Percutaneous renal biopsy using Biopty biopsy instrument and Biopty biopsy needle

We assessed the clinical usefulness of Biopty biopsy instrument & Biopty biopsy needle in percutaneous renal biopsy (PRB) compared with Tru-cut disposable needle and Vim-Silvermann needle. Sixty cases, each consisting 20 cases, were performed PRB by 3 different needles. There was no significant differences between Biopt y-cut needle and Tru-cut needle in the length of renal biopsy tissue and number of glomeruli obtained. The frequency of clinical complications such as fever, flank pain and decrease in Ht greater than 2% was lower in Biopty needle group after PRB. The frequency of middle and large size of hematoma was also lower in Biopty needle group after PRB. We could also obtain specimen from transplanted kidney without complications except small hematoma. From three results, Biopty biopsy needle is a useful tool in performing PRB.     

Aspiration biopsy of the prostate

Summary Fine needle aspiration biopsy of the prostate was performed on 158 patients and compared to histological material. All patients had Tru-cut needle biopsies; 83 had subsequent prostatectomies, 82 transurethral, 1 suprapubic, and 1 patient had a cystoprostatectomy. Fine needle aspiration biopsies had a sensitivity of 90% and a specificity of 100%. Core biopsies were compared to prostatectomy histologies with a sensitivity of 82% and a specificity of 100%. Fine needle aspiration biopsy is an accurate and well-tolerated method of diagnosing carcinoma of the prostate gland.     

Multiple pleural biopsy with the Abrams needle.

Multiple pleural biopsies (up to 10) were taken with the Abrams needle through a single aspiration site in 55 patients with pleural effusions. A definite positive or suggestive pleural biopsy diagnosis was made in 33 patients (60%). In 32 of the 33 patients the pathological abnormality was confined to only a proportion of the biopsies. Pleural biopsies were positive or suggestive in 26 out of 36 patients (72%) eventually shown to have tumour and seven out of eight patients (88%) with tuberculosis. Small pneumothoraces occurred in four patients and surgical emphysema in two.     

The complementary role of fine needle aspiration cytology and Tru-cut needle biopsy in the management of breast masses

Fine needle aspiration cytology (FNA) and Tru-cut needle biopsy (TNB) have been used for the pre-operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and Tru-cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non-diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru-cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non-diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non-diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.     

Value of Tru-cut biopsy in the diagnosis of soft tissue tumours

The light microscopic appearances of Tru-cut needle biopsies from 50 consecutive soft tissue tumours were assessed by three pathologists and compared with the definitive histological diagnosis. Forty-four patients had soft tissue sarcomas and six had benign soft tissue lesions. A correct predictive diagnosis of sarcoma was made on 87-98 per cent of adequate Tru-cut specimens, the accuracy varying between pathologists. Three sources of diagnostic error were recognized: false positive cores (8 per cent), false negative cores (8 per cent), and cores inadequate for diagnosis (16 per cent). The major source of confusion related to difficulties in differentiating infiltrating fibromatosis from malignant fibrous histiocytoma. The high sensitivity of Tru-cut needle biopsy suggests that it could be a valuable aid in the diagnosis of clinically suspected soft tissue sarcomas.     

Percutaneous lung biopsy with a fine bore cutting needle (Vacu-Cut): improved results using drill technique.

