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.

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.

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.

Staging the axilla in women with breast cancer: the utility of preoperative ultrasound-guided needle biopsy

Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly specific staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection(ALND) avoiding potentially unnecessary sentinel node biopsy(SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases(simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range(IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio(OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval(95% CI): 3.13, 6.13], P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9%(95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6%(95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modified their practice to omission of ALND for minimal nodal metastatic disease.

Breast Core-Needle Biopsy in a Large Tertiary Oncologic Centre—1-Year Experience after the Introduction of the Method

Ultrasound (US)-guided core-needle biopsy (CNB) is currently the procedure of choice for work-up of suspicious breast lesion. It is mainly used for evaluation of suspicious breast lesions categorized as BI-RADS 4 and 5 (Breast Imaging-Reporting and Data System). The conducted study included 56 female patients with detected suspicious breast leasions, and they underwent US-guided CNB during 1-year period with the aim to investigate the value of US-guided CNB of the breast in a tertiary-level large-volume oncological centre setting with respect of indications, technical adequacy and safety. 2 patients who entered the study were previously diagnosed as BIRADS 2, 3 patients as BIRADS 3, 18 patients as BIRADS 4 and 33 patients as BIRADS 5. In 14 patients with BC (breast cancer), both FNA (fine-needle aspiration) and CNB were performed, and the malignancy was accurately diagnosed by cytology in 9 patients, confirmed by subsequent CNB in all of them. ADH (atypical ductal hyperplasia) was initialy diagnosed by FNA in 5 patients, and in 2 of them, BC was initialy missed by FNA, but deteced by CNB. As it is known, the cytology has lower sensitivity for detection of BC than hystology, with false-negative rate ranging from 2.5% to 17.9%. In our material, 18.7% of carcinomas were initialy left undetected by FNAC, and subsequently confirmed by CNB. All confirmed carcinomas were correctly suspected on imaging, and categorized as BI-RADS 4 or 5, while all BI-RADS 2 and 3 findings were confirmed as benign on hystology. False-positive rate of imaging was 8%. An average number of 4 tissue cores (range: 2 - 7) was taken in our experience if good quality of the first 3 core was achieved, and there was no consistent reason to proceed with sampling.

The Diagnostic Significance of Ultrasound and Ultrasound-guided Coarse Needle Biopsy in Breast Cancer in Pregnancy

Objective:To explore the significance of ultrasound and ultrasound-guided coarse needle biopsy in the clinical diagnosis of breast cancer patients in pregnancy.Methods:A total of 10 patients with breast cancer in pregnancy were selected to study from October 2018 to October 2019 in our hospital,who were given preoperative ultrasound results and ultrasound-guided coarse-needle biopsy histopathology,and the results were analyzed.Results:All the 10 patients showed thickening of the mammary gland body,appeared to pick up disorderly situation,most of the dilated catheter,including 8 patients with solid hypoechoic mass,irregular shape,and“crab foot”edge burr.The corresponding aspect ratio value was greater than 1.The other 2 patients presented with cystic mixed masses with poor boundary definition,irregular shape,and mostly accompanied by posterior echo enhancement.Conclusion:Simple ultrasound diagnosis for patients with breast cancer during pregnancy has some errors,and should be used in combination with ultrasound-guided coarse needle biopsy operation.This method has a high clinical diagnosis rate and significant clinical application value,so it is worth promoting.

Transperineal core-needle biopsy of a rectal subepithelial lesion guided by endorectal ultrasound after contrast-enhanced ultrasound: A case report

BACKGROUND Rectal subepithelial lesions(SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abnormal tissues are not easily to be obtained by regular endoscopic forceps biopsy. Traditional guidance modalities of preoperative biopsy, including endoscopic ultrasound, computed tomography, and transabdominal ultrasound, are often unsatisfactory. An updated, safe, and effective biopsy guidance method is required. We herein report a new biopsy guidance modality—endorectal ultrasound(ERUS) combined with contrastenhanced ultrasound(CEUS).CASE SUMMARY A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy(CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.CONCLUSION Transperineal CNB guided by ERUS and CEUS is a safe and effective preoperative biopsy of rectal SELs yet with some limitations.

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.

