Sonographically guided percutaneous needle biopsy of soft tissue masses with histopathologic correlation.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of sonographically guided percutaneous core biopsy of soft tissue masses. METHODS: We retrospectively reviewed the medical records of patients who underwent sonographically guided biopsy of soft tissue masses at our institution during a 50-month period. Core biopsy histopathologic results were compared with surgical or clinical follow-up. RESULTS: One hundred eighty-three patients, 76 male and 107 female, with a mean age of 48.5 years were included in the study. Thirteen patients had more than 1 biopsy, and the total number of biopsies performed was 196. Five patients were lost to follow-up. Biopsy results were diagnostically accurate in 174 (91%) cases. Thirteen biopsies were inconclusive. No complications occurred. The overall sensitivity, specificity, positive predictive value, and accuracy in separating malignant from benign lesions were 97%, 99%, 99%, and 98%, respectively. CONCLUSIONS: Sonographically guided core needle biopsy is an accurate and safe means to obtain tissue samples for the histopathologic diagnosis of soft tissue masses. It obviates the need for open biopsy and should be performed routinely for treatment planning.     

Sonographically guided core needle biopsy of soft tissue neoplasms

PURPOSE: This study was conducted to evaluate the usefulness of sonography (US)-guided needle biopsy in the diagnosis of soft tissue masses. PATIENTS AND METHODS: Thirty-seven patients with a mean age of 49 years were enrolled in the study. The size of the biopsy needle was selected according to the kind of tumor suspected (ie, primary or metastatic). In patients with suspected metastases, smaller biopsy needles were used; in patients with suspected primary tumors, larger needles were used so that larger specimens could be obtained. Prebiopsy color Doppler sonography (CDUS) was routinely used to guide the cutting needle to areas of the lesion showing sufficient vascularity. From 3 to 6 cores were obtained, depending on their quality. We compared the diagnoses yielded by the core biopsy and the final histopathologic analysis of the resected tumor by classifying the results as "concordant" or "discordant." RESULTS: A total of 37 tumors were examined. Final diagnoses were 24 malignant tumors (6 metastases and 18 primary tumors) and 13 benign tumors. The lesions were diagnosed correctly as either benign or malignant in 35 of the 36 cases for which needle biopsy specimens were adequate, with only 1 misdiagnosis. The diagnoses were concordant in 33 cases (17 primary malignant tumors, 6 metastatic tumors, and 10 benign tumors) and were discordant diagnosis in the other 4 cases (1 primary malignant tumor and 3 benign tumors). No complications were attributable to the needle biopsy. CONCLUSIONS: US-guided percutaneous core needle biopsy of soft tissue neoplasms is an easy, safe, and useful procedure. It can be considered a first-line procedure for the acquisition of tissue specimens adequate for histopathologic diagnosis.     

Core needle biopsy of soft tissue tumors,CEUS vs US guided: a pilot study

Purpose

The purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in the bioptic sampling of soft tissue tumors (STT) compared with unenhanced ultrasonography alone.

Methods

This is a prospective longitudinal study of 40 patients subjected to ultrasonography (US)-guided core needle biopsy (CNB) to characterize a suspected STT. Three series of bioptic samplings were carried out on each patient, respectively using unenhanced US alone and CEUS in both the areas of the tumor enhanced or not by the contrast medium. All bioptic samples underwent a histological evaluation and the results were analyzed by comparing the histology of the biopsy with the definitive diagnosis in 15 surgically excised samples.

Results

27 (67.5 %) of the 40 patients completed the entire study procedure; in 19 cases (70.3 %) the three bioptic samplings gave unanimous results, also when compared to the surgical specimen; in seven cases (25.9 %) use of CEUS allowed to obtain additional or more accurate information about the mass in question, compared to simple US guidance without contrast; in one patient (3.7 %) sampling obtained using unenhanced ultrasonography guidance and in the areas enhanced by the contrast agent had precisely the same results of the surgical specimen.

Conclusions

CEUS, due to its ability to evaluate microvascular areas, has proven to be a promising method in guiding bioptic sampling of soft tissue tumor, directing the needle to the most significant areas of the tumor. Given the small number of patients evaluated in our study, to achieve statistically significant results, it would be appropriate to obtain a larger sample size, since the very first results seem to be encouraging and to justify the increase of the population.     

Sonographically guided core needle biopsy of cervical lymphadenopathy in patients without known malignancy.

