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Background: This study performed an overall assessment of the accuracy of ultrasound-guided fine-needle aspiration (FNA) and core needle biopsy (CNB) for detecting axillary lymph nodes in women with breast cancer based on qualified studies.Methods: Eligible studies and pertinent literature resources were identified on Cochrane, PubMed, Embase, CNKI, VIP, and Wanfang databases through searching key words or terms. The latest study was published in the March 2020. The eligible publications contained cohort and cross-sectional researches. All the publications obtained were tested for heterogeneity, and corresponding effect models were used to calculate amalgamative values of sensitivity, specificity and diagnostic odds ratio (DOR). Analysis of summary receiver operating characteristic (SROC) was performed on suspicious axillary lymph nodes.Results: A total of 22 studies involving 3548 patients were included to explore the accuracy of FNA in identifying axillary lymph nodes in women with breast cancer. 11 studies involving 758 patients were included to explore the accuracy of CNB in identifying axillary lymph nodes in women with breast cancer. The accuracy of FNA in identifying suspicious axillary lymph nodes was specifically as follows: overall sensitivity was 79% (95%CI: 73%-84%), global specificity was 96% (95%CI: 92%-98%), overall positive likelihood ratio was 18.55 (95% CI: 10.53-32.69), overall negative likelihood ratio was 0.22 (95% CI: 0.17-0.28), the overall DOR was 71.68 (95%CI: 37.19-138.12), and the acreage under the SROC was (AUC = 0.94; 95% CI: 0.92-0.96). The accuracy of CNB in identifying suspicious axillary lymph nodes was specifically as follows: overall sensitivity was 85% (95%CI: 81%-89%), global specificity was 93% (95%CI: 87%-96%), overall positive likelihood ratio was 11.88 (95% CI: 6.56-21.50), overall negative likelihood ratio was 0.16 (95% CI: 0.12-0.21), the overall DOR was 66.83 (95%CI: 33.28-134.21), and the acreage under the SROC was (AUC = 0.96; 95% CI: 0.94-0.97).Conclusions: The results indicated that both FNA and CNB had high accuracy for suspicious axillary lymph nodes.

Background Image-guided percutaneous core needle biopsy (CNB) has been an important diagnostic procedure for musculoskeletal lesions. Here we surveyed the variety of diagnostic strategies available and assessed the clinical usefulness and limitations of image-guided CNB carried out by a multidisciplinary team comprising specialists in various fields. Methods We conducted a retrospective study of 284 image-guided CNBs among 1899 consecutive biopsy procedures carried out at our institution for musculoskeletal tumorous conditions, focusing on their effectiveness including diagnostic accuracy and utility for classification of specimens according to malignant potential and histological subtype as well as their correlation with biopsy routes. Results Among the 284 studied biopsies, 252 (88.7%) were considered clinically “effective”. The sensitivity for detection of malignancy was 94.0% (110/117) and the specificity was 95.3% (41/43). The diagnostic accuracy for detection of malignancy was 94.4% (151/160) and that for histological subtype was 92.3% (48/52). The clinical effectiveness of the procedure was correlated with the complexity of the biopsy route (P = 0.015); the trans-pedicular, trans-retroperitoneal and trans-sciatic foramen approaches tended to yield ineffective results. Repeat biopsy did not have a significant impact on the effectiveness of image-guided CNB (P = 0.536). Conclusions The diagnostic accuracy rates of image-guided CNB performed at multidisciplinary sarcoma units were usable even for patients who have variety of diagnostic biopsy procedures. It is important to establish and implement diagnostic strategies based on an understanding that complicated routes, especially for spine and pelvic lesions, may be associated with ineffectiveness and/or complications.

The article deals with a review of scientific works on the issue of hepatic steatosis verification. Nowadays, the problem of timely detection and treatment of chronic diffuse liver diseases, in the pathogenesis of which fibrosis and hepatic steatosis play key role, becomes more and more important. It is recognized that hepatic steatosis is characterized by the accumulation of lipids in hepatocytes exceeding 5 % of the liver mass. In recent years, special attention is paid to the methods for verification of hepatic steatosis, which can be divided into invasive, minimally invasive and non-invasive. Invasive methods are still relevant, they include liver core needle biopsy — the gold standard. Minimally invasive methods for hepatic steatosis verification are based on the biochemical study of venous blood. Minimally invasive methods can be conditionally divided into routine — triglycerides, total cholesterol, high density lipoproteins etc., and calculated coefficients: SteatoTest and others. Their results are calculated on the basis of several indicators. Non-invasive methods of verification include: ultrasound, computed tomography, magnetic resonance imaging, elastometry with CAP™function (Fibroscan, model 502). In our opinion, for verification of hepatic steatosis, it is promising to use the ultrasound with the option of measuring the parameters of arterial stiffness in the WТrack mode. Among the non-invasive methods of hepatic steatosis verification, liver elastometry using FibroScan-502-touch device with CAP™ function made a breakthrough in some specific sense. Opening possibilities for early detection of hepatic steatosis enable to place on timely preventive and therapeutic measures and to create the conditions for stopping the progression, and possibly for the regression of hepatic steatosis., Статья посвящена обзору научных публикаций, посвященных проблеме верификации стеатоза печени. Сегодня все большее значение приобретает проблема своевременного выявления и лечения хронических диффузных заболеваний печени, в патогенезе которых ключевую роль играют фиброз и стеатоз печени. Считается, что стеатоз печени характеризуется накоплением липидов в гепатоцитах, превышающим 5 % массы печени. В последнее время особое внимание уделяется методам верификации стеатоза печени, которые можно разделить на инвазивные, малоинвазивные и неинвазивные. Не утратили актуальности инвазивные методы, к которым относится трепанбиопсия печени — золотой стандарт. Малоинвазивные методы верификации стеатоза печени основаны на биохимическом исследовании венозной крови. Малоинвазивные методы условно можно разделить на рутинные — триглицериды, общий холестерол, липопротеиды высокой плотности и др. — и расчетных коэффициентов: стеатотест и др., результат которых рассчитывается на основании нескольких показателей. К неинвазивным методам верификации относятся: УЗИ, КТ, МРТ, эластометрия с САРТМ-функцией (Фиброскан, модель 502). На наш взгляд, перспективным для верификации стеатоза печени является использование УЗИ с опцией измерения параметров жесткости артерий в режиме WТrack. Из неинвазивных методов верификации стеатоза печени в определенном смысле революцию произвела эластометрия печени при помощи аппарата FibroScan-502-touch с CAP™-функцией. Открывающиеся возможности ранней верификации стеатоза печени позволяют своевременно назначать комплекс лечебно-профилактических мероприятий и создавать предпосылки для остановки прогрессирования, а возможно, и для регресса стеатоза печени., Стаття присвячена огляду наукових публікацій, присвячених проблемі верифікації стеатозу печінки. Сьогодні все більшого значення набуває проблема своєчасного виявлення та лікування хронічних дифузних захворювань печінки, в патогенезі яких ключову роль виконують фіброз і стеатоз печінки. Вважається, що стеатоз печінки характеризується накопиченням ліпідів у гепатоцитах, що перевищує 5 % маси печінки. Останнім часом особлива увага приділяється методам верифікації стеатозу печінки, які можна розділити на інвазивні, малоінвазивні і неінвазивні. Не втратили актуальності інвазивні методи, до яких відноситься трепан-біопсія печінки — золотий стандарт. Малоінвазивні методи верифікації стеатозу печінки засновані на біохімічному дослідженні венозної крові. Малоінвазивні методи умовно можна розділити на рутинні — тригліцериди, загальний холестерол, ліпопротеїди високої щільності та ін. — та розрахункових коефіцієнтів — стеатотест та ін., результат яких розраховується на підставі декількох показників. К неінвазивним методам верифікації відносяться: УЗД, КТ, МРТ, еластометрія з САРТМ-функцією (Фіброскан, модель 502). На наш погляд, перспективним для верифікації стеатозу печінки є використання УЗД з опцією вимірювання параметрів жорсткості артерій у режимі WТrack. Із неінвазивних методів верифікації стеатозу печінки в певному сенсі революцію справила еластометрія печінки за допомогою апарату FibroScan-502-touch з CAP™-функцією. Відкриваються можливості ранньої верифікації стеатозу печінки, які дозволяють своєчасно призначати комплекс лікувально-профілактичних заходів і створювати передумови для зупинки прогресування, а можливо, і для регресу стеатозу печінки.

Core needle biopsy (CNB) is the first-choice method of sampling suspicious, focal breast lesions for histological analysis. Here we present the case of a 65-year-old woman who was recalled for evaluation of the left breast following a screening mammogram. An ultrasound-guided biopsy was performed using a disposable core biopsy needle and 3 weeks later a magnetic resonance imaging scan showed a distended vessel with adjacent sac measuring 17 × 15mm2. A Doppler ultrasound scan confirmed pseudoaneurysm. A review of the literature was made on breast pseudoaneurysm following CNB, and over the past 20 years there were few other reports. Pseudoaneurysms in the breast are a rare but serious complication of CNBs. They may spontaneously thrombose, but often require intervention, so it is essential that clinicians are aware of the risk.

