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We present a case of indolent neurolymphomatosis in a 55-year-old male patient with worsening pain and weakness in his right leg over the past few months. The patient has a past medical history of type II diabetes mellitus, four-year history of worsening left foot drop, left lower limb pain and weakness attributed to diabetic amyotrophy, and back pain. The new right-sided symptoms prompted further imaging which revealed a left sciatic nerve mass which was biopsied. Initial biopsy results were inconclusive. 18F-FDG PET/CT revealed the full extent of this patient's disease and helped plan for a more representative biopsy site, which finally established a diagnosis of diffuse large B-cell lymphoma involving the lumbosacral nerve roots. The patient underwent a course of chemotherapy. 18F-FDG PET/CT was ordered again at the end of treatment showing partial response to therapy. He underwent radiation therapy to the site of residual disease, with complete metabolic response of lesions on follow up PET CT.

Background Although there is increasing use of 18F-FDG PET/CT in the diagnostic procedure for IgG4-related disease (IgG4-RD), little is known about the quantification of 18F-FDG PET/CT. We aimed to evaluate the utility of the quantification of 18F-FDG PET/CT in the diagnosis of IgG4-RD by analyzing the relation between 18F-FDG PET/CT findings and histopathologic findings. Methods Twenty-one patients with IgG4-RD, in whom 18F-FDG PET/CT was performed at the time of diagnosis between November 2011 and July 2018, were enrolled. Tissue biopsy was performed at 24 sites in 21 patients. To perform quantitative analysis of 18F-FDG PET/CT imaging, the highest standardized uptake value (SUV) of the pixels (SUVmax) and the average SUV (SUVmean) within the biopsied lesion were measured. The SUVmean of the liver was also measured as a reference. Results The mean age at diagnosis was 64.6 ± 11.9 years, and the median serum IgG4 level was 650 mg/dl. Histological findings were consistent with IgG4-RD (histopathology-positive) at 19 out of 24 sites. Although there was no significant difference in the values of SUVmax between histopathology-positive and histopathology-negative tissues, the values of SUVmean were significantly higher in the histopathology-positive tissue than those in the histopathology-negative tissue (4.98 and 3.54, respectively P mean/liver were also higher in the histopathology-positive tissue (2.17 and 1.52, respectively P mean to determine which of multiple lesions should be biopsied, a receiver operating characteristic (ROC) curve was constructed. ROC curve analysis indicated SUVmean=4.07 or SUVmean/liver = 1.66 as a cut-off value that could discriminate IgG4-RD-related lesions. Conclusions Our present study suggested that quantitative analysis of 18FDG-PET/CT imaging might be useful for selecting the biopsy site in IgG4-RD. The calculation of SUVmean, not of SUVmax, is important for evaluating IgG4-RD-related lesions in 18F-FDG PET/CT imaging.

BACKGROUND. The greater omentum can serve as a useful target for percutaneous biopsy; in clinical practice, CT is commonly used for biopsy guidance. OBJECTIVE. The purpose of this study was to evaluate the diagnostic yield of percutaneous ultrasound (US)-guided omental biopsy and to explore the association of the diagnostic yield with prebiopsy diagnostic CT findings. METHODS. This retrospective study included 163 patients (120 women and 43 men; mean age, 65 ± 12 [SD] years; mean body mass index [BMI], 28.9 ± 7.9) who underwent US-guided omental biopsy between 2002 and 2020 at a single institution at which US served as the first-line modality for omental biopsy guidance. Biopsies were performed by abdominal radiologists without dedicated interventional radiology fellowship training. Postbiopsy clinical follow-up and imaging follow-up were reviewed to establish the ultimate diagnosis for each patient. Omental biopsies were characterized as diagnostic or nondiagnostic relative to the ultimate diagnosis. Associations were explored between diagnostic yield and findings on prebiopsy CT and biopsy US. RESULTS. US-guided omental biopsy was performed using an 18-gauge core needle biopsy technique in 156 patients and fine-needle aspiration in seven patients. The mean number of biopsy passes was 2.5 ± 1.0, and mean omental thickness near the biopsy site on CT was 2.6 ± 1.2 cm. On prebiopsy diagnostic CT, omental disease appeared infiltrative in 127 (78%) patients versus mass-forming in 36 (22%) and appeared hypoechoic in 105 (64%) patients versus iso- to hyperechoic in 58 (36%). The ultimate diagnosis was malignant tumor in 154 (95%) patients (most commonly, gynecologic tumors in 82 patients [high-grade serous adenocarcinoma in 56] and gastrointestinal tumors in 45 patients) and a benign finding in nine (6%) patients. The omental biopsy was diagnostic relative to the ultimate diagnosis in 155 (95%) patients. A diagnostic versus nondiagnostic biopsy was not associated (p > .05) with age, BMI, number of biopsy passes, or omental target thickness or attenuation. A total of 94% (120/127) of US-guided omental biopsies of infiltrative cases and 97% (35/36) of biopsies of mass-forming cases were diagnostic (p = .50). A total of 96% (102/106) of US-guided omental biopsies of hypoechoic cases and 93% (53/57) of biopsies of iso- to hyperechoic cases were diagnostic (p = .36). No complications occurred. CONCLUSION. US-guided biopsy of omental disease suspected on CT is safe and effective for tissue diagnosis. Although omental disease commonly appears on US as diffuse infiltrative thickening without a discrete target, sampling based on prebiopsy CT landmarks is diagnostic in most cases. CLINICAL IMPACT. US should be considered the first-line modality for omental biopsy guidance when feasible.