OBJECTIVE: The purpose of this study was to retrospectively evaluate the efficacy of sonographically guided core needle biopsy (core biopsy) for diagnosing the causes of cervical lymphadenopathy in patients without known malignancy. METHODS: One hundred fifty-five sonographically guided core biopsies performed in 155 patients with cervical lymphadenopathy were retrospectively evaluated. None of the 155 patients had any known primary malignancy. Final diagnoses were determined by the histologic examination from excision biopsy when performed or by the clinical and sonographic follow-up for more than 12 months. When a lymph node diagnosed as benign by sonographically guided core biopsy regressed spontaneously or by subsequent management, the diagnosis made by the sonographically guided core biopsy was considered correct. When a lymph node diagnosed as benign by sonographically guided core biopsy was unchanged or increased in size with subsequent management, excision biopsy was performed. Diagnostic yield, sensitivity, specificity, accuracy, and complications of core biopsy were evaluated. RESULTS: Histologic diagnosis could be made by sonographically guided core biopsy in 146 (94%) of the 155 patients. The histologic diagnoses were reactive hyperplasia in 44 patients, tuberculosis in 37, Kikuchi disease in 25, metastasis in 16, lymphoma in 16, normal in 7, and toxoplasmosis in 1. Sensitivity, specificity, and accuracy of sonographically guided core biopsy were 97.9%, 99.1%, and 97.9%, respectively. There were no procedure-related complications. CONCLUSIONS: Sonographically guided core biopsy is a safe and efficient tool for diagnosing the cause of cervical lymphadenopathy in patients without known malignancy and may obviate unnecessary excisional biopsy.     

C臂CT引导经皮骨肿瘤穿刺活检术

目的 观察C臂CT引导经皮穿刺骨肿瘤活检术的临床价值。方法 回顾性分析283例接受C臂CT引导经皮穿刺活检术的骨肿瘤患者，计算穿刺活检成功率、并发症发生率、手术时间及辐射剂量；以最终病理结果为标准，计算诊断敏感度、特异度及准确率，分析C臂CT引导穿刺活检诊断良恶性骨肿瘤的效能。结果 C臂CT引导经皮骨肿瘤穿刺活检术成功率100%，总手术时间（14.10±5.95）min，辐射剂量（11.21±4.12）mSv。283例中，3例（1.06%）轻微出血，80例（28.27%）术后轻度疼痛。经皮骨肿瘤穿刺活检术诊断骨肿瘤的敏感度为90.82%、特异度为86.97%，其准确率（89.81%）与最终病理结果差异无统计学意义（χ²=2.37，P>0.05）。结论 C臂CT引导经皮骨肿瘤穿刺活检术能实时透视准确定位病变，有效进行术前规划和降低辐射剂量，值得临床推广。     

Sonographically guided core biopsy in the assessment of thyroid nodules

PURPOSE: This study was conducted to assess the value of sonographically guided core biopsy in the evaluation of thyroid nodules by comparison with fine-needle aspiration cytology (FNAC) performed with and without sonographic guidance. METHODS: We performed a retrospective analysis of a consecutive series of 645 thyroid samples obtained at a single center. Samples came from 422 patients who underwent FNAC (with or without sonographic guidance), sonographically guided core biopsy, or excision of thyroid tissue with or without prior frozen sectioning. Final diagnoses were obtained from surgery or clinical follow-up. Initial and final diagnoses were compared. RESULTS: Adequate samples for assessment were obtained in 87% of core biopsies, compared with 60% of cytology aspirates (p <0.001). Sonographically guided core biopsy and sonographically guided FNAC both had zero false-negative rates for the diagnosis of malignancy, compared with a 7.0% false-negative rate (95% confidence interval, 2.0-12.0%) for aspiration cytology when sonography was not used. With core biopsy, 11% of patients required surgical confirmation of the diagnosis, compared with 43% of patients following FNAC (p <0.001). There were no major complications following core biopsy. CONCLUSIONS: Sonographically guided core biopsy provides an accurate and safe alternative to FNAC in the assessment of thyroid nodules.     

Sonographically guided percutaneous muscle biopsy in diagnosis of neuromuscular disease: a useful alternative to open surgical biopsy.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of sonographically guided percutaneous muscle biopsy in the investigation of neuromuscular disorders. METHODS: Sonographically guided percutaneous needle biopsy of skeletal muscle was performed with a 14-gauge core biopsy system in 40 patients over a 24-month period. Patients were referred from the Department of Neurology under investigation for neuromuscular disorders. Sonography was used to find suitable tissue and to avoid major vascular structures. A local anesthetic was applied below skin only. A 3- to 4-mm incision was made. Three 14-gauge samples were obtained from each patient. All samples were placed on saline-dampened gauze and sent for neuropathologic analysis. As a control, we retrospectively assessed results of the 40 most recent muscle samples acquired via open surgical biopsy. RESULTS: With the use of sonography, 32 (80%) of 40 patients had a histologic diagnosis made via percutaneous needle biopsy. This included 26 (93%) of 28 patients with acute muscular disease and 6 (50%) of 12 patients with chronic disease. In the surgical group (all acute disease), 38 (95%) of 40 patients had diagnostic tissue attained. CONCLUSIONS: Sonographically guided percutaneous 14-gauge core skeletal muscle biopsy is a useful procedure, facilitating diagnosis in acute muscular disease. It provides results comparable with those of open surgical biopsy in acute muscular disease. It may also be used in chronic muscular disease but repeated or open biopsy may be needed.     