Salivary gland tumours present a pleomorphic and complex morphology and, apart from the most common neoplasms with well-established histopathological criteria, may create diagnostic difficulty for histopathologists. The majority of salivary gland tumours occur in the parotid gland and the use of ultrasound guided parotid biopsy (US-PB) has increased. US-PB in contrast with fine needle aspiration (FNA), which is an easy and relatively painless technique, is performed under local anaesthesia, usually by radiologists. US-PB offers some advantages over the FNA such as tumour grading and the possibility of performing immunohistochemistry. We report our experience of the diagnostic value of US-PB in a large, referral centre in the United Kingdom.

Background: The management of cytologically indeterminate thyroid nodules is challenging for clinicians. This study aimed to compare the diagnostic performance of the Korean Thyroid Imaging Reporting and Data Systems (K-TIRADS) with that of the American College of Radiology (ACR)-TIRADS for predicting the malignancy risk of indeterminate thyroid nodules.Methods: Thyroid nodules diagnosed by fine-needle aspiration (FNA) followed by surgery or core needle biopsy at a single referral hospital were enrolled.Results: Among 200 thyroid nodules, 78 (39.0%) nodules were classified as indeterminate by FNA (Bethesda category III, IV, and V), and 114 (57.0%) nodules were finally diagnosed as malignancy by surgery or core needle biopsy. The area under the curve (AUC) was higher for FNA than for either TIRADS system in all nodules, while all three methods showed similar AUCs for indeterminate nodules. However, for Bethesda category III nodules, applying K-TIRADS 5 significantly increased the risk of malignancy compared to a cytological examination alone (50.0% vs. 26.5%, P=0.028), whereas applying ACR-TIRADS did not lead to a change.Conclusion: K-TIRADS and ACR-TIRADS showed similar diagnostic performance in assessing indeterminate thyroid nodules, and K-TIRADS had beneficial effects for malignancy prediction in Bethesda category III nodules.

Follicular variant papillary thyroid carcinoma (FVPTC) is a problematic entity. FVPTCs are often misdiagnosed by the standard fine needle aspiration (FNA); in addition, FVPTCs represent a mixed group of tumors with two biologically distinct subtypes: The indolent encapsulated FVPTC and the aggressive infiltrative FVPTC. Recent changes in guidelines suggests that FVPTC management may be improved if subtypes can be determined preoperatively. Preoperative assays, FNA, core needle biopsy (CNB), and ultrasonography (US) were compared for their ability to identify and subtype FVPTCs to determine the most appropriate test to manage FVPTCs. The preoperative assays and clinicopathologic variables of 255 resected FVPTCs cases at Samsung Medical Center between 2012 and 2016 were retrospectively evaluated. CNB had the overall best ability to manage FVPTCs with the highest rate of diagnosis indicating surgery, lowest rate of inconclusive results, high sensitivity (88.9%), specificity (87.7%), negative predictive value (97.0%), diagnostic odds ratio (DOR; 56.9), and excellent predictive ability (AUC 0.906) for differentiating FVPTC subtypes. US had a moderate DOR (12.8), good predictive ability (AUC 0.802), high sensitivity (75.0%) and specificity (81.0%). CNB and US both had significantly higher accuracy for discriminating FVPTC subtypes than FNA (AUC 0.908 and 0.877 > 0.671; p

PURPOSE According to the American Association for the Study of Liver Diseases (AASLD) guidelines, biopsy is a diagnostic option for focal hepatic lesions depending on the Liver Imaging Reporting and Data System (LI-RADS) category. We evaluated the diagnostic performance of ultrasonography-guided core-needle biopsy (CNB) according to LI-RADS categories. METHODS A total of 145 High-risk patients for hepatocellular carcinoma (HCC) who underwent magnetic resonance imaging (MRI) followed by CNB for a focal hepatic lesion preoperatively were retrospectively enrolled. Focal hepatic lesions on MRI were evaluated according to LI-RADS version 2018. Pathologic results were categorized into HCC, non-HCC malignancies, and benignity. The categorization was defined as correct when the CNB pathology and surgical pathology reports were identical. Nondiagnostic results were defined as inadequate CNB pathology findings for a specific diagnosis. The proportion of correct categorizations was calculated for each LI-RADS category, excluding nondiagnostic results. RESULTS After excluding 16 nondiagnostic results, 131 lesions were analyzed (45 LR-5, 24 LR-4, 4 LR-3, and 58 LR-M). All LR-5 lesions were HCC, and CNB correctly categorized 97.8% (44/45) of LR-5 lesions. CNB correctly categorized all 24 LR-4 lesions, 16.7% (4/24) of which were non-HCC malignancies. All LR-M lesions were malignant, and 62.1% (36/58) were non-HCC malignancies. CNB correctly categorized 93.1% (54/58) of LR-M lesions, and 12.5% (3/24) of lesions with CNB results of HCC were confirmed as non-HCC malignancies. CONCLUSION In agreement with AASLD guidelines, CNB could be helpful for LR-4 lesions, but is unnecessary for LR-5 lesions. In LR-M lesions, CNB results of HCC did not exclude non-HCC malignancy.

To identify commonly used needle types in cross-sectional interventional radiology (CSIR) and to review features and safety profiles of those needles. Members of the Society of Abdominal Radiology (SAR) emerging technologies commission (ETC) on CSIR were sent a 13-question survey about what needles they use for common CSIR procedures: random and targeted solid organ biopsy, ultrasound-guided paracentesis, and ultrasound-guided thyroid fine needle aspiration (FNA). Results were compiled with descriptive statistics, and features of the most commonly used needles were reviewed. 19 surveys were completed (response rate 57.6%, 19/33) from 16 institutions. For solid organ biopsies, the majority of respondents reported using an 18-gauge needle with an automatic firing mechanism and a variable throw length option. The most commonly used needle for both random and targeted biopsies was the Argon BioPince (26.3%, 5/19) The three most commonly used needles for solid organ biopsies all featured automatic firing, variable throw length options, and 18-gauge size. A 5 French Cook Yueh needle was most the most commonly used paracentesis needle (36.8%, 7/19). For thyroid FNA, all respondents used spinal needles, and 25-gauge was the most common size (72.2%, 13/18). Abdominal radiologists use a variety of needles when performing common interventional procedures. Members of the SAR CSIR ETC commonly use automatic, 18-gauge, variable throw length needles for solid organ biopsies, 5 French catheter style needles for paracentesis, and 25-gauge spinal needles for thyroid FNA.

Background Core needle biopsy (CNB) has become the most common tissue sampling modality for pathological diagnosis of peripheral lung nodules. However, approximately 10% of pulmonary CNB specimens cannot be unambiguously diagnosed, even with auxiliary techniques. This retrospective study investigated the diagnostic value of liquid‐based cytology on residual pulmonary CNB material collected from needle rinses. Methods Computed tomography‐guided pulmonary CNB specimens and relevant cytology of CNB needle rinses (CNR) from July 2017 to June 2020 were reviewed. A total of 406 patients, each of whom underwent a CNB procedure, were included in the study. Results Of the 406 cases, a more serious diagnosis was rendered by CNR in 6.4% (n = 26) of cases. Furthermore, among these 26 cases, 13 malignancies were confirmed only from CNR. Of the remaining 13 patients with uncertain lesions identified from CNR, six were diagnosed with definite benign lesions from tissue samples, five were found to harbor malignant neoplasms through repeated CNB or follow‐up examination, and two had tuberculosis. The sensitivity (320/332, 96.4%) of combined CNR/CNB (both CNR and CNB) in distinguishing malignancies from benign lesions was higher than that of CNB alone (307/332, 92.5%). A total of 320 malignant neoplasms included 198 cases of primary lung adenocarcinoma and 71 cases of primary lung squamous cell carcinoma. Conclusions CNR with higher nuclear and cytoplasmic resolution than CNB exhibited a high diagnostic efficacy for differentiating malignant from benign lesions in the lung. Moreover, combined CNR/CNB achieved optimal results in reducing the false‐negative rate and the subtyping of non‐small cell lung cancer., This retrospective study provides novel insights into a method for evaluating lung nodules in low‐to‐moderate income countries. It elucidates how a combined approach, which utilizes the core needle biopsy (CNB) technique as well as cytology of CNB needle rinses (CNR) containing residual pulmonary CNB material, helps to improve the accuracy and efficacy of diagnosing lung nodules.

