwent histopathologic evaluation. A final diagnosis was confirmed by independent surgical pathology. RESULTS: The rate of success for the diagnosis for specimens that were adequate for histopathologic analysis was 94.5% (104 of 110 specimens). The sensitivity, specificity, and accuracy in diagnosing malignancy were 95.1%, 100%, and 96.2%, respectively. A specific cell type could be characterized in 95.2% of those 104 lesions (99 lesions; malignant, 76 lesions; benign, 23 lesions). The specific cell type was precisely diagnosed, and was confirmed after surgery in 65 malignant lesions and 23 benign lesions. The biopsy-induced complications encountered were pneumothorax in 34.5% (38 of 110 patients) and hemoptysis in 6.4% (7 of 110 patients). No patient had a serious complication. CONCLUSION: CT fluoroscopy-guided lung biopsy using the Auto Surecut needle provides a high degree of diagnostic accuracy, allows for the specific characterization of lung nodules, and can be performed safely.     

两种不同类型的穿刺针在经皮肺穿刺中的应用比较

目的比较两种穿刺针诊断肺周围性病变的性质及造成的并发症的差别。方法收集本院五年期间的患者资料,比较两种穿刺针的准确性及造成的并发症。结果Bard18G和Angiotech18G穿刺针的准确性分别为96．03％和94％;其中分别有2l例和6例患者发生了气胸;12例和6例发生了咳血或痰中带血;6例和5例发生了肺内渗血。结论两种穿刺针诊断肺周围性病变的准确性及造成的并发症无明显差别。     

Prospective study of a Trucut needle for performing EUS-guided biopsy with EUS-guided FNA rescue

BACKGROUND: EUS-guided FNA (EUS-FNA) is an accurate technique for sampling extraintestinal masses and lymph nodes. The use of a Trucut needle to perform EUS-guided biopsy (EUS-TCB) may improve the results or simplify the procedure. To date, few studies have prospectively assessed the performance and the safety of EUS-TCB. METHODS: Patients with a known or a suspected malignancy referred for a diagnostic and/or staging EUS examination were enrolled in a prospective study. EUS-guided biopsy was performed first with a 19-gauge Trucut needle. If the Trucut failed to obtain an adequate sample or when the "in room" touch preparation was benign, EUS-FNA was performed with a standard 22-gauge FNA needle. The objective of the study was to assess the yield of detection of malignancy and the safety of EUS-TCB in patients with known or suspected malignancies and to investigate if EUS-FNA has a role for rescue in cases of Trucut failure. OBSERVATIONS: Thirty-nine lesions underwent EUS-TCB in 30 patients. Sufficient follow-up was available for all patients. By using EUS-TCB, we were able to obtain a sample for diagnosis in all but 3 patients (one pancreatic mass and two lymph nodes) in which technical problems arose. In these patients, the diagnosis was obtained in two cases by EUS-FNA and in the other one by EUS-TCB from the primary pancreatic tumor. The yield of detection of malignancy for EUS-TCB was 84%. No complications were recorded in any patients at 1 and 7 days of follow-up. The sample size is limited to generalize conclusions. CONCLUSIONS: EUS-TCB is a safe and an accurate procedure to obtain a histologic diagnosis in patients with known or suspected malignancies. EUS-FNA can serve as a rescue technique in cases of Trucut failure.     

Ultrasound-guided core biopsy of thoracic tumors.

Two hundred and eighteen patients, with thoracic tumors larger than 3 cm in size, underwent ultrasound-guided percutaneous transthoracic core biopsy with a large-bore Tru-Cut needle. Fifty-five tumors were in the mediastinum, and 122 tumors were located at subpleural area, and 42 tumors were within the lungs. In 122 subpleural tumors, the sensitivity of ultrasound-guided core biopsy for the diagnosis of malignancy was 96.8%, and accuracy was 97.5%. Sensitivity for the diagnosis of malignant tumors located within the lungs was 94.6%, and accuracy was 95.2%. In 54 patients with mediastinal tumors, definite histologic diagnosis could be obtained in 48 patients (88.9%). The sensitivity of ultrasound-guided biopsy for the diagnosis of malignancy in these 48 mediastinal tumors was 97.1%, with an accuracy of 97.9%. Three patients had complications with minimal pneumothorax and one with mild hemoptysis. We conclude that percutaneous transthoracic core biopsy with Tru-Cut needle under ultrasound guidance is a safe and sensitive way to obtain specimens for accurate histologic diagnosis of thoracic tumors. The diagnostic yield is high, and the technique, relatively simple, can also be used for outpatients.     

