合并病理性骨折的上肢骨肿瘤穿刺活检结果分析

目的:分析合并病理性骨折的上肢骨肿瘤穿刺活检结果,对可能的影响因素进行分析.方法:分析2015年1月至2019年12月收治的合并病理性骨折的上肢骨肿瘤患者,入选标准为患者行穿刺活检并接受了最终手术治疗,获得了穿刺活检及术后2次病理检查.符合入选标准的共77例,男55例,女22例;年龄5～88岁,中位年龄27岁;肿瘤位于...     

骨肿瘤病理活检有效性的影响因素分析

[目的]评价骨骼系统病变病理活检的有效性；明确影响活检准确率的独立危险因素，并分析该因素对穿刺活检后导致切开活检几率的影响。[方法]回顾性分析2003年6月-2006年10月间共206例骨破坏病例，所有病例均进行芯针穿刺或切开活检。比较活检病理结果与术后病理结果是否一致，将病理活检结果分为正确、无诊断和错误3种。将结果正确的活检定义为有效活检；将结果错误和无诊断的活检定义为无效活检。分析下列因素对活检有效性的影响：活检方式、病变位置、黏液成分、病变种类，明确病理活检有效性的独立危险因素；同时分析其对阴性穿刺结果导致切开活检发生率的影响。[结果]206例患者中，147例（71．4％）患者行芯针穿刺活检，47例（22．8％）行切开活检，12例（5．8％）患者进行芯针穿刺后，再次进行切开活检。176例（85．4％）活检结果正确，19例（9．2％）无诊断，11例（5．3％）活检结果错误。Logistic多因素回归分析提示病变含有黏液成分是影响活检正确率的独立危险因素（P=0．02）。[结论]大部分骨骼系统病变通过芯针穿刺活检或切开活检可以明确诊断。病变内有黏液成分会降低活检诊断的正确率；没有单一因素增加切开活检几率。骨骼系统病变的正确诊断仍需依靠临床、病理及影像三结合的模式。     

骨肿瘤122例经皮芯针活检病理诊断率分析

目的：探讨经皮芯针活检诊断骨肿瘤诊断价值及安全性。方法：回顾性分析2007年3月至2011年2月间共122例骨肿瘤病例,所有病例均进行经皮芯针穿刺活检,6例患者在芯针活检病理诊断不明确或可疑的情况下进行切开活检,根据病灶的组成成分（硬化性、实质非硬化性、囊性）以及良性、恶性等分类计算诊断阳性率及准确率,砰检验分析评估其诊断效果。结果：所有病灶总的诊断阳性率89％（109／122）、准确率82％（100／122）。硬化性（100％）与实质性病灶（85％）准确率之间无显著差别（P=0．165）,囊性病灶准确率最低（58％）（P=0．016）,三者诊断阳性率无差别（P=0．572）。恶性病灶（89％）与良性病灶（82％）准确率之间无显著差别（P=-0．299）,恶性（100％）与良性（90％）诊断阳性率差别显著（P=0．025）。经皮芯针穿刺活检鉴别良恶性肿瘤的准确率为97％（118／122）,经皮芯针活检的并发症发生率为0．82％。结论：经皮芯针穿刺活检是诊断骨与软组织肿瘤的一种安全、准确、快捷、可靠的重要检查方法,并发症少,骨骼系统病变的正确诊断仍需依靠临床、病理及影像三结合的模式。     

Stereotactic core needle biopsy of mammographic breast lesions as a viable alternative to surgical biopsy

