Renal biopsy in children: comparison of two techniques

Two hundred and thirty-five children who underwent percutaneous renal biopsy under real-time ultrasound guidance at The Hospital for Sick Children, between 1 January 1991 and 31 March 1993, were studied to compare the incidence of complications after biopsies with the Trucut needle (TN) and the Bard Biopty gun (BG). Of the 190 cases for which full clinical details were available and in which a single instrument was used for renal biopsy, 157 were biopsied with the BG and 33 with the TN. There was no significant difference between the two groups in variables such as age, weight, sex, number of needle passes and number of tissue cores obtained. The proportion of native and allograft biopsies in each group was similar. More children in the TN group underwent biopsy under general anaesthesia. Adequate diagnostic tissue samples were obtained in 189 of 190 cases. There were more complications in the TN group than in the BG group (P<0.001). When allograft and native kidney biopsies were analysed separately, this difference in complications remained highly significant for the native kidney group (P<0.005), though not for the allograft group. When the effect of needle size alone was investigated, there was no significant difference in the incidence of complications when TN biopsies were compared with 14-gauge BG biopsies or when 14- and 18-gauge BG biopsies were compared with each other.HSC price May 1993, Trucut needle Canadian $ 11.15, Biopty needle Canadian $ 30.50.     

Complications of percutaneous renal biopsy]

Three hundreds percutaneous renal biopsy cases were analyzed for recorded clinical complications retrospectively. Incidence of fever (> or = 37.5 degrees C), pain, and decrease in hematocrit (> or = 4%) was 21%, 28%, and 13% respectively. The incidence of fever and pain were less in the older patients. Prospectively, 125 cases who underwent ultrasonography following renal biopsies and 62 cases who underwent computerized tomography were analyzed. Bigger hematoma was followed by fever 5-7 days after renal biopsies. Incidence of pain and the decrease in hematocrit were correlated with the size of hematoma. Use of the ultrasonographic localization and a Tru-Cut biopsy needle or a Biopty-Cut needle decreased the incidence of hematoma more than 50ml following renal biopsy (0-5%). Incidence of fever and pain was less by these new procedure. The risk of hematoma increased as the biopsy needle went deeper into medulla.     

经皮肾穿刺活检术前血液透析对急性肾损伤患者术后出血并发症的影响

目的探讨经皮肾穿刺活检术(PRB)前血液透析能否降低急性肾损伤(AKI)患者术后的出血风险。方法本研究为队列观察性研究。纳入2015年1月至2018年12月于南方医科大学南方医院肾内科诊断为AKI并接受PRB的患者为研究对象。按PRB术前患者是否接受血液透析治疗分为术前透析组和术前未透析组;按照术后是否出现肾周血肿分为肾周血肿组和无肾周血肿组。比较两组患者PRB术前AKI分期、血红蛋白水平、凝血功能和肾脏病理改变等基线临床资料,以及术后出现肾周出血并发症情况,包括24 h内肾周血肿大小、肉眼血尿、腰腹痛、血红蛋白下降值及干预治疗(如介入手术、输血等)等。采用Logistic回归模型法分析PRB术后发生肾周血肿的危险因素。结果共90例AKI患者被纳入本研究,其中术前透析组41例,术前未透析组49例。术前透析组AKI 2~3期占比显著高于未透析组(100.0%比75.5%,P<0.001)。两组术前凝血功能指标及血小板计数的差异无统计学意义。术后24 h内肾脏超声复查结果显示,两组术后肾周血肿发生率(56.1%比63.3%,P=0.489)、术后肾周大血肿(≥5 cm)发生率(26.1%比22.6%,P=0.766)、术后血红蛋白降幅(3.7%比1.2%,P=0.505)的差异无统计学意义;两组均无输血、动静脉瘘形成、肾血管介入或手术、院内死亡等情况发生。有肾周血肿组和无肾周血肿组肾脏病理表现均以急性肾小管坏死(ATN)为主,两组在年龄、性别、体重指数、合并糖尿病和高血压、AKI分期、术前透析与否、血肌酐、血尿素氮、血红蛋白、血小板计数和肾脏病理类型等项目上的差异均无统计学意义。Logistic回归分析结果显示,PRB术后肾周血肿发生风险与术前血液透析治疗无独立相关性(β=0.568,P=0.241);多因素Logistic回归分析结果显示,PRB术后大血肿与术前透析亦无独立相关性(β=0.967,P=0.958)。结论术前血液透析对AKI患者PRB术后肾周血肿发生率及血红蛋白降幅无明显影响。术前血液透析降低PRB术后出血风险的作用还有待进一步研究验证。     