Does needle size affect diagnostic yield of transthoracic needle biopsy in malignant pulmonary lesions?: Comparison of 18‐, 22‐ and 25‐gauge needles in surgical specimens

OBJECTIVE: To evaluate the effect of needle size on the diagnostic yield of transthoracic needle aspiration biopsy in malignant pulmonary lesions. METHODS: The study assessed samples from 35 patients who underwent surgery for lung cancer. We used surgical specimens for needle aspiration biopsy. Aspirations were performed with 25-, 22- and 18-gauge, 9 cm in length aspirating needles. All pathology preparations were coded. At the end of the study period, all needle aspiration preparations were interpreted by the same pathologist. RESULTS: Lobectomy was performed in 19 patients, pneumonectomy in 15 and bilobectomy in one. Squamous cell carcinoma was the most frequent tumour type, followed by adenocarcinoma. The diagnostic yield of aspiration biopsy was 85.7% for 18-gauge needle and 82.9% for both 22-gauge and 25-gauge needles. There was no statistically significant difference for the three needles with respect to diagnostic yield (P > 0.05). Cell type concordance for 18-, 22- and 25-gauge needles was 70%, 65.6% and 65.6%, respectively. There was no statistically significant difference for the three needles with respect to cell type concordance (P > 0.05). CONCLUSION: Needle size did not affect diagnostic yield or accuracy for malignant lesions. Smaller needles such as 22-gauge needle would appear to be suitable for transthoracic needle aspiration biopsy in the diagnosis of malignant pulmonary lesions.     

The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy

The risk of complications from percutaneous liver biopsy is low, but discomfort is common and complications require hospitalization in approximately 4% of patients. The optimal method of performing these biopsies is unknown. The goal of our study was to determine whether the use of ultrasonography in the biopsy room immediately prior to or during the procedure would lessen the risk of complications and to compare the safety and efficacy in obtaining tissue by use of a Trucut needle versus an automatic biopsy needle. Between 1992 and 1994, 836 patients were entered into a randomized study (489 in Rochester, MN; 347 in Barcelona, Spain). Patients were randomized immediately prior to liver biopsy into four groups: Trucut needle, or automatic biopsy needle, and with or without ultrasonography. Fisher's Exact Test and a logistic regression model were also used to assess the effect of needle and ultrasonography on the odds for complications. The four biopsy groups were well-matched at entry with respect to age, sex, underlying liver disease, hemoglobin, prothrombin time, and platelet count. The use of ultrasound was associated with a decreased rate of hospitalization for pain, hypotension, or bleeding (2 vs. 9, P < .05). No difference in safety was found between the two types of needles. The number of passes needed to obtain specimens was similar for all four groups. The average length of the specimen was slightly greater with ultrasonographic-guided biopsies (1.7 mm vs. 1.6 mm, P < .05) and with biopsies obtained using the automatic biopsy needle when compared with the Trucut needle (1.7 mm vs. 1.5 mm, P < .05), but this did not seem to be clinically important. The addition of ultrasonography reduces complications in patients undergoing percutaneous liver biopsy. The type of needle appears to offer little difference in safety or yield of diagnostic tissue. The use of ultrasonography for guidance of percutaneous liver biopsy will lead to a lower rate of complications. The value of this benefit must be weighed against the added cost of ultrasonographic guidance. (Hepatology 1996 May;23(5):1079-83)     

Ultrasound-guided aspiration biopsy of small peripheral pulmonary nodules.

We compared the diagnostic yields of ultrasound-guided aspiration biopsy, sputum cytology, and fiberoptic bronchoscopy with biopsy in 30 patients with peripheral pulmonary nodules smaller than 3.0 cm in diameter. Among them, there were 4 minute nodules with diameter less than 1.0 cm, 12 between 1.1 to 2.0 cm, and 14 between 2.1 to 3.0 cm. The final diagnoses in these 30 patients, as confirmed by histologic findings, microbiology, and clinical follow-up, revealed 24 malignant lesions and 6 benign. All of these 30 nodules received ultrasound-guided transthoracic fine-needle aspiration biopsy, and confirmative diagnoses were obtained in 27 (90 percent). Twenty-two (92 percent) of 24 patients with malignant nodules had positive cytology for malignancy and 5 (83 percent) of 6 patients with benign lesions had diagnosis made by cytologic and microbiologic examinations. One patient developed asymptomatic pneumothorax after needle aspiration. The size of the lesions did not affect the diagnostic yield and complication rate. None of the lesions was diagnosed by sputum cytology (0 of 19; 0 percent). Two patients had diagnoses obtained by fiberoptic bronchoscopy with biopsy (2 of 10; 20 percent). We conclude that ultrasound-guided aspiration biopsy is a useful and safe method for diagnosis of peripheral pulmonary nodules, even when the size of the nodule is less than 3 cm in diameter. The diagnostic yield far exceeds that which can be obtained by sputum cytology and fiberoptic bronchoscopy with biopsy.     

