Percutaneous ultrasound-guided coaxial core needle biopsy for the diagnosis of multiple splenic lesions: A case report

BACKGROUND The overlap of imaging manifestations among distinct splenic lesions gives rise to a diagnostic dilemma.Consequently,a definitive diagnosis primarily relies on his-tological results.The ultrasound(US)-guided coaxial core needle biopsy(CNB)not only procures sufficient tissue to help clarify the diagnosis,but reduces the incidence of puncture-related complications.CASE SUMMARY A 41-year-old female,with a history of pulmonary tuberculosis,was admitted to our hospital with multiple indeterminate splenic lesions.Gray-scale ultrasono-graphy demonstrated splenomegaly with numerous well-defined hypoechoic ma-sses.Abdominal contrast-enhanced computed tomography(CT)showed an en-larged spleen with multiple irregular-shaped,peripherally enhancing,hypodense lesions.Positron emission CT revealed numerous abnormal hyperglycemia foci.These imaging findings strongly indicated the possibility of infectious disease as the primary concern,with neoplastic lesions requiring exclusion.To obtain the precise pathological diagnosis,the US-guided coaxial CNB of the spleen was ca-rried out.The patient did not express any discomfort during the procedure.CONCLUSION Percutaneous US-guided coaxial CNB is an excellent and safe option for obtaining precise splenic tissue samples,as it significantly enhances sample yield for exact pathological analysis with minimum trauma to the spleen parenchyma and sur-rounding tissue.

Core needle biopsy for thyroid nodules assessment-a new horizon?

Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings.Nevertheless,this diagnostic method traditionally has its weak points.Several diagnostic categories such as BethesdaⅠ,ⅢandⅣare not reliable for thyroid carcinoma risk assessment.Recent advancements in a core needle biopsy made it possible to use this tool as a new method for thyroid nodules evaluation.The main feature of this method is the use of thin needles(18-21G)and guns with an automatic trigger mechanism.The histological material collected with the use of a core needle biopsy is usually superior to cytological.Therefore,the core needle biopsy can be used as a complementary technique to a standard fine needle aspiration in difficult and dubious cases of thyroid neoplasia with uncertain malignant potential.

Phase II Clinical Study of Three-Dimensional Printed Coplanar Template Combined with CT-Guided Percutaneous Core Needle Biopsy of Pulmonary Nodules in Elderly Patients

Background: As the population age structure gradually ages, more and more elderly people were found to have pulmonary nodules during physical examinations. Most elderly people had underlying diseases such as heart, lung, brain and blood vessels and cannot tolerate surgery. Computed tomography (CT)-guided percutaneous core needle biopsy (CNB) was the first choice for pathological diagnosis and subsequent targeted drugs, immune drugs or ablation treatment. CT-guided percutaneous CNB requires clinicians with rich CNB experience to ensure high CNB accuracy, but it was easy to cause complications such as pneumothorax and hemorrhage. Three-dimensional (3D) printing coplanar template (PCT) combined with CT-guided percutaneous pulmonary CNB biopsy has been used in clinical practice, but there was no prospective, randomized controlled study. Methods: Elderly patients with lung nodules admitted to the Department of Oncology of our hospital from January 2019 to January 2023 were selected. A total of 225 elderly patients were screened, and 30 patients were included after screening. They were randomly divided into experimental group (Group A: 30 cases) and control group (Group B: 30 cases). Group A was given 3D-PCT combined with CT-guided percutaneous pulmonary CNB biopsy, Group B underwent CT-guided percutaneous pulmonary CNB. The primary outcome measure of this study was the accuracy of diagnostic CNB, and the secondary outcome measures were CNB time, number of CNB needles, number of pathological tissues and complications. Results: The diagnostic accuracy of group A and group B was 96.67% and 76.67%, respectively (P = 0.026). There were statistical differences between group A and group B in average CNB time (P = 0.001), number of CNB (1 vs more than 1, P = 0.029), and pathological tissue obtained by CNB (3 vs 1, P = 0.040). There was no statistical difference in the incidence of pneumothorax and hemorrhage between the two groups (P > 0.05). Conclusions: 3D-PCT combined with CT-guided percutaneous CNB can improve the puncture accuracy of elderly patients, shorten the puncture time, reduce the number of punctures, and increase the amount of puncture pathological tissue, without increasing pneumothorax and hemorrhage complications. We look forward to verifying this in a phase III randomized controlled clinical study. .