BACKGROUND-- Percutaneous transthoracic needle biopsy is used in the diagnosis of pulmonary and pleural lesions. The standard procedure using the Vacu-Cut cutting type of needle is the "thrust" technique in which the needle is rapidly forced through the lesion. In our experience this technique has a low yield of histological biopsy specimens. The diagnostic yield of a new biopsy technique ("drill" technique) using the Vacu-Cut needle was assessed. METHODS-- The series comprised 29 consecutive patients, 23 with localised peripheral pulmonary lesions and six with pleural lesions. The Vacu-Cut 1.2 mm needle was rotated and drilled by hand through the lesion. RESULTS-- Biopsy specimens 4-30 mm long were obtained in 20 of the 23 patients with pulmonary lesions; in three patients material was available for cytological examination only. The diagnostic yield in the 18 malignant pulmonary lesions was 89% and in the five non-malignant lesions 80%. Biopsy specimens 10-30 mm long were obtained in all patients with pleural lesions. The diagnostic yield in the four malignant and two non-malignant lesions was 100%. The total diagnostic yield in malignant lesions was 20 of 22 patients and in non-malignant lesions six of seven patients. The diagnostic yield in the entire series was 26 of 29 patients (90%). Pneumothorax occurred in seven of the patients and three needed a chest tube. There was no haemoptysis and no deaths. CONCLUSIONS-- The drill technique has a high diagnostic yield in both malignant and non-malignant pulmonary and pleural lesions, and is suggested as the ideal biopsy technique when using the Vacu-Cut needle.     

Percutaneous biopsy of bladder-drained pancreas transplants.

Percutaneous biopsy is a valuable investigation in the management of allograft rejection for all solid organs. Pancreas transplants have not been biopsed percutaneously, though open and percystoscopic biopsies have proved useful. We have compared percutaneous needle core biopsy with fine-needle aspiration cytology for the diagnosis of rejection in 18 patients receiving combined kidney and pancreas transplants and in one who was transplanted with the pancreas alone. Percutaneous needle core biopsy was successful in 37 of 40 attempts (93%), while fine-needle aspiration yielded diagnostic material on 33 of 47 attempts (70%). Transient hyperamylasemia occurred in 29%, returning to baseline in three days. One patient twice developed transient macroscopic hematuria. There was agreement between needle core biopsy and fine-needle aspiration on the diagnosis of rejection on six occasions and for the absence of rejection on 16. There was an 8% false-positive rate for fine-needle aspiration. In 13 instances of histologically proved renal rejection, concurrent pancreas biopsy revealed rejection in 69%. Pancreas rejection was not, however, seen in the absence of renal rejection. In this pilot study, percutaneous biopsy of the bladder-drained pancreas allograft was shown to be a practicable and valuable investigation without major complications.     

Percutaneous visceral pleural biopsy with fenestrated cup biopsy forceps.

When there is an exudative pleural effusion often both the parietal and the visceral pleura are affected, but the usual practice is to perform a percutaneous parietal pleural biopsy alone for diagnosis. Percutaneous visceral pleural biopsy was carried out in 20 patients with exudative pleural effusions with fenestrated cup biopsy forceps. In all 20 biopsies pleural tissue was obtained and it was diagnostic in 19 cases. The procedure is painless and appears safe.     

Ultrasound-guided Tru-cut biopsy of the breast.

Ultrasound-guided automated Tru-cut needle biopsy may be used as an alternative to fine needle aspiration cytology for the assessment of discrete mass lesions of the breast. This is a retrospective study of 187 biopsies, comparing the results with a final diagnosis obtained from subsequent excision or outpatient follow-up. Biopsies were performed using a spring-loaded gun under ultrasound guidance. Invasive malignancy was demonstrated in 114 biopsies, 98 of which were subjected to surgery, with no false-positives. Twelve biopsies contained 'atypical cells', pre-invasive malignancy or risk factors for invasive carcinoma, ten of which proved to be invasive malignancy on excision. Normal or benign tissue was found in 61 biopsies, but of those that proceeded to excision biopsy, 16 were invasive or in situ carcinoma. The sensitivity of the procedure for detecting significant pathology was 88.7%, and the specificity 100%. When used as part of triple assessment, the sensitivity increases to 97.9%. Ultrasound-guided Tru-cut needle biopsy is a well-tolerated and reliable procedure for providing a tissue diagnosis of malignancy before definitive treatment, and obviating the need for formal excision biopsy of lesions for which there is a low index of suspicion.     

Chest wall implantation of thymic cancer after computed tomography-guided core needle biopsy.