Ultrasound-guided prostate biopsy. Biopty gun superior to aspiration

We used a 7 MHz transrectal ultrasound scanner to perform guided core biopsy and aspiration cytologies on 292 patients with findings suspicious for prostate cancer. One hundred two cancers were identified, 35 of which were not palpable and were detected only by ultrasound. Aspiration needles were guided by ultrasound through the center of the suspicious lesion. Core biopsies were performed using an 18-gauge Tru-Cut type of needle with an automatic, spring-powered needle biopsy device (Biopty). All patients received only local anesthetic and biopsies were done as an outpatient office procedure. The core biopsies gave excellent specimens which detected 89 percent of the cancers, whereas the aspiration method detected 51 percent (P less than 0.001). Aspiration cytology was significantly less sensitive among well-differentiated compared with moderately differentiated cancers. High-resolution transrectal ultrasound and the Biopty device are detecting and documenting prostate cancer with much greater sensitivity than preceding techniques have achieved.     

Percutaneous renal biopsy in children: survey of pediatric nephrologists in Japan

Between 1996 and 1997, 2,045 percutaneous renal biopsies were performed on native kidneys in 2,013 patients in pediatric nephrology units in Japan. Of these, 50.8% were performed by automated needle biopsy gun under ultrasound guidance, and the standard biopsy needle, Tru-cut needle or Vim-Silverman needle, under fluoroscopic guidance was used in 12.4% and 12.3% of the biopsies, respectively. Adequate renal tissue for histological diagnosis was obtained in 98.7% of cases, and the success rates for the techniques were not significantly different. The overall complication rate was 5.8%; gross hematuria occurred in 2.7% and large perirenal hematoma in 0.9% of cases. These complication rates were higher when a standard needle under fluoroscopic guidance was used compared with an automated needle under ultrasound guidance. We conclude that pediatric nephrologists in Japan perform percutaneous renal biopsies safely, partly due to technical improvements, such as the automated needle or ultrasound guidance. Received: 16 October 1998 / Revised: 15 February 1999 / Accepted: 25 March 1999     

Digitally-directed transrectal biopsy using Biopty gun versus transrectal needle aspiration: comparison of diagnostic yield and comfort

A technique for digitally-directed core biopsy using the Biopty device and prospective comparison of accuracy and comfort, using this technique simultaneously with transrectal needle aspiration, are presented. To better estimate the true prevalence of carcinoma in the study population, a repeat combined procedure was performed on all subjects who did not have carcinoma confirmed on the initial core biopsies. All procedures were done by one investigator and all pathology reviewed by one senior pathologist. A total of 180 combined procedures were performed on 100 consecutive patients with palpably abnormal prostates; 30 carcinomas were detected. Digitally-directed Biopty biopsy yielded a sensitivity rate of 87 percent compared with 57 percent for needle aspiration (p less than 0.05). Using a numerical comfort scale, the Biopty device was also rated less painful than needle aspiration (p = 0.0001). The morbidity of the combined procedure was minimal, with a minor complication rate of 2.2 percent. No infections occurred.     

Experience of renal biopsy in children with nephrotic syndrome

Percutaneous renal biopsy (PRB) is useful in childhood renal diseases. This study was done to determine the indications for renal biopsy in nephrotic children, to correlate the indications with histology and to document the complications of PRB. This study included 250 nephrotic children younger than 18 years old who had renal biopsy from January 1988 to December 2002. Ultrasonographic guidance was used in the latter part of the study. Coagulation profile and renal function assessment and blood group testing were done prior to biopsy. Children were monitored clinically during and after the procedure. All children had local anesthesia and 202 children also had short-acting general anesthesia. All biopsies were done on the left kidneys. The specimens were studied under light and immunofluorescent microscopy. All had a post-biopsy ultrasonography at 24 h. Biopsy was diagnostic in 95.2% of children, with a failure rate of 4.8%. The most common indication for biopsy was steroid-resistant nephrotic syndrome (65.2%), and minimal change disease (52.1%) was the most common histology, irrespective of the indications for renal biopsy. Mild (16.0%) and gross (16.8%) hematuria and subcapsular hematoma (6.0%) were the common complications. Fifty-five percent of the children had no complications. Only two children (0.8%) had biopsy site infection.     