The purpose of this study was to investigate the role of contrast-enhanced ultrasound (CEUS) in determining the viable target area in patients with subpleural pulmonary lesions before ultrasound-guided transthoracic core biopsy. In this retrospective study, we analyzed 92 patients with subpleural pulmonary lesions (63 males and 29 females; mean age: 65.17 ± 11.72 y). All patients underwent B-mode ultrasound, color Doppler and CEUS. Color Doppler was performed to identify the major vessels. The time to enhancement of the contrast agents, homogeneity of enhancement and the presence of areas without enhancement were recorded after administration of the contrast agents. The viable target areas were defined as regions showing enhancement relative to those without enhancement and regions showing delayed enhancement in reference to peripheral lung tissues showing early enhancement. Afterward, real-time ultrasound-guided transthoracic core needle (18 gauge) biopsies were performed and the complication rate, success rate and diagnostic accuracy were calculated. With CEUS, the needle pathways of these lesions were readjusted the biopsy strategy in 40/92 patients (43.5%). It was determined that the satisfactory rate of the subsequent biopsy specimen was 100%. The histologic diagnostic accuracy of the biopsy was 97.83%. No serious complications occurred during the biopsy. In conclusion, the application of CEUS before biopsy was able to depict the viable target areas of the lesion to readjust the biopsy routes. With the help of CEUS, ultrasound-guided core biopsy could obtain adequate samples, improve the diagnostic accuracy and reduce the complication rates of biopsies.

BACKGROUND Accurate and swift tissue diagnosis is extremely important for the timely initiation of treatment in pediatric oncology. In our department, ultrasound-guided core needle biopsy (US-guided CNB) is used for tissue diagnosis. In 2016, we added on-site cytology, allowing for an immediate primary diagnosis. We retrospectively reviewed our performance in terms of safety and accuracy for CNBs and on-site cytology. METHODS All pediatric biopsies performed in our hospital between February 2016 and December 2020, were included. Patient clinical, procedural and follow-up data were collected. CNB pathology and cytology results were compared to the final pathologic diagnosis. RESULTS We included 71 patients for which 72 biopsies with on-site touch imprint (TI) cytology were performed; the average latency time to biopsy was 1 day. Altogether, we had 61 tumors, (58 malignant, 3 benign) and 11 other lesions. On-site cytology diagnosed 58 malignant tumors, 3 benign tumors and 11 non-tumor tissues. The cytologist correctly differentiated tumor from inflammation in all cases, and diagnosed the precise tumor type in 57 cases, with an accuracy of 94% for final diagnosis. We had no complications related to the procedure or sedation. CONCLUSION US-guided CNB with on-site TI cytology for suspected malignancy in the pediatric population is highly available, safe, and accurate, with real-time diagnosis in most cases. This accelerated diagnostic route has a huge impact on patient care.

OBJECTIVE. Diagnostic accuracy of core needle biopsy (CNB) for adipocytic tumors can be low because of sampling error from these often large, heterogeneous lesions. The purpose of this study was to...

Introduction: The frequent and widespread use of imaging in clinical practice, particularly CT, has led to a steep increase in incidental ndings of asymptomatic solitary pulmonary nodules. In this situation, histocytopathological analysis is needed to conrm the diagnosis by CTguided biopsy / FNAC. So, the researcher purposively, designed this study. The aim of this study was to assess the outcomes of CT-Guided Fine-Needle Aspiration Cytology and Core Needle Biopsies of Solitary Lung Lesions. CT-uoroscopy guidance helps in this process by accurate needle positioning thus increase the success rate. Materials and Methods: This was a retrospective study conducted at the Department of Radiology & Imaging in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during January 2017 to January 2019.Atotal of 270 patients who were referred to the Department of Radiology& Imaging for the evaluation of suspicious solitary lung lesions after the detection of a solitary pulmonary nodule in X-ray or CT scan, were included in this study. The results of CT uoroscopy–guided biopsy and FNAC for the included patients were analyzed to determine the diagnostic accuracy, complication rates, and independent risk factors for diagnostic failure and severe pneumothorax in this study. The factors related to the patients' solitary lesions, and procedures were evaluated by univariate analyses using the twosided Student t test for numeric values and Chi-squared test for categorical values where p

BACKGROUND:Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them.OBJECTIVES:Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB).DESIGN:Prospective evaluation of complications.SETTING:Single center in Turkey.PATIENTS AND METHODS:For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology.MAIN OUTCOME MEASURES:The complications and risk factors for complications were evaluated.SAMPLE SIZE:123 adult patients.RESULTS:The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema (P=.022), non-peripheral location of the lesion (PPP=.011), increased number of pleura penetrations (P=.024), prolonged needle time across pleura (P=.037), and decreased lesion size (P=.033). The pneumothorax rate increased with non-peripheral location of the lesion (PP=.021), prolonged needle time across the pleura (P=.013), and decreased lesion size (P=.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion (PP=.001, OR=156.2, 95% CI =7.34–3324.7 for pneumothorax).CONCLUSION:Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications.LIMITATIONS:Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding.CONFLICT OF INTEREST:None.

Introduction: Percutaneous ultrasound-guided core needle biopsy is a well-established method in the diagnosis of musculoskeletal tumors. It is unclear which factors contribute the most to a successful biopsy. The aim of the study was to determine the value of ultrasoundguided core needle biopsy of solid lesions in the musculoskeletal system using a 16-gauge needle. Material and methods: A retrospective analysis performed at a regional sarcoma center over one year included patients referred for ultrasound-guided biopsy of musculoskeletal soft tissue lesions. At least 6 months’ clinical and radiological follow-up, results from repeat or excisional biopsy, or interventional treatment, served as outcome reference. The biopsy procedure and yield were analyzed. The biopsy was classified as ‘diagnostic’ when a definitive diagnosis could be made on the first biopsy, and ‘accurate’ when only the malignant or benign nature of the tumor could be determined. Results: From 102 referrals for biopsy of soft tissue lesions in 2019, a total of 73 biopsies of solid lesions with a 16-gauge cutting needle were included (73 patients). There were 34 males and 39 females, with a mean age of 57.7 years. The overall proportion of diagnostic biopsies was 84%, for malignant lesions 88% and benign lesions 81%. The tumor could be classified as malignant or benign in 12 patients (16%) (accurate biopsy). It was possible to discriminate between malignant and benign lesions in each case. The majority of biopsied lesions were benign 64% (n = 47). Conclusion: The diagnostic value of ultrasound-guided percutaneous core needle biopsy of musculoskeletal soft tissue lesions performed with 16-gauge needle is good, with a high rate of diagnostic biopsies, both for benign and malignant lesions.

In the last few years, ultrasound-guided vacuum-assisted breast biopsy (US-VABB) has replaced surgical biopsy due to higher diagnostic accuracy and lower patient discomfort, and, at present, an even greater possibility is represented by the new wireless ultrasound-guided VAB device (Wi-UVAB). The purpose of our study is to determine the diagnostic accuracy of this new device in a sizeable representative number of patients. From January 2014 to June 2018, 168 biopsies were performed in our institution using the new Wi-UVAB device. We analyzed sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of biopsies obtained with the new device using surgical results as reference point, following patients for at least one year. In our cohort, we obtained a complete sensitivity of 97.5%, an absolute sensitivity of 94.3%, a complete specificity of 98%, and an absolute specificity of 98%. The positive predictive value of the procedure was 97.5% while the negative predictive value was 98%. The diagnostic accuracy was 98%. The Wi-UVAB is a safe procedure with high diagnostic accuracy, comparable to that of the traditional vacuum-assisted breast biopsy and even higher than that of core needle biopsy (CNB). Moreover, the Wi-UVAB is easy to use and shows low costs as core needle biopsy (CNB).

Background Percutaneous core needle biopsy (PCNB) has become an accepted method to collect tumour tissue samples given its safety, minimal invasiveness, high accuracy and cost-effectiveness. Procedure It is a single centre, retrospective evaluation of 213 ultrasound (US) or computed tomography (CT) guided PCNBs of paediatric solid tumours performed from 2005 to 2017. Safety, diagnostic yield, accuracy, and efficacy assessments of the PCNB procedure were performed. Univariate logistic models were applied to assess the relation of the diagnostic yield with patient, procedure and lesion features. Results The image-guide was US in 91.08% of biopsies; the needle gauge was ≥16 G in 69.01% of the biopsies. The anatomical site of lesion was deep in 113 biopsies (53.05%). The nature of the lesion was the only factor associated with diagnostic yield (OR: 4.04; 95% CI 1.23–13.28; p: 0.022), with benign lesion as an unfavourable factor. Complication incidence was 1.41%. Overall, the diagnostic yield of PCNB was 93.90% (95% CI: 89.79-96.71%), the diagnostic accuracy was 96.86% (95% CI: 93.29–98.84%) and the diagnostic efficacy was 93.33% (95% CI: 86.75–97.28%). Sensitivity was 97.94% (95% CI: 92.75–99.75%) and specificity 100% (95% CI: 66.37–100%). Conclusion PCNB can be recommended as the first-choice method for solid tumours diagnosis in paediatric, adolescent and young adult patients because of its high diagnostic success, safety and accessibility.

