Comparative analysis of CT guided vertebral biopsy by a conventional bone biopsy needle versus bone biopsy needle with acquisition cradle

BackgroundWe aimed to compare the rate of diagnostically successful vertebral biopsies using conventional bone biopsy needles versus those performed with bone biopsy needles with an acquisition cradle.MethodsWe retrospectively analyzed the data of patients who underwent CT-guided vertebral biopsy between December 2017 to December 2019 at our institute. From December 2017 to November 2018, the procedure was performed on 185 patients using an 11G conventional bone biopsy needle, Jamshidi needleTM “(group 1)”. From December 2018 to December 2019, the procedure was performed on 242 patients using an 11G T-handle Jamshidi needle with an acquisition cradle “(group 2)”. We reviewed their histopathological reports for both groups of patients to determine the rate of diagnostically successful biopsies. We also compared the crush artifact amongst the unsuccessful biopsy samples acquired by the two types of biopsy needles.Results427 patients (270 male and 157 female patients; mean age, 46.4 years; age range, 25–67 years) who underwent CT-guided vertebral biopsy from December 2017 to December 2019 were included in our study. In group 1, diagnostic success was achieved in 136 out of 185 biopsies (73.5%); whereas in group 2, diagnostic success was achieved in 219 out of 242 biopsies (90.50%), p < 0.0001. Out of the diagnostically unsuccessful biopsies in Group 1, 36 out of 49 (73.5%) were due to crush artifact; whereas crush artifact accounted for only 3 out of 23 (13.0%) diagnostically unsuccessful biopsies in group 2, p < 0.0001. Other causes of unsuccessful biopsies (hemorrhagic contents or presence of normal osseous tissue and fibrin only) were statistically insignificant.ConclusionThe use of a T-handle Jamshidi needle with an acquisition cradle appears beneficial compared to the conventional Jamshidi needle in terms of the significantly higher rate of diagnostic success and a lower rate of crush artifact.     

Diagnosis of renal lymphoma by percutaneous image guided biopsy: experience with 11 cases

PURPOSE: We reviewed an institutional experience with image guided percutaneous biopsy of focal renal masses that yielded a diagnosis of lymphoma. MATERIALS AND METHODS: We retrospectively reviewed the hospital records of patients undergoing percutaneous renal biopsy between September 1997 and February 2005. RESULTS: A total of 407 image guided focal renal lesion biopsies were identified. A diagnosis of lymphoma was made in 11 patients (3%). Biopsies were performed under computerized tomography guidance in 9 cases (82%) and under ultrasound guidance in 2 (18%). Core biopsies were performed in 11 cases, while fine needle aspiration was done in 10 (91%). Fine needle aspirations underwent cytological analysis in 10 cases and flow cytometry analysis in 9. The final combined pathological diagnoses were B-cell lymphoma in 10 cases and lymphomatoid granulomatosis in 1. Analysis of core biopsies yielded a diagnosis of B-cell lymphoma in 10 cases (91%) and lymphomatoid granulomatosis in 1. Analysis of fine needle aspirations yielded a diagnosis of B-cell lymphoma in 3 cases (30%), lymphoma in 4 (40%), suspicion of lymphoma in 1 (10%), atypical cells in 1 (10%) and a nondiagnostic sample in 1 (10%). Flow cytometry concurred with cytology in the diagnosis of B-cell lymphoma in 2 cases, allowed the identification of lymphoma subtype, which was not made on cytology, in 4, was insufficient in 2 and identified no abnormality in 1. No patients underwent surgery or an ablative procedure. CONCLUSIONS: Core biopsy has a higher diagnostic yield than fine needle aspiration for diagnosing renal lymphoma. Flow cytometry analysis adds additional diagnostic information to cytological examination of fine needle aspiration samples. Accurate diagnosis of lymphoma in these cases allowed proper treatment without unnecessary surgery or other procedures.     