CT-guided biopsy of paraaortic lesions: report of three cases]

Computed tomographic (CT)-guided biopsies of the lesions in paraaortic region were performed for three urologic disease conditions: retroperitoneal fibrosis, lymph node metastases of transitional cell carcinoma of renal pelvis and lymph node metastasis of renal cell carcinoma. The biopsies were performed without complications using the Bard Biopty biopsy gun with a Bard Biopty-Cut needle. Every biopsy specimen we obtained by the Biopty rendered an excellent biopsy core from which a definite histopathological diagnosis was made. CT-guided biopsy is considered to be safe and useful for diagnosis of the disease of the paraaortic region, even when ultrasonography guided biopsy is difficult. The use of the Biopty for CT-guided biopsy provides a high quality specimen for histopathological diagnosis.     

Comparison of the Tru-cut biopsy needle with the Abrams punch for pleural biopsy.

In a prospective study pleural biopsy specimens obtained with a Tru-cut needle were compared with those obtained with an Abrams pleural biopsy punch from 36 patients in Zimbabwe judged to have an effusion of at least 1.5 litres; one patient had two biopsies. Both instruments were used on each patient, the Abrams punch being followed by the Tru-cut needle. There were no serious complications. The diagnoses determined by biopsy were: tuberculosis (11); carcinoma (12); chronic inflammation (9); and pleural fibrosis (4); one biopsy showed nothing abnormal. In 23 (62%) patients both biopsy needles produced adequate diagnostic material; in eight the Tru-cut needle alone produced diagnostic material and in six the Abrams punch alone. Thus diagnostic material was obtained in 31 patients from the Tru-cut needle and in 29 from the Abrams punch. The Tru-cut needle was useful and safe for pleural biopsy in this series and appeared to be particularly useful when the pleura was thickened.     

Core needle biopsy in renal transplantation

Core biopsies have been done by ultrasound assisted 18-G disposable needles with a spring loaded gun (Biopty) system in 140 renal transplant cases either for investigation of an early non-functioning graft or evaluation of deteriorating graft functions. The biopsy procedure was successfully completed in 99.5% and sufficient amount of renal tissue was obtained in 88% of cases. The pathological diagnoses were confirmed 100% by the other clinical parameters of cases with acute cellular rejection, pyelonephritis, acute tubular necrosis and there was disease recurrence. In another 8 patients (6%) where the pathological picture was showing either no or nonspecific changes there was no major change in clinical outcome. In addition, clinical diagnoses of chronic vascular rejection and Cyclosporin A toxicity were confirmed in 93.7% and 91.7%, respectively, in biopsies of these cases. Complications were seen in 3 patients as a bowel perforation, intra-abdominal bleeding and formation of an intrarenal arterio-venous fistula. In former two complicated cases there was no need for any extra treatment but the arterio-venous fistula was successfully embolized through an angiography catheter without losing the graft. We conclude that the Biopty system is more efficient than the fine needle aspiration biopsy especially when the pathological diagnosis can be made upon tissue components rather than cells alone.     

A new percutaneous renal biopsy device for pediatric patients

A new automated biopsy technique is described for performing percutaneous renal biopsies in pediatric patients. The biopsy device (Bard Biopty Instrument) employs a relatively small needle (18 gauge). We believe this procedure offers a safer and more effective means of obtaining adequate renal tissue for pathological assessment in pediatric patients.     