Objective Endomyocardial biopsy (EMB) is a useful diagnostic tool though the yield may be limited in many myocardial diseases. Data on the diagnostic yield and prognostic significance of EMB guided by abnormal electrograms (EGM-Bx) in suspected cardiac sarcoidosis (CS) are scarce. Methods Seventy-nine patients (mean age: 56 ± 12 years; 61% men) with suspected CS based on clinical and imaging features underwent right or left ventricular EGM-Bx guided by electroanatomic mapping. Tissue samples were obtained from sites with abnormal EGMs and/or abnormal cardiac imaging. The diagnostic yield of EGM-Bx was evaluated in reference to histopathologic analysis. Left ventricular assist device (LVAD) and transplantation-free survival were compared between patients with positive and negative EGM-Bx for CS. Results A total of 254 samples were obtained from abnormal EGM sites, and 126 samples from normal EGM sites guided by pre-procedure imaging findings. Abnormal histopathology was noted in 65 (26%) and 10 (8%) samples from abnormal and normal EGM sites, respectively. Histopathology confirmed CS in 16 (20%) patients, while an alternative tissue diagnosis emerged in 10 (13%) patients. Abnormal EGMs at the biopsy site had sensitivity 89% and specificity 33% for a histopathologic diagnosis of CS. LVAD and transplantation-free survival were not significantly associated with the EGM-Bx result (log-rank p = .91). Conclusion In patients with suspected CS, abnormal EGM-Bx has high sensitivity and low specificity for establishing a definite CS diagnosis. Consideration of substrate abnormalities apparent on preprocedural imaging as an adjunct for selection of biopsy sites may further improve EGM-Bx yield.

Initial reports of a clinical response in patients treated with the radioligand [177Lu]-PSMA-617 for castration-resistant prostate cancer (CRPC) are promising, despite known inter- and intrapatient heterogeneity. In metastatic CRPC, we examined the association of baseline immunohistochemical (IHC) expression of prostate-specific membrane antigen (PSMA) in a single lesion and responsiveness to [177Lu]-PSMA-617 therapy, measured as the PSMA maximum standardized uptake value (SUVmax). Between 2015 and 2020, 19 patients with multiple metastases underwent single-lesion biopsy, [68Ga]-PSMA positron emission tomography (PET) imaging, and treatment with [177Lu]-PSMA-617. A monoclonal anti-PSMA antibody was used to semiquantitatively assess PSMA IHC in the biopsy specimen. Imaging evaluation of the biopsied single lesion and overall response was performed according to Positron Emission Tomography Response Criteria in Solid Tumors. The PSMA IHC histoscore correlated positively with pretreatment same-site PSMA SUVmax (rs = 0.6). Nine patients had imaging after three cycles of [177Lu]-PSMA-617 and were included in the lesion-specific analysis. Of these, five patients (55.6%) had an SUVmax response at the biopsy site, but three experienced overall progression. The histoscore was unable to predict the lesion-specific change in SUVmax (95% confidence interval [CI] −44.2 to 69.2) or PSA (95% CI−125.2 to 17.2). There was no correlation between single-lesion SUVmax and overall progression (rs = 0.1) on [68Ga]-PSMA PET imaging. Additional studies need to interrogate the clinical consequence of PSMA expression heterogeneity in metastases and the association with response to [177Lu]-PSMA-671. Patient summary Treatment with a radioactive binding molecule called [177Lu]-PSMA-617 for men with prostate cancer resistant to castration (CRPC) is showing promise. We investigated the association between the presence of PSMA protein in metastatic lesions at biopsy and response to [177Lu]-PSMA-617 among men with metastatic CRPC. We found that assessment of PSMA presence at biopsy is not a reliable predictor of response to [177Lu]-PSMA-617. Additional studies are needed to better determine which CRPC metastatic sites will respond to this therapy.

This work reports on the first systematic experimental study on tissue phantoms that evaluates the efficacy of the radiofrequency (RF) multistatic radar for breast health monitoring in the presence of a titanium site marker, typically inserted post-biopsy. We show results of breast phantom measurements for a homogenous fat phantom in several scenarios: all-fat phantom simulating a simple healthy case, a case with an added small 1 cm diameter tumor, a case with a glandular insertion, and finally, a scenario of a tumor embedded in gland. To evaluate the system's performance with respect to post-biopsy site markers, we then show investigations of the system performance with the same phantom and a biopsy marker attached to a glandular insertion with and without an embedded tumor, and compare the imaging results to those phantoms without the biopsy marker. We conclude that our RF radar can detect the tumor despite the presence of a biopsy site marker, and that the conductive titanium marker does not interfere with the system's intended function.