Percutaneous core needle biopsy is a useful procedure for diagnosing lung and mediastinal tumors. However, it has the potential to spread malignant cells from the tumor to the chest wall and pleural cavity. We report the case of a patient with thymic cancer who developed a metastatic tumor at the transthoracic needle biopsy site following a curative resection. The patient underwent an additional chest wall resection, but she developed recurrence in the pleural cavity 1 month after the second operation. The risk of tumor implantation and the related complications that can occur with transthoracic needle biopsy should be considered in patients with a malignant tumor. The indications for transthoracic needle biopsy should be restricted.     

影响CT引导下胸膜病变同轴活检诊断准确率及相关并发症的因素分析

目的探讨影响CT引导下同轴活检诊断胸膜恶性病变的准确率和相关并发症的因素。方法分析88例接受CT引导下胸膜病变穿刺活检的病例资料,最终诊断结果依据病理诊断或临床随访。采用单因素及多因素分析CT引导下影响穿刺活检诊断胸膜恶性病变的准确率及相关并发症发生的主要因素。结果 88例患者中CT引导下同轴活检诊断胸膜恶性病变56例,良性病变28,性质待定4例;其诊断胸膜恶性病变的准确率、敏感度、特异度分别为89.29%(75/84)、86.15%(56/65)、100%(19/19)。穿刺活检过程中发生气胸14例,单因素分析提示无影响CT引导下胸膜病变同轴活检诊断准确率的相关因素;多因素分析提示穿刺部位病变大小/胸膜厚度是气胸发生的危险因素(OR:8.744),而胸腔积液是气胸发生的保护因素(OR:0.171)。结论 CT引导下胸膜病变同轴活检是相对安全的技术并且诊断准确率较高,值得临床推广应用。     

Comparison of diagnostic quality of kidney biopsy obtained using 16G and 18G needles in patients with diffuse renal disease

To determine the diagnostic quality and complication rates of 16G and 18G needles in biopsy of the kidney, we performed renal biopsy using a biopsy gun under ultrasound guidance in 50 patients who were prospectively and evenly assigned to one of the two needle biopsy methods from April 2007 until May 2008. Two cores of renal biopsy specimen were obtained in each case and subjected to histopathological and immunoflourescence (IF) examination. Pain associated with the procedure was assessed using a visual analog scale. The number of glomeruli retrieved using the 16G needle ranged from 0 to 30 (mean 9.42 ± 5.5) and those retrieved using 18G needle ranged from 0 to 19 (mean 7.72 ± 4.4), P <0.05. The quality of biopsy was poorer with 18G needle as compared with 16G needles because of a higher amount of fragmentation and crushing artifact. There was no difference in the complication rates between the two needles (2% each). The 16G needle was associated with significantly more pain than the 18G needle. We conclude that our study demonstrates the benefit of the larger 16G needle in providing more tissue and glomeruli, which is more diagnostically useful. However, the use of 16G needle was associated with significantly more pain than the 18G needle, and may be a better compromise for diagnostic usefulness and patient acceptability.     

Thoracoscopic coaxial cutting needle biopsy for clinically suspected lung cancer: technical details, diagnostic accuracy, and probable complications

Background

Little has been described regarding the technical details, diagnostic accuracy, and probable complications of thoracoscopic cutting needle biopsy, which seems to be preferable to transthoracic needle biopsy for patients scheduled to undergo surgery for suspected lung cancer.

Methods

This study was a retrospective analysis of a prospective database of patients who underwent surgical biopsy for suspected lung cancer (n?=?176). Sixty-two patients underwent thoracoscopic cutting needle biopsy, which was performed via thoracoport using a 16?gauge coaxial cutting needle; the remaining 114 patients underwent excisional biopsy, followed by curative intent surgery.

