Purpose
It is still not clear the role of perilesional biopsy (PL) and the extension of the random biopsy (RB) scheme to be adopted during mpMRI-guided ultrasound fusion biopsy (FB). To evaluate the ...increase in diagnostic accuracy achieved by PL and different RB schemes over target biopsy (TB).
Methods
We collected prospectively 168 biopsy-naïve patients with positive mpMRI receiving FB and concurrent 24-core RB. The diagnostic yields of the different possible biopsy schemes (TB only; TB + 4 PL cores; TB + 12-core RB; TB + 24-core RB) were compared by the McNemar test. Clinically significant (CS) prostate cancer (PCA) was defined according to the definition of the PROMIS trial. Regression analyses were used to identify independent predictors of the presence of any cancer, csPCA.
Results
The detection rate of CS cancers increased to 35%, 45%, and 49% by adding 4 PL cores, 12, and 24 RB cores, respectively (all
p
< 0.02). Notably, the largest scheme including 3 TB and 24 RB cores identified a small but statistically significant 4% increase in detection rate of CS cancer, as compared with the second largest scheme. TB alone identified only 62% of the CS cancers. Such figure increased to 72% by adding 4 PL cores, and to 91% by adding 14 RB cores.
Conclusions
We found that PL biopsy increased the detection rate of CS cancers as compared with TB alone. However, the combination of those cores missed about 30% of the CS cancers identified with larger RB cores, notably including a considerable 15% of cases located contralaterally to the index tumor.
Background
The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30 years, this has evolved from the use of fine-needle ...aspiration biopsy (FNAB) to the current methodology of vacuum assisted biopsy (VAB).
Methods
This article provides an historical review of the application of needle interventions of the breast in the diagnosis and management of breast conditions, and discusses current indications for the use of vacuum assisted biopsies and vacuum assisted excisions.
Results
Whilst FNAB continues to have a limited role in breast disease diagnosis, the necessity of achieving an histological diagnosis has preferentially seen the development and wider application of automated core needle biopsies (CNB) and VAB in the assessment and management of breast lesions. The advantages of CNB and VAB include the ability to distinguish in situ and invasive disease pre-operatively, and the ability to achieve prior knowledge of immunohistochemical tumour markers particularly in the setting of neoadjuvant drug treatments.
Conclusion
Due to its ability to obtain larger tissue samples, VAB does have diagnostic advantages over CNB and indications for the utilization of VAB are discussed. VAB additionally has an expanding role as a tool for breast lesion excision.
Objective
To assess the outcomes of multiparametric magnetic resonance imaging (mpMRI) transperineal targeted fusion biopsy (TPFBx) under local anaesthesia.
Patients and Methods
We prospectively ...screened 1327 patients with a positive mpMRI undergoing TPFBx (targeted cores and systematic cores) under local anaesthesia, at two tertiary referral institutions, between September 2016 and May 2019, for inclusion in the present study. Primary outcomes were detection of clinically significant prostate cancer (csPCa) defined as (1) International Society of Urological Pathologists (ISUP) grade >1 or ISUP grade 1 with >50% involvement of prostate cancer (PCa) in a single core or in >2 cores (D1) and (2) ISUP grade >1 PCa (D2). Secondary outcomes were: assessment of peri‐procedural pain (numerical rating scale NRS) and procedure timings; erectile (International Index of Erectile Function) and urinary (International Prostate Symptom Score) function changes; and complications. We also investigated the value of systematic sampling and concordance with radical prostatectomy (RP).
Results
A total of 1014 patients were included, of whom csPCa was diagnosed in 39.4% (n = 400). The procedure was tolerable (NRS pain score 3.1 ± 2.3), with no impact on erectile (P = 0.45) or urinary (P = 0.58) function, and a low rate of complications (Clavien–Dindo grades 1 or 2, n = 8; grade >2, n = 0). No post‐biopsy sepsis was recorded. Twenty‐two men (95% confidence interval CI 17–29) needed to undergo additional systematic biopsy to diagnose one csPCa missed by targeted biopsies (D1). ISUP grade concordance of biopsies with RP was as follows: k = 0.40 (95% CI 0.31–0.49) for targeted cores alone and k = 0.65 (95% CI 0.57–0.72; P < 0.05) overall.
Conclusions
The use of TPFBx under local anaesthesia yielded good csPCa detection and was feasible, quick, well tolerated and safe. Infectious risk was negligible. Addition of systematic to targeted cores may not be needed in all men, although it improves csPCa detection and concordance with RP.