Sonographic appearances of mucosa-associated lymphoid tissue lymphoma of the submandibular gland confirmed with sonographically guided core needle biopsy

A 71-year-old man presented with mucosa-associated lymphoid tissue (MALT) lymphoma of the submandibular gland 52 months after initial diagnosis of MALT lymphoma of the lung. Ultrasonography showed a well-demarcated, markedly hypoechoic, heterogeneous solid mass with linear echogenic strands and hypervascularity. Ultrasound-guided core-needle biopsy demonstrated histological findings of MALT lymphoma. Sonographic features of MALT lymphoma of the submandibular gland are characteristic and ultrasound-guided core-needle biopsy may be a suitable replacement for surgical biopsy.     

Ultrasonographically guided needle biopsy of benign and malignant soft tissue and bone tumors.

In 65 patients an ultrasonographically guided needle biopsy was performed for histologic diagnosis of benign and malignant soft tissue and bone tumors. On the basis of the histopathologic findings, a final diagnosis could be made in 54 cases after sonographically guided needle biopsy of the soft tissue tumor component. In addition, tumor grouping was possible in seven cases; however, due to the small volume of the biopsy specimen, further tumor differentiation proved to be unsuccessful. A definite diagnosis was not possible in four patients, who had mainly cystoid tumors; however, malignancy could be ruled out in three of these cases. The decisive advantage of the ultrasonographically guided needle biopsy procedure over what is known as a blind tumor biopsy is that the biopsy needle can be positioned exactly by means of imaging control. The ultrasound screen enables the user to monitor the biopsy procedure; multiple biopsies of different parts of the tumor soft tissue component can be performed using a single needle tract. No complications occurred in our study. Because of the far-reaching consequences of ultrasonographically guided needle biopsy, this type of procedure should be performed only at tumor centers.     

The role of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors

Soft-tissue tumors are not very common, but their diagnosis can be very difficult. In the final analysis, their diagnosis requires a biopsy, which must furnish a sufficient amount of material to allow a reliable histological diagnosis. The authors evaluated the diagnostic efficacy of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors of the musculoskeletal system. The aim of the study was to optimize the biopsy procedure, with particular emphasis on the choice of the biopsy needle (large-gauge manual versus semiautomatic) based on the characteristics of the neoplastic mass (consistency, depth, size, location). The results of the study showed that appropriate needle selection significantly reduced the frequency of biopsies that were insufficient for histological diagnosis. The method proved to be highly reliable for diagnosis of soft-tissue tumors but strongly related to the proper selection of the needle to be used.     

X线导向经皮骨穿刺活检价值

目的:探讨X线导向经皮骨穿刺活检对骨病的诊断价值。材料和方法:骨穿刺活检79例,通过观察X线片及确定活检的最佳部位。在X线导向下进行多点和不同深度的骨穿刺活检取材。结果:79例行骨穿活检82次。因3例穿刺2次。76例穿刺活检结果能作出诊断,阳性率为96.2%。没有发生并发症。结论:本法的优点是适应证广、简单、安全、快速、可靠、经济,并发症少及缩短诊断时间。医生在穿刺活检过程中不受X线辐射,而病人只有短暂的透视定位。     

CT引导下的同轴全自动及半自动活检针在经皮肺穿刺活检中的应用效果

目的比较CT引导下的同轴全自动及半自动活检针在经皮肺穿刺活检中的应用效果。方法将行经皮肺穿刺活检的400例患者根据活检方式分为对照组与观察组,各200例。对照组采用半自动活检针,观察组采用同轴全自动活检针。比较两组的应用效果。结果观察组的调针次数、一次穿刺成功率、穿刺时间及平均标本量均优于对照组(P<0.05)。观察组的准确度、灵敏度、针道出血率均高于对照组,各并发症缓解时间均短于对照组(P<0.05)。结论CT引导下同轴全自动活检针在经皮肺穿刺活检中的操作性更强,整体诊断效能及安全性较好。     

Value of ultrasonically guided needle biopsy of pleural masses: An under-utilized technique