Background: Pre-operative/neoadjuvant treatment utilization in early-stage breast cancer has been increasing, particularly during the COVID-19 pandemic. With goals of minimizing potential exposure to SARS-COV-2, as well as resource rationing, physicians are urged to triage breast cancer patients by identifying those that require urgent surgical care vs. those who may delay surgical treatment.1 Accurate risk assessment is an integral component of this triaging process, which has recommended that genomic testing on diagnostic core needle biopsy (CNB) samples be used to assist with the identification of patients with low risk tumor biology who may be candidates for surgical delay.1 MammaPrint (MP), a 70-gene risk of recurrence signature, and BluePrint (BP), an 80-gene molecular subtyping signature, have been routinely used in formalin-fixed paraffin embedded (FFPE) CNB and surgical resection (SR) samples since MammaPrint obtained FDA clearance for FFPE tissue in 20152. In addition, over 1,500 CNB tumor samples from patients enrolled in prospective neoadjuvant treatment trials (NBRST and ISPY-2) have received successful MP & BP testing. This study compares the gene expression results between CNB and SR specimens to better elucidate how these tests perform across specimen type. Methods: Routine diagnostic samples submitted to Agendia, Inc. (Irvine, CA) between Feb 2017 and May 2020 for MP and BP testing were processed according to standard FFPE microarray procedures. MP was used to stratify samples into Ultra Low Risk (UL), Low Risk (LR), and High Risk (HR). BP was used to classify samples into Luminal, HER2, or Basal-type. This study included 13,603 CNB and 25,684 SR specimens. MP Index (MPI) distribution on BP defined Luminal-type tumors were compared between CNB and SR samples. Comparative “logistics metrics” (average turnaround time [TAT] and success rate) were also assessed between these specimen types. Results: Of the 39,287 samples included in this analysis, 35% were CNB and 65% were SR (Table). BluePrint Luminal, HER2 and Basal-type distributions were 86%, 4%, and 10% respectively for CNB samples and 94%, 1%, and 5% respectively for SR samples. Within BP defined Luminal-type tumors, the frequency of UL, LR, and HR results were 18%, 58%, and 42% for CNB, and 16%, 60%, and 40% for SR, respectively. Overall, MP Index distributions were similar between samples tested from CNB vs. SR. Average TAT between CNB and SR were 4.52 and 4.55 days, respectively. For specimens that met the minimum tumor % threshold, successful testing rates for CNB and SR were 97.5% and 98.4%, respectively. Conclusions: MP and BP testing were successfully performed on both CNB and SR samples in approximately 98% of all eligible specimens with rapid TAT allowing for timely pre-operative decision-making. The frequency of each MP risk group as well as the distribution pattern of MP Index were nearly identical between CNB and SR specimens, indicating comparable performance regardless of specimen type. With no meaningful difference in MPI distribution, TAT or success rate between CNB specimens and SR specimens, pre-operative use of MP+BP genomic testing is feasible, in alignment with recent COVID-19 pandemic guidelines. References1.Dietz, J.R., et al. Breast Cancer Res Treat 181, 487-497 (2020).2.FDA 510(k) Clearance K141142, January 2015. Table:(n)(%)(n)(%)Total CNB13,60335%Total SR25,68465%CNB Ultralow2,17516%SR Ultralow3,89815%CNB Low Risk6,90051%SR Low Risk14,65657%CNB High Risk6,70349%SR High Risk11,02843%(n)(%)(n)(%)Luminal-type CNB10,05738%Luminal-type SR16,31162%CNB Ultralow1,82418%SR Ultralow2,58816%CNB Low Risk5,78558%SR Low Risk9,77160%CNB High Risk4,27242%SR High Risk6,54040% Citation Format: Joseph McKelley, Jennifer Wei, Brian Hoxeng, Andrea Menicucci, Erin Yoder, Shiyu Wang, William Audeh. Comparing MammaPrint and BluePrint results between core needle biopsy and surgical resection breast cancer specimens [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-19.

Introduction: Flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), radial scars (RS) and atypical ductal hyperplasia (ADH) are lesions of uncertain malignant potential in the breast, which are described as B3 lesions in the B classification system of the European Working Group for Breast Cancer Screening Pathology. Current standard for management of B3 lesions on core needle biopsy (CNB) or vacuum assisted biopsy (VAB), is wide local excision (WE). However, recent consensus-based guidelines no longer recommend WE for all such lesions, but propose surveillance following CNB or VAB to be sufficient in some cases. In the absence of a Belgian guideline on the treatment of B3 lesions, this study was conducted to identify which B3 lesions have the lowest likelihood for breast malignancy and could therefore be spared from WE. Methods: Using data from the Belgian Cancer Registry (BCR), all patients with a new diagnosis of a B3 lesion on CNB or VAB between 2013-2016 and who had a histological follow up with VAB or WE after CNB or WE after VAB were included. Histological follow-up was retrieved from BCR and limited to 12 months following diagnosis. Histology was compared between the first- and follow-up investigation to determine the upgrade risk to ductal carcinoma in situ (DCIS) or invasive breast cancer (IC) according to the type of B3 lesion. Patients with synchronous (pre-) invasive lesions were excluded. Results: Between 2013-2016 there were 812 B3 lesions available for upgrade analysis after initial diagnosis. After CNB 551 lesions had WE or VAB as follow up and after VAB 261 lesions had WE. After primary diagnosis on CNB, the total upgrade risk was 19,0%. There was histological agreement in 57,9% and no B3 lesion or upgrade was reported in 21,8%. Per B3 lesion subtype the upgrade risk to DCIS - IC after diagnosis on CNB was: ADH 17,1%-12,4%, FEA 21,1% - 18,4%, LN 18,9% -21,6%, RS 14,3% - 11,4%, and PL 7,2% - 3,2%. After initial diagnosis on VAB the total upgrade risk was 14,9%. There was histological agreement in 52,9% and no B3 lesion or upgrade was found in 31,4%. Per B3 subtype the upgrade risk to DCIS - IC after diagnosis on VAB was: ADH 17,3%- 2,7%, FEA 11,7%- 5,9%, LN 0,0% - 4,3%, PL 10,4% - 2,1%. We found no upgrade for RS. (Table 1). Conclusions: In a series of B3 lesions with a histological follow-up, we notice that overall upgrade risk is higher for lesions detected on CNB than on VAB: 19,0% vs. 14,9%. The majority of lesions showed histological agreement between initial B3 diagnosis and histological follow-up: 57,9% after CNB and 53,5% after VAB. More investigation is needed to make a proper risk assessment as to which B3 lesions can be followed with regular surveillance. Also, further prospective research is needed to get a better understanding of associated risk factors for upgrade, upgrade risk and lifetime risk of developing breast cancer after diagnosis of a B3 lesion. Table 1: Upgrade risk per B3 subtype after diagnosis on CNB or VABSubtypeNumberCNB followed by VAB or WEDCISICTotal Upgrade riskCNBNumberVAB followed by WEDCISICUpgrade riskVAB followed by WEADH10517,1%12,4%29,5%11017,3%2,7%20,0%FEA3821,1%18,4%39,5%5111,7%5,9%17,6%LN3718,9%21,6%40,5%460%4,3%4,3%PL3367,2%3,2%10,4%4810,4%2,1%12,5%RS3514,3%11,4%25,7%60%0%0%Total551261Upgrade105/55119,0%39/26114,9%B3 lesion319/55157,9%138/26152,9%No B3 lesion120/55121,8%82/26131,4%Result not available7/5511,3%2/2610,8% Citation Format: Nynke Willers, Patrick Neven, Giuseppe Floris, Cecile Colpaert, Eva Oldenburger, Sileny Han, Chantal Van Ongeval, Ann Smeets, Francois Duhoux, Hans Wildiers, Petra Denolf, Isabel De Brabander, Nancy Van Damme, Harlinde De Schutter. The upgrade risk to (pre-)invasive breast cancer for B3 lesions diagnosed on core needle or vacuum assisted biopsy. A Belgian retrospective study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-52.

