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Objective: Existing guidelines for ultrasound-guided fine-needle aspiration biopsy lack specifications on sampling sites, but the number of biopsies improves diagnostic reliability. We propose the use of class activation maps (CAMs) and our modified malignancy-specific heat maps that locate important deep representations of thyroid nodules for class predictions. Methods: We applied adversarial noise perturbations to the segmented concentric "hot" nodular regions of equal sizes to differentiate regional importance for the malignancy diagnostic performances of an accurate ultrasound-based artificial intelligence computer-aided diagnosis (AI-CADx) system using 2,602 retrospectively collected thyroid nodules with known histopathological diagnosis. Results: The AI system demonstrated high diagnostic performance with an area under the curve (AUC) value of 0.9302 and good nodule identification capability with a median dice coefficient >0.9 when compared to radiologists' segmentations. Experiments confirmed that the CAM-based heat maps reflect the differentiable importance of different nodular regions for an AI-CADx system to make its predictions. No less importantly, the hot regions in malignancy heat maps of ultrasound images in comparison with the inactivated regions of the same 100 malignant nodules randomly selected from the dataset had higher summed frequency-weighted feature scores of 6.04 versus 4.96 rated by radiologists with more than 15 years of ultrasound examination experience according to widely used ultrasound-based risk stratification American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) in terms of nodule composition, echogenicity, and echogenic foci, excluding shape and margin attributes, which could only be evaluated on the whole rather than on the sub-nodular component levels. In addition, we show examples demonstrating good spatial correspondence of highlighted regions of malignancy heat map to malignant tumor cell-rich regions in hematoxylin and eosin-stained histopathological images. Conclusion: Our proposed CAM-based ultrasonographic malignancy heat map provides quantitative visualization of malignancy heterogeneity within a tumor, and it is of clinical interest to investigate in the future its usefulness to improve fine-needle aspiration biopsy (FNAB) sampling reliability by targeting potentially more suspicious sub-nodular regions. [ABSTRACT FROM AUTHOR]

Background: Although polymyalgia rheumatica (PMR) is a very common rheumatic inflammatory disease, current insight into the pathobiology of PMR is limited and largely based on studies in blood. We investigated T helper 1 (TH1) and T helper 17 (TH17) cell responses in blood, synovial fluid and bursa tissue of patients with PMR. Materials and methods: Blood samples were collected from 18 patients with new-onset PMR and 32 healthy controls. Synovial fluid was aspirated from the inflamed shoulder bursae or biceps tendon sheath of 13 patients. Ultrasound-guided biopsies of the subacromial-subdeltoid (SASD) bursa were obtained from 11 patients. T cells were examined by flow cytometry, immunohistochemistry and immunofluorescence staining. Results: Besides an increase of TH17 (CD4+IL-17+IFN-γ-) cells and T cytotoxic 17 (TC17; CD8+IL-17+IFN-γ-) cells, no other major changes were noted in the circulating T cell compartment of patients with PMR. Absolute numbers of CD4+ and CD8+ T cells were similar in blood and synovial fluid of patients with PMR. Synovial fluid T cells showed an effector-memory (CD45RO+CCR7-) phenotype. Percentages of TH1 (CD4+IFN-γ+IL-17-) cells and TH1/TH17 (CD4+IFN-γ+IL-17+) cells, but not TH17 or TC17 cells, were increased in the synovial fluid. Bursa tissue biopsies contained a small number of T cells, which were mostly CD8 negative. The majority of bursa tissue T cells produced IFN-γ but not IL-17. For comparison, B cells were scarcely detected in the bursa tissue. Conclusion: Although the circulating TH17 cell pool is expanded in patients with PMR, our findings indicate that TH1 cells are involved in the inflammation of bursae and tendon sheaths in this condition. Our study points towards the TH1 cell pathway as a potential target for therapy in PMR. [ABSTRACT FROM AUTHOR]

BackgroundAlthough polymyalgia rheumatica (PMR) is a very common rheumatic inflammatory disease, current insight into the pathobiology of PMR is limited and largely based on studies in blood. We investigated T helper 1 (TH1) and T helper 17 (TH17) cell responses in blood, synovial fluid and bursa tissue of patients with PMR.Materials and methodsBlood samples were collected from 18 patients with new-onset PMR and 32 healthy controls. Synovial fluid was aspirated from the inflamed shoulder bursae or biceps tendon sheath of 13 patients. Ultrasound-guided biopsies of the subacromial-subdeltoid (SASD) bursa were obtained from 11 patients. T cells were examined by flow cytometry, immunohistochemistry and immunofluorescence staining.ResultsBesides an increase of TH17 (CD4+IL-17+IFN-γ-) cells and T cytotoxic 17 (TC17; CD8+IL-17+IFN-γ-) cells, no other major changes were noted in the circulating T cell compartment of patients with PMR. Absolute numbers of CD4+ and CD8+ T cells were similar in blood and synovial fluid of patients with PMR. Synovial fluid T cells showed an effector-memory (CD45RO+CCR7-) phenotype. Percentages of TH1 (CD4+IFN-γ+IL-17-) cells and TH1/TH17 (CD4+IFN-γ+IL-17+) cells, but not TH17 or TC17 cells, were increased in the synovial fluid. Bursa tissue biopsies contained a small number of T cells, which were mostly CD8 negative. The majority of bursa tissue T cells produced IFN-γ but not IL-17. For comparison, B cells were scarcely detected in the bursa tissue.ConclusionAlthough the circulating TH17 cell pool is expanded in patients with PMR, our findings indicate that TH1 cells are involved in the inflammation of bursae and tendon sheaths in this condition. Our study points towards the TH1 cell pathway as a potential target for therapy in PMR.

