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The use of gene expression profiling (GEP) in cancer management is rising, as GEP can be used for disease classification and diagnosis, tailoring treatment to underlying genetic determinants of pharmacological response, monitoring of therapy response, and prognosis. However, the reliability of GEP heavily depends on the input of RNA in sufficient quantity and quality. This highlights the need for standard procedures to ensure best practices for RNA extraction from often small tumor biopsies with variable tissue handling. We optimized an RNA extraction protocol from fresh-frozen (FF) core needle biopsies (CNB) from breast cancer patients and from formalin-fixed paraffin-embedded (FFPE) tissue when FF CNB did not yield sufficient RNA. Methods to avoid ribonucleases andto homogenize or to deparaffinize tissues and the impact of tissue composition on RNA extraction were studied. Additionally, RNA’s compatibility with the nanoString nCounter® technology was studied. This technology platform enables GEP using smallRNA fragments. After optimization of the protocol, RNA of high quality and sufficient quantity was obtained from FF CNB in 92% of samples. For the remaining 8% of cases, FFPE material prepared by the pathology department was used for RNA extraction. Both resulting RNA end products are compatible with the nanoString nCounter® technology., The use of gene expression profiling (GEP) in cancer management is rising, as GEP provides insight in molecular and cellular processes through evaluation of thousands of genes at once. GEP can be used for disease classification and diagnosis, tailoring treatment to underlying genetic determinants of pharmacological response, monitoring of therapy response and prognosis. However, the reliability of GEP heavily depends on input of RNA at sufficient quantity and quality. This highlights the need for standard procedures to ensure best practices for RNA extraction from tumor biopsies, which are often small with variable tissue handling. We optimized an RNA extraction protocol from fresh-frozen (FF) core needle biopsies (CNB) from breast cancer patients and from formalin-fixed paraffin-embedded (FFPE) tissue, when FF CNB did not yield sufficient RNA. Methods to avoid ribonucleases, to homogenize or to deparaffinize tissues, and the impact of tissue composition on RNA extraction were studied. Additionally, the RNAs compatibility with the nanoString nCounter® technology was studied. This technology platform enables GEP using RNA and target specific probes of 50 bases that can bind to small RNA fragments. After optimization of the protocol, RNA of high quality and sufficient quantity was obtained from FF CNB in 92% of samples. For the remaining 8% of cases, FFPE material prepared by the pathology department could be used for RNA extraction. Both resulting RNA end products are compatible to the nanoString nCounter® technology.

Background and Objective: Computed tomography guided percutaneous lung biopsy is a commonly used method for clarifying the nature of pulmonary nodules. However, due to the existence of breathing movement, the lungs have greater mobility, and biopsy of small pulmonary nodules is difficult. In recent years, 3D-printed coplanar templates are gradually used in percutaneous biopsy of small pulmonary nodules. Therefore, this study aimed to evaluate the application value of 3D-printed coplanar puncture template assisted computed tomography guided percutaneous core needle biopsy of small (≤20mm) pulmonary nodules. Method: From January 2018 to January 2021 in Taihe Hospital, 210 hospitalized patients with pulmonary nodules underwent percutaneous core needle biopsy for histopathology/cytopathology diagnosis and were included in the study. All patients were randomly allocated into two groups, patients in Free-hand group underwent percutaneous core needle biopsy without 3D-printed coplanar templates, and patients in 3D-PCT group underwent percutaneous core needle biopsy with 3D-printed coplanar templates. The number of needle adjustments, number of CT scans, surgical time-consuming, diagnostic accuracy, and incidence of complications were recorded and compared between the two groups. Rapid on site evaluation was routinely used for guiding specimens’ triage. Approval for this trial was obtained from the Ethics Committee of the Taihe hospital. Result: The number of needle adjustments (1.41±0.63 vs. 2.23±0.85), the number of CT scans (3.63±0.73 vs. 4.25±0.81) and the incidence of pneumothorax (9.6% vs. 21.1%) during the procedure were significantly lower in the observation group than the control group (P< 0.05), whereas there were no significant differences in the diagnostic accuracy (95.2% vs. 94.3%) and incidence of pulmonary hemorrhage (65.4% vs. 62.3%) between the two groups (P> 0.05), however, the surgical time-consuming in 3D-PCT group is significantly more than Free-hand group.Conclusions: These findings indicated that the 3D-printed coplanar puncture template combined with CT guided percutaneous biopsy can relatively fix the target lesion, reduce the number of needle adjustments and number of CT scans, reduce iatrogenic radiation, and reduce the incidence of complications, especially pneumothorax.