Accurate diagnostic biomarker testing, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2) expression profile, is crucial to appropriate management decisions in breast cancer. Receptor status testing is typically performed on the initial core needle biopsy (CNB) and surgical specimen (SS). The rate of concordance between CNB and SS is unclear as is the impact this has on clinical decision making. The current guidelines on retesting are vague, which results in individual institutions and providers determining retesting policies. Several studies worldwide have assessed the concordance of receptor testing with mixed conclusions. We aim to determine concordance between CNB and SS, and whether this leads to clinically relevant management changes. A retrospective analysis was performed on patients with invasive breast cancer with available CNB and SS pathology at our institution between January 2010- May 2020. Patients who were treated with primary surgical resection and neoadjuvant chemotherapy with residual disease were included. Concordance rates between CNB and SS were assessed for ER, PR, and Her2 IHC/ FISH amplification. ER and PR status were defined per NCCN guidelines as “positive,” “low-positive (ER)” or “negative.” Major discrepancy was defined as a change in label of “positive” or “negative”. Minor discrepancy was defined as change >10% without a “positive” or “negative” label change. Major discordance in Her2 was defined as change in label of “positive” or “negative” based on IHC or FISH amplification results. A minor discrepancy was a change in Her2 IHC (0-3) or FISH amplification without change in label of “positive” or “negative.” The clinical impact of discordant results was determined by investigator review. 748 patients met the eligibility criteria, and 64 of these patients received neoadjuvant therapy. For ER, there was 90.6% concordance, 2.2% major discordance, and 7.8% minor discordance between CNB and SS. For PR, there was 59.64% concordance, 11.9% major discordance, and 28.46% minor discordance. For Her2, there was 54.7% concordance, 1.6% major discordance, and 43.8% minor discordance. Of major discordance, ER (43.8%) led to the most change in management compared to Her2 and PR (12.5% and 2.2%, respectively). Retesting Her2 on SS did not change management when initial CNB was Her2 positive. For major discrepancies, patient demographics, tumor characteristics, treatment course, recurrence, and survival were reviewed. Although discordance was more common in PR and Her2 than ER biomarker profiles, major discordance leading to treatment changes were more common in ER and Her2. Retesting ER and Her2 on CNB and SS may be more clinically beneficial than retesting PR. Guidelines for retesting receptor profiles on CNB and SS are needed to best guide patient care management decisions that maximize clinical benefits while minimizing healthcare costs. Table: Concordance of ER, PR, and HER2 Expression ProfileConcordanceMajor DiscrepancyMinor Discrepancy# Patients with Change in Treatment with Major DiscrepanciesER90.6%2.2%7.8%7/16 (43.8%)PR59.6%11.9%28.5%2/90 (2.2%)Her254.7%1.6%43.8%5/12 (12.5%) Citation Format: Jessica Anne Slostad, Nicole Yun, Aimee Schad, Surbhi Warrior, Ruta Rao. Concordance of breast cancer biomarker testing in core-needle biopsy and surgical specimens: A single institution experience [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-34.

Objectives. The usefulness of core needle biopsy (CNB) for the diagnosis of thyroid nodules remains controversial, and preferences vary across hospitals. The purpose of this study was to assess the actual use of CNB in Korea and to analyze the advantages and disadvantages of CNB through a systematic review and meta-analysis of papers published by Korean authors.Methods. A meta-analysis of full-text publications published in English presenting data from Korea retrieved from the Embase literature database was performed.Results. CNB led to a significantly lower proportion of non-diagnostic results than fine-needle aspiration (FNA). However, the frequency of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) did not decrease as a result of performing CNB in nodules with initial AUS/FLUS results, while it increased in consecutive cases. A subcategory analysis of AUS/FLUS showed that the increased frequency of AUS/FLUS findings on CNB was due to more frequent diagnoses of architectural atypia and follicular neoplasm, which resulted in a higher frequency of inconclusive findings in consecutive cases compared to FNA. Hospitals favoring CNB had a higher proportion of AUS/FLUS diagnoses. Although the complication rate did not differ significantly between CNB and FNA, serious complications of CNB did occur.Conclusion. A reduced frequency of non-diagnostic results may be a definite advantage of CNB over FNA. However, the increased frequency of diagnoses of architectural atypia and follicular neoplasm should be considered when selecting CNB as a diagnostic tool.

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.

The aim of this study was to evaluate the diagnostic accuracy of navigation-guided core needle biopsy for skull base and parapharyngeal lesions. Twenty patients with skull base and parapharyngeal lesions were included in this study. The preoperative design and intraoperative real-time image guiding was done using an optical navigation system. A spring-loaded semi-automatic biopsy gun and biopsy needle were used for specimen harvesting. Accuracy was established on the basis of the postoperative pathology. All patients underwent needle biopsy successfully without any immediate or delayed complications. The subzygomatic approach was adopted in all cases. The number of passes ranged from three to five. The diagnostic accuracy was 90% (18/20). Navigation-guided core needle biopsy offers an easy approach for the diagnosis of skull base and parapharyngeal lesions, with a high yield of specimens and good patient tolerance.

Introduction: Core-needle biopsy (CNB) is a minimally invasive procedure used in preoperative diagnosis of breast lumps. It has been seen that in few years, the CNB seems to be replacing the fine-needle aspiration cytology (FNAC), although no study had yet conclusively proved a superiority of one over the other. Aims and Objectives: The aim of this study was to study the cytohistological spectrum of palpable breast lesions and to evaluate the diagnostic accuracy of FNAC versus CNB for breast lesions. Materials and Methods: The study was a cross-sectional study conducted in the Department of Pathology and Surgery, over a period of 1 year in 152 patients. All the patients were subjected to FNAC and CNB. Cytosmears were stained with May-Grunwald Giemsa and hematoxylin and eosin was done on CNB and excision biopsy (EB) specimens. Sensitivity and specificity were calculated in percentage with 95% confidence interval with reference to CNB/surgical specimens. Kappa statistics were used to compare the level of agreement between FNAC versus CNB and CNB versus surgical specimens. Results: A total of 152 patients were taken for FNAC and CNB. EB was performed in only 104 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNAC verses CNB in correlation with subsequent histopathology were found to be (93.40 vs. 94.06%), (97.50 vs. 100.00%), (99.00 vs. 100.00%), (84.78 vs. 33.33%), and (94.52 vs. 94.23%), respectively. Conclusion: CNB has overcome the pitfall of FNAC but CNB cannot replace FNAC but both procedures are complementary to each other.

Context.— The diagnosis of classic Hodgkin lymphoma (CHL) traditionally requires surgical tissue biopsy because of the paucity of diagnostic Hodgkin and Reed-Sternberg cells. Diagnosis can be challenging in small core needle and cytologic biopsies, which are increasingly used because of reduced costs and minimal invasiveness. Flow cytometric (FC) identification of Hodgkin and Reed-Sternberg cells is possible, but FC test efficacy is not well studied outside of validation settings, especially in small specimens. Objective.— To assess the testing efficacy of FC performed on small biopsy and cytology specimens for the diagnosis of CHL. Design.— We reviewed 131 patients with CHL and 459 patients without CHL during a 3-year period who underwent a small biopsy procedure, including core biopsy and/or cytology evaluation, with concurrent routine clinical FC testing for CHL, assessing performance of FC in small specimens. Results.— Evaluating testing efficacy, sensitivity was 95.4% and specificity was 98.2%, whereas positive and negative predictive values were 92.2% and 99.0%, respectively. Although there were more false-positive results than compared with published validation studies, expert review identified distinct diagnostic pitfalls; awareness of these may improve testing efficacy. Conclusions.— Although FC diagnosis of CHL was historically considered unfeasible, our findings in a real-world clinical setting suggest that FC adds diagnostic value to small biopsy evaluation, reducing time to treatment, costs, and invasive excisional procedures.

Purpose: To describe our experience in performing biopsy of post-septal orbital masses with core needle under computerized tomography guidance (CT-CNB). Methods: The medical records of all patients who underwent this procedure were reviewed. The procedure was performed under local anesthesia on a day case basis under a peribulbar block. A planning non-contrast computerized tomography (CT) scan of the orbits was performed to localise the mass. A 6-cm 18-G Temno Evolution® semi-automated biopsy needle was inserted through the skin into the orbit. Prior to further advancement of the needle, a low-dose CT limited to the previously determined plane was performed to confirm its position. The needle was then advanced, and the cutting needle was deployed to obtain the biopsy. Results: Five patients who underwent CT-CNB were identified. The CNB was successful in 4 patients and revealed a metastatic prostate adenocarcinoma, diffuse large B-cell lymphoma, a metastatic neuroendocrine tumour, and orbital inflammatory disease. The biopsy failed in the fifth patient when the needle failed to penetrate the tumour despite good localisation on CT. He was eventually diagnosed with fibrous meningioma of the greater wing of sphenoid on open biopsy. None of the patients had any complications other than peri-ocular bruising which was present in all of them. Conclusion: CT-CNB of mass lesions located in the lateral aspect of the orbit can be an alternative to open biopsy in selected cases. It avoids major surgery and allows the use of radiotherapy, if required, without any delay.