Results

The sensitivity and specificity of diagnosing lung cancer by thoracoscopic needle biopsy were 57/59 (96.6%) and 1/3 (33.3%), respectively. One false-negative result and one undiagnostic result occurred, but both lesions were correctly re-diagnosed by backup excisional biopsy during the same operation. When analysis was restricted to patients with lung lesions predominantly presenting with ground glass opacity, the sensitivity and specificity were 13/14 (92.9%) and 1/1 (100%), respectively. The sensitivity, specificity, and accuracy of diagnosing lung cancer by surgical biopsy in all patients were 164/165 (99.4%), 9/11 (81.8%), and 173/176 (98.3%), respectively. Pleural recurrence was identified in one patient after thoracoscopic needle biopsy whose pleural lavage cytology, performed before biopsy, was negative.

Conclusions

Thoracoscopic cutting needle biopsy can be effectively applied to patients with an indeterminate lung tumor, especially those patients with lesions possessing ground glass opacity. However, further evaluation is necessary to confirm the risk of pleural dissemination induced by this procedure.     

Is liver biopsy in gallbladder operations still indicated?

Biopsy of the liver with the Tru-cut needle was done as a routine diagnostic procedure during gallbladder surgery in 166 cases. The data of history, ultrasonography and laboratory were compared with the microscopic liver findings. Preoperatively in 89% of the cases there was an indication for liver biopsy. In 11% of the cases, where there was no indication for preoperative biopsy, we found severe changes in liver histology. Therefore we recommend liver biopsy during gallbladder surgery as a routine procedure.     

A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy

BACKGROUND: Needle-core biopsy remains one of the most important investigations in cases of renal allograft dysfunction. The size and quality of the biopsy material are likely to be important factors in achieving an accurate diagnosis. The aim of this study was to compare the success and complication rates of renal transplant biopsy procedures using three differently sized needles. METHODS: One hundred renal allograft recipients undergoing transplant biopsy using an automated needle core method were randomized to a 14, 16, or 18 gauge (G) needle. The size of each biopsy core was measured, and the presence or absence of renal cortical and medullary tissue and the number of glomeruli were recorded. Assessments of the ease with which the procedure was performed, the diagnostic usefulness of the biopsy material, and the discomfort associated with the procedure were made using verbal response and linear analog scales. RESULTS: Fourteen G biopsy cores (N = 33) were larger than both 16G (N = 33) and 18G (N = 34) cores and contained more gomeruli (mean number for 14G, 16G, and 18G = 15, 11 and 9, respectively). There were no differences in the ease of use of the three needle types, but scores for diagnostic usefulness were higher for 14G versus 18G and 16G versus 18G. The 14G needle was associated with significantly more pain than the two smaller needles when this was assessed using a linear analog score. Macroscopic hematuria occurred in eight patients, but there were no differences in complications rates between the three groups. CONCLUSIONS: All three needle sizes are safe for use in renal allograft biopsy using a semiautomated biopsy gun. The larger needles provide more tissue and glomeruli and, thus, are more diagnostically useful. Use of a 14G needle may be associated with more pain, and the 16G needle appears to offer the best compromise between diagnostic usefulness and patient acceptability.     

Value of punch and puncture drill biopsy in the diagnosis of tuberculous spondylitis

Thanks to a specially designed guide instrumentarium, punch and drill aspiration biopsy for the vertebrae and intervertebral spaces have become routine diagnostic procedures which any patient can be expected to tolerate. With the authors' puncture technique material can be obtained from a single vertebra at various heights or simultaneously from different segments with the drilling cannula. For an experienced osteopathologist histologic assessment of the tissue cylinders obtained or of aspirated material presents no problems. Percutaneous removal of samples by this method avoids an open diagnostic intervention with its considerably greater attendant risks, or enables a therapeutic intervention to be prepared with greater precision. The authors report on their own experience of drill aspiration biopsy in 35 fully documented patients and discuss considerations regarding indication and confirmation of the diagnosis.     