The diagnostic role of fine-needle aspiration cytology (FNAC) and core-needle biopsy (CNB) has not been comprehensively assessed in head and neck sarcomas. A systematic review of published cases (1990-2020) was conducted. Diagnostic performance of both FNAC/CNB to determine tumor dignity and histopathological diagnosis was calculated. One hundred and sixty-eight cases were included for which FNAC (n = 156), CNB (n = 8), or both (n = 4) were used. Predominant histologies were skeletal muscle, chondrogenic and vascular sarcomas. FNAC correctly assessed dignity in 76.3% and histology in 45% of cases. Dignity was significantly better for vascular tumors, metastatic and recurrent specimens, and worse for chondrogenic sarcomas. CNB showed a 92% accuracy to identify dignity and 83% for histopathology. FNAC and CNB are useful methods for the diagnosis of head and neck sarcomas, particularly well-suited in the context of recurrent or metastatic disease. The role of CNB remains largely unexplored for this indication.

Background To determine risk factors for pneumothorax associated with computed tomography (CT)-guided percutaneous core needle biopsy (PCNB) of the lung. Whether the lung function characteristics are related to pneumothorax is unclear. This study was designed to provide a risk assessment of pneumothorax based on pulmonary function analysis, which can predict the risk especially for patients with severe pulmonary dysfunction. Methods We retrospectively evaluated 343 patients who received CT-guided pulmonary PCNBs and underwent preoperative pulmonary function testing. Demographical, lesion-related, procedure-related features and histopathological diagnosis, as well as results of pulmonary function test were analyzed for risk factors of pneumothorax Results Variables associated with higher rate of pneumothorax were location of lesion, presence of emphysema and dwell time. Furthermore, there was significant difference of pulmonary function parameters between groups with or without pneumothorax as expressed by FEV1/FVC ratio, FEV1/FVC ratio (%, pred), FEF50% (% pred), FEF75% (% pred), and FEF25 − 75% (% pred). Obstructive pulmonary function abnormalities were associated with a higher incidence of pneumothorax. However, no correlation was found between the pneumothorax rate and the severity of pulmonary function abnormalities. Multivariate logistic regression analysis showed lower location of lesion sampled and presence of emphysema were independent predictors of pneumothorax. Conclusions Patients with obstructive pulmonary dysfunction have a higher risk of pneumothorax. FEV1/FVC ratio, FEF50%, FEF75% and FEF25 − 75% has the potential to identify the high-risk population of pneumothorax.

Accurate characterization of suspicious microcalcifications is critical to determine whether these calcifications are associated with invasive disease. Our overarching objective is to enable the joint characterization of microcalcifications and surrounding breast tissue using mammography images and digital histopathology images. Towards this goal, we investigate a template matching-based approach that utilizes microcalcifications as landmarks to match radiographs taken of biopsy core specimens to groups of calcifications that are visible on mammography. Our approach achieved a high negative predictive value (0.98) but modest precision (0.66) and recall (0.58) in identifying the mammographic region where microcalcifications were taken during a core needle biopsy.

Introduction: Excisional biopsy (EB) is considered the gold standard for lymphoma diagnosis. Although recent advances in interventional radiology enable sampling with core-needle biopsy (CNB), only few studies evaluated the utility of CNB compared to that of EB. Methods: We analyzed patients with lymphoma who had a diagnostic biopsy at the National Cancer Center Hospital during 2002–2017. We investigated the clinical and pathological characteristics of CNB in 2017. Results: The proportion of CNB utility in total biopsy procedures had increased from 11 to 48% during the 15 years. In 2017, CNB was opted more frequently than EB for a biopsy of superficial, abdominal, or anterior mediastinal lesions. Only one out of 72 patients who had CNB required re-biopsy with EB because of insufficiency. The incidence of complications was comparable between CNB and EB: 2 (4%) cases of minor bleeding with CNB and 1 (8%) case of minor bleeding with EB. The median time from the first visit to biopsy was significantly shorter with CNB (5.5 days) than with EB (15 days). Conclusion: There is an increasing trend in the utility of CNB. CNB is a less invasive method with shorter time to biopsy and can be considered an alternative to EB.

The diagnosis via core needle biopsy of concurrent ductal carcinoma in situ and lobular carcinoma in situ within an enlarging previously biopsied benign fibroadenoma in women in their 40s is rare. Several case reports have described the occurrence of malignant changes within fibroadenomas, usually as an incidental finding following excision, and few reports have documented the transition of a fibroadenoma to malignancy. The current case report emphasises the importance of re-biopsying enlarging fibroadenomas, even with otherwise maintained benign appearing features on imaging, in women in their 40s, in order to exclude the possibility of malignancy.

Soft tissue tumors, including sarcomas are complex and diagnostically challenging tumors. This is as a result of their heterogeneity and overlapping clinicopathological, immunohistochemical and also molecular features, the latter to some extent. More than 80 types of sarcoma have been described. Current management, which is best offered at centers with active multidisciplinary care, is based on balancing oncologic and functional outcomes in such cases. This has transcended into the types of specimens received for grossing these rather uncommon tumors. Over the years, diagnostic specimens have reduced in their sizes from, open biopsies to core needle biopsies. These specimens need to be adequately and judiciously triaged for ancillary techniques, such as molecular testing. Conservative surgeries have led to resected specimens for marginal assessment. Lately, post neoadjuvant (chemotherapy or radiation therapy)-treated resection specimens of soft tissue sarcomas are being submitted for surgical pathology reporting. This article focuses on the grossing of soft tissue tumors, including sarcomas, in terms of types of specimens, grossing techniques including rationale, tissue triage, reporting, and recommendations from the surgical pathologists actively engaged in reporting musculoskeletal tumors, based on current evidence.