We aimed to examine the predictability of the need for soft tissue reconstruction during limb-sparing surgery through preoperative magnetic resonance (MR) imaging in patients diagnosed with a malignant bone tumor in the distal femur. The study included 42 patients who were operated for a bone sarcoma of the distal femur at our clinic between 2016 and 2018. The recorded parameters included the demographic characteristics of the patients, tumor diagnosis, tumor side, total tumor volume, tumor soft tissue component volume, tumor soft tissue component volume-to-total tumor volume ratio, tumor localization by MR imaging, the need for soft tissue reconstruction, the muscles used for soft tissue reconstruction, the biopsy site, and the biopsy type. Tumor volume was calculated on MR imaging of the distal femur region performed before surgery. Our study established cut-off values for soft tissue reconstruction need following resection as a total tumor volume of 96.4 cm3 , a tumor soft tissue component volume of 22 cm3 , a tumor soft tissue component volume-to-total tumor volume ratio of 48.9%, and tumor localization in two different regions on axial distal femoral MR images. Considering these cut-off values, by calculating tumor volume values preoperatively we can predict the need for rotational muscle flaps for soft tissue coverage following distal femur bone sarcoma resection and endoprosthesis reconstruction. Anticipating the need for soft tissue reconstruction may affect the duration and success of the operation.

Frameless stereotactic navigation is used to direct the trajectory and biopsy site of target lesions. We report on a novel intra-operative stimulating (IOS) probe that is integrated into a commercially available stereotactic biopsy needle with the rationale that stimulation of the intended biopsy site should predict functional tissue thus preventing inadvertent biopsy of eloquent tissue. Patients undergoing brainstem biopsies for atypical lesions were offered the additional stimulation procedure. The IOS probe was used to deliver stimulation in an attempt to determine the proximity of eloquent tissue. Once the desired location of the biopsy needle was achieved, the IOS probe was inserted down the centre of the biopsy needle and the stimulus applied. If no action potential was recorded, biopsies from four quadrants of the lesion were taken. If however a compound action potential was recorded, a new target was selected. Nine patients had the biopsy and stimulation procedure performed. The median age was 36 months. A minimum of 8 samples were obtained from each patient. Biopsy material was adequate to obtain a diagnosis in all 9 patients. In 2 cases use of the device influenced the insertion trajectory or biopsy site. No patients experienced any complications directly attributable to either the biopsy procedure or application of the stimulation. Use of the IOS probe for intra-operative stimulation of the intended brainstem biopsy site was found to be safe and feasible. The addition of stimulation using the IOS probe can be done with minimal change in workflow.

Background: Only a few clinicopathological epidemiological studies detailing histopathologically diagnosed skin diseases have been carried out in Nigeria. Thus, the aim of this study was to retrospectively survey the histopathological spectrum and clinicopathological concordance of histopathologically diagnosed skin diseases in Nigeria over a 16-year period. Materials and Methods: This study involved the assessment of all skin biopsy specimens received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2004 to December 2019. Histopathological diagnoses based on these skin biopsies were made by consultant anatomical pathologists using routine hematoxylin and eosin-stained slides. All relevant demographic data and provisional clinical diagnoses were obtained from the histopathology laboratory requisition forms provided with the specimens. The skin lesions were then classified according to the International Classification of Diseases, Tenth revision (2019). Results: A total of 347 skin lesion biopsy specimens were included in this study. Most of the patients were aged 20–39 years old, with a mean age of 34.2 years. One hundred and forty-eight (42.7%) of the patients were males, whereas 199 (57.3%) were females. The most common 1CD-10 categories were disorders of skin appendages (105/347 [30.3%] cases) and papulo squamous disorders (81/347 [23.3%] cases), whereas the least common category was radiation-related disorders of the skin (2/347 [0.6%] cases). The most common disorder of the skin appendage was epidermal inclusion cyst (71/105 [71.4%] cases). Lichen planus was the most common papulosquamous disorder observed (26/81 [32.1%] cases). Only 202 cases included records of the biopsy site. The lower extremities were the most common sites of involvement (48/202 [23.8%] cases). The clinical diagnosis was concordant with the histopathological diagnosis in 55.3% of the cases, whereas it was discordant in the remaining cases. Conclusion: The most common skin diseases observed in this study were disorders of skin appendages and papulosquamous lesions. Our study provides baseline data for future population-targeted studies of nonneoplastic skin diseases.

Introduction: In animal models, it can be difficult to confirm therapeutic effects due to technical inconsistencies and other reasons. Although renal biopsy is widely used in clinical diagnosis, it is rarely used in animal experimental models, especially in mice, because the problems of surgery-induced renal injury and bleeding have not been solved. Methods: We developed an easy-to-use method of renal biopsy in mice and evaluated whether 3 consecutive renal biopsies can be performed in the same kidney in a standardized manner. This method was verified using 2 mouse models, a healthy mouse model and a unilateral ureteral obstruction (UUO) mouse model, and evaluated based on renal function and histological changes. Results: There were no perioperative complications in any of the model mice. There was no significant difference in serum Cr, 24-h urine protein, or kidney/body weight ratio between the biopsy and control groups. Each biopsy sample contained sufficient renal tissue. The damage to the operated tissue was limited to the tissue near the biopsy site. Compared with renal tissues in the corresponding control group, the renal tissues obtained from the 3 biopsies (healthy model days 0, 4, and 7 and UUO model days 3, 7, and 10) and the remnant renal tissues after the biopsy showed no significant difference in the glomerular sclerosis index, degree of renal tubular damage, inflammatory response and renal fibrosis in these 2 models. Conclusions: Our new standardized method of renal biopsy in mice is a safe and cost-saving approach that allows repeated renal biopsies and ensures minimal trauma and sufficient sample size to quality in experimental disease models.

