Retrospective analysis of discordant results between histology and other clinical diagnostic tests on helicobacter pylori infection

BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.

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.

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.

Liver histological changes in untreated chronic hepatitis B patients in indeterminate phase

BACKGROUND Studies with large size samples on the liver histological changes of indeterminate phase chronic hepatitis B(CHB)patients were not previously conducted.AIM To assess the liver histological changes in the indeterminate phase CHB patients using liver biopsy.METHODS The clinical and laboratory data of 1532 untreated CHB patients were collected,and all patients had least once liver biopsy from January 2015 to December 2021.The significant differences among different phases of CHB infection were compared with t-test,and the risk factors of significant liver histological changes were analyzed by the multivariate logistic regression analysis.RESULTS Among 1532 untreated CHB patients,814(53.13%)patients were in the indeterminate phase.Significant liver histological changes(defined as biopsy score≥G2 and/or≥S2)were found in 488/814(59.95%)CHB patients in the indete-rminate phase.Significant liver histological changes were significant differences among different age,platelets(PLTs),and alanine aminotransferase(ALT)subgroup in indeterminate patient.Multivariate logistic regression analysis indicated that age≥40 years old[adjust odd risk(aOR),1.44;95%confidence interval(CI):1.06-1.97;P=0.02],PLTs≤150×10^(9)/L(aOR,2.99;95%CI:1.85-4.83;P<0.0001),and ALT≥upper limits of normal(aOR,1.48;95%CI:1.08,2.05,P=0.0163)were independent risk factors for significant liver histological changes in CHB patients in the indeterminate phase.CONCLUSION Our results suggested that significant liver histological changes were not rare among the untreated CHB patients in indeterminate phase,and additional strategies are urgently required for the management of these patients.

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.

Endoscopic ultrasound-fine needle biopsies of pancreatic lesions: Prospective study of histology quality using Franseen needle

BACKGROUND The introduction of fine needle biopsies(FNB)to clinical practice presents a changing trend towards histology in the endoscopic ultrasound-guided tissue acquisition(EUS-TA).AIM To evaluate the clinical performance of a new FNB needle,the 22-gauge(22G)Franseen needle,when sampling pancreatic solid lesions.METHODS Consecutive patients with an indication for EUS-TA for the assessment of pancreatic solid lesions were included in this prospective,single-center,singlearm trial.Each patient underwent a puncture of the lesion two times using the 22G Franseen needle and the obtained samples were directly placed into formalin for histological analysis.The primary study endpoint was the rate of high-quality obtained specimen.Secondary endpoints included the length and diameter of the core specimen,the diagnostic accuracy and the complication rate.RESULTS From June 2017 to December 2018,forty patients with pancreatic solid lesions(22 females;mean age 67.2 years)were enrolled.Tissue acquisition was achieved in all cases.High-quality histology,rated with Payne score 3,was obtained in 37/40 cases(92.5%)after two needle passes.The mean size of the acquired histological core tissue was 1.54 mm×0.39 mm.The diagnostic accuracy for the correct diagnosis was 85%(34/40).Only one adverse event was occurred,consisting of a self-limiting bleeding in the puncture site.CONCLUSION The 22G Franseen needle achieved according to our standardized protocol a high rate of histological core procurement,and a high diagnostic accuracy,with one minor adverse event reported.

Liver histology in ICU patients dying from sepsis:A clinico-pathological study

AIM:To determine end-stage pathologic changes in the liver of septic patients dying in the intensive care unit. METHODS: Needle liver biopsies obtained immediately after death from 15 consecutive patients with sepsis and no underlying liver disease were subjected to routine histological examination. Liver function tests and clinical monitoring measurements were also recorded. RESULTS: Liver biochemistries were increased in the majority of patients before death. Histology of liver bi- opsy specimens showed portal inflammation in 73.3%, centrilobular necrosis in 80%, lobular inflammation in 66.7%, hepatocellular apoptosis in 66.6% and cholan- gitis/cholangiolitis in 20% of patients. Mixed hepatitic/ cholestatic type of liver injury was observed in 6/15 (40%) patients and hepatitc in 9/15 (60%). Steatosis was ob- served in 11/15 (73.3%) patients affecting 5%-80% of liver parenchyma. Among the histological features, the presence of portal inflammation in liver biopsy was as- sociated with increased hospitalization in the ICU prior death (P = 0.026). CONCLUSION: Features of hepatitis and steatosis arethe main histological findings in the liver in the majority of patients dying from sepsis.