Author(s): Majumdar, Shamaita; Iskander, Paul; Luhar, Aarti | Abstract: Alagille Syndrome is a multisystem genetic disorder characterized by paucity of interlobular bile ducts, which can lead to early cirrhosis and increase the risk of developing focal liver lesions including hepatocellular carcinoma. As a result, routine imaging surveillance is often performed in these patients.nnHowever, it can be challenging to distinguishing incidentally found benign liver tumors from their malignant counterparts in this subset of patients. Here we present the case of a giant regenerative hepatic nodule in a 17-year-old female with Alagille syndrome, and the associated imaging characteristics that favored a benign diagnosis, with benign pathology confirmed by image-guided core needle biopsy.n

Lesions of uncertain malignant potential represent a group of diverse histopathological entities, with a variable degree of associated malignancy. The lesions in this group include atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumours and radial scars (RS). They are found in the 4–9% of all core needle biopsies (CNB) and this value increases with other techniques such as vacuum-assisted biopsy (VAB).

Minimally invasive liver biopsy is used in neonates and children to diagnose and track progression of a variety of liver diseases. Laboratory values and imaging obtained preoperatively for hyperbilirubinemia help to guide in forming a differential diagnosis. Special anesthetic considerations include lower insufflation pressures in neonates. Operative approach includes an umbilical port and working ports to obtain a sample and perform an intraoperative cholangiogram if indicated. Cautery, sharp biopsy with scissors, or using the core needle method can be used in conjunction with laparoscopy.

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Several inflammatory or inflammatory-like lesions that involve the breast have an overall spindle cell appearance or may develop focal areas with spindled or histiocytoid morphology. Such lesions can present diagnostic challenges given the broad differential that arises from their often overlapping histologies, especially on the limited sampling of a core needle biopsy. Some of these lesions are specific to the breast, while others are more ubiquitous and are known to involve multiple anatomic sites. As such, remembering that they may occur in the breast is key in their diagnosis and subsequent appropriate management which is especially relevant as the biologic behavior of this group ranges from benign to malignant.

Objective To evaluate incidental breast lesions on chest computed tomography with histopathological correlation. It is important for general radiologist to characterize a breast lesion as benign, indetermined, or sufficiently suspicious to warrant further work-up. Methods A total of 35.000 chest CT examinations were performed between January 2016 and December 2020. 27 patients (mean age 70 years, age range 48–87 years) with incidental breast lesions were identified in this retrospective study. Two radiologists scored incidental breast lesions independently regarding their morphology, and the results were compared to histopathology which was obtained by an ultrasound-guided core needle biopsy or a surgical excision. Results Out of 35.000 chest CT examinations, a total of 31 incidental breast lesions in 27 patients were detected. Among the 31 lesions, 23 were malignant and 8 benign. The malignant lesions included 17 carcinomas and 6 metastases (4 lymphomas and 2 melanomas). The benign lesions contained 2 hematomas, 4 fat necrosis, and 2 fibrosis lumps. Conclusion Chest computed tomography as a standard imaging technique is helpful for evaluation of suspicious breast lesions. This may ultimately influence patient management and lead to further imaging.

Introduction Computed tomography (CT)-guided core needle biopsy (CNB) is an essential step in the management of lung nodules (LNs). Low-dose CT (LDCT)-guided CNB has been used to decrease the radiation exposure. Aim To evaluate the technical success, safety, diagnostic capacity, and radiation exposure to patients between LDCT-guided and standard-dose CT (SDCT)-guided CNB for LNs. Material and methods This is a retrospective, single-centre study. Patients who underwent LDCT-guided or SDCT-guided CNB for LNs from January 2015 to December 2017 were included. Data on technical success, diagnostic performance, complications, and radiation exposure were collected and analysed. Results A total of 70 and 65 patients underwent LDCT-guided and SDCT-guided CNB procedure, respectively. The technical success rates were 100% in both groups. The diagnostic yield, sensitivity, specificity, and overall diagnostic accuracy in the LDCT and SDCT groups were 71.4% and 67.7% (p = 0.637), 97.8% and 93.2% (p = 0.625), 100%, and 100%, and 98.6% and 95.4% (p = 0.560), respectively. The independent risk factor of diagnostic failure was less sample tissues (p = 0.012; 95% confidence interval: 0.033–0.651). Pneumothorax was found in 9 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.369). Lung haemorrhage was found in 11 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.671). The mean dose-length product was 38.3 ±17.0 mGy · cm and 376.0 ±118.7 mGy · cm in the LDCT and SDCT groups, respectively (p < 0.001). Conclusions Compared to SDCT, LDCT-guided CNB can provide comparable safety and diagnostic performance for LNs while reducing exposure to radiation.