Yield and efficacy of biopty gun testis needle biopsy

OBJECTIVES: To assess whether a preliminary skin incision enhances diagnostic yield of percutaneous testis biopsy and to further evaluate the clinical efficacy of this procedure. METHODS: A total of 45 men (67 testes) underwent testicular biopsy with two passes of a Biopty gun spring-loaded needle. Twenty-seven biopsies were performed without a preliminary skin incision (group 1), and 40 were performed after a small scrotal incision (group 2). In 56 testes, needle biopsy histopathologic diagnosis was compared with that of open biopsy or orchiectomy specimens from the same patient. Needle and surgical specimens were fixed in Bouin's solution and sent separately for independent, blinded, histologic interpretation. RESULTS: Complications of the procedure were negligible. In all 67 needle biopsies, specimen quality was adequate for histopathologic interpretation. The mean number of seminiferous tubules obtained from needle biopsy was 28% higher among patients having a preliminary skin incision (25.9) compared with those without (18.7, P = 0.023). Correlation between needle and open histopathologic diagnosis was excellent (55 of 56, 98%). CONCLUSIONS: A preliminary skin incision made before needle biopsy increases the diagnostic yield of percutaneous testis biopsy. Percutaneous testis biopsy using the Biopty gun needle provides equal diagnostic information when compared with open testis biopsy or orchiectomy specimens. The concomitant reduction in morbidity and cost make this an attractive diagnostic procedure.     

Technique of renal biopsy by ultrasound guided percutaneous puncture with a spring loaded "gun".

The study consisted of 89 consecutive patients (mean age = 41.5, range = 16-82, 64 men, 25 women) referred for renal biopsy because of clinical suspicion of renal parenchymal disease. Neither transplant kidneys nor tumour evaluation were included. A biopsy "gun" (Biopty) and 14 (2.0 mm) and 18 (1.2 mm) gauge needles were used with ultrasound guidance. Sixtyseven renal biopsies were guided using a freehand technique 42 using a fixed angle guide attachment. The mean glomerular yield was 9.4 glomeruli. Almost 25% of the 18 gauge needle biopsies (n = 57) had to be repeated and 29.3% of the 14 gauge needle biopsies (n = 75). The yield difference was not statistically significant (Chi-squared = 0.37, p = 0.54). There was no statistically significant difference between the distributions of failure to obtain a significant material for evaluation caused by the biopsy technique used (Chi-squared = 0.08, p = 0.78). When analysing cases of single successful pass the thinner needle produced 6.7 glomeruli (n = 36, SD = 5.08) and the thicker needle 13.8 glomeruli (n = 18, SD = 6.82). No serious complications occurred.     

Anuria secondary to percutaneous needle biopsy of a transplant kidney: a case report

Unexplained deterioration of renal function after renal transplantation is often an indication for percutaneous needle biopsy of the allograft. This procedure, even when supplemented by modern radiographic techniques, is not without complications. We report a case of anuria secondary to subcapsular hematoma following an ultrasound-guided needle biopsy. Diagnosis, operative management and postoperative care are discussed.     

Comparison of automated percutaneous kidney biopsy using needles of different gauge

Summary: Percutaneous renal biopsy, an essential procedure for the evaluation of a patient with renal disease, has been improved by the use of semi-automated, spring-loaded renal biopsy guns. We have carried out a prospective, randomized study comparing the safety and tissue adequacy for histopathological diagnosis of renal biopsies performed under real-time ultrasound guidance using the Biopty gun (Bard, Covington, GA, USA) and a 14 or 18 gauge needle on 103 native and 30 transplant kidneys. Repeat biopsy was necessary for only one renal transplant (0.75%) because of inadequate tissue. the biopsy procedure was well tolerated and complications (<5%) were uncommon in both groups. Biopsies of native kidneys with the 14 gauge needle required fewer attempts (3.23 vs 3.98; P = 0.005) and the cores obtained contained more glomeruli for light (24.8 in 2.78 cores vs 16.0 in 3.03 cores; P =0.0001) and immunofluorescence microscopy (9.5 vs 7.4; P = 0.01) than with the 18 gauge needle. Similarly, more glomeruli were obtained from transplant kidneys with the 14 gauge needle (19.5 in 1.19 cores vs 12.9 in 1.57 cores; P =0.004).     