Indications for Renal Needle Biopsy and Histological Spectrum of Kidney Disease in Togo

Introduction: The frequent late-stage diagnosis of chronic kidney disease (CKD) constrains the treatment choices for nephrologists. Renal biopsy (RB) is crucial for accurately identifying renal lesions. This key nephrological procedure, however, is invasive and not without potential complications. The purpose of this study was to evaluate the indications, frequency, and histological lesion profiles of renal biopsies in Togo. Materials and Methods: We conducted a descriptive cross-sectional study encompassing all renal biopsies performed in Togo from the inception of nephrology services to the present. Data were compiled from the medical records of the patients. Results: From 2015 to 2023, 68 high-quality renal biopsies were executed in Togo. The patients had an average age of 30.6 years, with a predominance of males (69.1%). The most common indication was nephrotic syndrome, accounting for 66.2% of cases. Histologically, glomerulopathies were predominant, representing 61.8% of lesions, followed by vascular nephropathies (25%) and tubulointerstitial nephropathies (13.2%). The most frequently observed primary glomerulopathy was focal segmental glomerulosclerosis (FSGS). Gross hematuria was the sole complication, occurring in 1.4% of the cases. Conclusion: RB is an evolving practice in Togo. Glomerulopathies are the most commonly observed lesions. The histological categorization of renal lesions is vital for clinicians in their diagnostic reasoning and approach.

The efficacy and safety of endoscopic ultrasound-guided fine-needle biopsy in gallbladder masses

Background: Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB) is a widely used modality for acquiring various target samples, but its efficacy in gallbladder masses is unknown. The aim of this retrospective study was to evaluate the efficacy and safety of EUS-FNB in patients with gallbladder masses. Methods: The study samples were composed of patients from March 2015 to July 2019 who needed to identify the nature of gallbladder masses through EUS-FNB. The outcomes of this study were the adequacy of specimens, diagnostic yields, technical feasibility, and adverse events of the EUS-FNB in gallbladder masses. Results: A total of 27 consecutive patients with a median age of 58 years were included in this study. The 22-gauge FNB needle was feasible in all lesions. The median follow-up period of the patients was 294 days. The specimens sufficient for diagnosis account for 89%(24/27) and 93%(25/27) in cytology and histology, respectively. The overall diagnostic yields for malignancy showed the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.45% [95% confidence interval(CI): 75.12%-99.76%], 100%(95% CI: 46.29%-10 0%), 10 0%(95% CI: 80.76%-100%), 83.33%(95% CI: 36.48%-99.12%), and 96.30%(95% CI: 80.20%-99.99%), respectively. The subgroup analysis revealed that FNB could obtain sufficient specimens and high diagnostic yields in both gallbladder mass < 20.5 mm group and ≥20.5 mm group. One patient experienced mild abdominal pain after the procedure and recovered within one day. Conclusions: EUS-FNB is a reasonable diagnostic tool for the pretreatment diagnosis of patients with gallbladder masses, especially for patients who may miss the opportunity of surgery and need sufficient specimens to identify the pathological type so as to determine chemotherapy regimens. Further largescale studies are needed to confirm our conclusion.

Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy:Don't miss the tuberculosis

Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis.Recently,macroscopic on-site evaluation(MOSE)performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB.The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB.Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms.Therefore,this challenging diagnosis is based on endoscopy,imaging,and the bacteriological and histological examination of tissue biopsies.This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer.EUS-FNB can be very useful in providing a valuable histopathological diagnosis.A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis,leading to the request of the GeneXpert,which can detect Mycobacterium tuberculosis deoxyribonucleic acid and resistance to rifampicin.A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.