Background: Stereotactic needle biopsy technique has received considerable attention as a possible alternative to surgical biopsy of nonpalpable breast lesions. The exact role of this procedure in the management of mammographic breast lesions has not yet been accurately defined. Methods: Data have been collected prospectively on 416 patients over an 8-month period (January 1992 through August 1992). Of 416, 356 patients underwent only stereotactic breast biopsy with a 14-gauge needle. Sixty patients underwent stereotactic breast biopsy followed by surgical biopsy. Based on mammographic findings before biopsy, lesions were classified as benign (24%), likely benign (49%), malignant (2%), likely malignant (6%), and indeterminate (19%). The number of core biopsy specimens obtained from each patient ranged from one to six. Results: The specimen was considered adequate in 98% of cases. Complications were minimal. The tissue diagnosis was benign in 92% and malignant in 8% of patients. In those patients undergoing surgical and stereotactic biopsy, 57 of 60 had matching histopathological results, representing an agreement rate of 95% (p<0.001). The three patients whose histopathological results did not match had malignant diagnoses on stereotactic biopsy that were subsequently not identified in the modified radical mastectomy specimen because the entire focus of malignancy was removed by the several passes made by the core needle during biopsy. No patient had a negative stereotactic biopsy result in whom malignancy was later detected by surgical biopsy. Conclusions: This study indicates excellent agreement between surgical and stereotactic needle biopsy findings. Stereotactic biopsy with a 14-gauge needle could obviate the need for surgical biopsy in certain women with radiologically benign, likely benign, and indeterminate lesions. The results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

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     

A case report of pseudoaneurysm after a core needle biopsy of breast cancer

Breast pseudoaneurysms after a core needle biopsy are a rare complication with a low incidence. However, it is important to be aware of the possibility of complications that require treatment.     

骨肿瘤经皮套管针穿刺活检

[目的]报告171例穿刺活检的结果并探讨相关影响因素。[方法]采用套管活检针对骨肿瘤进行术前穿刺活检，回顾分析171例骨肿瘤患者的穿刺活检的结果。[结果]171例，穿刺活检阳性155例，穿刺活检阳性率90．64％，行手术治疗获得大体标本病理诊断者122例，活检准确诊断者98例，准确率80．33％，误诊5例。恶性肿瘤总例数110例，穿刺活检敏感性95．41％，特异性100％。[结论]穿刺活检对骨肿瘤术前诊断有较大价值，实施者对骨肿瘤的认识水平，操作的细致程度，对活检阳性率、准确率及并发症的发生有重要影响。     

Clinical and radiologic data and core needle biopsy findings should dictate management of cellular fibroepithelial tumors of the breast

Fibroepithelial lesions with cellular stroma identified on core needle biopsy (CNB) may prove to be either fibroadenoma or phyllodes tumor at excision; therefore, management of these rare lesions is highly controversial. We aim to assess the management and the outcome of 101 cellular fibroepithelial lesions diagnosed on CNB over a 6-year period in one institution. Consensus on clinical management in each individual patient was reached during multi-disciplinary conferences, based on careful correlation of clinical data with results of imaging studies and pathology of CNB samples. Radiologic findings (mammogram and sonogram) and multiple histologic parameters on CNB specimen were blindly re-evaluated by one experienced breast radiologist and two breast pathologists, respectively, and results were correlated with final diagnosis at excision. Cellular fibroepithelial lesions with indeterminate or suspect imaging findings, with larger size, and with an equivocal comment such as "cannot rule out phyllodes tumor" in the pathology report were excised more frequently (p = 0.05, p = 0.034, and p = 0.01, respectively). Of 43 excised lesions, 13 were classified as benign phyllodes tumors, 23 as fibroadenoma and seven as benign cellular fibroepithelial lesion. The final diagnosis at excision did not significantly correlate with any clinical data, or with retrospective evaluation of imaging findings or comprehensive evaluation of multiple histologic parameters. In 58 patients who had clinical and radiologic follow-up (mean ± SD: 30 ± 21 months) there was no evidence of disease progression. No clinical and radiologic findings and/or comprehensive evaluation of multiple histologic parameters on CNB specimen are distinctive enough to predict final classification of equivocal cellular fibroepithelial lesions. However, careful clinico-pathologic and radiologic correlation may help to select the most clinically significant lesions for proper immediate surgical management. Follow-up alone may be an appropriate alternative for a subset of patients, given a good clinical, pathologic, and radiologic correlation.     