Diagnosis and guidance of treatment of breast cancer cutaneous metastases by multiple needle biopsy: A case report

BACKGROUND Breast cancer patients have a high skin metastasis rate.However,reports on treatment of cutaneous metastases of breast cancer are scarce.CASE SUMMARY We report the treatment process for one breast cancer case with bone,lung,and skin metastases.The patient was a 43-year-old woman with advanced breast cancer and skin metastasis.She underwent pathological diagnosis by needle biopsy to guide the treatment.When the disease progressed,a new pathological diagnosis was determined by needle biopsy to guide the treatment.The patient received chemotherapy,endocrine therapy,and photodynamic dynamic therapy,followed by sonodynamic therapy.CONCLUSION Repeated puncture should be performed for advanced breast cancer with skin metastasis,in order to obtain the pathology and directly determine diagnosis when the disease progresses.The treatment should focus on controlling the systemic metastasis,rather than the local disease.

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.

The Significance of Minimally Invasive Core Needle Biopsy and Immunohistochemistry Analysis in 235 Cases with Breast Lesions

OBJECTIVE To evaluate core needle biopsy (CNB) as a mini-mally invasive method to examine breast lesions and discuss theclinical significance of subsequent immunohistochemistry (IHC)analysis.METHODS The clinical data and pathological results of 235 pa-tients with breast lesions, who received CNB before surgery, wereanalyzed and compared. Based on the results of CNB done beforesurgery, 87 out of 204 patients diagnosed as invasive carcinomawere subjected to immunodetection for p53, c-erbB-2, ER and PR.The morphological change of cancer tissues in response to chemo-therapy was also evaluated.RESULTS In total of 235 cases receiving CNB examination, 204were diagnosed as invasive carcinoma, reaching a 100% consistentrate with the surgical diagnosis. Sixty percent of the cases diag-nosed as non-invasive carcinoma by CNB was identified to havethe presence of invading elements in surgical specimens, and simi-larly, 50% of the cases diagnosed as atypical ductal hyperplasia byCNB was confirmed to be carcinoma by the subsequent result ofexcision biopsy. There was no significant difference between theCNB biopsy and regular surgical samples in positive rate of im-munohistochemistry analysis (p53, c-erbB-2, ER and PR; P >0.05).However, there was significant difference in the expression rate ofp53 and c-erbB-2 between the cases with and without morphologi-cal change in response to chemotherapy (P < 0.05). In most caseswith p53 and c-erbB-2 positive, there was no obvious morphologi-cal change after chemotherapy.CONCLUSION CNB is a cost-effective diagnostic method withminimal invasion for breast lesions, although it still has some limi-tations. Immunodetection on CNB tissue is expected to have greatsignificance in clinical applications.

Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum

The factors influencing the incidence of common complications（pneumothorax and pulmonary hemorrhage） of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax（13 cases, 27.1%） and pulmonary hemorrhage（14 cases, 20.24%）. ？2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases（17.5%） out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases（60%） out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases（41.4%） out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases（70%） out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words： biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage

Management of Intraductal Papilloma of the Breast Diagnosed on Core Needle Biopsy:Latest Controversies

Intraductal papillomas(IDPs),including central papilloma and peripheral papilloma,are common in the female population.Due to the lack of specific clinical manifestations of IDPs,it is easy to misdiagnose or miss diagnose.The difficulty of dif-ferential diagnosis using imaging techniques also contributes to these conditions.Histopathology is the gold standard for the diagnosis of IDPs while the possibility of under sample exists in the percutaneous biopsy.There have been some debates about how to treat asymptomatic IDPs without atypia diagnosed on core needle biopsy(CNB),especially when the upgrade rate to carcinoma is considered.This article concludes that further surgery is recommended for IDPs without atypia diagnosed on CNB who have high-risk factors,while appropriate imaging follow-up may be suitable for those without risk factors.

Evaluation of pathological diagnosis using ultrasonographyguided lymph node core-needle biopsy

Background Image-guided core-needle biopsy as a minimally invasive procedure has partially replaced excisional biopsy of the lymph node. However, it is still a great challenge to pathologists. The aim of this study was to survey and evaluate the accuracy of pathological diagnosis using the ultrasonography （US）-guided core-needle biopsy （CNB） of the lymph node.Methods Lymph node CNBs of 1119 consecutive patients from the Chinese People＇s Liberation Army （PLA） General Hospital were reviewed retrospectively. Biopsies were performed following outpatient procedures with direct US guiding by using 18-gauge cutting needle. The tissues of CNB were prepared according to the routine paraffin embedding and hematoxylin-eosin staining. Ancillary studies, including acid-fast staining and immunohistochemical staining, were performed when necessary.Results The age range was 1 year old to 85 years old. Locations of the lymph node were as follows： cervical area （n=482）, clavicular region （n=-227）, retroperitoneum （n=-150）, axilla （n=93）, groin （n=79）, abdomen/mesentery （n=44）,submaxillary region （n=-33）, postauricular region （n=4）, iliac rosa （n=3）, parotid （n=2）, hepatic hilar region （n=1）, and elbow （n=1）. The histological diagnoses were conclusive in 815 cases （73%） and inconclusive in 304 cases （27%）. The conclusive cases mainly included metastatic carcinoma （n=-449）, tuberculosis （n=111）, lymphoma/leukemia （n=124）, reactive hyperplasia （n=-87）, and other rare diseases （n=44）. The reasons for inconclusive cases were insufficient material for diagnosis, noncompliance of outpatients, or crushing artifacts of tissues caused by operation.Conclusions US-guided CNB can obtain lymphoid tissues from nearly all parts of the body for diagnostic purposes.Conclusive pathological diagnosis can be made in most of cases when adequate material was provided. Besides metastatic carcinoma,lymphomas with special immunophenotype can be accurately diagnosed and subclassified by US-guided CNB.