The World Health Organization (WHO) and numerous expert guidelines for lymphoma diagnosis and subclassification advocate the use of histology from surgical nodal excision biopsy (SEB) over core needle biopsy (CNB) due to perceived higher diagnostic yield. CNB is associated with lower morbidity and is more cost-effective compared to SEB. Furthermore, current practice increasingly demonstrates material obtained from CNB can rapidly diagnose individuals with a clinical suspicion of lymphoma and allow initiation of treatment in the majority of patients. We performed a literature review to assess the suitability of CNB in lymphoma diagnosis given recent advances in radiological and histopathological techniques in obtaining and processing tissue. Additionally, expert international guidelines in lymphoma diagnosis were compared. We found that CNB demonstrated a diagnostic efficacy between 79% and 97% (median 91%) where the diagnostic outcome was conclusive with full lymphoma subclassification. Studies demonstrate that there is a high diagnostic reproducibility amongst haematopathologists (87%-93%) in lymphoma diagnoses with full subtyping from material obtained via CNB. Furthermore, CNB is a safe, rapid and reliable method of obtaining tissue from lymph nodes for histopathological analysis. These procedures are minimally invasive, well-tolerated and should be considered the first-line diagnostic approach in clinical practice in patients with suspected lymphoproliferative disorders.

Purpose: Axillary lymph node status is an important prognostic factor in breast cancer. Axillary lymph nodes can be evaluated using fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB) before surgery. This study compared the accuracy and false-negative rates between FNAC and CNB in patients with breast cancer who either did or did not receive neoadjuvant chemotherapy (NAC). Methods : : The clinicopathological factors of the patients were analyzed retrospectively, and the sensitivity, specificity, positive and negative predictive values, false-positive and false-negative rates, and accuracy of FNAC (n = 27) and CNB (n = 23) were compared. Results : : Regardless of whether or not NAC was performed, the CNB evaluation of the metastatic axillary lymph nodes had a 100.0% sensitivity, specificity, negative predictive value, and accuracy, except for one case with an inadequate sample. In the FNAC group, the false-negative rate was higher in patients with breast cancer who received NAC before evaluating the lymph nodes (9.1% vs. 7.7%). Moreover, ultrasound imaging was the most sensitive imaging modality that can detect the suspicious axillary lymph node. Conclusion : : CNB was more effective in evaluating the axillary lymph nodes in breast cancer than FNAC and was performed without major complications.

Back ground: Breast microcalcifications are considered an early mammographic sign of breast cancer which are present with tiny bright spots of different morphology. In an ultrasound (US) image, the presence of microcalcifications within breast is an important indicator of malignancy.With an improved sonographic detection of microcalcification, ultrasound could be used for biopsy guidance for target sampling of tissue containing suspicious microcalcifications. If the biopsied lesions had a suspicious microcalcifications, specimen radiograph is mandatory to confirm the presence of microcalcifications in which a core containing any calcification on specimen radiography was defined as asuccessfully retrieved core. 14-G(Gauge) semi-automated core needle biopsy(CNB) device is less costly than other biopsy device. Methods:A prospective study was conducted on thirty female patients with thirty- two lesions their mean age was 48.53 years (age range, 21-75 years) radiologically classified as BIRADS (Breast Imaging Reporting and Data system) 4 (b, c) and5 from those referred to women imaging health unit in Radiology department for Sono- Mammography and those patients were referred from the inpatient wards and outpatient clinics of the surgery departments during the period from September 2018 till May 2019.All patients underwent conventional digital mammography and B-mode ultrasound examination and Ultrasound guided biopsy, specimen radiography then tissue samples were sent to histopathology department in which slide picture was done.Then (28) females done surgery and (2) patient still for follow up. Results: Radiological diagnosis of our lesions using BIRADS(Breast Imaging Reporting and Data system) categorical method were identified as two intermediate suspicious lesions (BIRADS 4B 6.3 %), twelve moderate suspicious lesions (BIRADS 4C 34.4 %), and 19 highly suggestive of malignancy lesions (BIRADS 5 59.4 %). Retrieval rate of calcifications according to specimen radiography were successfully retrieved in 30/32 lesions (93.8 %) and confirmed on specimen radiography .CNB( core needle biopsy) identified 28 lesions (87.5 %) malignant and four (12.5 %) benign lesions. Distribution of lesions according to pathological diagnosis in successful and fail retrieval group, the successful retrieval group comprised 26 malignant (22 IDC(Invasive ductal carcinoma), 2 DCIS(Ductal carcinoma Insitu), 2 ILC(Invasive Lobuler carcinoma) ) and four benign lesions.After CNB( core needle biopsy), 30 lesions underwent surgical excision and final pathology results were provided. All 24 IDC on 14-G semi-automated CNB (core needle biopsy) were confirmed to be IDC(Invasive ductal carcinoma) on final pathology. Of the two DCIS(Ductal carcinoma Insitu) on US(Ultrasound) guided CNB( core needle biopsy), one DCIS, were upgraded to IDC, the other one confirmed to be DCIS on final pathology,the two ILC were confirmed to be ILC on final pathology.Of the four benign lesions, the two ADH(Atypical Ductal hyperplasia) underwent surgical excision, finally diagnosed as DCIS,the other two benign lesions (fibroadenoma and fibroadenosis) their BIRADS assessments were category 4C and were recommended for follow-up.The overall accuracy of US-guided 14-G(Gauge) semi-automated CNB( core needle biopsy) was 90.0 % (27/32). Conclusion: The present study confirms the good retrieval rate (93.8%) of US-guided 14-G semi-automated CNB and diagnostic accuracy of (90.0%). Thus, this could be useful procedure for suspicious microcalcifications apparent on sonography.Specimen radiography proved to be a great help in deciding the accurate retrieval of microclcifications by core biopsy. It should be done in all cases of core biopsy for calcifications with marking of the core containing calcifications to be specially assessed by histopathology. We should try to do core biopsy before using VAB (Vaccum-Assisted Biobsy)for calcifications if well seen by ultrasound.

Objective: Breast cancer is a leading cause of mortality in industrialized and developing countries. Mammography and a core needle biopsy are among the detection methods that are used to diagnose and confirm tumor subtypes. Methods: A retrospective, noninterventional observational study was conducted in a tertiary center between January 2009 and December 2014. A total of 265 patients underwent ultrasonography (US)–guided core needle biopsy (CNB). A cohort of 147 patients met the inclusion criteria and data were subsequently extracted from their medical records. Results: From this cohort, US-CNB detected malignant lesions in 109 patients, with a total sensitivity and specificity for malignancy at 96.33% and 75.10%, respectively. The most frequent malignant tumor diagnosed with US-CNB was invasive ductal carcinoma. The most common benign masses detected were 38 (32.1%) fibroadenomas and fat necrosis. The positive and negative predictive values for US-CNB were 92.4% and 87.5%, respectively. Conclusion: The findings would suggest that the use of US-CNB could play a major role in the identification and management of the breast lesions. It could also redeem any biopsy errors or operator inexperience. Sensitivity and specificity in detecting tumors, malignant or benign, using US-CNB could aid in efforts to provide an appropriate medical management plan.

Introduction. Efficient execution of image-guided percutaneous biopsy is a procedural competency milestone in radiology training. Despite the importance of achieving such mastery, literature on successful execution by residents is limited. The purpose of this study was to evaluate resident performance as measured by nondiagnostic biopsy and major complication percentages, on CT-guided transthoracic core needle biopsies (TTNB) of lung and mediastinal lesions. Methods. A 12-year retrospective cohort study was conducted using charts from an academic hospital, 2006 - 2018, to evaluate TTNBs. Inclusion criteria were ≥ 18 years of age and ≥ 1 follow-up CT scan and chest x-ray. Bivariable associations by outcome(s) were evaluated. Results. Of 1,191 biopsies conducted, case distribution was 41%, 26%, 18%, and 15% for postgraduate years (PGY) 2 - 5, respectively. Results from biopsies were 139 (11.7%) nondiagnostic, 218 (18.3%) benign, and 834 (70.0%) malignant cases. Resident year by nondiagnostic outcome was not significant; p = 0.430. There were 148 major complications. Complication rate by PGY 2 - 5 was 13.0%, 13.3%, 12.9%, and 9.2%, respectively; differences were not significant, p = 0.488. Of the 139 nondiagnostic cases, 42 were re-biopsied during the study period with 81% re-classified as malignant; no repeat biopsy was observed for the remaining 97 nondiagnostic cases.Conclusion. Of 1,191 lung/mediastinal biopsies analyzed, nearly 12% were nondiagnostic and over 12% had major complications; neither associated with resident level of experience. Outcomes were not affected significantly by level of training. Residency programs may benefit from affording opportunities for newer PGY classes to participate in procedures. Nondiagnostic cases may benefit from timely, repeat biopsies.