Usefulness of a scoring system in the interpretation of histology in neonatal cholestasis

AIM:To ascertain the usefulness of a histological scoring system devised to assist in the interpretation of liver histology in neonatal cholestasis(NC) .METHODS:Liver biopsy specimens obtained from infants with NC referred to a tertiary pediatric unit in Malaysia were prospectively studied.The first author,blinded to the final diagnosis,devised the histological diagnosis based on a 7-feature(portal ductal proliferation,bile plugs in portal ductules,portoportal bridging,lymphocytic infiltration in portal region,multinucleated hepatocytes,neutrophilic infiltration,hepatocellular swelling) ,15-point(0 to 15) scoring system.The author classified the histological diagnosis as either biliary atresia(BA) or neonatal hepatitis(NH,all other diagnoses) ,and subsequently compared the author's diagnosis with the final diagnosis.RESULTS:Eighty-four biopsy specimens obtained from 78 patients were reviewed.Without the scoring system,BA was correctly diagnosed by the author histologically in 30 cases,labelled as NH in 3.For other diagnoses,BA was excluded correctly in 33 cases and mislabeled as BA in 2 cases.The overall sensitivity for BA was 91%,specificity 86% and accuracy 88%.With the scoring system,a score of ≥ 7 had the best diagnostic utility to differentiate BA from other intrahepatic cholestasis histologically(sensitivity 88%,specificity 94%,accuracy 92%) .Four patients with a score < 7 had BA,and 3 patients with a score ≥ 7 had NH.CONCLUSION:A 7-feature,15-point histological scoring system had good diagnostic accuracy in the interpretation of liver histology in neonatal cholestasis.

Discrepancies in the histologic type between biopsy and resected specimens:A cautionary note for mixed-type gastric carcinoma

AIM: To evaluate discrepancies between biopsy and resected specimens using the Japanese Classification of Gastric Carcinoma(JCGC) and tumor-node-metastasis(TNM) classification.METHODS: A total of 376 consecutive paired samples from biopsy and resected gastric specimens, which were derived from curative gastrectomy for gastric cancer between 2008 and 2011, were retrospectively analyzed.RESULTS:(1) Discrepancies in the histologic type were observed between biopsy and resected specimens; 11.7%(44/376) in the JCGC and 18.1%(68/376) in TNM. In specimens diagnosed as the differentiated type from biopsy specimens, 14.4%(28/195) in the JCGC and 41.1%(67/163) in TNM were finally diagnosed as the undifferentiated type from resected specimens; and(2) the incidence of mixed-type gastric cancer was significantly higher in specimens with discrepancies than in those without in both the JCGC and TNM(both P < 0.0001); 93.2%(41/44) of specimens with discrepancies in the JCGC and 97.1%(66/68) of specimens with discrepancies in TNM were mixed-type gastric cancers. CONCLUSION: Mixed-type gastric cancer was associated with a high incidence of histologic discrepancies between biopsy and resected specimens in both the JCGC and TNM definitions. Care should be taken in deciding treatments based on diagnosis of the histologic typefor mixed-type gastric cancer from biopsy specimens.

Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease

AIMTo determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD).METHODSEndoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children&#x02019;s Hospital from 2010-2012 were retrospectively reviewed.RESULTSClinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%.CONCLUSIONIn the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.

Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms:A retrospective study

To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODSPatients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm. RESULTSOne hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100. CONCLUSIONThe step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%.

Diagnostic Performance of glmM Gene and Histological Stains for Detection of Helicobacter pylori in Gastric Biopsy from Patients Admitted to Wad Madani Teaching Hospital, Sudan

Helicobacter pylori is the microbial agent most responsible for gastro-duodenal ulcer and chronic gastritis, which can develop into carcinoma of the stomach. This study was performed in Wad Medani Teaching Hospital, Sudan to detect Helicobacter pylori in stomach samples, and evaluate the performance of the tests used, which were histological stains and PCR. Gastric biopsies were obtained from 105 referred patients during endoscopy, and fixed specimens examined by haematoxylin-eosin and Warthin-Starry silver stains, while DNA was extracted for glmM gene amplification. Epigastric pain was the most common symptom at 78% (82/105) and chronic gastritis recorded with 71% (68/105) of endoscopy results. Warthin-Starry silver stain gave 31% (33/105) as positive for Helicobacter pylori followed by glmM gene 27% (28/105) and haematoxylin-eosin 24% (25/105). The study indicated good performance of histological staining and high specificity of glmM gene in detection of Helicobacter pylori from gastric biopsies.