Correlation between needle biopsy of lung tumors and histopathologic analysis of resected specimens

Needle aspiration of a pulmonary mass may accurately delineate malignant from nonmalignant pulmonary lesions; however, needle aspiration may be unable to identify a specific cell type. Therefore, a retrospective review of patients undergoing needle aspiration of pulmonary masses was carried out for the years, 1979 through September 1984. A Lee needle was used, which produces a sample of tissue 1-mm in diameter suitable for histopathologic analysis as well as a cytologic specimen. A total of 87 needle biopsies were carried out, but only 46 patients later underwent resection. Five patients (6 percent) sustained a pneumothorax, and four required a chest tube. Minimal hemoptysis occurred in three patients (3 percent). Eight patients were subsequently found to have benign lesions, and there were 38 malignant tumors. Seven needle biopsies (18 percent; 7/38) were nondiagnostic and subsequently proved to be malignant. Thirty-one needle biopsies were diagnostic of malignant neoplasms (82 percent; 31/38). Twenty specimens showed the same cell type as the needle biopsy (65 percent 20/31). Eleven resected specimens disagreed with the cell type from the needle biopsy (35 percent; 11/31). In these 11 patients a change in management was indicated because of the delineation of a different cell type in only four (11 percent of all 38 patients with cancer). Mixed tumors and small cell carcinoma provide the area of most concern. Our conclusions are that needle biopsy accurately indicated a malignant neoplasm in 82 percent of the patients undergoing later resection and that the specimens from Lee needle biopsy accurately predicted the cell type in 65 percent of the specimens. The inaccurate histologic diagnosis was important clinically in only 11 percent of the patients. Overall, the needle biopsy of pulmonary lesions provided a correct decision on management in 87 percent of the cases in which biopsy provided diagnosis of a malignant neoplasm (31 patients).     

EUS-guided Trucut mural biopsies in the investigation of unexplained thickening of the esophagogastric wall

BACKGROUND: In patients with thickened esophagogastric wall on CT but without evidence of malignancy on endoscopic mucosal biopsies, obtaining adequate histology from the gut wall is difficult. We examined whether it is feasible to obtain diagnostic tissue core from the gut wall by using EUS-guided Trucut biopsy technique in this group of patients. METHODS: Ten patients were included in this study. Under EUS guidance, mucosa was penetrated by using a 19-gauge Trucut needle, and a 18-mm tissue tray was advanced obliquely through the wall layers to avoid penetration of the serosa. Then, the cutting sheath was fired over the tray. OBSERVATIONS: Biopsies were performed without complications. Diagnoses of carcinoma were made in 5 patients. Four other patients had benign histology, and, during follow-up, all these diagnoses have been proven to be true negatives. One Trucut biopsy specimen was considered false negative. CONCLUSIONS: The EUS-guided Trucut mural biopsy technique could yield diagnostic tissue cores in patients with unexplained thickening of the esophagogastric wall.     

Echo guided percutaneous needle biopsy for diagnosis of thoracic lesions

Echo guided percutaneous needle biopsy was performed in 32 cases with thoracic lesions. A definitive diagnosis was made histopathologically in 11 (100%) of 11 malignancies, 4 (67%) of 6 benign tumors and 7 (47%) of 15 inflammatory lesions. Furthermore, using cytological specimens, definitive diagnosis was successfully made in 10 (91%) of 11 malignancies and 1 (17%) of 6 benign tumors. Such highly accurate diagnostic rates were due to 1) the accurate puncture of the lesions under real time sonographic guidance, 2) repeated biopsy in case in which sample was inadequate for cytological diagnosis, and 3) aggressive application of needle biopsy for histopathological diagnosis. Following this procedure, three patients suffered from a minor pneumothorax. To prevent pneumothorax, great care is necessary, especially in high risk cases, such as with a pneumatic pattern and thin lesion. One patient suffered from minor hemoptysis but recovered without any medication. No complications were noticed in cases of extrapulmonary lesions. We conclude that echo guided percutaneous needle biopsy is not only a complementary method for biopsy of mediastinal, peripheral pulmonary and chest wall lesions, but due to its simplicity and convenience, it should be a routine method for biopsy of thoracic lesions.     