The aim of our work is to illustrate a new technique for the histological diagnosis of Paget’s disease (PD) using a core needle biopsy with a semiautomated 14-gauge needle called nipple-core needle biopsy (N-CNB). We report 3 years’ experience in our senology unit. Twenty-six women with 26 clinical of nipple–areola complex (NAC) changes with suspected PD and subjected to core needle biopsy using our new 14G semiautomated needle technique were included in our study group. Institutional review board approval was obtained for this retrospective analysis. A semiautomated biopsy gun with a 14-gauge, 15-cm-long needle was used for this new procedure. After a subcutaneous injection of anesthetic and spray-ice application to the NAC, the 14G needle was opened with the cradle exposed and positioned on the NAC with considerable pressure exerted on the same. The cradle was then closed by triggering the needle spring, and 2–4 core samples were withdrawn by moving the needle position each time. Clinical, instrumental and histological differences between the lesions that gave benign results after N-CNB and those that resulted PD were analyzed by applying the Fisher's exact test. After N-CNB, 13/26 lesions were found to be PD (50%) while 13/26 alterations were benign (50%). No malignant lesions were detected during the follow-up in patients with benign N-CNB results. The diagnosis of PD obtained with N-CNB was confirmed in all 13 cases by means of a histological analysis of the surgical specimens. No significant post-biopsy complications were recorded. Patients with PD more frequently presented nipple retraction (ρ = 0.0407) and associated suspicious (i.e., BI-RADS 4 and 5) mammographic (ρ = 0.0006) findings compared to patients whose N-CNB had given benign results and the difference was statistically significant. In conclusion, with this novel technique, we were able to obtain an easy, painless, major complication-free and accurate diagnosis of PD of the NAC using a semiautomated core needle biopsy with a 14-gauge needle.

Cytological specimens may be the ideal source of nucleic acids for the molecular characterization of tumors in the next generation sequencing (NGS) era. Liquid‐based shaking of core needle biopsy samples could enhance the diagnostic yield, allowing additional material to be examined in parallel with histopathology.

We present cases of separate disease categories with shear wave elastography (SWE) and surgical pathology or core needle biopsy (CNB), and discuss the diagnostic performance of SWE in the differential diagnosis of thyroid nodules to try to figure out the possible prediction of histopathology by two-dimensional SWE (2D-SWE).

Purpose This case series explores the utility of positron emission tomography (PET)/computed tomography (CT) guidance for biopsy of 18F-fludeoxyglucose (FDG)-avid osseous lesions that are inconspicuous on CT. Methods PET/CT-guided core biopsies were performed in four patients with suspected malignancies given 18F-FDG-avid osseous lesions that were inconspicuous on CT alone. The final diagnosis for each patient was determined by histopathological and molecular testing. Results PET/CT-guided biopsy yielded accurate sampling via core needle biopsy (CNB) with histopathological confirmation of osseous metastases of the primary malignancy as opposed to a secondary malignancy in three patients and ruled-out metastatic spread in the fourth. Conclusion PET/CT-guided biopsy of hypermetabolic osseous lesions that are inconspicuous on CT alone is an effective and safe diagnostic tool in patients with suspected malignancy.

Lobular carcinoma in situ (LCIS) is currently classified as classic (CLCIS), florid (FLCIS), and pleomorphic (PLCIS). Given the rarity of FLCIS and PLCIS, information on their clinico-pathologic features and biologic potential remains limited. We evaluated the upgrade rates at excision of FLCIS and PLCIS diagnosed on inhouse core needle biopsy (CNB) and their clinical presentation and follow-up. Over a period of 11 and a half years, there were a total of 36 inhouse CNBs with pure PLCIS (n = 8), FLCIS (n = 24), or LCIS with pleomorphic features (LCIS-PF) (n = 4). The upgrade rates to invasive carcinoma or ductal carcinoma in situ (DCIS) were 25% for PLCIS (2/8), 17% for FLCIS (4/24), and 0% for LCIS-PF (0/4). The overall upgrade rate of PLCIS and FLCIS combined was 19% (6/32). All but one case (not upgraded at excision) were radiologic-pathologic concordant. Apocrine features, previously reported only in PLCIS, were also noted in FLCIS. HER2 overexpression was seen in 13% of cases. This study highlights the more aggressive biologic features of PLCIS and FLCIS compared to CLCIS and supports surgical management for these lesions.