Accuracy between clinical and radiological diagnoses compared to surgical orbital biopsies

AIM:To assess the concordance between diagnosing orbital lesions by clinical examination,orbital imaging,and histological evaluation,in order to help guide future research and clinical practice.METHODS:A retrospective analysis was undertaken at a large regional tertiary referral centre of all surgical orbital biopsies performed over a 5-year period,from 1st January 2015 until 31st December 2019.Accuracy and concordance between clinical,radiological and histological diagnoses are reported as percentage sensitivity and positive predictive value.RESULTS:A total of 128 operations involving 111 patients were identified.Overall,sensitivities of 47.7%for clinical and 37.3%for radiological diagnoses were found when compared to the histological gold standard.Vascular lesions that have characteristic clinical and radiological features had the highest sensitivity at 71.4%and 57.1%,respectively.Inflammatory conditions showed the lowest sensitivity in both clinical(30.3%)and radiological(18.2%)diagnoses.The PPV for inflammatory conditions were 47.6%for clinical and 30.0%for radiological diagnoses.CONCLUSION:Accurate diagnoses are difficult to reach by relying on clinical examination and imaging alone.Surgical orbital biopsy with histological diagnosis should remain the gold standard approach for definitively identifying orbital lesions.Although larger scale prospective studies would help further refine concordance and guide future research avenues.

超声引导下细胞学和组织学穿刺活检在乳腺癌腋窝淋巴结转移中的诊断价值

目的 研究超声引导下细针抽吸细胞学(FNA)、空芯针组织学穿刺活检术(CNB)在乳腺癌腋窝淋巴结转移中的诊断价值。方法 回顾性分析172例常规超声判断疑似腋窝淋巴结异常的乳腺癌患者,其中80例行FNA检测,另外92例行CNB检测,均以术后病理结果为金标准,评价FNA、CNB检测腋窝淋巴结转移的准确度、灵敏度、特异度以及并发症的发生率。结果 根据手术后病理结果,其中132例发生转移,40例未发生转移。相较于金标准,FNA检测的准确度、灵敏度、特异度分别为86.25%、85.71%、88.24%,CNB检测的准确度、灵敏度、特异度分别为95.65%、94.20%、100.00%,CNB检测的准确度明显高于FNA检测(P<0.05),CNB检测的灵敏度、特异度与FNA检测相比,差异无统计学意义(P>0.05);出血、疼痛、感染和气胸等穿刺并发症的发生率,CNB检测和FNA检测相比差异无统计学意义(P>0.05)。结论 FNA、CNB检测在诊断乳腺癌淋巴转移中具有很高的诊断价值,相较于FNA检测,CNB检测的准确度更高,且并发症发生率并无增高。

狼疮性肾炎中相关尿液生物标志物的研究进展

狼疮性肾炎(LN)是系统性红斑狼疮(SLE)累及肾脏所引起的一种免疫复合物型肾炎,是SLE诱发死亡及终末期肾脏病(ESKD)的主要原因之一。早期诊断、有效治疗、减少复发是延缓LN进入ESKD的重要手段。肾活检是确诊和判断LN分型及活动性的“金标准”,但属于有创性操作,不易重复。因此,尚需一些能早期正确监测肾脏受损程度、有效反映组织学分型、疾病活动性、判断疗效和预后的临床指标。本文就LN相关尿液生物标志物的研究进展进行综述,以期为LN的基础研究及临床治疗提供思路。

结直肠癌患者肠道内窥镜活检病理诊断的临床效果观察

目的 探讨结直肠癌患者肠道内窥镜活检病理诊断的结果。方法 选取福清市第二医院2021年12月—2022年12月就诊的结直肠癌患者50例,所有患者均开展肠道内窥镜活检,完成活检后将其与术后诊断结果进行对比,对结肠癌活检病理诊断的价值展开研究。结果 术后活检病理诊断结果与结肠癌活检病理诊断比较,差异无统计学意义(P>0.05)。是否存在黏膜下侵犯对比,肠道内窥镜活检率为76.00%,病理诊断率为80.00%,差异无统计学意义(P>0.05)。结论 结直肠癌患者行病理诊断可获得理想的诊断结果,有助于后续结直肠癌患者的治疗。肠道内窥镜活检无法对黏膜下是否侵犯精准判断,要想将临床诊断准确度显著提升,需与患者的具体状况相结合或联合其他检查手段对患者的病情予以明确,从而开展针对性治疗。

Safety and Efficacy of Frameless Stereotactic Brain Biopsy Techniques

Objective To explore the safety and efficacy of frameless stereotactic brain biopsy.Methods Diagnostic accuracy was calculated by comparing biopsy diagnosis with definitive pathology in 62 patients who underwent frameless stereotactic brain biopsy between January 2008 and December 2010 in Xiamen University Southeast Hospital.Preoperative characteristics and histological diagnosis were reviewed and then information was analysed to identify factors associated with the biopsy not yielding a diagnosis and complications.Results Diagnostic yield was 93.5%.No differences were found between pathological diagnosis and frozen pathological diagnosis.The most common lesions were astrocytic lesions,included 16 cases of low-grade glioma and 12 cases of malignant glioma.Remote hemorrhage,metastasis,and lymphoma were following in incidence.Multiple brain lesions were found in 17 cases (27.4%).Eleven cases were frontal lesions (17.7%),8 were frontotemporal (12.9%),6 were frontoparietal (9.7%),and 5 each were temporal,parietal,and parietotemporal lesions (8.1%).Postoperative complications occurred in 21.0% of the patients after biopsies,including 10 haemorrhages (16.1%) and 3 temporary neurological deficits (1 epilepsy,1 headache,and 1 partial hemiparesis).No patient required operation for hematoma evacuation.Conclusion Frameless stereotactic biopsy is an effective and safe technique for histologic diagnosis of brain lesions,particularly for multifocal and frontal lesions.