经直肠与经会阴途径穿刺活检诊断前列腺癌的对比分析

目的比较经直肠途径与经会阴途径穿刺活检对前列腺癌(PCa)的检出率。方法回顾性收集128例首次确诊的PCa患者,根据活检途径不同,分为经直肠途径组62例和经会阴途径组66例,比较2种途径诊断不同总前列腺特异性抗原(TPSA)水平PCa及临床意义前列腺癌(CsPCa)检出率的差异。对其中104例(经直肠途径组42例,经会阴途径组62例)在常规超声检查基础上行CEUS,于83例(经直肠途径组28例,经会阴途径组55例)检出阳性病灶后行靶向穿刺,比较2组系统穿刺及靶向穿刺PCa、CsPCa的检出率。结果经直肠途径组PCa检出率为35.48%(22/62),CsPCa检出率为25.81%(16/62);经会阴途径组PCa检出率为42.42%(28/66),CsPCa检出率为28.79%(19/66),差异均无统计学意义(P=0.471、0.676);2组对不同TPSA水平PCa及CsPCa的检出率差异均无统计学意义(P均0.05)。经直肠途径组与经会阴途径组在系统穿刺中PCa检出率[35.48%(22/62) vs 40.91%(27/66);P=0.587]、阳性针数/总针数[14.25%(106/744) vs 14.52%(115/792);P=0.879]、CsPCa检出率[25.81%(16/62) vs 28.79%(19/66);P=0.676]差异均无统计学意义;靶向穿刺活检PCa检出率[35.71%(10/28) vs 14.55%(8/55);P=0.002]、阳性针数/总针数[30.77%(24/78) vs 6.76%(10/148);P0.001]差异有统计学意义。结论超声引导下前列腺穿刺活检经直肠途径与经会阴途径对PCa及CsPCa检出率无差异。CEUS可引导前列腺靶向穿刺活检,穿刺操作时选择与CEUS相同的患者体位及解剖断面可提高PCa检出率。     

Epidemiology of renal disease in Romania: a 10 year review of two regional renal biopsy databases.

BACKGROUND: Epidemiological data of renal disease are available from large national renal biopsy registries from Central and Western European countries; in contrast, detailed epidemiological data from Eastern European countries are missing. This report is the first review of histological data, over a period of 10 years (1995-2004), covering a population of over 6 million inhabitants and two distinct regions from an East European country - Romania. METHODS: 635 eco-guided kidney biopsies from the Moldova (North-Eastern Romania, 8 counties, 4 754 048 inhabitants) and Banat (Western Romania, 3 counties, 1 454 747 inhabitants) regions were analysed. Data on serum creatinine concentration (sCr), 24 h proteinuria, haematuria, clinical diagnosis, histological diagnosis and complications after renal biopsy were collected. RESULTS: The number of biopsies performed varied between 10.9 p.m.p./year in 1995 and 11.3 p.m.p./year in 2004. The most common clinical syndromes - as indication for performing the renal biopsy - were: nephrotic syndrome (52.3%), followed by nephritic syndrome (21.9%), acute renal failure (ARF) (12.4%), chronic kidney disease (CKD) (10.2%) and asymptomatic urinary abnormalities (AUA) (3.3% of the cases). The major histological groups identified were: primary glomerulonephritis (GN) (66.2%), secondary GN (26.4%), vascular nephropathies (2.3%), and tubulointerstitial nephropathies (TIN) (1.5%) of the cases. Among primary GN's, the most frequent diagnoses were: membranoproliferative GN (MPGN) (29.4%, incidence in 2004 - 9.3 p.m.p./year), mesangioproliferative GN (MesGN) (28.9%, incidence - 10 p.m.p./year), membranous GN (MGN) (11.2%, incidence - 5.3 p.m.p./year), minimal change disease (MCD) (8.5%, incidence - 7.3 p.m.p./year), focal and segmental glomerulosclerosis (FSGS) (11.5%, incidence - 3.3 p.m.p./year) and crescentic GN (CGN) (7.9%, incidence - 3.3 p.m.p./year). The prevalence of membranoproliferative GN significantly decreased from 1995 to 2004. The prevalence of different types of secondary GN was similar to Western and Central European countries, with the particular difference of higher infectious diseases associated GN. CONCLUSION: The present data are an important contribution to the epidemiology of renal diseases in Europe, highlighting not only numerous similarities but also significant epidemiological differences in Western and Central European countries, particularly a higher, albeit declining, incidence and prevalence of membranoproliferative GN. This report represents the basis for the future of Romanian Registry of Renal Biopsies and is intended to serve as a source of information for nephrologists concerned with East European renal pathology.     