A new automated renal biopsy technique under ultrasound guidance

We evaluated a new automated biopsy device for percutaneous renal biopsies under ultrasound guidance, which was recently introduced in Japan for prostate biopsies. This device (Biopty-Gun: Bard Biopty Instrument Uppsala, Sweden) employs a Tru-Cut type smaller needle (18 gauge). We were able to obtain one or two renal tissues in all 57 cases with great ease and in little time. The length of specimen was sufficient (5-17 mm), but the width was thinner than the samples with the Vim-Silverman or Tru-Cut needles. We could achieve a definitive pathological diagnosis in 54 of 57 cases (94.7%), but now, we try to obtain two pieces of tissue for taking more adequate tissue. Only three patients had perirenal hematomas noted by computerized tomography or ultrasonography. We believe that this new automated technique offers a safer and more effective means of obtaining renal tissue.     

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.     

Subcapsular Hematoma and Hypertension Following Percutaneous Needle Biopsy of a Transplanted Kidney

Percutaneous needle biopsy of a transplanted kidney is indicated as a diagnostic procedure in the evaluation of unexplained deteriorated renal function after renal transplantation. This procedure is not always without complications. We report a case of a subcapsular hematoma and hypertension following a percutaneous needle biopsy of a transplanted kidney. The cause of hypertension in this patient and the management of the subcapsular hematoma are discussed.     

A comparison of fine needle aspiration cytology and tru-cut tissue biopsy in the diagnosis of acute renal allograft rejection

Simultaneous Tru-cut biopsies and fine needle aspirations (FNAs) performed over a 2-year period on patients following renal transplantation were assessed by independent pathologists. When there was histological evidence of rejection, FNAs also demonstrated cellular features of rejection in 83% of cases, and this increased to 92% with repeated sampling. The presence of monocytes and histiocytes in FNAs correlated with vascular features of rejection on biopsy and failure to reverse the rejection process with steroids.     

A randomized, prospective, comparative study of manual and automated renal biopsies

A percutaneous renal biopsy can be performed in several ways, including using a spring-loaded biopsy gun. As this form of renal biopsy has become more popular, a controversy has developed regarding tissue adequacy and the incidence of complications. To compare these two aspects in an automated biopsy and a manual biopsy, we studied 166 patients assigned to one of the two renal biopsy methods. In a randomized, prospective manner from June 1994 until February 1997, group 1 (67 patients) received a 14 G Tru-cut needle (Baxter, Deerfield, IL) manual biopsy while group 2 (99 patients) received an 18 G automated gun biopsy. There was no difference in sex, age, hemoglobin level, prothrombin time, partial thromboplastin time, or diastolic and systolic blood pressure prebiopsy in groups I and II. Indications for biopsy were proteinuria (38%), proteinuria accompanied by hematuria (31.3%), acute renal failure (9.6%), lupus nephropathy (9.6%), chronic renal failure (6%), and hematuria only (5.4%). In group I, the number of cores was 1.88 +/- 0.56, the glomeruli obtained were 27.3 +/- 13.8, and the number of glomeruli per core were 15.3 +/- 8.4. In group II, the values were 2.37 +/- 0.88, 20.7 +/- 11.1, and 9.95 +/- 6.9, respectively. These results showed a statistically significant difference (P < 0.05). In all cases, pathological diagnosis was possible. The histology showed IgA nephropathy in 25.9%, minimal change disease in 16.3%, lupus nephritis in 11.4%, membranous glomerulonephropathy in 9.3%, membranoproliferative glomerulonephritis in 5.4%, and others. The incidence of postbiopsy hematoma was marginally greater in group I (22.3% v 11.1%) and the area of perirenal hematoma shown on ultrasound 24 hours postbiopsy was larger in group I, as well (848 +/- 623 mm2 v 338 +/- 260 mm2). Hematocrit levels before and after biopsy showed a significant difference (34.9% +/- 7.9% and 34.0% +/- 7.6%, respectively; P < 0.05) in group I, but no significant difference was observed in group II (35.1% +/- 7.0% and 34.7% +/- 6.9%). Both techniques rendered adequate tissue sampling, but the extent of bleeding was more severe with the manual 14 G Tru-cut needle biopsy.