Application of confocal laser scanning microscopy to the observation of bone biopsy specimens

Iliac bone biopsy specimens from five patients with endstage renal disease were observed by confocal laser scanning microscopy. Images of affected bone specimens were accurately focused, whereas images viewed with conventional light microscopy from thick ground sections were obscure. Especially at high magnifications, fine structures of bone cells, otherwise blurred, were clearly observed with confocal scanning microscopy. From thin-cut sections, images satisfactory for pathological diagnosis were viewed with light microscopy even at high magnification. However, the sections tended to shrink vertically compared with the cross-sectional images of the blocks observed directly by confocal laser scanning microscopy. A three-dimensional image of bone tissue was also constructed from serial optical sections. Confocal laser scanning microscopy is a useful technique for observing bone tissues, and may become essential for the evaluation of bone biopsy specimens.     

Risk of needle-track seeding after diagnostic image-guided core needle biopsy in breast cancer.

OBJECTIVE: Image-guided core needle biopsy (IGCNB) is an accepted technique for sampling nonpalpable mammographically detected suspicious breast lesions. However, the concern for needle-track seeding in malignant lesions remains. An alternative to IGCNB is needle-localization breast biopsy (NLBB). No study has been done to compare the local recurrence rate of breast cancer after IGCNB versus NLBB. METHODS: We have retrospectively reviewed the local recurrence of breast cancer in patients diagnosed by either IGCNB or NLBB who underwent breast-preserving treatment for their cancer between May 1990 and June 1995. The length of follow-up averaged 29.7 months. RESULTS: Three hundred ninety-eight patients were diagnosed with breast cancer by IGCNB (297 patients) or NLBB (101 patients). All patients underwent breast-conserving surgery. Fifteen (3.77%) patients had a local recurrence: 11(3.70%) in the IGCNB group and 4 (3.96%) in the NLBB group. These recurrence rates are not statistically different. CONCLUSION: Concerns for seeding of the needle track with cancer cells have made some surgeons wary of IGCNB. However, we did not find an increased rate of recurrence due to needle-track seeding, and IGCNB remains our procedure of choice for diagnosing mammographically detected suspicious breast lesions.     

Predictors of residual invasive disease after core needle biopsy diagnosis of ductal carcinoma in situ

Core needle biopsy (CNB) is used to sample both mammographically and ultrasound detected breast lesions. A diagnosis of ductal carcinoma in situ (DCIS) by CNB does not ensure the absence of invasive cancer upon surgical excision and as a result an upstaged patient may need to undergo additional surgery for axillary nodal evaluation. This study evaluates the accuracy of CNB in excluding invasive disease and the preoperative features that predict upstaging of DCIS to invasive breast cancer. Two hundred fifty-four patients over an 8-year period from 1994 to 2002 with a diagnosis of DCIS alone by CNB were retrospectively reviewed. Underestimation of invasive cancer by CNB was determined. Radiographic, pathologic, and surgical features of the cohort were compared using univariate and multivariate analysis. The mean age was 55 years (range 27-84) and mean follow-up was 25 months with one patient unavailable for follow-up. There were a total of six patient deaths, all of which were not disease-specific. A total of 21 out of 254 patients (8%) with DCIS by CNB were upstaged to invasive cancer following surgical excision. There was a significant inverse relationship between the number of core biopsies and the incidence of upstaging (p < 0.006) in that patients with fewer core samples were more likely to be upstaged at surgical pathology. No relationship was noted between the size of the core samples and the likelihood of upstaging (p > 0.4). Of 21 patients with invasion, all but two had comedonecrosis by CNB. Comedonecrosis by CNB significantly increased the likelihood of upstaging (p < 0.001). Of the 21 patients who were upstaged, 12 required subsequent surgery for nodal evaluation while nine had sentinel node biopsy at initial operation. Finally, upstaged patients were significantly more likely to have a positive margin (p < 0.008). Ductal carcinoma in situ with comedonecrosis on CNB can help to predict the possibility of invasion. Increasing the number of core biopsies reduced the likelihood of sampling error.     