The accuracy of transrectal aspiration biopsy of the prostate: an analysis of 452 cases

This study compares cytological findings obtained by transrectal aspiration biopsy of the prostate with histological findings obtained by simultaneously performed transperineal punch biopsy. All interventions were performed on outpatients. Complications such as hematuria, urinary infection, or epididymitis occurred in 4.4% of the cases, the majority of them being attributed to punch biopsies. Exact correspondence was found in 78.8% of 433 usable specimens, the accuracy for carcinoma amounting to 71.1%. Specimens cytologically judged either false "negative" or "suspicious" were histologically mostly well-differentiated (G1 and G2) carcinomas (96.1%). The value of fine needle biopsy of the prostate as nonstaining diagnostic procedure will be discussed.     

Prospective comparison of stereotactic core biopsy and surgical excision as diagnostic procedures for breast cancer patients

OBJECTIVE: To determine whether stereotactic core biopsy (SCNB) is the diagnostic method of choice for all mammographic abnormalities requiring tissue sampling. SUMMARY BACKGROUND DATA: Stereotactic core needle biopsy decreases the cost of diagnosis, but its impact on the number of surgical procedures needed to complete local therapy has not been studied in a large, unselected patient population. METHODS: A total of 1,852 mammographic abnormalities in 1,550 consecutive patients were prospectively categorized for level of cancer risk and underwent SCNB or diagnostic needle localization and surgical excision. Diagnosis, type of cancer surgery, and number of surgical procedures to complete local therapy were obtained from surgical and pathology databases. RESULTS: The malignancy rate was 24%. Surgical biopsy patients were older, more likely to have cancer, and more likely to be treated with breast-conserving therapy than those in the SCNB group. For all types of lesions, regardless of degree of suspicion, patients diagnosed by SCNB were almost three times more likely to have one surgical procedure. However, for patients treated with lumpectomy alone, the number of surgical procedures and the rate of negative margins did not differ between groups. CONCLUSIONS: Stereotactic core needle biopsy is the diagnostic procedure of choice for most mammographic abnormalities. However, for patients undergoing lumpectomy without axillary surgery, it is an extra invasive procedure that does not facilitate obtaining negative margins.     

Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia.

OBJECTIVE: We directly examined the thoracic cavity by thoracoscopy under local anesthesia, performed pleural biopsy, and made a definitive pathological diagnosis in tuberculous pleurisy. SUBJECTS AND METHODS: We performed a retrospective study of 32 patients who had been bacteriologically and pathologically diagnosed with tuberculous pleurisy by thoracoscopy under local anesthesia in our hospital between January 1995 and November 2004. RESULTS: Bacteriological examination of pleural fluids obtained by thoracentesis before examination showed that one sample was polymerase chain reaction (PCR)-positive, and 5 samples were culture-positive. Bacteriological examination of pleural fluids obtained by thoracoscopy revealed that 2 samples were PCR-positive, and 5 samples culture-positive, including 2 preoperatively positive samples. The adenosine deaminase (ADA) levels ranged from 18.3 to 279.0 U/L, with a mean of 72.9 U/L, including 50 U/L or less in 5 patients and 35 U/L or less in 3 patients. Thirty patients (93.8%) were successfully diagnosed by pleural biopsy with pathological examination, and 21 (65.6%) of them by pathological examination alone. CONCLUSION: In patients with suspected tuberculous pleurisy, thoracoscopic pleural biopsy under local anesthesia should be actively performed, because the technique has a high diagnostic rate, and can be easily and safely performed.     

CT引导下穿刺活检术在骨疾患诊断中的应用和准确性分析

[目的]评价CT引导下经皮骨组织穿刺活检术的实用性和对疾病诊治的意义。[方法]对CT引导下骨组织穿刺活检术137例进行总结分析。[结果]病灶刺中率100％，穿刺活检病理结果122例获得明确诊断，15例诊断不明确或误诊。穿刺活检总的诊断准确率89．0％，其中转移癌、原发恶性肿瘤和良性病变诊断准确率分别为95．8％、85．7％和85．1％。[结论]CT引导下经皮骨组织穿刺活检术，创伤小、诊断准确率高、并发症少，是一种安全有效的诊断方法，对指导治疗有重要意义。