Is sentinel lymph node biopsy necessary for the patients diagnosed with breast ductal carcinoma in situ using core needle biopsy or vacuum-assisted biopsy as the initial diagnostic method？

Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ （DCIS）. The purpose of this study was to investigate whether sentinel lymph node biopsy （SLNB） should be performed in patients with an initial diagnosis of DCIS. Methods： A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results： Eighty-two patients （66.1%） had pure DCIS and 25 （20.2%） had DCIS with microinvasion （DCISM）, 17 （13.7%） updated to invasive breast cancer （IBC）. 115 patients （92.7%） underwent SLNB, among them, 70 patients （56.5%） underwent axillary node dissection. 3 of 115 patients （2.6%） had a positive sentinel lymph node, only 1 （1.4%） of 70 patients had axillary lymph node metastasis, in 84 patients （66.7%） who were diagnosed DCIS by core needle biopsy （CNB） and vacuum-assisted biopsy （VAB）. 26 patients （31.0%） were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion： The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients.

Endoscopic ultrasound fine needle aspiration vs fine needle biopsy for pancreatic masses,subepithelial lesions,and lymph nodes

Endoscopic ultrasound tissue acquisition,in the form of both fine needle aspiration(EUS-FNA)and fine needle biopsy(EUS-FNB),is utilized for pancreatic mass lesions,subepithelial lesions,and lymph node biopsy.Both procedures are safe and yield high diagnostic value.Despite its high diagnostic yield,EUS-FNA has potential limitations associated with cytological aspirations,including inability to determine histologic architecture,and a small quantitative sample for further immunohistochemical staining.EUS-FNB,with its larger core biopsy needle,was designed to overcome these potential limitations.However,it remains unclear which technique should be used and for which lesions.Comparative trials are plagued by heterogeneity at every stage of comparison;including variable needles used,and different definitions of endpoints,which therefore limit generalizability.Thus,we present a review of prospective trials,systematic reviews,and meta-analyses on studies examining EUS-FNA vs EUSFNB.Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions,and yield conflicting results in terms of demonstrating the superiority of one method.However,consistent among trials is the potential for diagnosis with fewer passes,and a larger quantity of sample achieved for next generation sequencing.With regard to subepithelial lesions and lymph node biopsy,fewer prospective trials exist,and larger prospective studies are necessary.Based on the available literature,we would recommend EUS-FNB for peri-hepatic lymph nodes.

Improved diagnostic yield of endoscopic ultrasound-fine needle biopsy with histology specimen processing

BACKGROUND Endoscopic ultrasound-guided fine needle biopsy(EUS-FNB)has emerged as a safe,efficacious alternative to fine needle aspiration(FNA)for tissue acquisition.EUS-FNB is reported to have higher diagnostic yield while preserving specimen tissue architecture.However,data on the optimal method of EUS-FNB specimen processing is limited.AIM To evaluate EUS-FNB with specimen processing as histology vs EUS-FNA cytology with regards to diagnostic yield and specimen adequacy.METHODS All EUS-FNA and EUS-FNB performed at our institution from July 1,2016,to January 31,2018,were retrospectively analyzed.We collected data on demographics,EUS findings,pathology,clinical outcomes,and procedural complications in two periods,July 2016 through March 2017,and April 2017 through January 2018,with predominant use of FNB in the second data collection time period.FNA specimens were processed as cytology with cell block technique and reviewed by a cytopathologist;FNB specimens were fixed in formalin,processed for histopathologic analysis and immunohistochemical staining,and reviewed by an anatomic pathologist.Final diagnosis was based on surgical pathology when available,repeat biopsy or imaging,and length of clinical follow up.RESULTS One hundred six EUS-FNA and EUS-FNB procedures were performed.FNA alone was performed in 17 patients;in 56 patients,FNB alone was done;and in 33 patients,both FNA and FNB were performed.For all indications,diagnostic yield was 47.1%(8/17)in FNA alone cases,85.7%(48/56)in FNB alone cases,and 84.8%(28/33)in cases where both FNA and FNB were performed(P=0.0039).Specimens were adequate for pathologic evaluation in 52.9%(9/17)of FNA alone cases,in 89.3%(50/56)of FNB alone cases,and 84.8%(28/33)in cases where FNA with FNB were performed(P=0.0049).Tissue could not be aspirated for cytology in 10.0%(5/50)of cases where FNA was done,while in 3.4%(3/89)of FNB cases,tissue could not be obtained for histology.In patients who underwent FNA with FNB,there was a statistically significant difference in both specimen adequacy(P=0.0455)and diagnostic yield(P=0.0455)between the FNA and FNB specimens(processed correspondingly as cytology or histology).CONCLUSION EUS-FNB has a higher diagnostic yield and specimen adequacy than EUS-FNA.In our experience,specimen processing as histology may have contributed to the overall increased diagnostic yield of EUS-FNB.