Objective To introduce a new & novel method of obtaining big lung tissue samples by transbronchial lung cryobiopsy by twin bronchoscopes (kissing technique) in an advanced interventional pulmonology suite. Methods In patients of diffuse parenchymal lung diseases, transbronchial lung cryobiopsy were taken using this novel approach using simultaneously two bronchoscopes under C- arm guidance under conscious sedation. First, a standard fibreoptic bronchoscope was inserted intranasally and fixed just above the area to be biopsied, then fogarty's catheter was introduced through FOB's suction channel and protruded it at the biopsy site. Second, another video bronchoscope was introduced orally by the side of FOB and cryobiopsy were taken using cryobiopsy forceps. Immediately, Fogarty's catheter was inflated and sealed the opening from where biopsy was taken to stop the bleeding. Third Video bronchoscope was also used which went up to larynx to take photograph of two bronchoscopes kissing each other and entering the vocal cords only, after which it was withdrawn. Results Transbronchial lung cryobiopsy in patients of diffuse parenchymal lung diseases were taken using this novel approach. This new technique called twin bronchoscopy (Kissing technique) has been practiced for the first time, it's a technique about which we want the world to be known. Conclusion This new and novel two scope kissing bronchoscopy technique for TBLC under conscious sedation can be an alternative and fruitful method, especially the use of Fogarty's catheter to contain intra-bronchial bleeding. There is no deleterious effect on the patient and the patient can be discharged on the same day.

This review describes the indications and contraindications for endoscopic biopsy, in routine practice, of the upper gastrointestinal (GI) tract. We accept that this review provides grounds for controversy, as our stance in certain situations is counter to some national guidelines. Nevertheless, we provide evidence to support our viewpoints, especially on efficiency and economic grounds. We describe the particular controversies concerning the biopsy assessment of Barrett's oesophagus, chronic gastritis and the duodenum in the investigation of coeliac disease. We accept that there are indications for more extensive upper GI biopsy protocols in children than in adults; the latter constitute our main focus in this article. We would encourage detailed discussion between pathologists and their endoscopy colleagues about the indications, or lack of them, for routine upper GI endoscopic biopsy, as studies have shown that adherence to agreed guidelines has resulted in a very considerable diminution in the biopsy workload without compromising patient management. Furthermore, where biopsy is indicated, we emphasise the importance of accompanying clinical information provided to the pathologist, in particular regarding biopsy site(s), and regular feedback to endoscopists to improve and maintain the quality of such information. Finally, local dialogue is also advised, when necessary, to indicate to endoscopists the need to appropriately segregate biopsies into separate, individually labelled specimens, to maximise the information that can be derived by pathological evaluation and thereby improve the quality of the final pathology report.

Background Skin scarring can occur after punch biopsies, prohibiting their routine utilization, especially in the central face. Objectives This paper describes a scarless, 0.33-mm-diameter skin microbiopsy for molecular analysis of skin. Methods This is was single-center, randomized, prospective study with 15 patients receiving no biopsy or biopsy on the left or right nasolabial fold. Six blinded raters assessed participant photos at baseline, 1 month, and 3 months post biopsy to evaluate for a visualized scar. Patient and Observer Scar Assessment Scale was completed. Additionally, biopsies from various skin regions of body along with arm skin after treatment with a single Erbium-YAG laser were processed for molecular analysis. Results No patients exhibited scar formation based on evaluation of photographs and patient feedback. There was no mark at the biopsy site 7 days post-procedure. Optical coherence tomography showed a complete closing of the biopsy-punch wound 48 hours post-biopsy. One month post-biopsy, photography reviewers were unable to identify a scar, on average, 90% of the time at 3-month follow-up. Microbiopsies from various anatomical regions were successfully extracted for histology, electron microscopy, and gene expression analysis. Selected skin rejuvenation markers in the biopsies from Erbium-YAG–treated forearm skin resulted in significant gene upregulation in extracellular matrix molecules at 1 month posttreatment compared with untreated skin. Conclusions A core microbiopsy of 0.33 mm can be extracted reproducibly for histological, ultrastructural, and gene expression analysis without scarring. This allows repeated sampling for assessment of skin treatments and diseases, including aesthetics and wound-healing progress.