Thirty-six patients with pleural masses underwent ultrasonically guided needle biopsy (UGNB), including ultrasonically guided aspiration biopsy (UGAB) in all 36 patients and ultrasonically guided cutting biopsy (UGCB) in 13 patients. Using UGAB alone, the diagnostic rate for pleural masses was 64% (23/36); carcinomatous pleural masses were more easily diagnosed than non-carcinomatous pleural masses (87% vs 23%, p < 0.01). If both UGAB and UGCB were used, the diagnostic rate was 89% (32/36); thus, selective UGCB was valuable in improving the diagnostic rate of non-carcinomatous pleural masses (from 23% to 69%). In patients with pleural effusions (n = 19), 11 underwent cytologic examinations of the pleural effusion (3 also undergoing pleural biopsy) without conclusive diagnosis; however, the diagnosis was made from pleural masses by UGAB (n = 7) or UGCB (n = 4). In patients without pleural effusions (n = 17), 12 had only pleural masses (3 also having multiple peripheral pulmonary nodules and 4 having mediastinal tumors) and could not be diagnosed by conventional bronchoscopic and sputum examinations. However, the diagnosis was rapidly confirmed by UGAB (n = 5) or UGCB (n = 3) from the pleural masses in 8 patients. We conclude that UGNB is a useful and valuable diagnostic tool, not only detecting the pleural masses hidden by pleural effusions but also for rapidly diagnosing the pleural masses. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25 : 119–125, 1997.     

Sonographic appearances of small organizing hematomas and thrombi mimicking superficial soft tissue tumors

We retrospectively reviewed 2 cases of organizing hematomas and 2 cases of intravascular organizing thrombi and investigated correlations between sonographic and pathologic findings. In all 4 cases, a well-defined hypoechoic heterogeneous mass with surrounding increased echogenicity was evident in the subcutaneous fat layer. Organizing hematomas and thrombi have sonographic features similar to those of benign-looking soft tissue tumors. These lesions should therefore be considered in the differential diagnosis of superficial soft tissue masses.     

如何提高超声内镜引导下细针穿刺活检阳性率

超声内镜自面世以来以广泛应用于胃肠道肿瘤的判读及分期、胆胰系统及其他壁外器官的扫查中,超声内镜引导下细针穿刺活检（EUS FNA）的出现大大拓展了超声内镜的应用范围。如何提高EUS FNA的阳性率一直是内镜医师关注的焦点。本文对EUS FNA的操作过程、穿刺针选择、穿刺方法策略及快速现场病理评估等方面的进展进行综述,探讨提高EUS FNA阳性率的方法。     

超声引导下颈外路径切割组织穿刺活检术在咽旁间隙肿瘤诊断中的应用

目的 探讨超声引导下颈外路径切割组织穿刺活检术在咽旁间隙肿瘤的应用。 方法 回顾性分析43例咽旁间隙肿瘤经超声引导下颈外路径切割组织穿刺活检,判断穿刺结果与术后病理结果符合率。结果 43例患者,42例穿刺病理结果与术后病理结果一致,穿刺诊断符合率为97.7%,所有患者均无并发症。结论 超声引导下咽旁间隙肿瘤颈外路径切割组织穿刺活检,操作简单,用时短,穿刺结果与术后病理符合率高,术后并发症少,对咽旁间隙肿物的术前定性诊断有一定的临床应用价值。     

Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow.

OBJECTIVE: Chronic tendinosis of the common extensor tendon of the lateral elbow can be a difficult problem to treat. We report our experience with sonographically guided percutaneous needle tenotomy to relieve pain and improve function in patients with this condition. METHODS: We performed sonographically guided percutaneous needle tenotomy on 58 consecutive patients who had persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the common extensor tendon, and the tip of the needle was used to repeatedly fenestrate the tendinotic tissue. Calcifications, if present, were mechanically fragmented, and the adjacent bony surface of the apex and face of the epicondyle were abraded. Finally, the fenestrated tendon was infiltrated with a solution containing corticosteroid mixed with bupivacaine. After the procedure, patients were instructed to perform passive stretches and to undergo physical therapy. During a subsequent telephone interview, patients answered questions about their experience, their functioning level, and their perceptions of procedure outcome. RESULTS: Fifty-five (95%) of 58 patients were contacted by telephone and agreed to participate in the study. Thirty-five (63.6%) of 55 respondents reported excellent outcomes, 16.4% good, 7.3% fair, and 12.7% poor. The average follow-up time from the date of the procedure to the date of the interview was 28 months (range, 17-44 months). No adverse events were reported; 85.5% stated that they would refer a friend or close relative for the procedure. CONCLUSIONS: Sonographically guided percutaneous needle tenotomy for lateral elbow tendinosis is a safe, effective, and viable alternative for patients in whom all other nonsurgical treatments failed.