OBJECTIVE: To investigate the diagnostic value of core-needle biopsy (CNB) guided by contrast-enhanced ultrasound (CEUS) in cervical tuberculous lymphadenitis (CTL). METHODS: 178 patients with pathological confirmation of CTL were retrospectively enrolled. All of them had undergone CNB prior to the final surgery. According to the different ways of puncture guidance, they were divided into two groups: conventional ultrasound (US) group (n = 81) and CEUS group (n = 97). The comparison of diagnostic efficacy between two groups was compared and analyzed. RESULTS: Among the 178 patients, 146 were directly diagnosed as CTL by CNB, including 59 patients in CEUS group and 87 patients in US group. The diagnostic accuracy were 89.7% (87/97) and 72.8% (59/81), respectively (P 2.0 cm and ≤3.0 cm) and large size group (>3.0 cm), 91.7% for CEUS group vs. 69.0% for US group (P

Objective: This study was conducted to assess the effectiveness of Ultrasound-guided Core Needle Biopsy (US-CNB) to provide sufficient information for diagnosis and initiation of the treatment for head and neck lymphoma.Study Design: We carried out the prospective consecutive case series in a single- center study.Setting: The tertiary medical center setting.Patients and Methods: Totally, 72 patients were enrolled and the US-CNB of suspicious cervical lymph node was performed. Demographics, imaging and pathological data were collected for each patient and used to identify the factors that shape the diagnostic yield of US-CNB.Results: We observed among 72 CNBs 52 were fully diagnosed and 20 cases needed Excisional Surgical Biopsy for sub-classification. Then the factors influencing the results of the US-CNB, as the first-line diagnostic procedure for suspected cervical lymphadenopathy were discussed. The CNB results did not differ in terms of BMI, neck circumference and pathological subtype. Fully diagnosis CNB results demonstrated an association with higher mean tumor size and LAP in cervical zones 1 to 4 rather than posterior triangle.Conclusion: About 30% of the patients in the present study required ESB after US-CNB for fully diagnosis and this delayed their treatment. Therefore, the use of US-CNB as a primary method in assessment of cervical lymphadenopathy still needs more studies to investigate the factors influencing the results and shaping its diagnostic yield.

AimsTo determine if a simple prewash step added to the processing workflow of tissue procurement by a core needle biopsy device will recover enough cells to expand the laboratory testing armamentarium.MethodsTissue was obtained from unfixed resection specimens using a core needle device and washed in a buffered solution before fixation. This creates a liquid aliquot from which dislodged cells can be kept and separated from the tissue specimen, the latter of which can then undergo traditional formalin-fixed, paraffin-embedded processing.ResultsCells dislodged from the tissue during the biopsy procedure are recoverable, are representative of the tissue section and of sufficient quantities for additional laboratory testing.ConclusionsThe core needle biopsy wash is an under-recognised and underutilised approach to extending the diagnostic capabilities of the limited amount of targeted material obtained during this common procedure. The ability to recover supplemental amounts of diagnostic material yields great potential as a substrate for a multitude of current and developing laboratory assays.

High-risk breast lesions (HRLs) are a group of heterogeneous lesions that can be associated with a synchronous or adjacent breast cancer and that confer an elevated lifetime risk of breast cancer. Management of HRLs after core needle biopsy may include close imaging and clinical follow-up or excisional biopsy to evaluate for cancer. This article reviews histologic features and clinical presentation of each of the HRLs, current evidence with regard to management, and guidelines from the American Society of Breast Surgeons and National Comprehensive Cancer Network. In addition, imaging surveillance and risk-reduction strategies for women with HRLs are discussed.

AimsTo determine the proportion of thyroid fine needle aspiration (FNA) and core needle biopsy (CNB) cases reported at a single institute into each UK Royal College of Pathologists (RCPath) Thy1-5 and local T category, respectively. Where subsequent histology was available, malignancy rates, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were compared for both procedures.Methods1591 FNAs (2010–2018) and 514 CNBs (2013–2018) cases were identified, together with paired histology excision specimens.ResultsThe FNA samples were classified as: Thy1: 45.3%, Thy2/Thy2c: 22.1%, Thy3a/Thy3f: 28%, Thy4: 1.6% and Thy5: 3%; while the CNB were classified as: T1: 7.2%, T2: 22.4%, T3 59.3%, T4: 1% and T5: 10.1%. Comparison of FNA and CNB classified as Thy5/T5 showed a 100% risk of malignancy (ROM), sensitivity (98% vs 100%), specificity (14.1% vs 12.1%), PPV (29.4% vs 29.4%), NPV (94.9% vs 100%) and accuracy (36.5% vs 35.6%), respectively, for a diagnosis of malignancy. ROMs for other categories were: Thy1/T1 (9% vs 6.7%), Thy2/T2 (5.1% vs 0%), Thy3/T3 (17.5% vs 18.4%) and Thy4/T4 (73.3% vs 100%).ConclusionsThe proportion of cases in each RCPath Thy category has remained relatively stable during the 9-year study period, with the exception of the Thy3a category, which has increased over time. This finding is in line with other more recent reports in the literature and the proportion of T3 cases in the CNB group. The proportion of Thy2/Thy2c cases has also reduced over time, reflecting a local change in the triaging protocol for probable benign lesions. Both FNA and CNB showed comparable performance in our study.