Needle tract seeding of papillary thyroid carcinoma after fine-needle capillary biopsy:A case report

BACKGROUND Fine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules.It includes two primary methods:Fine-needle capillary biopsy(FNCB)and fine-needle aspiration biopsy.Needle tract seeding(NTS)is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB.Here,we present an extremely rare case of a papillary thyroid carcinoma(PTC)patient with FNCB-derived NTS.CASE SUMMARY We report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy.NTS was diagnosed based on clinical manifestations,biochemistry indices,and imaging(computed tomography and ultrasound).Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis.Surgical resection was the main method used to treat the disease.After surgery,thyroid function tests and ultrasound scans were performed every 3-6 mo.To date,no evidence of tumor recurrence has been observed.CONCLUSION FNCB is a safe procedure as NTS is rare,and can be easily removed surgically with no recurrence.Accordingly,NTS should not limit the usefulness of FNCB.

Late recurrence of papillary thyroid cancer from needle tract implantation after core needle biopsy: A case report

BACKGROUND Papillary thyroid cancer(PTC)has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up.In this study,we report recurrence of PTC in subcutaneous area combined with lymph node metastasis.A suspicion of needle tract implantation after core needle biopsy was found.CASE SUMMARY A 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area.The location of the palpable nodule was not associated with her postoperative scar.After excision of the skin tumor,it was diagnosed as recurrence of PTC.Furthermore,results of subsequent imaging showed lymph node metastasis on her right cervical area.According to the previous medical records,the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure.The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years.As treatment,the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment.CONCLUSION Needle tract implantation can occur after core needle biopsy.Further studies are needed to compare core-needle biopsy and fine-needle aspiration.

Endoscopic ultrasound fine needle aspiration vs fine needle biopsy in solid lesions:A multi-center analysis

BACKGROUND While endoscopic ultrasound(EUS)-guided fine needle aspiration(FNA)is considered a preferred technique for tissue sampling for solid lesions,fine needle biopsy(FNB)has recently been developed.AIM To compare the accuracy of FNB vs FNA in determining the diagnosis of solid lesions.METHODS A retrospective,multi-center study of EUS-guided tissue sampling using FNA vs FNB needles.Measured outcomes included diagnostic test characteristics(i.e.,sensitivity,specificity,accuracy),use of rapid on-site evaluation(ROSE),and adverse events.Subgroup analyses were performed by type of lesion and diagnostic yield with or without ROSE.A multivariable logistic regression was also performed.RESULTS A total of 1168 patients with solid lesions(n=468 FNA;n=700 FNB)underwent EUS-guided sampling.Mean age was 65.02±12.13 years.Overall,sensitivity,specificity and accuracy were superior for FNB vs FNA(84.70%vs 74.53%;99.29%vs 96.62%;and 87.62%vs 81.55%,respectively;P<0.001).On subgroup analyses,sensitivity,specificity,and accuracy of FNB alone were similar to FNA+ROSE[(81.66%vs 86.45%;P=0.142),(100%vs 100%;P=1.00)and(88.40%vs 85.43%;P=0.320].There were no difference in diagnostic yield of FNB alone vs FNB+ROSE(P>0.05).Multivariate analysis showed no significant predictor for better accuracy.On subgroup analyses,FNB was superior to FNA for non-pancreatic lesions;however,there was no difference between the techniques among pancreatic lesions.One adverse event was reported in each group.CONCLUSION FNB is superior to FNA with equivalent diagnostic test characteristics compared to FNA+ROSE in the diagnosis of non-pancreatic solid lesions.Our results suggest that EUS-FNB may eliminate the need of ROSE and should be employed as a first-line method in the diagnosis of solid lesions.

Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 11-gauge vacuum-assisted biopsy

Objective： The objective of this study was to compare the underestimation rate of invasive carcinoma cases with ductal carcinoma in situ （DCIS） at percutaneous ultrasound-guided core biopsies of breast lesions between 14-gauge automated core needle biopsy （ACNB） and 11-gauge vacuum-assisted biopsy （VAB）, and analyze the diagnostic advantages and insufficiencies in DCIS between this two methods, and to determine the relationship between the lesion type （masses or microcalcifications on radiological findings ） and DCIS underestimation rate. Methods： We collected 152 breast lesions which were diagnosed as DCIS by retrospectively reviewing data about ultrasound-guided biopsies of breast lesions （from February 2003 to July 2010）. There were 98 lesions in 95 patients by 14-gauge ACNB, and 54 lesions in 52 patients by 11-gauge VAB （The system used in this study called Mammatome, MMT）. The clinical and radiological findings were reviewed; meanwhile all the selected patients had histological results of the biopsies and follow-up surgeries which also achieved the reliable pathological results to compare with the biopsy results. The differences between two correlated histological results defined as underestimation, and the histological DCIS underestimation rates were compared between the two groups. According to the radiological characteristics, each group was classified into two subgroups （masses or micrecalcifications group）, and the differences between subgroups were also analyzed. Results： The DCIS underestimation rate was 45.9% （45/98） for 14-gauge ACNB and 16.6% （9/54） for MMT. According to the lesion type on ultrasonography, DCIS underestimation was 31.0% （26/84） in masses （43.1% using ACNB and 12.1% using MMT; P = 0.003） and 42.6% （29/68） in microcalcifications （48.9% using ACNB and 23,8% using MMT; P = 0,036）, Conclusion： The underestimation rate of invasive carcinoma in cases with DCIS at ultrasound-guided core biopsies is significantly higher for ACNB than for MMT. Furthermore, this difference does not alter among the two lesion types presented on ultrasonography. So ultrasound-guided VAB （MMT system） could be an effective and useful method for the diagnosis of DCIS lesions no matter what the lesion type is.

Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology?——A meta-analysis and systematic review

AIM To compare the accuracy of endoscopic ultra-sonography(EUS) 19 G core biopsies and 22 G core biopsies in diagnosing the correct etiology for a solid mass.METHODS Articles were searched in Medline, Pub Med, and Ovid journals. Pooling was conducted by both fixed and random effects models. RESULTS Initial search identified 4460 reference articles for 19 G and 22 G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G(n = 289) and 16 studies for 22G(n = 592) which met the inclusion criteria. EUS 19 G core biopsies had a pooled sensitivity of 91.6%(95%CI: 87.1-95.0) and pooled specificity of 95.9%(95%CI: 88.6-99.2), whereas EUS 22 G had a pooled sensitivity of 83.3%(95%CI: 79.7-86.6) and pooled specificity of 64.3%(95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19 G core biopsies was 9.08(95%CI: 1.12-73.66) and EUS 22 G core biopsies was 1.99(95%CI: 1.09-3.66).The negative likelihood ratio of EUS 19 G core biopsies was 0.12(95%CI: 0.07-0.24) and EUS 22 G core biopsies was 0.25(95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74(95%CI: 18.31-392.26) for 19 G core biopsies and 10.55(95% CI: 3.29-33.87) for 22 G needles. CONCLUSION EUS 19 G core biopsies have an excellent diagnostic value and seem to be better than EUS 22 G biopsies in detecting the correct etiology for a solid mass.