Comparison of ultrasound‐guided core biopsy versus fine‐needle aspiration biopsy in the evaluation of salivary gland lesions

Ultrasound‐guided core biopsy provides many benefits compared with fine‐needle aspiration cytology and has begun to emerge as part of the diagnostic work‐up for a salivary gland lesion. Although the increased potential for tumor‐seeding and capsule rupture has been extensively discussed, the safety of this procedure is widely accepted based on infrequent reports of tumor‐seeding. In fact, a review of the literature shows only 2 cases of salivary tumor seeding following biopsy with larger‐gauge needle characteristics, with 2 reported cases of salivary tumor seeding following fine‐needle aspiration cytology. However, the follow‐up interval of such studies (<7 years) is substantially less than the 20‐year follow‐up typically necessary to detect remote recurrence. Studies on tumor recurrence of pleomorphic adenoma, the most common salivary gland lesion, suggest that as many as 16% of tumor recurrences occur at least 10 years following initial surgery, with average time to recurrence ranging anywhere from 6.1 to 11.8 years postoperatively. Despite the benefits of ultrasound‐guided core biopsy over fine‐needle aspiration biopsy, which include both improved consistency and diagnostic accuracy, current studies lack adequate patient numbers and follow‐up duration to confirm comparable safety profile to currently accepted fine‐needle aspiration cytology. In this report we: (1) compare the relative benefits of each procedure, (2) review evidence regarding tumor seeding in each procedure, (3) discuss time course and patient numbers necessary to detect tumor recurrence, and (4) describe how these uncertainties should be factored into clinical considerations. © 2012 Wiley Periodicals, Inc. Head Neck, 35 : 1657–1661, 2013     

CT引导一次性半自动活检针经皮肺结节穿刺活检46例分析

目的探讨CT引导一次性半自动活检针经皮肺穿刺活检对诊断肺部结节价值。方法收集46例常规病检有困难的肺结节病例，应用一次性半自动活检针，在CT引导下做经皮穿刺活检，分析其诊断的准确性，安全性。结果46例病人，获得明确病理诊断40例(87％)，包括恶性肿瘤24例，结核10例，炎性病变4例，其它良性病变2例。有症状并发症发生率13％(6／46)，包括1例严重气胸和5例少量咯血。结论CT引导一次性半自动活检针经皮肺穿刺活检因取材确切、定位准确，对肺部结节的病理诊断具有重要的实用价值。     

The role of renal biopsy in women with kidney disease identified in pregnancy.

BACKGROUND: Renal disease may present for the first time in pregnancy, either as symptomatic disease or as a consequence of antenatal screening. The role of antenatal and post-partum percutaneous renal biopsy in the management of such patients is discussed. METHODS: We describe two series of women; the first is a series of 20 women presenting with renal disease of a severity to warrant renal biopsy during pregnancy whilst the second, comprises 75 women who had an initial presentation of renal disease in pregnancy and underwent post-partum renal biopsy. RESULTS: Biopsy during pregnancy revealed a glomerular disorder in 19/20 (95%) with immediate change of management in 9/20 (40%). In 17/20 (85%) there was delivery of a live infant at median gestation of 36 weeks (range 25-40). Follow-up of women [median 103.3 months (2.5-256)] showed 9/20 (45%) had a GFR of <60 ml/min/1.73 m(2) [six at end-stage renal failure (ESRF)] and 3/20 were dead. The majority (62/75; 82.6%) of women undergoing post-partum renal biopsy presented with significant proteinuria (40% pre-eclampsia) during pregnancy not resolving post-partum. A glomerular abnormality was found in 64%. At last follow-up of 47 women [median 51.5 months (range 1-212)], 14 patients (29.7%) had significant proteinuria and 20 (42.6%) had a GFR<60 ml/min/1.73 m(2). Six women (12.7%) had ESRF. CONCLUSIONS: Diagnosis and follow-up of renal disease diagnosed in pregnancy is important as progressive disease occurs in this group. Routine antenatal screening provides a useful diagnostic opportunity to detect asymptomatic renal disease. In a selected sub-group, renal biopsy during pregnancy can be helpful in initiation of correct treatment and allowing progression of pregnancy to fetal viability.     