BACKGROUND: A new disposable percutaneous positioning device was developed which permits adjustment of the fixing puncture angle while performing a percutaneous core needle lung biopsy (CNLB). The aim of the study was to explore the positioning accuracy and clinical safety of the new device during CT-guided percutaneous CNLB. METHODS: A prospective, open and randomized controlled study with two parallel groups was conducted on 150 patients with pulmonary nodules between July 1, 2018 and June 30, 2019 including 101 males and 49 females who were divided (allocation ratio: 1:1) into a standard CNLB group without the percutaneous positioning device (control, n=75) and a new percutaneous positioning device group combined with CNLB (experimental, n=75). The efficacy was determined by the success rate of reaching the target location on the first percutaneous attempt, the number of CT scans performed and the time required for successful puncture positioning. Safety evaluations included complications related to percutaneous surgery and the new positioning device. RESULTS: The success rate of reaching the target location on the first percutaneous attempt in the experimental group was significantly higher than in the control group [96.0% (72/75) vs. 42.7% (32/75), P

Background/Aims: The core needle biopsy (CNB), fine needle aspiration cytology (FNAC) and touch imprint cytology (TIC) are commonly used tools for the diagnosis of hepatic malignancies. However, little is known about the benefits and criteria for selecting appropriate technique among them in clinical practice. We aimed to compare the sensitivity of ultrasound-guided CNB, FNAC, TIC as well as combinations for the diagnosis of hepatic malignancies, and to determine the factors associated with better sensitivity in each technique.Methods: From January 2018 to December 2019, a total of 634 consecutive patients who received ultrasound-guided liver biopsies at the National Taiwan University Hospital was collected, of whom 235 with confirmed malignant hepatic lesions receiving CNB, FNAC and TIC simultaneously were enrolled for analysis. The clinical and procedural data were compared.Results: The sensitivity of CNB, FNAC and TIC for the diagnosis of malignant hepatic lesions were 93.6%, 71.9%, and 85.1%, respectively. Add-on use of FNAC or TIC to CNB provided additional sensitivity of 2.1% and 0.4%, respectively. FNAC exhibited a significantly higher diagnostic rate in the metastatic cancers (P=0.011), hyperechoic lesions on ultrasound (P=0.028), and those with depth less than 4.5 cm from the site of needle insertion (P=0.036).Conclusions: The sensitivity of CNB is superior to that of FNAC and TIC for the diagnosis of hepatic malignancies. Nevertheless, for shallow (depth

To evaluate the safety and effectiveness of core needle biopsy (CNB) under the assistance of hydrodissection (HDS). Of 2325 patients requiring biopsy of thyroid lesions, 21 high-risk patients with subcapsular nodules smaller than 10 mm were recruited into this study. All patients underwent HDS with 0.9% saline solution followed by ultrasound (US)-guided CNB with an 18-gauge semi-automated biopsy needle. The separation success rate (SSR) of the HDS, technical success rate (TSR) of CNB, histopathologic success rate (HSR), and complications were assessed. Both the SSR of HDS and TSR of CNB were 100% (21/21). The HSR of the thyroid nodules was 85.7% (18/21). No major complications were recorded. HDS before CNB can successfully lead to safe biopsy of small subcapsular thyroid nodules. Level 4, Case Series

Myofibroblastoma (MFB) of the breast belongs to a benign mesenchymal tumor1, this group of solid neoplasias of the breast are uncommon, also can generate a diagnostic challenge specially in the diagnosis with de needle biopsy2. In this review we refer to a case of a male patiente with a diagnosis of a infiltratin ductal carcinoma in the core needle biopsy with a pathological diagnosis of the surgery specimen of a epitheloid cell myofibroblastoma of the breast. El miofibroblastoma de glándula mamaria es un tipo de tumor mesenquimal benigno1, este grupo de neoplasias sólidas de la mama son infrecuentes, además de poder generar problemas diagnósticos diferenciales especialmente en biopsia por aguja2. En esta revisión hacemos referencia a un caso de un paciente masculino con diagnóstico de Carcinoma ductal infiltrante en la biopsia por aguja gruesa con diagnóstico patológico de la pieza quirúrgica de miofibroblastoma epiteloide de mama.

We developed a novel dividing device that can split needle biopsy tissues along longitude axis aiming to achieve definitive molecular-biological and genetical analysis with reference of pathological diagnosis of the side-by-side divided tissue as spatially matched information. The aim of this study was to evaluate the feasibility and potential usefulness of the novel dividing device to provide the appropriate materials for molecular diagnosis. The new device was examined using mouse xenograft tumors. Real-time quantitative PCR and genetic test were performed to evaluate the feasibility and usefulness of the device. All the samples from needle biopsy were successfully divided into two pieces. Quality and quantity from divided samples harbor high enough to perform gene expression analysis (real-time PCR) and genetic test. Using two divided samples obtained from xenograft tumor model by needle biopsy, the % length of xenograft tumor (human origin) was significantly correlated with the % human genomic DNA (p = 0.00000608, r = 0.987), indicating that these divided samples were spatially matched. The novel longitudinally dividing device of a needle biopsy tissue was useful to provide the appropriate materials for molecular-biological and genetical analysis with reference of pathological diagnosis as spatially matched information.