The clinician could have CNB in mind for thyroid nodules when FNA results were nondiagnostic. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules. Usefulness of preoperative tissue sampling and pathology diagnoses in thyroid tumors were accepted worldwide. We investigate the role of Core needle biopsy (CNB) in the thyroid nodules lesions when FNA results are nondiagnostic. We conducted a cross-sectional study to evaluate twenty-six CNBs results of suspicious malignant thyroid nodules with nondiagnostic repeated fine needle aspiration. 25 from 26 CNBs were diagnostic. Twenty-one needle biopsy reports were papillary thyroid carcinoma, three CNB samples diagnosed medullary thyroid carcinoma and one of them had anaplastic results. All diagnostic needle biopsies results were compatible with final pathology. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules while repeated FNA yielded nondiagnostic results.

To evaluate and compared the diagnostic performances of FNA and CNB using various cytopathologic criteria and size subgroups to see how the comparison results differ accordingly. From May 2012 to May 2019, 8187 thyroid nodules in 8139 patients who had undergone preoperative US-guided FNA or CNB at outside clinics were included in this retrospective study (mean size: 11.9 ± 9.5 mm). Preoperative US-FNA was performed in 7496 (91.6%) nodules and US-CNB was performed in 691 (8.4%) nodules. Propensity score matching was used to compare the sensitivities between FNA and CNB in diagnosis of malignancy and neoplasm according to different cytologic test criteria. Of the 8187 thyroid nodules, 7833 (95.7%) were malignant and 354 (4.3%) were benign. Mean size of the thyroid nodules in the CNB group was significantly larger than the FNA group, 15.7 ± 12.7 mm vs. 11.6 ± 9.0 mm, respectively (P 0.05, respectively). Results comparing sensitivities between FNA and CNB differ according to the different cytopathologic criteria used for calculation. CNB has significantly higher sensitivity to FNA in subcentimeter nodules when using criteria 1 or 2. Diagnostic sensitivities did not show significant differences for nodules ≥10 mm regardless of the cytopathologic criteria used, that should be considered in selecting biopsy methods.

Objective Whether the optimal management of pure flat epithelial atypia (FEA) found on core needle biopsy (CNB) specimens is surgical excision or imaging follow-up remains controversial. This study aimed to determine the upgrade rate to ductal carcinoma in situ (DCIS), invasive carcinoma or a high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ), and it explored the relationship between a family history of breast cancer and the risk of upgrade. Methods Cases with pure FEA found on stereotactic CNB of microcalcifications between March 2011 to December 2017 were followed by excisional biopsy or periodic imaging. The proportion of cases upgraded to a high-risk lesion and the odds of upgrade as related to a family history of breast cancer were determined with 95% confidence intervals (CIs). Results We identified 622 cases of pure FEA; 101 (16.2%) underwent surgical excision and 269 (43.2%) had imaging follow-up of ≥ 24 months. There were no upgrades to DCIS or invasive cancer in any of these 370 individuals (0%), and 4.6% (17/370; 95% CI: 2.9%–7.2%) were upgraded to a high-risk lesion. There was a nonstatistically significant trend between family history and upgrade to high-risk lesion (odds ratio 1.72 [95% CI: 0.65%–4.57%]). Conclusion In our study, the upgrade rate of pure FEA to malignancy was 0%. We suggest that regular imaging follow-up is an appropriate alternative to surgery. Because of potential differences in biopsy techniques and pathologist interpretation of the primary biopsy, individual institutions should audit their own results prior to altering their management of FEA.

Introduction: Lung carcinomas are one of the most common malignancies and major cause of cancer-related deaths worldwide. India also shares a great burden of this disease. Computed topography (CT)-guided fine-needle aspiration cytology of lung masses is a widely used and simple diagnostic tool which is being replaced increasingly by CT-guided core biopsies. This study shows our experience at a diagnostic center. Materials and Methods: This was a prospective study conducted over a period of 1 year from April 2018 to April 2019 and consisted of 107 cases. After taking detailed history, CT-guided core biopsies were obtained using coaxial needles of 17–19 gauge and biopsy needles of 18–20 gauge. The tissues were then examined histopathologically and the results were noted. Results: Out of the 107 patients, 81.3% were male and 18.7% were female. The age range of patients was from 33 to 92 years, with mean age being 63.7 years. Majority of the lesions were located in the right lung (57.9%). The most common histopathological diagnosis was squamous cell carcinoma 74.7%, followed by small cell carcinoma (12.1%) and adenocarcinoma (9.3%), Hodgkin lymphoma (1.8%), malignant mesothelioma (0.9%), and angiosarcoma (0.9%). Conclusions: This study shows our experience regarding lung malignancies in a diagnostic center in Western India. The epidemiology of lung malignancies seen across the Indian subcontinent reflects in our study. CT-guided core needle biopsies though less invasive may cause complications in some patients. Hence, utmost care should be taken during the procedure to ensure patient safety.

Background: Breast cancer is the female cancer with the highest mortality. While early detection is a public health priority in Western European countries, a screening program in our country has yet to be implemented. The best diagnostic accuracy is achieved through the use of triple assessment: clinical examination, imaging, and core-needle biopsy where indicated. Prognosis is influenced by clinical, histological, and biological factors, and therapy is most effective when individually tailored. Aim of the study: To analyze the clinical, histological, and immunohistochemical characteristics of the biopsied nodules and summarize our experience from the last three years. Material and Methods: We retrospectively analyzed data from 137 patients who underwent core-needle biopsy between 2017 and 2019. Imaging score was assigned based on ultrasound examination or mammography. Clinical and pathological parameters were recorded, followed by statistical processing of the data. Results: The mean age of the patients was 58 ± 14 years, lesions had a mean size of 22.83 ± 14.10 mm. Most nodules (n = 63, 47.01%) were located in the upper-outer quadrant, and bilateral presence was found in 4 (3.08%) cases. We found a significant positive correlation between lesion size and the patients’ age (Spearman r = 0.356; 95% CI 0.186, 0.506; p = 0.000). The malignancy rates within the Breast Imaging Reporting and Data System (BI-RADS) categories were as follows: 0% for „4a”, 31.58% for „4b”, 71.42% for „4c”, and 97.72% for „5”. Most malignancies (n = 73, 78.35%) were represented by invasive ductal carcinoma of no special type, 58.43% (n = 52) were grade 2, 89.13% (n = 82) were estrogen receptor positive, and Luminal B-like type was the most common (n = 63, 78.75%). Conclusions: The mean size of tumors was larger than the average size at discovery described in the literature. In our region, age and tumor size are positively correlated. Preoperative histological results may indicate the reliability of the imaging risk stratification system. Most cases can benefit from adjuvant endocrine therapy.

Introduction: In recent years, techniques with minimally invasive have been gradually developed and used in the diagnosis of lymphoma. Among minimally invasive techniques, core needle biopsy (CNB) has been widely accepted as an effective tool for the diagnosis of malignant lymphoma, carcinoma and deep tumors that are only accessible via CT or endoscopic-guided. This study was conducted to investigate of diagnostic value of ultrasound guided CNB in the diagnosis of lymphoma in all parts of the body compared to surgical excisional biopsy (SEB). Materials and Methods: This is an descriptive epidemiological study that was performed on patients with suspected lymphoma referred to the intervention ward of Golestan Hospital in Ahvaz in 2019. For all patients with suspected lymphoma, CNB of lymph nodes was performed by ultrasound-guided. Finally, the final diagnosis of CNB was compared with the results of surgical biopsy in the studied specimens. Results: In this study, 40 patients were evaluated with suspected lymphoma. At initial diagnosis with CNB, 12 (30%) had NHL, 19 (47.5%) had Hodgkin's lymphoma, and 2 had high-grade lymphoma. Of the 40 patients examined, 29 required IHC to confirm the diagnosis. In 8 cases, the final diagnosis was done using SEB. Final diagnosis in 9 (22.5%) patients was confirmed by CNB only. The CNB along with the IHC also led to the final diagnosis in 23 (57.5%) patients. However, another 8 patients required biopsy to confirm the diagnosis by SEB. Conclusion: The findings of this study indicated that US-CNB is a highly efficient method of diagnosis of lymphoma with high specificity, in the fastest possible mode and with the least complications.