Decision analysis model comparing cost of multiparametric magnetic resonance imaging vs. repeat biopsy for detection of prostate cancer in men with prior negative findings on biopsy

PurposeWe compared cost of multiparametric magnetic resonance imaging (MP-MRI) vs. repeat biopsy in detection of prostate cancer (PCa) in men with prior negative findings on biopsy.MethodsA decision tree model compared the strategy of office-based transrectal ultrasound–guided biopsy (TRUS) for men with prior negative findings on biopsy with a strategy of initial MP-MRI with TRUS performed only in cases of abnormal results on imaging. Study end points were cost, number of biopsies, and cancers detected. Cost was based on Medicare reimbursement. Cost of sepsis and minor complications were incorporated into analysis. Sensitivity analyses were performed by varying model assumptions.ResultsThe baseline model with 24% PCa found that the overall cost for 100 men was $90,400 and $87,700 for TRUS and MP-MRI arms, respectively. The MP-MRI arm resulted in 73 fewer biopsies per 100 men but detected 4 fewer cancers (16 vs. 20.4) than the TRUS arm did. A lower risk of PCa resulted in lower costs for the MP-MRI arm and a small difference in detected cancers. At lower cancer rates, MP-MRI is superior to TRUS over a wide range of sensitivity and specificity of MRI. A lower sensitivity of MP-MRI decreases the cost of the MP-MRI, as fewer biopsies are performed, but this also reduces the number of cancers detected.ConclusionsThe use of MP-MRI to select patients for repeat biopsy reduced the number of biopsies needed by 73% but resulted in a few cancers being missed at lower cost when compared with the TRUS arm. Further studies are required to determine whether cancers missed represent clinically significant tumors.     

An Unusual Cause of Renomegaly and Renal Insufficiency: A Case Report of Renal Involvement in Common Variable Immunodeficiency disease

Common variable immunodeficiency disease (CVID) represents a heterogeneous group of primary hypogammaglobulinemias of unknown etiology, characterized by decreased serum immunoglobulin levels and recurrent bacterial infections and is often accompanied by autoimmune disease. Renal involvement is rare in CVID, despite widespread involvement of other organ systems. We describe a 21-year-old girl who presented with recurrent infections, hepatosplenomegaly, renomegaly, and renal insufficiency. Renal biopsy revealed a remarkable diffused interstitial infiltration and severe degenerative tubular lesions. Interstitial infiltration consisted mainly of CD8⁺ T cells and CD68⁺ macrophages with less CD4⁺ T and rare B cells. For the cases with recurrent infections, multiple organomegaly, and renal insufficiency, clinicians should consider to exclude CVID, so as to make the timely diagnosis and appropriate management.     

An analysis of fine needle aspiration versus core needle biopsy in clinically palpable breast lesions: a report on the predictive values and a cost comparison

BackgroundAlthough fine-needle aspiration (FNA) is an established tool in the biopsy of breast masses, there has been a trend toward using core-needle biopsy (CNB). The aim of this study was to determine whether FNA has comparable predictive value with CNB and whether FNA is more cost effective.MethodsA retrospective review was conducted on 162 patients who underwent either FNA or CNB of palpable breast lesions and had histologic confirmation with surgical biopsy in calendar year 2005.ResultsThere were no false-positives or false-negatives in either group. The sensitivity, specificity, and positive predictive value for FNA were 89%, 98%, and 94%, respectively. CNB had sensitivity, specificity, and positive predictive value of 100%, 90%, and 93%, respectively. The cost to perform FNA was $166.34, compared with $477.92 for CNB.ConclusionsFNA and CNB had comparable predictive value, with FNA being more cost effective.     