Objective We evaluated the diagnostic accuracy of computed tomography (CT)-guided transthoracic core needle biopsy (TCNB) for small (≤20-mm) lung nodules and identified predictive factors for true negatives among benign biopsy results. Methods From March 2010 to June 2015, 222 patients with small lung nodules underwent CT-guided TCNB. We retrospectively analysed data regarding technical success, diagnostic accuracy, and predictors of true negatives. Results The technical success rate was 100%. The TCNB results of the 222 lung nodules included malignancy (n = 136), suspected malignancy (n = 8), specific benign lesion (n = 17), and nonspecific benign lesion (n = 61). The final diagnosis of 222 lung nodules included malignant (n = 160), benign (n = 60), and nondiagnostic lesions (n = 2). The sensitivity, specificity, and overall diagnostic accuracy of CT-guided TCNB for small lung nodules were 90.0%, 100%, and 92.7%, respectively. Pneumothorax and haemoptysis occurred in 23 and 41 patients, respectively. Based on the Cox regression analysis, the significant independent predictive factor for true negatives was a biopsy result of chronic inflammation with fibroplasia. Conclusions CT-guided TCNB offers high diagnostic accuracy for small lung nodules, and a biopsy result of chronic inflammation with fibroplasia can predict a true-negative result.

Background In the last three decades, axillary lymph node dissection (ALND) has been replaced by sentinel lymph node biopsy (SLNB) in all clinically node-negative patients. However, when SLNB alone is performed in clinically node-positive patients who are rendered node-negative by neoadjuvant chemotherapy, the procedure has a high false-negative rate and other complementary procedures have been described to improve its reliability. Preoperative tattooing of the suspicious lymph node with India ink at the time of biopsy, in addition to sentinel lymph node biopsy, is a reasonable alternative. The objective of our study is to determine, in clinically node-positive patients, the feasibility of tattooing suspicious axillary lymph node at the time of percutaneous needle biopsy and its retrieval at the time of surgery. Methods A prospective experimental study will be conducted divided into two phases—phases I and II. In phase I, 10 patients committed to undergo upfront surgery (without neoadjuvant chemotherapy) will have a suspicious lymph node tattooed by injecting India ink at the time of core needle biopsy. All patients will undergo a SLNB, during which the axilla will be inspected to determine if the tattooed lymph node can be visualized. Routine microscopic examination will follow, and concordance between the sentinel and tattooed node will also be established. In phase II, the process will be repeated for 30 patients who undergo surgery after neoadjuvant chemotherapy. The analysis will be performed in Stata version 12. Discussion There is a need to identify and test the techniques for the down-staged axilla in post-neoadjuvant chemotherapy patients, which are not only practical and limit the number of invasive procedures necessary but are representative of the new axillary status and help limit the extent of axillary surgery without negatively impacting outcomes. We propose that, for the patient undergoing neoadjuvant chemotherapy with a biopsy-proven disease in the axilla, this could be achieved by India ink which allows marking, identification, and retrieval of the biopsied lymph node. Retrieval of this previously biopsied lymph node along with sentinel nodes, if found to be representative of the status of the remainder of the axilla, could potentially eliminate the need for routine axillary lymph node dissection and thus limit morbidity. Trial Registration ClinicalTrials.gov, NCT03939598. Retrospectively registered on 7 May 2019.

Introduction: Transthoracic ultrasound has become important diagnostic tool in peripheral pulmonary lesions and transthoracic needle biopsy,under US guidance is relatively safe and easy procedure, may provide adequate tissue sampling for cytological or histopathological examination.Objectives: evaluate role of ultrasound guided transthoracic fine needle aspiration and core needle biopsy in diagnosis of peripheral pulmonary lesions. Patients & Methods: study was carried out at Chest and Radiodiagnosis&imaging department, Tanta University Hospitals It included 30 patients with undiagnosed peripheral parenchymal lesions. Ultrasound guided biopsy by fine needle aspiration with or without core needle biopsy were performed by free hand technique using needles of different pores and lengths for fine needle aspiration, spring loaded biopsy needles. Results: total diagnostic yield of transthoracic lung sampling (fine needle aspiration with or without core needle biopsy)80 %,The diagnostic yield of fine needle aspiration was 70 %, while of core needle biopsy 72.73 % and combined fine needle aspiration and core needle biopsy) 81.82%.The sensitivity of combined technique (both fine needle and core needle biopsy) (94.12%) was higher than sensitivity of fine needle alone(76%) and of core needle biopsy alone (88.24%). two main complications were pneumthorax (6.66%),hemorrhage(3.33%) Conclusions: Chest US guided biopsy is safe reliable fast procedure with low cost and low complications.conclusions:Ultrasound-assisted fine needle aspiration and core needle biopsy are complementary methods in diagnosing peripheral lung lesions.

