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.     

Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam

OBJECTIVE: To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB). PATIENTS AND METHODS: Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB. RESULTS: Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects. CONCLUSIONS: This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.     

Predicting unilateral prostate cancer on routine diagnostic biopsy: sextant vs extended

Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b

OBJECTIVE

To compare the diagnostic properties of routine office‐based sextant and extended biopsies for unilateral prostate cancer, as validated by final pathology, because focal therapy of prostate cancer is gaining acceptance as a viable treatment option and thus patient selection is of paramount consideration.

PATIENTS AND METHODS

We retrospectively analysed records of patients who had a radical prostatectomy (RP) for biopsy confirmed prostate cancer at our institution between 1990 and 2007. Records with incomplete data were excluded. Diagnostic properties for sextant and extended biopsies were calculated and compared for diagnostic accuracy, sensitivity, specificity, positive and negative predictive values (PPV, NPV) and false‐positive and ‐negative rates.

RESULTS

We identified 882 records (729 sextant, 153 extended biopsies) matching our criteria. Overall, unilateral prostate cancer was confirmed in 151 (16%) of pathological RP specimens. The sensitivity improved from 84.1% to 88.0% on sextant and extended biopsy, respectively. Similarly, the PPV increased from 21.9% to 27.2%, specificity from 37.1% to 53.9% (P < 0.05), and NPV from 91.8% to 95.8% (P < 0.05). These changes are reflected in the decrease in false‐positive rates (from 62.9% to 46.1%) and false‐negative rates (from 15.9% to 12.0%). The overall diagnostic accuracy increased from 49% on sextant to 59% on extended biopsy (P < 0.05).

CONCLUSIONS

Taking more prostate biopsy cores improves the diagnostic properties for identifying unilateral prostate cancer. However, a 12‐core biopsy is not an ideal diagnostic test to select patients for focal therapy, and should be interpreted in conjunction with imaging and clinical variables. Additional research should investigate the diagnostic gain associated with a further increase in the number of biopsy cores.     

Systematic review and meta-analysis comparing cognitive vs. image-guided fusion prostate biopsy for the detection of prostate cancer

ObjectiveTo perform a systematic review and meta-analysis comparing overall prostate cancer detection rate and clinically-significant prostate cancer detection rate between MRI-ultrasound image guided fusion biopsy (MRI-US FB) and cognitive biopsy (CB).MethodsA systematic review of Pubmed, EMBASE, MEDLINE, and Cochrane library databases was performed. Identified studies were assessed for clinical relevance and excluded based on a set of predefined criteria. Final articles included in the analysis comprised only prospective trials that compared CB vs. MRI-US FB in men with MRI-identifiable lesions (Prostate Imaging Reporting and Data System score 2+). Articles were reviewed for patient demographics, MRI protocol, and rates of overall and clinically significant prostate cancer detection by both modalities.ResultsNine studies were analyzed. A composite 1,714 men with mean age 64.6 years and mean PSA 8.2 ng/dL were reviewed. When comparing FB to CB, the odds ratio for overall and for clinically significant prostate cancer detection was 1.11 (95%CI 0.91–1.36, P = 0.30) and 1.13 (95%CI 0.89–1.44, P = 0.32), respectively. Heterogeneity among the studies was moderate but not significant for either overall (X² = 14.67; I² = 45%; P = 0.07) or clinically significant prostate cancer detection (X² = 11.81; I² = 49%; P = 0.07).ConclusionMRI-US FB demonstrates a trend toward improved rates of prostate cancer detection compared to CB, although this is not statistically significant. Further comparative studies may help to further elucidate whether one of these modalities is superior over the other.     

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.     

Increasing prostate biopsy cores based on volume vs the sextant biopsy: a prospective randomized controlled clinical study on cancer detection rates and morbidity

OBJECTIVE: To determine if a volume-adjusted increase in the number of biopsy cores could detect more prostate cancers than the standard sextant biopsy alone, without increasing morbidity, and to determine its applicability in Malaysian patients, as a standard sextant biopsy misses 20-25% of prostate malignancies. PATIENTS AND METHODS: In a prospective randomized study of patients undergoing transrectal ultrasonography (TRUS)-guided biopsy for a prostate-specific antigen (PSA) level of 4-20 ng/mL without abnormal digital rectal examination (DRE), the men were divided into five main groups (A-E) with prostate volumes of <20, 20-40, 40-60, 60-80 and >80 mL, respectively. Patients in groups B-E were randomized into sextant (B1 to E1) and increased biopsy-core subgroups, i.e. B2 (eight cores), C2 (10 cores), D2 (12 cores) and E2 (14 cores). The morbidity profile was also evaluated during and after TRUS biopsy, assessing a pain score, rectal bleeding, haematuria, haemospermia and development of fever. In all, 132 patients were recruited (mean age 67.8 years; mean PSA 9.41 ng/mL). RESULTS: The overall cancer detection rate was 24% (32 men). Taking more cores detected 65.5% of cancers, and the sextant biopsy 34.5% (P = 0.0025), but did not increase the overall morbidity. CONCLUSIONS: The volume-adjusted, increased-core regimen significantly increased the positive biopsy rate of TRUS-guided prostate biopsies with no added morbidity.     

Effect of core-needle biopsy vs fine-needle aspiration on pathologic measurement of tumor size in breast cancer

HYPOTHESIS: Core-needle biopsy (CNB) and fine-needle aspiration (FNA) play an important role in the initial diagnosis of breast cancer. However, CNB might alter the size of the tumor, which might subsequently change its pathologic stage and thus affect the decision about adjuvant chemotherapy. PATIENTS: Between January 2000 and May 2002, we studied 291 patients with invasive carcinoma lesion in a retrospective analysis. One hundred ninety-nine patients underwent ultrasonography-guided CNB. Ninety-two patients had FNA before surgical manipulation. MAIN OUTCOME MEASURES: The clinically measured tumor size using ultrasonography was compared with the pathologic tumor size in both the CNB and FNA groups. The difference in each group was determined and analyzed using a t test. The mean +/- SD preoperative ultrasonographically measured size in the CNB group was 2.09 +/- 1.06 cm and in the FNA group, 2.16 +/- 0.92 cm (no significant difference). The pathologic measurement of the lesion on surgical specimens revealed that the mean pathologic tumor size was 2.09 +/- 0.90 cm in the CNB group and 2.36 +/- 0.92 cm in the FNA group. The changes in size from preoperative measurements by ultrasonography to pathologic measurements on surgical specimens were greater in the CNB group (0.003 +/- 0.65 cm) than in the FNA group (0.20 +/- 0.39 cm; P = .001). CONCLUSIONS: Although the reduction in tumor size might be small with patients who undergo CNB, it must be considered when deciding adjuvant treatment, especially for tumor sizes on the "borderline" in establishing the indication for and the type of adjuvant treatment.