Ultrasound-guided fine needle biopsy of intra- hepatic nodules and low elevation of AFP in early diagnosis of hepatocellular carcinoma

BACKGROUND: With the progress in early clinical treat- ment of hepatocellular carcinoma (HCC), early detection and diagnosis of HCC have been increasingly pressing. Combined alpha-fetoprotein ( AFP) determination and ul- trasonography has become the main method for the detec- tion of small HCC; but the relationship between low eleva- tion of AFP and pathologic findings of small HCC has not been well defined. The aim of this study was to assess the value of ultrasound-guided fine needle biopsy of intrahe- patic nodules and low elevation of serum AFP in the early diagnosis of HCC. METHODS; Fifty-nine patients with serum AFP exceeding 20 ng/ml and intrahepatic nodules varying from 0.8 cm to 5.0 cm in diameter who had been detected by ultrasonogra- phy underwent ultrasound-guided percutaneous fine needle biopsy, and cytological staining and histological sectioning were performed at the same time. RESULTS: Among the 59 patients, 11 patients (18.6%) showed AFP level above 400 ng/ml, 5 (8. 5%) from 200 ng/ml to 400 ng/ml, 18 (30. 5%) from 50 ng/ml to 200 ng/ml and 25 (42. 4% ) from 20 ng/ml to 50 ng/ml. Fol- low-up demonstrated that 53 patients (89.8%) had a pro- gressive increase of AFP level. In 58 patients (98.3%) cancer cells were found by cytological staining and/or his- tological sectioning. CONCLUSIONS: In those patients with slightly increased or continuously positive AFP, hepatic carcinoma should be highly suspected when AFP increases gradually and intrahe- patic nodules are detected by ultrasonography in follow-up. Once intrahepatic carcinoma nodules are suspected, ultra- sound-guided fine needle biopsy should be performed as early as possible for early diagnosis and treatment.

Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy

Objective: Patients preoperatively diagnosed with ductal carcinoma in situ(DCIS) by core needle biopsy(CNB) exhibit a significant risk for upstaging on final pathology, which leads to major concerns of whether axillary staging is required at the primary operation. The present study aimed to identify clinicopathological factors associated with upstaging in patients preoperatively diagnosed with DCIS by CNB.Methods: The present study enrolled 604 patients(cN0 M0) with a preoperative diagnosis of pure DCIS by CNB, who underwent axillary staging between August 2006 and December 2015, at Fudan University Shanghai Cancer Center(Shanghai, China).Predictive factors of upstaging were analyzed retrospectively.Results: Of the 604 patients, 20.03%(n = 121) and 31.95%(n = 193) were upstaged to DCIS with microinvasion(DCISM) and invasive breast cancer(IBC) on final pathology, respectively. Larger tumor size on ultrasonography(> 2 cm) was independently associated with upstaging [odds ratio(OR) 1.558, P = 0.014]. Additionally, patients in lower breast imaging reporting and data system(BI-RADS) categories were less likely to be upstaged(4 B vs. 5: OR 0.435, P = 0.002;4 C vs. 5: OR 0.502, P = 0.001). Overall,axillary metastasis occurred in 6.79%(n = 41) of patients. Among patients with axillary metastasis, 1.38%(4/290), 3.31%(4/121)and 17.10%(33/193) were in the DCIS, DCISM, and IBC groups, respectively.Conclusions: For patients initially diagnosed with DCIS by CNB, larger tumor size on ultrasonography(> 2 cm) and higher BIRADS category were independent predictive factors of upstaging on final pathology. Thus, axillary staging in patients with smaller tumor sizes and lower BI-RADS category may be omitted, with little downstream risk for upstaging.

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM： To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound （EUS）-guided fine needle aspiration （FNA） material in the differential diagnosis of pancreatic solid masses. METHODS： Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs （22G needle） were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Haterials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS： Length of the core specimen obtained for histological analysis was 6.5±5.3 mm （range 1-22 mm）. Cytological and histological samples were considered as adequate in 51 （82.3%） and 52 cases （83.9%）, respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Conbary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases （90.3%）, with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION： Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.

Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy？ A prospective, randomized trial

Transperineal prostate biopsy is a procedure that can be used to obtain histological samples from the prostate. To improve both the quality of the biopsy core samples and prostate cancer detection, we are currently performing a prospective, randomized trial comparing prostate biopsy samples obtained using an 18 G-needle to those obtained using a 16 G-needle. The aim of this preliminary study was to evaluate pain and complication rates in both groups in order to assess whether performing a prostate biopsy with a larger calibre needle is a feasible procedure. One hundred and eighty-seven patients undergoing transperineal prostate biopsy were prospectively evaluated and divided into two groups. The first group （94 patients, Group A） received a transperineal prostate biopsy using a 16 G-needle and the second group （93 patients, Group B） underwent transperineal prostate biopsy with an 18 G-needle. Anaesthesia was obtained with a single perineal injection at the prostatic apex in all subjects. A visual analogue scale （VAS） and facial expression scale （FES） were used to assess pain during multiple steps of the procedure in each group. A detailed questionnaire was used to obtain information about drug use because it could potentially influence the pain and complications that patients experienced. Two weeks after the procedure, early and late complications were evaluated. Statistical analysis was carried out using non-parametric tests. Prostate Specific Antigen （PSA） and drug use were similar at baseline between the two groups. Pain during prostate biopsy, which was measured with both the VAS and FES instruments, did not differ significantly between the 18- and 16 G-needle groups, and no significant differences were found in early or late complication rates between the groups. Transperineal prostate biopsy with a 16 G-needle is a feasible Further studies with larger patient populations are required to prostate cancer detection rates. procedure in terms of pain and complication rates. assess whether or not this procedure can improve

Diagnostic utility of endoscopic ultrasound-guided fineneedle aspiration biopsy for glomus tumor of the stomach

A 52-year-old man was referred for further investigation of a gastric submucosal tumor on the greater curvature of the antrum. Endoscopic ultrasonography demonstrated a hypoechoic solid mass, which was primarily connected to the muscular layer of the stomach. We performed endoscopic ultrasoundguided fine-needle aspiration biopsy. The pathological examination showed proliferation of oval-shaped cells with nest formation, which stained strongly positive for muscle actin, and negative for c-kit, CD34, CD56,desmin, S-100, chromogranin, and neuron-specific enolase. Therefore, we performed laparoscopy and endoscopy cooperative surgery based on the preoperative diagnosis of glomus tumor of the stomach. The final histological diagnosis confirmed the preoperative diagnosis. Although preoperative diagnosis of glomus tumor of the stomach is difficult with conventional images and endoscopic biopsy, endoscopic ultrasoundguided fine-needle aspiration biopsy is an essential tool to gain histological evidence of glomus tumor of the stomach for early diagnosis.

Histopathological characteristics of needle core biopsy and surgical specimens from patients with solitary hepatocellular carcinoma or intrahepatic cholangiocarcinoma

BACKGROUND Pathological manifestations of hepatic tumours are often associated with prognosis. Although surgical specimens(SS) can provide more information,currently, pre-treatment needle core biopsy(NCB) is increasingly showing important value in understanding the nature of liver tumors and even in diagnosis and treatment decisions. However, the concordance of the clinicopathological characteristics and immunohistochemical(IHC) staining between NCB and SS from patients with hepatic tumours were less concerned.AIM To introduce a more accurate method for interpreting the IHC staining results in order to improve the diagnostic value of hepatic malignancy in NCB samples.METHOD A total of 208 patients who underwent both preoperative NCB and surgical resection for hepatocellular carcinoma(HCC) or intrahepatic cholangiocarcinomaRESULTS Morphologically, the presence of compact tumour nests or a cord-like structure in NCB was considered the primary cause of misdiagnosis of HCC from ICC. The kappa statistic showed a moderate agreement in histomorphology(k = 0.504) and histological grade(k = 0.488) between NCB and SS of the tumours. A 4-tier(+++,++, +, and-) scoring scheme that emphasized the focal neoplastic cell immunoreactivity of tumour cells revealed perfect concordance of CK19, GPC3 and HepPar1 between NCB and SS(k = 0.717; k = 0.768; k = 0.633). Furthermore,with the aid of a binary classification derived from the 4-tier score, a high concordance was achieved in interpreting the IHC staining of the three markers between NCB and final SS(k = 0.931; k = 0.907; k = 0.803), increasing the accuracy of NCB diagnosis C(k = 0.987; area under the curve = 0.997, 95%CI: 0.990-1.000; P< 0.001).CONCLUSION These findings imply that reasonable interpretation of IHC results in NCB is vital for improving the accuracy of tumour diagnosis. The simplified binary classification provides an easy and applicable approach.