Purpose To assess the performance of preoperative breast MRI biopsy recommendations based on breast cancer molecular subtype. Methods All preoperative breast MRIs at a single academic medical center from May 2010 to March 2014 were identified. Reports were reviewed for biopsy recommendations. All pathology reports were reviewed to determine biopsy recommendation outcomes. Molecular subtypes were defined as Luminal A (ER/PR+ and HER2-), Luminal B (ER/PR+ and HER2+), HER2 (ER-, PR- and HER2+), and Basal (ER-, PR-, and HER2-). Logistic regression assessed the probability of true positive versus false positive biopsy and mastectomy versus lumpectomy. Results There were 383 patients included with a molecular subtype distribution of 253 Luminal A, 44 Luminal B, 20 HER2, and 66 Basal. Two hundred and thirteen (56%) patients and 319 sites were recommended for biopsy. Molecular subtype did not influence the recommendation for biopsy (p = 0.69) or the number of biopsy site recommendations (p = 0.30). The positive predictive value for a biopsy recommendation was 42% overall and 46% for Luminal A, 43% for Luminal B, 36% for HER2, and 29% for Basal subtype cancers. The multivariate logistic regression model showed no difference in true positive biopsy rate based on molecular subtype (p = 0.78). Fifty-one percent of patients underwent mastectomy and the multivariate model demonstrated that only a true positive biopsy (odds ratio: 5.3) was associated with higher mastectomy rates. Conclusion Breast cancer molecular subtype did not influence biopsy recommendations, positive predictive values, or surgical approaches. Only true positive biopsies increased the mastectomy rate.

A 27-year-old man, previously diagnosed with IgA nephropathy, was referred for native kidney biopsy. After the procedure, the patient presented active bleeding revealed by Doppler and contrast-enhanced ultrasonography at the biopsy site. Successful embolization of the cortical fistula, the focus of bleeding, was achieved using ultrasound-guided thrombin injection and confirmed by Doppler ultrasonography, contrast-enhanced ultrasonography, and CT angiography. This case report shows that contrast-enhanced ultrasonography is useful for detecting active bleeding after a solid organ biopsy. Moreover, ultrasound-guided thrombin embolization is a safe and minimally invasive treatment and an alternative to angiography-guided embolization.

To assess the safety of fluoroscopically guided drill-assisted bone marrow aspirate and biopsy in severely thrombocytopenic patients. The study was approved by the IRB with waiver of informed consent. Retrospective review of 111 bone marrow aspirate and biopsies (BMAB) performed in 94 patients who received a CT scan which included the pelvis and biopsy site within the 7 days following the BMAB. The 94 patients were subdivided based on their platelet count: severe thrombocytopenia ( 50 platelets × 109/L). The procedure report was reviewed for sedation time, aspirate volume, and aggregate size of core biopsy specimens. The electronic medical record was reviewed for specimen adequacy; pathologic diagnosis; body mass index; pre- and post-procedure labs including platelet count, hemoglobin (HGB), hematocrit (HCT), prothrombin time (PT), and international normalized ratio (INR) levels; post-procedural transfusion; and complications including mortality at 30 and 90 days. CT scans were independently reviewed by 2 fellowship-trained radiologists for the presence of post-procedural hemorrhage. There was no significant difference in CT-identified post-procedural hematoma, or change in the hemoglobin and hematocrit levels pre- and post-procedure between the three groups. There was no significant difference in complication rate or all-cause mortality. There was a significant difference in transfusion at 30 days with thrombocytopenic and severely thrombocytopenic patients more likely to receive transfusion within the 30 days post-procedure. Fluoroscopically guided BMAB can be safely performed in patients with severe thrombocytopenia.

Summary Objectives To assess the influence that several factors, such as the amount of obtained biopsies, difficult procedures, biopsy site and the experience of the attending physician, have on accuracy of flexible endoscopic biopsy (FEB). Materials and methods 203 FEB procedures for benign or malignant laryngopharyngeal lesions were prospectively included. During the procedure, three representative biopsies (macroscopically containing vital tumor tissue and not only necrosis or healthy tissue) were obtained. The accuracy of each biopsy was separately analyzed. Difficulties during the procedures leading to failure of acquiring three representative biopsies were recorded and classified into tumor, patient and procedural factors. Histological results of FEB were defined correct when consistent with clinical context, additional biopsies or Positron emission tomography-computed tomography (PET-CT) revealed equivalent pathology, or the lesion was stable or resolved in >6 months follow-up. Results The first representative biopsy yielded a correct diagnosis in 65% of the cases. After the second representative biopsy, 78% was correctly diagnosed. The contribution of the third and fourth representative biopsies to accuracy was 3%. The overall accuracy of FEB was 85%. Difficult procedures were more likely to result in misdiagnosis, whereas biopsy site or experience of the attending physician did not influence results. Conclusions FEB was accurate in diagnosing laryngopharyngeal lesions when at least two representative biopsies were obtained. Accuracy of FEB could be further improved by limiting possible constraints during the procedures, for example by selecting, informing, and anesthetizing patients carefully.