Value of sonographically guided fine needle aspiration biopsy in evaluating the liver with sonographic abnormalities

This retrospective study was undertaken to evaluate the diagnostic usefulness of 97 sonographically guided fine needle aspiration biopsy cytologies in 92 patients with one or more hepatic lesions suspicious of malignancy. Results of the fine needle aspiration biopsy were then compared with the definitive results obtained by histologic examination, or with the subsequent course of the patient. A final diagnosis of malignancy was established in 65 cases, of which fine needle aspiration biopsy cytology revealed a concordant diagnosis in 54 cases. The diagnostic sensitivity of this technique was 83% for malignant lesions with 93% specificity. Of the 54 cases with malignant cytology, it was possible to distinguish between a primary or secondary lesion in 31 cases (57%). Benign lesions were aspirated in 32 cases, of which 30 cases concorded with the final diagnosis. This study confirms the usefulness of sonographically guided fine needle aspiration biopsy cytology in diagnosing malignant hepatic tumors.     

Performance of a new histology needle for EUS-guided fine needle biopsy: A retrospective multicenter study

ObjectiveProcurement of tissue core biopsy may overcome some of the limitations of EUS-FNA. We aimed at assessing the safety, core procurement yield and diagnostic accuracy of two novel available histology needles.MethodsData from consecutive patients with solid lesions who underwent EUS-FNB using the 25G-22G SharkCore™ needles were retrieved from 4 tertiary-care centers database.Results146 patients (mean age 64 ± 12 years; M/F, 76/68) with 156 lesions (114 pancreatic) were identified. In 83 cases the 22G needle was used. 3.6 ± 1.2 passes per lesion were performed, without any major complications. A core biopsy was procured in 89.1% of cases. Considering malignant vs. non-malignant disease, the sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 90.2% (95% CI, 83.7–94.3), 100% (95% CI, 87.2–100), 0.099 (95% CI, 0.058–0.170), 60.4 (95% CI, 3.86–947.4), and 92.3% (95% CI, 88.1–96.5). Procurement yield was significantly higher for the 22G (95.2% vs. 82.2%, p = 0.011), despite the fact that more needle passes were performed with the 25G needle (3.8 ± 1.3 vs. 3.4 ± 1.0, p = 0.028).ConclusionsEUS-FNB using the 25G-22G SharkCore™ needles is able to reach a very good procurement yield and diagnostic accuracy. The 22G-size needle showed superior core procurement and diagnostic capabilities. Large prospective studies are warranted to further evaluate the use of these types of needles.     

Diagnostic fiberoptic bronchoscopy: Techniques and results of biopsy in 600 patients.

Six hundred patients underwent diagnostic flexible fiberoptic bronchoscopy (FFB). The two diseases most frequently encountered were bronchogenic carcinoma in 330 patients (55 percent) and bacterial infection in 94 (16 percent). A positive cytology on biopsy material was obtained in 279 of 330 patients (85 percent) with primary lung cancer. Fluoroscopy was a valuable aid in diagnosing bronchogenic carcinoma, since 42 percent of the tumors were not visible endoscopically and required fluoroscopic control for placement of the biopsy instrument. Of the 55 patients with hemoptysis and negative chest x-ray films, nine (15 percent) had fiberoptically visible endobronchial carcinomas! In addition, two patients with carcinoma of the larynx and one with carcinoma of the nasopharynx were discovered. Transbronchial biopsy (TBB) in 68 patinets with diffuse and localized disease achieved an overall 69 percent diagnostic success, including a correct diagnosis in each of four patients with Pneumocystis carinii pneumonia. Brush biopsy provided additional valuable laboratory data in bacterial, mycobacterial and cytomegalovirsu infectious but had a poor yield in Pneumocystis infection. Complications as a result of forceps biopsy were minimal, except for brisk bleeding in six patients.     