Diagnosis of primary squamous cell carcinoma of the pancreas using endoscopic ultrasound-guided core needle biopsy

Primary squamous cell carcinoma(SCC)of the pancreas is a particularly rare entity.Diagnosis of this tumor is tentatively made after ruling out metastatic SCC from another primary site and adenosquamous carcinoma(ASC)of the pancreas.Here we discuss the case of a 76-year-old woman who was found to have a solitary pancreatic lesion and multiple hepatic lesions.Results of computed tomography-guided biopsy of the liver lesions were consistent with a metastatic carcinoma displaying squamous differentiation;therefore,an endoscopic ultrasound(EUS)-guided core-needle biopsy(CNB)of the pancreatic mass was performed.Meticulous histopathological examination of the pancreatic specimen at multiple levels revealed moderately well-differentiated SCC with no glandular component.An extensive metastatic work-up did not reveal an extra-pancreatic origin for this SCC;hence,a diagnosis of primary SCC of the pancreas was established.To our knowledge,this is the first report of the diagnosis of a primary SCC of the pancreas using EUS-guided CNB.We believe that CNB has a diagnostic yield equivalent to that of fine-needle aspiration for recognizing pancreatic adenocarcinoma;however,when cytological examinations reveal atypical squamous epithelial cells suggestive of malignancy,CNB may provide a better tissue specimen,from which to determine the presence of a glandular component.Such an assessment will differentiate pancreatic SCC from ASC.

COMPARATIVE EXPERIMENTAL STUDY OF HO-YAG LASER AND TRUE- CUT BIOPSY NEEDLE IN MYOCARDIAL REVASCULARIZATION

Objective.To study the mechanism and effects of blood perfusion on acute ischemic region of myocardium through channel created by Ho- Yag laser and True- cut biopsy needles with myocardial contrast echocardiography. Methods. We partially ligated the left anterior descending coronary artery of canine hearts between the lst and 2nd diagonal branches to produce two groups of acute myocardial ischemia models and then performed tran- smyocardial revascularization (TMR) on this region with Ho- Yag laser and True- cut biopsy needles. Myocardial contrast echocardiography was performed with a new generation of ultrasound contrast agent and second harmonic imaging of this region before, during ischemia and after revascularization. Pictures were taken with“ R” wave trigger skill. Results. Acoustic density (dB) in the ischemic region (anterior wall) with myocardial contrast echocardiography decreased obviously after the left anterior descending artery was ligated (Laser group: 5.40± 1.81, Needle group: 7.11± 2.51) compared with that before (Laser group: 11.69± 1.61, Needle group: 12.96± 2.88, P< 0.01). dB increased remarkably after TMR by either laser or True cut biopsy needle (Laser group: 11.02± 2.01, Needle group: 10.01± 4.45. P< 0.01) compared to that during ischemia and approximated to that before ischemia (P >0.05). We found that the acoustic density of the contrast developed one picture (one cardiac cycle) ahead in the transmyocardial revascularization region than that in the lateral and other region of the left ventricle wall in the scan of both groups. Conclusions. Acute ischemic myocardium can be perfused immediately by oxygenated blood from the left ventricle through channels created with both Ho- Yag laser and True- cut biopsy needles. Evidence of blood perfusion through these channels mainly during systolic phase was detected, and myocardial contrast ultrasound using intravenous perfluorocarbon- exposed sonicated dextrose albumin was regarded as a reliable method in the study of transmyocardial revascularization.

Contrast-enhanced guided endoscopic ultrasound procedures

Contrast-enhanced endoscopic ultrasound(CH-EUS)can overcome the limi-tations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours.Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions,further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS.This review details the knowledge based on the available data on contrast-guided procedures.The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions,which occur in select cases.Additionally,the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage,and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented.Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours,in which case CH-EUS can be used to reveal the incomplete tumour destruction.