Receptor targeted imaging using prostate specific membrane antigen (PSMA)-a labeled radioisotope currently plays a key role in prostate cancer imaging. This is due to the overexpression of PSMA, a type II Tran's membrane protein, in prostate cancer cells. Gallium-68 and fluorine-18 labeled PSMA are currently available for positron emission tomography/ computed tomography (PET/CT) imaging for the diagnosis, staging, treatment planning and follow-up of prostate cancer.In this case report we discuss a 70 year old male who presented with progressively rising serum prostate-specific antigen (PSA) levels. Three prostate biopsies performed at different time points were negative and failed to provide a histological diagnosis. 68Ga-PSMA PET/CT was subsequently requested to guide biopsy and appropriately stage the disease. PSA level at the time of imaging was 39ng/ml. Uptake was demonstrated in the left posterior-lateral aspect of the prostate gland (SUVmax=15.27), identifying the target biopsy site for histological confirmation of the diagnosis of prostate cancer (Figure 1).Unusual uptake was also noted in a right axillary lymph node (SUVmax=6.18). Biopsy of this lymph node confirmed Hodgkin’s Lymphoma (Figure 2&3).This clinical case demonstrates the non-specific nature of PSMA in prostate cancer, despite its name. We would like to advise caution in the interpretation of distant nodal uptake sites on 68Ga-PSMA PET/CT imaging for the diagnosis and/or staging of prostate cancer.

Establishing the diagnosis of classical Hodgkin lymphoma (cHL) in a timely fashion can be a challenge, as there are no pathognomonic signs or symptoms. The percutaneous needle biopsy (CNB) of the tumor gained increased popularity due to its minimal invasiveness and expeditious recovery from procedure. The diagnostic accuracy of CNB depends upon patient size, mass accessibility, and feasibility to obtain diagnostic tissue assuming that the tumor is histologically homogenous. We report on a patient with cHL who underwent multiple CNB from different sites before the diagnosis was established. Yet, only the incisional biopsy of the most metabolically-active tumor site resulted in diagnostic success. It is imperative to thoroughly consider both the biopsy method and the biopsy site for establishing correct diagnosis.

In India cancer patients come at a very advanced stage with many of them being crossed the stage of resection. A wide range of non invasive techniques like toludine blue staining, methylene blue staining, Narrow band imaging have been developed for the early detection of malignant and premalignant lesions in the mucosa including oral cavity and gastrointestinal tract. However it is difficult for the clinicians to decide which diagnostic tool is most appropriate and useful for screening, resulting in failure to pick up the lesions at an early stage. Various online journals have been reviewed and no journal was found to support this point. This study here by describes Toludine blue and narrow-band imaging (NBI), diagnostic tools already proven independently as a useful screening method in many fields, and demonstrate its usefulness in the early detection of premalignant and malignant lesions of the oral cavity, as reported by previous studies in the otolaryngologic literature and compare both screening tools which has not been done till now. This study was done in a tertiary referral centre in middle India from March 2018 to August 2019 in order to evaluate the role of different screening tools (NBI and Toludine blue).44 patients with suspicious oral cavity lesions (premalignant and malignant) who had given consent for both NBI and toludine blue screening techniques were selected from the suspected (premalignant and malignant lesions) who had visited the OPD during the study period. Patients with proven malignancy were excluded from the study. A detailed history of the patient taken and standard Ear, nose, throat, oral cavity and neck examination of patient carried out. After subjecting the patients to screening tools like NBI and toludine blue, the efficacy of these techniques in helping us to take a representative biopsy was evaluated. In present study the sensitivity (to correctly identify all patients with disease), specificity (to correctly reject healthy patients without disease) of older technique toludine blue in detecting premalignant lesion was 66.6%, 87.8% while for NBI was 66.6%, 95%. For malignant lesion sensitivity and specificity of toludine blue was 94.3%, 100%, while the same for NBI was 100%, 88.8% respectively. Both NBI and toludine blue staining can be adopted for screening and the accurate detection of biopsy site and in the follow up of premalignant lesions to look for malignant transformation. Time tested is Toludine blue which is cheap and easily available. But being a better tool and having an upper hand in evaluating the lesions, NBI should be made available in all the secondary and tertiary care centres as a screening method.

PURPOSE: We investigated the clinical role of F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in the identification of the primary site and the selection of the optimal biopsy site in patients with suspected bone metastasis of unknown primary site. METHODS: The patients with suspected bone metastasis who underwent PET-CT for evaluation of primary site were enrolled in this study. The primary sites were identified by the histopathologic or imaging studies and were classified according to the FDG uptake positivity of the primary site. To evaluate the guiding capability of PET-CT in biopsy site selection, we statistically analyzed whether the biopsy site could be affected according to the presence of extra-skeletal FDG uptake. RESULTS: Among 74 enrolled patients, 51 patients had a metastatic bone disease. The primary site was identified in 48 of 51 patients (94.1%). Forty-six patients were eligible to test the association of clinical choice of biopsy site with PET positivity of extra-skeletal lesion. The extra-skeletal biopsies were done in 42 out of 43 patients with positive extra-skeletal uptake lesions. Bone biopsies were inevitably performed in the other three patients without extra-skeletal uptake lesions. The association came out to be significant (Fisher’s exact test, P