Phyllodes tumors (PTs) of the breast are considered a rare fibroepithelial neoplasms of the breast and are considered a challenging for both pathologists and surgeons. The World Health Organization (WHO) has classified PTs histologically as benign, borderline, and malignant. PTs can be detected in all ages; however, the median age of presentation is 45 years. PTs can mimic fibroadenoma in clinical presentations. Breast imaging is also similar to fibroadenomas. Cytological diagnosis of PTs by biopsy is usually unreliable. However, a core needle biopsy is superior to fine-needle aspiration. Surgery is considered the mainstay treatment for PTs of the breast with a goal of achieving negative margins. Adjuvant chemotherapy and radiation therapy use for malignant PTs are controversial.

Objective To evaluate the 2015 American Thyroid Association (ATA) guidelines and 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) for their efficacy in predicting malignant thyroid nodules and safety in recommending fine needle aspiration (FNA). Methods We reviewed data of 970 thyroid nodules from 908 patients with core needle biopsy pathology. We calculated the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for each guideline to predict malignancies. We compared the areas under the curve and FNA recommendations between the 2 guidelines. Results According to the core needle biopsy pathology, 59.9% (581/970) of the thyroid nodules were malignant. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value was 68%, 91%, 33%, 67%, and 70%, respectively, for the ATA guidelines and 70%, 84%, 49%, 71%, and 68%, respectively, for the ACR TI-RADS. Areas under the curve (ATA: 0.71 vs ACR TI-RADS: 0.74; P = .054) were similar when predicting malignancies. For the 545 nodules with maximum diameter ≥1.0 cm, the ACR TI-RADS recommended FNA less often than the ATA guidelines (83.3% [454/545] vs 87.7% [478/545]; P = .01). For the 321 malignant nodules with maximum diameter ≥1.0 cm, the proportions of FNA recommendations were not significantly different (ACR TI-RADS: 90.7% [291/321] vs ATA: 92.5% [297/321]; P = .06). Conclusion The 2015 ATA guidelines and 2017 ACR TI-RADS showed a similar ability in predicting malignancies. Reducing FNA recommendations by the ACR TI-RADS would not lead to a significant decrease in the FNA recommendations given for malignancies with maximum diameter ≥1.0 cm.

OBJECTIVE. The purpose of this article is to provide a step-by-step guide for bone imaging-guided percutaneous core needle biopsy, including the armamentarium available and the most recent advances. CONCLUSION. Bone imaging-guided percutaneous core needle biopsies are well-established, minimally invasive, cost-effective interventions for histologic characterization of bone lesions with an excellent safety profile and diagnostic outcomes; they play a crucial role in management of patients. Radiologists involved in the care of patients with bone lesions must be familiar with the various steps involved in such procedures and their role in patient management.

Desmoid-type fibromatosis (DF) is a rare neoplasm characterized by fibroblastic and myofibroblastic proliferation. While characterized as a benign lesion that does not metastasize, desmoid-type fibromatosis exhibits a wide range of behavior from aggressive local tissue invasion and post-surgical recurrence to spontaneous regression. Tumor regression can occur following systemic medical therapy or rarely may occur in the absence of therapy. We present a case of a 50-year-old female with a left thigh vastus medialis intramuscular mass which underwent imaging work-up and subsequent core needle ultrasound-guided biopsy showing results of desmoid-type fibromatosis. Following biopsy, the tumor showed prompt, complete regression with complete MRI resolution 2 months following biopsy. The patient showed no evidence of disease recurrence out to one year on MRI surveillance. This case report will discuss desmoid-type fibromatosis imaging features, treatment strategies, spectrum of disease behavior, and atypical behavior such as the spontaneous tumor regression as seen in this case report. To our knowledge there have been no reported cases of DF spontaneous regression 2 months following a core needle biopsy. Understanding the variable behavior of desmoid-type fibromatosis can assist the radiologist in guiding management of these lesions with the goal of optimizing clinical outcomes and preventing unnecessary aggressive treatments for stable or regressing disease.

Amyloid goiter (AG) (primary or secondary) is extremely rare. An abdominal fat pad core needle biopsy (CNB) is the diagnostic gold standard for secondary amyloidosis. Although CNB is useful to detect amyloid infiltration of a specific organ, fine-needle aspiration (FNA) is proven to be the best diagnostic method for thyroid disorders. Guidelines recommend an ultrasound-guided FNA (US-FNA) whenever possible. This procedure is usually performed by various interventional specialists, including pathologists, who perform the procedure in addition to validating the adequacy of the sample. We report a rare case of AG diagnosed using US-FNA performed by a pathologist in a 39-year-old patient with systemic amyloidosis. US-FNA performed by pathologists is a proven, less-invasive, and cost-effective tool that ensures acquisition of adequate specimens and reduces nondiagnostic rates of this procedure to ensure timely cytological diagnosis.