Purpose A semi-LASER sequence was optimized for in vivo lactate detection in the prostate. Methods The ethical committee waived the need for informed consent to measure 17 patients with high grade ...prostate cancer on a 3T system. A semi-LASER sequence was used with an echo time of 144 ms and optimized interpulse timing for a spectral citrate shape with high signal intensity. An LCModel basis set was developed for fitting choline, creatine, spermine, citrate, and lactate and was used to fit all spectra in tumor-containing voxels. For patients without detectable lactate, the minimal detectable lactate concentration was determined by adding in all spectra of tumor tissue a simulated lactate signal. The amplitude of the simulated lactate signal was iteratively decreased until its fit reached a Cramer Rao lower bound >20%, which was then set as the patient-specific detection limit. Results In none of the patients a convincing lactate signal was found. We estimated that on average the lactate levels in high grade prostate cancer are below 1.5 mM (range 0.9-3.5 mM), Interestingly, in one patient with extensive necrosis in the tumor biopsy samples (Gleason score 5+5), large lipid resonances were observed, which originated from the tumor. Conclusion The minimal detectable lactate concentration of 1.5 mM in high grade prostate cancer indicates that if lactate is increased it remains at low concentrations. Magn Reson Med 71:26-34, 2014. copyright 2013 Wiley Periodicals, Inc.
2 The 0.4% complications rate of self-limiting pneumothorax reported using a specific technique that includes a dedicated US probe with a central hole and a semi-automated (20-gauge) modified ...Menghini type needle is impressive;3 however, this technique is not universally available nor universally applicable and further research is required to confirm these very promising results. ...sampling peripheral lesions are often challenging, and the choice of the best approach should be individualized according to the specific characteristics of the patient and the lesion.
Introduction: Despite advances in immunosuppressive therapy, acute rejection (AR) after lung transplantation is reported as about 28% in the first year. Acute cellular rejection is staged according ...to the presence of peribronchial, perivascular or interstitial lymphocytic infiltration and bronchial inflammation. It is not usual to present as panbronchiolitis. Case Presentation: A 53-year-old female patient underwent bilateral lung transplantation in January 2018 with the diagnosis of lymphangioleiomyomatosis admitted to us with dyspnea and cough complaints at the postoperative 9th month. Nodular formation and bud-in-tree signs were observed in bilateral lower zones on thorax computed tomography. Fiberoptic bronchoscopy (FOB) was performed to obtain gram staining and required bacteriological, viral and fungal cultures, furthermore transbronchial biopsy was performed to evaluate whether the rejection was present. Empirical antibiotic, antifungal (voriconazole) and antiviral (ganciclovir) treatments were started. FOB and TBB were repeated because there was neither specific pathogen for lung infection nor specific pathology for rejection in the investigations. Acide resistant bacillus and tuberculose culture tests were negative. Open lung biopsy was planned because the materials were not diagnostic and clinical progression was developed. Right minitoracotomy and lung wedge resection were performed. Pathological examination revealed a diffuse panbronchiolitis characterized by peribronchiolar CD3, CD20 positive lymphocyte infiltration and CD138, kappa and lambda positive plasma cell infiltration whereas bacillus, fungi and amyloid were not detected. Intravenous pulse steroid treatment was started due to clinical and histopathological findings. Clinico-radiological improvement was observed and the patient was discharged with healing. Pulmonary function test performed the outpatient control of her showed 30% increase in FEV1 and 20% increase in FVC. Conclusion: Acute rejection presented as a panbronchiolitis is not a common condition in lung transplantation. In patients with clinical and radiological deterioration after transplantation, rejection should be kept in mind and if necessary, diagnostic interventions reaching to surgical lung biopsy should be performed quickly.
"Approximately 1 million prostate biopsies are performed each year in the United States. This procedure has traditionally been performed using a transrectal approach, which is associated with a ...significant risk of infectious complications including sepsis. In recent years, transperineal prostate biopsy has been increasingly adopted due to its lower associated infectious risk. In this review, we explore the benefits of the transperineal approach for performing prostate biopsy and detail technical advancements that have allowed for this procedure to now be routinely performed in the outpatient settings under local anesthesia."
Background
While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be ...catastrophic for the patient.
Purpose
To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB.
Material and Methods
We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018.
Results
Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure.
Conclusion
A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.
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