Use of ultrasound-guided percutaneous needle biopsy in the diagnosis of mediastinal tumors

We herein report the usefulness of ultrasoundguided percutaneous needle biopsy for histological diagnosis in 18 patients with mediastinal tumors. Computed tomography revealed these tumors to be in contact with the chest wall. The preoperative diagnosis was thymoma in 7 patients, germinoma in 5, neurogenic tumor in 3, and other in 3. The most commonly encountered indication for an ultrasound-guided percutaneous needle biopsy was an anterior mediastinal lesion (78%; 14 of 18 patients). In 16 (89%) of the 18 patients, the biopsy diagnosis corresponded to the post-operative diagnosis. No complications were encountered in any of the patients. This new technique of ultrasound-guided percutaneous needle biopsy is both relatively simple and highly accurate and may thus be useful for outpatients. Preoperative ultrasound-guided percutaneous needle biopsy is thus considered to be a safe and reliable method for the histological diagnosis of mediastinal tumors, and a good alternative to traditional biopsy techniques such as mediastinoscopy or thoracotomy.Presented at the 11th Biennial Asian Congress on Thoracic and Cardiovascular Surgery, Kuala Lumpur, Malaysia, November, 21–25, 1993.     

Atypical ductal hyperplasia on core needle biopsy: Surgical outcomes of 200 consecutive cases from a high-volume breast program

Atypical ductal hyperplasia (ADH) is an indication for excisional biopsy to rule out occult breast cancer. We analyzed pathological findings on excisional biopsy for ADH diagnosed in a high volume breast center equipped with digital tomosynthesis. Two hundred consecutive patients were diagnosed with ADH on core biopsy with radiographic concordance followed by excisional biopsy. On excisional biopsy, 33 patients (16.5%) were diagnosed with DCIS or invasive breast cancer. Patients with a concurrent diagnosis of papilloma had a higher risk of upstaging on both univariate and multivariate analysis (41.7% vs. 14.9%, p=0.015). No other statistically significant predictors of upgrading were identified (p>0.05).     

A comparison of biopsy through a parasternal anterior mediastinotomy under local anesthesia and percutaneous needle biopsy for malignant anterior mediastinal tumors

P = 0.0318). Moreover, the mediastinotomy biopsy specimens revealed subtypes of lymphomas and germ cell tumors. All of the patients from whom a mediastinotomy biopsy had been taken began appropriate therapy without delay according to the histologic diagnosis. These results suggest that the PAM approach should be chosen as the preferred method of biopsy for suspected malignant anterior mediastinal tumors. (Received for publication on June 30, 1997; accepted on Jan. 6, 1998)     

Distinguishing papillary endothelial hyperplasia and angiosarcoma on core needle biopsy of the breast: The importance of clinical and radiologic correlation

Papillary endothelial hyperplasia (PEH) is a rare non‐neoplastic exuberant organizing hematoma that can closely mimic angiosarcoma due to a resemblance to malignant anastomosing blood vessels. It could be particularly difficult to distinguish PEH from angiosarcoma in breast core needle biopsies. We identified all cases of these lesions diagnosed on core needle biopsy in order to identify clinical, radiologic, and pathologic features that could prove helpful to arrive at the correct diagnosis. Four cases of PEH and 4 cases of angiosarcoma were identified. The mean age at diagnosis was 62 for PEH and 33 for primary angiosarcoma. All cases of PEH formed small masses with circumscribed or lobulated margins by imaging (mean size 0.9 cm). In 3 cases, the masses were difficult or impossible to identify after the biopsy. Angiosarcomas presented as larger masses with ill‐defined margins (mean size 2.8 cm) that were unchanged in size after biopsy. PEH was surrounded by adipose tissue, whereas angiosarcoma invaded into fibrous stroma and involved lobules. The pseudopapillary structures of PEH were composed mainly of collagen, and thus, additional histologic stains for fibrin were not helpful for diagnosis. The 4 patients with PEH received no further treatment and are alive and disease‐free at 2‐11 years of follow‐up. In contrast, the patients with angiosarcoma underwent mastectomy and chemotherapy or radiation therapy. Two of the patients with angiosarcoma died 3 years after diagnosis and the other 2 patients are alive without disease at 5 and 6 years. Therefore, distinguishing PEH and angiosarcoma is essential for appropriate management. This is the first series to compare these lesions on core needle biopsy and the first to note important clinical, imaging, and histologic differences that aid in making a diagnosis of PEH with confidence on breast core needle biopsy.