Background/Aims: Liver biopsy (LB) remains the gold standard for the evaluation of liver disease. However, over the past two decades, many noninvasive tests have been developed and utilized in clinical practice as alternatives to LB. The aim of this study was to evaluate the clinical use and safety of LB in the era of noninvasive assessment of liver fibrosis.Methods: This retrospective study included 1,944 consecutive cases of LB performed between 2001 and 2018 in a tertiary hospital. All of the LBs were conducted under ultrasonography guidance with 18-gauge cutting needles.Results: LBs were performed an average of approximately 108 times per year during the study period. Chronic hepatitis B (25.3%) and suspected malignancy (20.5%) were the two most common indications for LB. The use of LB for nonalcoholic fatty liver disease increased from 8.1% to 17.2% in the past 5 years compared to the last 10 years, while that for viral hepatitis decreased from 40.3% to 18.9%. Discordance rate between the suspected diagnosis and the final diagnosis was 2.6% (51 cases). The overall rate of major adverse events was 0.05% (one case), which involved delayed bleeding at the biopsy site. Liver cirrhosis was observed in 563 cases (28.9%), and the presence of cirrhosis did not affect the frequency of complications (P=0.289).Conclusions: LB is widely used in clinical practice as an irreplaceable diagnostic tool, even in the era of noninvasiveness. Ultrasonography-guided LB can be performed safely in patients with liver cirrhosis.

To evaluate the impact of patient positioning during CT-guided lung biopsy on patients’ outcomes. In this retrospective, IRB-approved, HIPAA-compliant study, consecutive CT-guided lung biopsies performed on 5/1/2015–12/26/2017 were included. Correlation between incidence of pneumothorax, chest tube placement, pulmonary bleeding with patient, and procedure characteristics was evaluated. Lesion-trachea-table angle (LTTA) was defined as an angle between the lesion, trachea, and horizontal line parallel to the table. Lesion above trachea has a positive LTTA. Univariate and multivariate logistic regression analysis was performed. A total of 423 biopsies in 409 patients (68 ± 11 years, 231/409, 56% female) were included in the study. Pneumothorax occurred in 83/423 (20%) biopsies with chest tube placed in 11/423 (3%) biopsies. Perilesional bleeding occurred in 194/423 (46%) biopsies and hemoptysis in 20/423 (5%) biopsies. Univariate analysis showed an association of pneumothorax with smaller lesions (p = 0.05), positive LTTA (p = 0.002), and lesions not attached to pleura (p = 0.026) with multivariate analysis showing lesion size and LTTA to be independent risk factors. Univariate analysis showed an association of increased pulmonary bleeding with smaller lesions (p

Positron emission tomography combined with computed tomography (PET/CT) allows for assessment of not only anatomical and structural, but also metabolic changes in tumor masses. 18 F-fluoroethyl tyrosine ( 18 F-FET) PET/CT is based on evaluation of transport of 18 F-labeled amino acid tyrosine in tissues. Precise evaluation of brain tumor WHO Grade (I-IV) is a crucial step in assessment of prognosis and treatment planning for patients with glial neoplasms. 18 F-FET PET-tracer allows to carry out multi-stage and dynamic examinations, which significantly increases method’s sensitivity. 18 F-FET PET makes it possible to acquire information about tumor tissue metabolism and to determine the most proliferatively active parts of neoplasm. In addition to glial neoplasms, a topical matter of neuro-oncology is the metastatic lesions of the central nervous system. It is highly important for the prognosis and therapeutic tactics to differentiate between brain tumors recurrence, post-treatment changes and mixed lesions. The use of 18 F-FET PET-tracer provides high specificity of the obtained diagnostic data which allows for precise determination of an optimal biopsy site and radiation-treatment planning, as well as for differential diagnosis in cases of suspected tumor recurrence. 18 F-FET PET/CT demonstrated high efficiency in differentiation of actively proliferating neoplasms from conditionally benign tumors, as well as from manifestations of iatrogenic nature, primarily after radiation-treatment.

To evaluate the efficacy and safety of performing a fluoroscopically guided bone marrow aspiration and biopsy (BMAB) using a drill-powered needle in a large patient population. This retrospective study received institutional review board approval with a waiver of patient informed consent. We identified all BMAB procedures from August 2012 through December 2016 performed at our institution using fluoroscopic guidance and a drill-powered needle. Clinical diagnosis, patient age, patient gender, biopsy site, biopsy needle gauge, bone marrow aspirate volume, bone marrow core biopsy length, patient platelet count, conscious sedation details, complications, and diagnostic adequacy were investigated for each case and summarized. A total of 775 BMAB procedures were performed and analyzed. These were performed in 436 female patients and 339 male patients ranging in age between 16 and 91 years (average age of 53 years). Samples obtained from the procedures in our series were diagnostic in 95.0% of cases. The complication rate for our series was 0.3%. The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy is a safe and efficacious procedure. • Fluoroscopy can be utilized for imaging guidance during bone marrow aspiration and biopsy. • The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy has a high diagnostic yield. • The procedure has an excellent patient safety profile.