CMV infection of the renal allograft is much more common than the pathology indicates: a retrospective analysis of qualitative and quantitative buffy coat CMV-PCR, renal biopsy pathology and tissue CMV-PCR.

BACKGROUND: Quantitative blood polymerase chain reaction (PCR) for cytomegalovirus (CMV) is used to direct therapy in kidney transplant patients, but cytomegalic inclusions are rarely found in allograft renal biopsies even with an elevated serum creatinine and apparent CMV disease. The relationship between quantitative blood CMV and renal allograft pathology is unknown. METHODS: Thirteen biopsy samples were available for analysis from patients suspected of CMV disease, who had a buffy coat CMV-PCR drawn within 2-5 days of a renal allograft biopsy for an elevated creatinine. All were evaluated for CMV pathologically, by light microscopy, immunohistochemistry, in situ hybridization and tissue PCR. RESULTS: Qualitative and quantitative buffy coat CMV-PCR were positive in 10/13 (77%) patients. Tissue CMV-PCR was positive in five (50%) biopsies, including two with CMV inclusions and three with no inclusions. Quantitative buffy coat CMV-PCR levels did not correlate with detection of CMV inclusions in renal tissue. Paradoxically, quantitative buffy coat CMV-PCR was low (239 and 538 copies/microg of DNA) when CMV inclusions were detected. All five biopsies with acute rejection were associated with CMV viraemia and two of the five with allograft CMV inclusions. A quantitative buffy coat CMV-PCR of <100 copies/microg of DNA ruled out disease with CMV inclusions. CONCLUSIONS: CMV nephropathy is much more common than previously reported when sensitive techniques are used for detection in tissue. Acute rejection and CMV viraemia occur commonly together in patients at risk for CMV. Quantitative buffy coat CMV-PCR does not correlate with the presence of CMV inclusions. These findings have implications for management of patients who have elevated serum creatinine and are at risk for CMV disease.     

A comparative analysis of core needle biopsy and final excision for breast cancer: histology and marker expression

Background

Core needle biopsy (CNB) is used increasingly not only to diagnose breast cancer, but to determine tumor histology, grade and marker expression, select neoadjuvant therapy, and predict sentinel lymph node status. Thus, we undertook this study to evaluate the accuracy of CNB as a predictor of breast cancer histology and marker expression.

Methods

We identified 209 Breast Cancer Registry cases with a preoperative CNB and reviewed all clinicopathologic data for accuracy. Statistical analysis was performed with statistical software.

Results

CNB unequivocally showed cancer in 93%. Exact tumor histology concordance was 86%. Ductal carcinoma in situ on CNB was upgraded to invasive cancer in 23%. Concordance was substantial for estrogen receptor expression (88%, κ = .71), but kappa values were less than .6 for tumor grade, mitotic rate, progesterone receptor (PR), Ki-67, HER-2/neu, and p53 expression.

Conclusions

Reliance on CNB grade and marker expression for critical decision making may be inadvisable. Further study is warranted to optimize breast cancer patient care.     

9+X法直肠超声引导下经会阴前列腺穿刺活检420例分析

目的:探讨9+X法经直肠超声引导下经会阴前列腺穿刺活检术诊断前列腺癌的临床价值及安全性。方法:回顾性分析2004年1月至2008年12月行9+X法经直肠超声引导下经会阴前列腺穿刺活检术的可疑前列腺癌患者420例临床资料。结果:穿刺确诊前列腺癌160例(阳性率38.1%)。PSA<4μg/L、4～10μg/L、>10μg/L、直肠指检(DRE)异常、经直肠或经腹部超声检查有异常者阳性率分别为7.4%、17.8%、65.4%、25.0%、22.2%。穿刺术后79例出现血尿(18.8%),急性尿潴留13例(3.1%),发热9例(2.1%),无其他严重并发症。结论:9+X法经直肠超声引导下经会阴前列腺穿刺阳性率高,并发症少,是诊断前列腺癌的理想方法。