New Wireless Handheld Ultrasound-Guided Vacuum-Assisted Breast Biopsy (VABB) Devices: An Important Innovation in Breast Diagnosis

Vacuum-assisted breast biopsy (VABB) plays a fundamental role in the preoperative assessment of breast lesions pro- viding large histology samples that are useful to define diagnoses and biological parameters to guide treatment planning. This technique has been used in our institute since 2000 and two new wireless handheld ultrasound-guided VABB de- vices have been introduced since May 2012. In this report we analyze our experience with these revolutionary devices which are able to provide the option of single-insertion contiguous tissue samples respectively with a 13/14-gauge aperture. Our initial experience on 75 lesions shows that these devices are safe, fast, procedurally advantageous for operators and well accepted by patients. Finally VABB procedures can markedly reduce the need for surgical biopsy.

Testicular Fine Needle Aspiration Cytology versus Open Biopsy in the Evaluation of Azoospermic Men

Background: Male infertility is a common problem and needs a minimally invasive method to arrive at the appropriate diagnosis. Alternative to open testicular biopsy the fine needle aspiration cytology (FNAC) of the testis is being increasingly used?as a minimally invasive method of evaluating testicular function. Aim: To determine the causes of azoospermia and evaluate the efficacy of FNAC as compared to open testicular biopsy in evaluating azoosparmic men by correlating diagnosis from testis FNAC with biopsy histology. Patients and Methods: We prospectively studied 67 consecutive infertile patients who referred to andrology department of Al-Yarmouk Teaching hospital, Baghdad, Iraq between (January 2010-January 2014). All patients were azoospermic. They underwent bilateral testicular fine needle aspiration for cytological evaluation as well as bilateral testicular biopsy for histopathological correlation. Results: The morphological diagnosis revealed normal spermatogenesis in 12 patients (17.9%), hyposparmatogenesis in 4 (5.9%), spermatogenic arrest in 39 (58.2%), Sertoli cell only in 7 (10.4%), and complete tubular hyalinization in 5 patients (7.4%). Good correlation between the 2 methods was found in 120 (91.6%) testes which was identical in the right and left testis. Discrepancies between cytology and histology were mainly the result of insufficient and scanty smears. Conclusion: Testicular FNAC is a simple and minimally invasive alternative method to open testicular biopsy in the investigation and assessment of patients with azoospermia.

Ultrasound-Guided Core Needle Biopsy of Breast Lesions: Results and Usefulness in a Low Income Country

Background: Core needle biopsy (CNB) under ultrasound guidance is an accepted standard of care for the diagnosis of breast lesions. It is safe, cost-effective and minimally invasive compared with surgical excision. Objective: The aim of this study was to evaluate the CNB’s results regarding the procedure, complications, histopathological findings and their correlation with the imaging data and surgical histopathological findings. Method: A cross-sectional prospective and descriptive study of a consecutive series of ultrasound-guided CNB of breast lesions in women conduced from January 2015 to December 2016 at the Sylvanus Olympio university hospital of Lomé, in Togo. Results: There were 72 CNB performed under ultrasound guidance in women;from which 54 were retained for the study. The mean age was 44.9 years ± 9.8. 11.1% had a family history of breast cancer. Lesions were most often palpable (90.7%). They were located in the left breast in 54.7%. Lesions were categorized probably malignant or malignant (Birads 4 and 5) in 70.4% and probably benign (Birads 3) in 29.6%. Their mean size was 24.8 mm ± 7.6 at ultrasound. There were no major complications during the procedure. One CNB (1.9%) considered inconclusive was repeated. Histologically, invasive ductal carcinoma (61.1%) was the most common lesion. Fifty-three women underwent surgical procedure and histopathological confirmation. Ultrasound-guided CNB had a sensitivity of 97.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 92.8%, and an overall diagnostic accuracy of 98.1%. Breast Imaging Reporting and Data System (Birads) categorization had a sensitivity of 94.8%, specificity of 100%, positive predictive value of 100%, negative predictive value of 87.4%, and diagnostic accuracy of 96.2%. Conclusion: Ultrasound guided CNB represent accurate methods for the characterization of breast lesions, with high values of diagnostic accuracy, sensitivity, specificity and negative predictive value. It does not involve a major complication, even in tropical environments.