We herein report two cases of small intestinal metastasis from pulmonary sarcomatoid carcinoma (PSC) detected by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT). We reviewed the literature on 18 F-FDG PET/CT features in gastrointestinal metastasis of PSC patients since 1992, and further analyzed the imaging features. According to the literature review, 23 eligible cases were identified from eight studies, and no cases underwent 18 F-FDG PET/CT imaging. In this study, clinical and PET/CT imaging data of two patients are reported. In our cases, clinical and the CT images of lung masses were not typical, but the uptake of 18 F-FDG was remarkably high, with SUVmax exceeding 30. Small intestinal metastases may not be related to obstruction, or even the local intestinal cavity may be dilated. Therefore, in PSC patients with mild or without abdominal symptoms, 18 F-FDG PET/CT imaging could identify intestinal metastasis at a relatively early stage and may be used to determine the preferred biopsy site, or early intervention by surgery. KEY POINTS: 18 F-FDG PET/CT imaging of small intestinal metastasis of PSC has not been previously reported in the literature and here we report the 18 F-FDG PET/CT features of two cases. The uptake of 18 F-FDG was remarkably high in both the primary tumor and metastatic intestinal lesion. 18 F-FDG PET/CT imaging may therefore be used to determine the preferred biopsy site or early intervention by surgery.

We examined the impact of spatial, temporal, histologic, and quantitative factors on concordance between TP53 alterations in tissue DNA vs in circulating tumor DNA (ctDNA). Four hundred and thirty‐three patients underwent next‐generation sequencing (NGS) in which both tissue and blood samples were evaluated. TP53 was detected in 258 of 433 patients (59.6%); 215 had tissue TP53 alterations (49.7%); 159, ctDNA (36.7%); and 116, both tissue and ctDNA (27.8%). Overall concordance rate between ctDNA and tissue biopsies for TP53 alterations was 67.2%; positive concordance was 45.0%. Overall concordance for TP53 did not vary among patients with ≤ 2 months vs > 6 months between test samples; however, positive concordance trended higher when time intervals between test samples were shorter, suggesting that the lack of difference in overall concordance may be due to the large number of negative/negative tests. There was a trend toward higher overall concordance based on biopsy site (metastatic vs primary) (P = 0.07) and significantly higher positive concordance if the tissue biopsy site was a metastatic lesion (P = 0.03). Positive concordance significantly decreased in noncolorectal cancer patients vs colorectal cancer patients (P = 0.02). Finally, higher %ctDNA was associated with higher concordance rates between blood and tissue (P, This study presents evidence that the evaluation of the full spectrum of TP53 alterations in patients with diverse malignancies requires sequencing of both blood‐derived circulating tumor DNA and tissue DNA. Multiple factors can influence positive concordance rates between the tests, including site of tissue biopsy, %ctDNA, time between tissue biopsy and blood sample, and histologic context.

Dermatologists rely on skin biopsies to diagnose cutaneous tumors and rashes. Skin biopsy sites should be accurately identified with conventional anatomical site descriptors in the pathology request form. Reliance upon free-text entries to describe these biopsy sites is prone to user error and can cause medical misadventures such as wrong-site follow-up surgery. We sought to determine whether a smartphone application (RightSite) could improve the precision of biopsy site labeling. We conducted a prospective proof-of-concept study of 100 smartphone-assisted skin biopsy site identifiers with matched comparison to 100 historical controls. Student’s t-test was used to identify significant differences in the precision of anatomic descriptors before and after adoption of the application. We found a 69% improvement in precision of anatomic site labeling with the RightSite smartphone application (P

Liver biopsy remains the gold standard for characterizing and evaluating treatment response in nonalcoholic fatty liver disease (NAFLD). Liver heterogeneity and sampling variability can affect the reliability of results. This study aimed to compare histological variability of intraoperative wedge and core liver biopsies from different lobes in bariatric patients, to better inform surgeons on biopsy method and guide interpretation of results. We prospectively recruited bariatric surgical patients. Intraoperative core biopsies were taken from the left and right lobe, with a wedge biopsy taken from the left. All biopsies were graded by a specialist liver pathologist, blinded to clinical details and biopsy site. Concordance of histological findings between sites was evaluated. There were 91 participants (72.2% female), mean age 46.8 ± 12.0 years, body mass index 45.9 ± 9.4 kg/m2. There was no significant pattern for up- or down-grading disease dependent on biopsy technique. Moderate to strong agreement was seen in the presence of NAFLD and nonalcoholic steatohepatitis (NASH, κ = 0.609–0.865, p

A unilateral, malformed gnathotheca in a green-winged macaw ( Ara chloropterus) was managed for 16 mo with periodic beak trims. Biopsy of the affected beak did not identify an underlying cause; however, at postmortem examination, a densely cellular neoplasm invaded the mandible from the beak, dissecting and effacing the cortex and trabecular bone and inciting periosteal proliferation. There was no evidence of metastasis. Neoplastic cells were strongly immunopositive for cytokeratin AE1/AE3, consistent with squamous cell carcinoma (SCC). A black-headed caique ( Pionites melanocephalus) was presented with a similar clinical history, timeline, and gross appearance. Biopsy of the mandibular portion of the lesion resulted in a diagnosis of SCC. Medical management with toceranib at a palliative dose resulted in adverse side effects and was discontinued. Early diagnosis of mandibular SCC may allow for early intervention and development of treatment modalities. Our 2 cases suggest that the mandibular bone, not the beak, may be a preferred biopsy site in the diagnosis of mandibular SCC in psittacines.