AmaçBu çalışmada BT eşliğinde transtorasik çekirdek iğne biyopsisinde, iğne manevrası sayısı ve plevral ponksiyon sayısının pnömotoraks üzerine etkisini araştırmak amaçlandı.Yöntem Hastalara uygulanan BT eşliğinde çekirdek iğne biyopsisi kayıtları retrospektif olarak incelendi. Demografik veriler, işlem raporları, patoloji raporları, tomografi görüntüleri, takip muayeneleri ve biyopsiye bağlı komplikasyonlar incelendi. Daha sonra, iğnenin plevraya kaç kez girdiği ve akciğerdeki manevra sayısı listelenmiştir. Plevral ponksiyon sayısı 1 veya ≥2 olarak kaydedildi. İğne manevra sayısı 1, 2 veya ≥3 olarak kaydedildi. Listelenen tüm değişkenler istatistiksel olarak değerlendirildi.Bulgular Toplamda 393 hasta çalışmaya dahil edildi. Pnömotoraks komplikasyonu 87(%22,1) hastada oldu. Pnömotoraksa bağlı toraks tüpü uygulaması 39(%9,9) hastada gerekli oldu. Biyopsi uygulama esnasındaki akciğerlerdeki iğne manevrası sayısının 3+ olduğu durumlarda, pnömotoraks insidansında ve toraks tüpü uygulama gereksiniminde artış saptandı (p=0.001). Lezyon boyutu azaldıkça ve lezyon plevra mesafesi arttıkça iğnenin akciğer içerisindeki manevra sayısı artmıştır (p=0.001, p=0.008). Plevra delinme sayısı ≥2 olan 48 hastada, pnömotoraks ve toraks tüpü uygulama oranları artmıştır (p=0.001, p=0.001).Sonuç BT eşliğinde yapılan pulmoner transtorasik çekirdek iğne biyopsisi uygulamalarında, iğne manevrası sayısı ve plevral ponksiyon sayısı pnömotoraks gelişme riskine katkıda bulunan ana faktörleri oluşturmaktadır., AimThis study sought to investigate the effect of the needle maneuver count and number of pleural punctures on pneumothorax in CT-guided transthoracic core needle biopsy. Materials and MethodsRecords of CT-guided core needle biopsy performed on patients were retrospectively reviewed. Demographic data, procedure reports, pathology reports, tomography images, follow-up examinations, and complications due to biopsy were examined. Next, the number of times the needle penetrated the pleura and the number of maneuvers in the lung were listed. The number of pleural punctures was recorded either as 1 or ≥2. The needle maneuver count was recorded either as 1, 2, or ≥3. All listed variables were statistically evaluated.ResultsA total of 393 patients were included in the study. Complications of pneumothorax occurred in 87 (22.1%) patients. A thorax tube application due to pneumothorax was required in 39 (9.9%) patients. When the needle maneuver count in the lungs during biopsy was greater than 3, the incidence of pneumothorax and the need for a thorax tube application were increased (p = 0.001). As the size of the lesion decreased and the lesion-pleura distance increased, the needle maneuver count in the lung increased (p = 0.001, p = 0.008). Pneumothorax and thorax tube application rates were increased in 48 patients with pleural punctures ≥2 (p = 0.001, p = 0.001).Conclusion In CT-guided pulmonary transthoracic core needle biopsy applications, needle maneuver count and the number of pleural punctures constitute the major factors contributing to the risk of developing pneumothorax.

Objectives Breast adenomas are rare benign tumors. The aim of this study was to describe the ultrasound findings of breast adenomas, including less common worrisome features that can mimic malignancy. Methods From November 2014 to November 2019, we performed 1605 core needle biopsies guided by ultrasound in our department. In all, 229 corresponded to fibroadenomas and 12 to breast adenomas. Results Breast adenomas represented 0.75% of all core needle biopsies; 50% (6 of 12) were tubular adenomas; 17% (2 of 12) were ductal adenomas; and 33% (4 of 12) were lactating adenomas. Tubular and lactating adenomas occurred in young women and ductal adenomas in postmenopausal women. Lactating adenomas occurred in pregnant or breastfeeding women and were larger than the other adenomas. Ultrasound showed a mass with an oval shape, a parallel orientation, circumscribed margins, and hypoechoic and homogeneous patterns in most cases. However, up to one-third of them presented with suspicious findings. Conclusions Breast adenomas are rare benign entities with no specific clinical and radiologic features. Sometimes, they appear as suspicious tumors on radiologic modalities, requiring a histopathologic assessment to rule out malignancy. Radiologists need to be familiar with this entity to determine concordance between imaging and the final pathologic analysis.

A radiomics-based classifier to distinguish phyllodes tumor and fibroadenoma on gray-scale breast ultrasonography was developed and validated. A total of 93 radiomics features were extracted from representative transverse plane ultrasound images of 182 fibroepithelial lesions initially diagnosed by core needle biopsy. High-throughput radiomics features were selected using the intra-class correlation coefficient between two radiologist readers and the Least Absolute Shrinkage and Selection Operator regression through 10-fold cross-validation. When applied to the validation set, the radiomics classifier for the differentiation of phyllodes tumors and benign/fibroadenomas achieved an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0.597-0.888) with an accuracy of 0.703 (sensitivity: 0.857; specificity: 0.5). Our radiomics signature-based classifier may help predict phyllodes tumors among fibroepithelial lesions on breast ultrasonography.

Background: Guided lung biopsies and Fine needle aspiration cytologies (FNAC) have been used for diagnosis of peripheral lung lesions and both have advantages and disadvantages. In our institution, core needle biopsies of lung are done from Computed tomography (CT) and thoracoscopic guided procedures. Methods: The histopathological records of our General Hospital were retrospectively reviewed for core needle biopsies of lung lesions between July 2018 to June 2019 (1 year). There were 89 cases during this period. Results: There were a total of 89 cases (66 males and 23 females) during the study period of one year. The specimens received were linear bits and average size was 0.5cm in length. Non-neoplastic lesions were 24(26.9%) and neoplasms contributed to 65 cases (73.03%). Maximum number of cases (47 cases) were reported in the age group of 41-60 years (47 cases) with male preponderance. In all the.age groups, malignant lesions were more common in which Adenocarcinoma was predominant. Conclusion: To conclude, in our study malignancies predominated over non neoplastic lesions. The most common histological cell type encountered in this study was an Adenocarcinoma.

Objective: Ultrasonography guided core needle biopsy is a real-time, inexpensive method with higher patient comfort. The aim of this study was to evaluate ultrasonography findings of microcalcifications without accompanying mass and also to investigate the accuracy of ultrasonography guided core needle biopsy results. Materials and Methods: The study included a total of 54 patients, with microcalcifications observed on mammography and no accompanying mass, who underwent ultrasonography guided core needle biopsy and surgical excision. Core needle biopsy specimen x-rays were obtained from 23 patients. In 11 patients, the location of microcalcification was confirmed by mammography following the administration of contrast agent under ultrasonography guidance. Ultrasonography findings of microcalcifications were identified. The results of ultrasonography guided core needle biopsy were compared with the excisional pathology results. Results: The microcalcifications without accompanying mass were presented with punctate echogenous foci, hypoechoic area, small distortion, ductal abnormality or fibrocystic changes on ultrasonography. Hypoechoic area and distortion were seen more in malignant lesions, and fibrocystic changes and ductal abnormalities in benign lesions but the difference was not statistically significant. The agreement between ultrasonography guided core needle biopsy and the excisional pathology results was high (Kappa = 0.781). When a specimen x-ray was obtained or core needle biopsy was performed after confirming the location of the microcalcifications with the use of contrast agent, Kappa values were even higher (0.87 and 1, respectively). Conclusions: Microcalcifications can be seen with targeted ultrasonography imaging and ultrasonography guided core needle biopsy has high accuracy. Taking a specimen x-ray, or biopsy performed after identifying of the location of microcalcifications with a trace amount of contrast agent, can increase the accuracy of ultrasonography guided core needle biopsy.

To determine the reliability of image-guided core needle biopsy (IGCNB) for the diagnosis and grading of chondral tumours of bone compared with surgical histology. Retrospective review of patients with a chondral tumour of bone who underwent IGCNB and surgical resection between January 2007 and December 2017. Data collected included age, sex, skeletal location, technique used for IGCNB, IGCNB result including histological grade and comparison with surgical histology. A total of 237 patients were included (135 males and 102 females with mean age 53.7 years, range 9–89 years). A total of 174 IGCNBs were CT-guided, 57 ultrasound-guided and 6 fluoroscopic-guided. Two hundred thirty-six of 237 (99.6%) IGCNBs were diagnostic for a chondral tumour, although grade could not be determined in 13 (5.5%) due to necrosis. A positive correlation for tumour grade between IGCNB and surgical histology was achieved in 181 cases (76.4%). In 36 patients (15.2%), IGCNB under-graded the tumour, while in 6 (2.5%), IGCNB over-graded the tumour. Discrepancy between IGCNB and surgical histology was significantly greater for surface/peripheral lesions (p = 0.02) and lesions arising from the flat bones or spine (p = 0.002). IGCNB can achieve a diagnosis of a chondral tumour in a high proportion of cases when compared with final diagnosis from surgical resection specimens. However, correlation of tumour grade between IGCNB and resection histology is less reliable with discordance seen in almost one-quarter of cases, most commonly at non-appendicular sites. Therefore, IGCNB results should not be considered in isolation of imaging and clinical features when planning surgical management.