Conventional transbronchial needle aspiration decreases the rate of surgical sampling of intrathoracic lymphadenopathy

BACKGROUND: Previous studies have suggested a decreased need for the surgical biopsy of intrathoracic lymph nodes (LNs) due to improved diagnostic rates utilizing transbronchial needle aspiration (TBNA) with endobronchial ultrasound and endoscopic ultrasound. The goal of this study was to determine whether conventional TBNA using combined cytologic and histologic analysis of tissue specimens impacted the rates of surgical diagnostic biopsies of patients with intrathoracic lymphadenopathy. METHODS: Retrospective review at a single academic center. All mediastinal and hilar tissue samples submitted for pathologic analysis over an 8.4-year period were analyzed. Patients were categorized into a "before" group and an "after" group based on two different time periods. The before group underwent only cytologic analysis of Wang needle (19-gauge or 21-gauge) aspirates. The after group had cytologic analysis of aspirates as well as histologic analysis of needle "core" (19 gauge) biopsy specimens. The groups were compared for the rate of intrathoracic LNs sampled by surgical means vs TBNA and the number of times that TBNA averted the need for a surgical diagnostic procedure. RESULTS: The success of TBNA increased significantly in the after group compared to that in the before group. The yield for the successful sampling of mediastinal and hilar LNs increased from 53 to 91% (p < 0.001) in the before group vs the after group. TBNA averted a surgical biopsy in 35% of the before cases compared to 66% of the after cases (p < 0.001). CONCLUSIONS: Conventional TBNA using large-bore needles with both cytology and surgical pathology evaluation decreases the need for surgical sampling of the mediastinum to diagnose thoracic lymphadenopathy.     

Surecut 0.6 mm liver biopsy in the diagnosis of cirrhosis

Liver biopsy with the 0.6 mm (23 gauge) Surecut needle was compared to conventional Menghini biopsy in the diagnosis of cirrhosis. Seventy-seven consecutive patients (mainly alcoholics) with a clinical indication for liver biopsy had both biopsies performed simultaneously. In 71 patients sufficient material for a morphological diagnosis concerning liver architecture was obtained with both biopsy techniques (Surecut insufficient in 5 cases and Menghini insufficient in 2 cases). The biopsies were classified as cirrhosis or non-cirrhosis. There was agreement in 69 cases (97%, confidence limits 90-100%). Using the result of the Menghini biopsy as the final diagnosis, the predictive values for a positive and negative diagnosis for the Surecut needle were 96% and 98%, respectively. There were no complications to either of the biopsies. It is suggested that the 0.6 mm Surecut biopsy may be used in the diagnosis of cirrhosis in cases where conventional Menghini needle biopsy is contraindicated.     

The factors determining diagnostic accuracy in CT-guided percutaneous needle biopsy of small pulmonary nodules]

Between February 1997 and March 1999, 79 consecutive CT-guided automated needle biopsy procedures were performed in 78 patients (79 small pulmonary nodules measuring 20 mm or less in diameter). In 69 (87%) of 79 lesions, sufficient material for histologic diagnosis was obtained. We evaluated the factors affecting diagnostic accuracy in CT-guided automated needle biopsy. Lesion diameter, depth from skin, chronic pulmonary disease and location were analyzed. The diameter of the lesion was a significant factor contributing to diagnostic accuracy (p = 0.0108). Pneumothorax occurred in 18 cases (23%). In 5 cases (6%), chest tube placement was necessary. Postbiopsy hemoptysis or hemosputum occurred in 23 cases (29%). In conclusion, lesion diameter was a critical factor in diagnostic accuracy. CT-guided automated needle biopsy is a feasible, useful and safe technique for the histological diagnosis of small lung lesions, but especially those larger than 8 mm in diameter.     

Low-risk large-needle biopsy of chest lesions

There were 210 chest lesions biopsied with large-bore cutting needles (14.5 to 18.0 gauge). The patients ranged in age from 13 to 84 years with a heavy preponderance of males (99 percent). Most of the lesions were pleural based lung masses (133). In the majority (140) only one pass was required for diagnosis. Certain technical considerations were employed which resulted in a low complication rate of 4.8 percent. Pneumothorax occurred in only eight cases (4 percent). There were eight false-negative biopsies and no false-positives. The key advantage of large needle biopsy (LNB) over skinny needle biopsy (SNB) is that a large tissue core is obtained that allows for more specific histologic diagnosis. With proper technique and careful patient and lesion selection, LNB can be performed as safely as thin-needle biopsy.     

Diagnosis of carcinoma of the breast by aspiration biopsy cytology

The authors performed fine needle aspiration biopsy in 174 patients with mammary lesions. In 124 cases the cytologic examination was followed by surgery combined with histologic examination. The cytologic findings can be considered to be satisfactory in regard to literary data. In principles, however, it cannot substitute the histologic examination. In combination with the other diagnostic methods aspiration cytology may yield useful diagnostic information. In case of recurrences, inoperable tumors and contralateral metastases the fine needle aspiration biopsy cytology is of diagnostic value.