Background Minimally invasive autopsies, also known as minimally invasive tissue sampling (MITS), have proven to be an alternative to complete diagnostic autopsies (CDAs) in places or situations where this procedure cannot be performed. During the coronavirus disease 2019 (COVID-19) pandemic, CDAs were suspended by March 2020 in Brazil to reduce biohazard. To contribute to the understanding of COVID-19 pathology, we have conducted ultrasound (US)–guided MITS as a strategy. Methods This case series study includes 80 autopsies performed in patients with COVID-19 confirmed by laboratorial tests. Different organs were sampled using a standardized MITS protocol. Tissues were submitted to histopathological analysis as well as immunohistochemical and molecular analysis and electron microscopy in selected cases. Results US-guided MITS proved to be a safe and highly accurate procedure; none of the personnel were infected, and accuracy ranged from 69.1% for kidney, up to 90.1% for lungs, and reaching 98.7% and 97.5% for liver and heart, respectively. US-guided MITS provided a systemic view of the disease, describing the most common pathological findings and identifying viral and other infectious agents using ancillary techniques, and also allowed COVID-19 diagnosis confirmation in 5% of the cases that were negative in premortem and postmortem nasopharyngeal/oropharyngeal swab real-time reverse-transcription polymerase chain reaction. Conclusions Our data showed that US-guided MITS has the capacity similar to CDA not only to identify but also to characterize emergent diseases. [ABSTRACT FROM AUTHOR]

Tenosynovial giant cell tumors (TGCTs) are benign histo-fibrocystic tumors originating from the synovium of joints, bursae, or tendon sheaths. They are categorized into localized and diffuse types, each with distinct clinical presentations and management approaches. The diffuse form, which is rare, generally affects a single joint and is characterized by joint swelling, pain, functional limitation, and often hemarthrosis. While MRI is commonly used for diagnosis, we present a case highlighting ultrasound's significance in diagnosing and managing TGCTs, particularly for identifying vascular complications. A 59-year-old female with a 10-year history of recurrent swelling, pain, and functional limitation of the right knee was evaluated for persistent symptoms and unilateral right peripheral edema. Ultrasound revealed multiple hypoechoic, vascularized masses with both homogeneous and heterogeneous echostructures and a significant suprapatellar effusion. An ultrasound-guided biopsy confirmed the diagnosis of a recurrent diffuse TGCT complicated by vascular compression of the popliteal vein. The patient underwent mass resections, total synovectomy, and radiotherapy to reduce the risk of recurrence.  Ultrasound is cost-effective and highly beneficial for the diagnosis, treatment planning, and monitoring of diffuse TGCTs. Total synovectomy combined with radiotherapy or intra-articular yttrium-90 injection is the preferred treatment to prevent recurrence and complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Augustin et al.)

Objective: To investigate the imaging properties of mammographically suspicious microcalcifications (MC) that can be detected by ultrasonography (USG). Methods: Cases with suspected MC in categories 4 and 5 according to the Breast Imaging-Reporting and Data System (BI-RADS) in screening mammography between June 2019 and January 2021 were included in the study. The patients were scanned with USG. USG guided core needle biopsy was performed for those whose MC area could be detected by USG and evaluated histopathologically. Mammographic features of MCs [morphological type (fine pleomorphic, amorphic, coarse heterogeneous, fine linear pleomorphic branching)], distribution (clustered, regional, segmental, diffuse, linear) and BI-RADS (4A, 4B, 4C, 5) category was determined. Other findings accompanying MC areas on mammography and USG were recorded. Results: The mean age of 43 patients included in the study was 45.27±8.58 (30-84). 48.8% (n=21) of the calcifications were fine pleomorphic, 30% (n=13) amorphous, 16% (n=7) coarse heterogeneous, 4.6% (n=2) fine pleomorphic branching type. While 70% (n=30) of the patients had asymmetrical density accompanying MCs on mammography, parenchymal distortion was found in 12% (n=5); on USG, hypoechoic area was found in 58% (n=25) of the patients, irregular ductal ectasia in 19% (n=8), parenchymal distortion in 9% (n=4), and 10% (n=4) microcyst cluster were accompanying pathologies. As a result of the histopathological evaluation, 42% of the patients had benign histopathology (n=18), 16% had ductal carcinoma in situ (n=7), and 42% (n=18) had invasive ductal cancer. Conclusion: In our study, the distinctive features of BI-RADS 4 and 5 MCs that can be followed by USG were evaluated. Although MCs that can be detected on USG are more likely to be malignant than benign ones, fine pleomorphic MC areas can be observed most frequently. Knowing the features of mammographic suspected MCs on USG will be helpful in daily radiology practice and biopsy planning. [ABSTRACT FROM AUTHOR]

The most common cause of an Opaque Hemithorax is Pleural Effusion. It is a rare occurrence to find patients with extensive mass leading to an opaque hemithorax. Thorough search of literature did not yield any case with such a large lung mass leading to opaque hemithorax, without the presence of pleural effusion. Lung cancer is the most common cancer diagnosed worldwide and has predominantly been attributed to tobacco smoke exposure. Of the several types, small cell lung cancer differs from others by its early spread and extensive dissemination leading to metastatic classification at the time of diagnosis. Here, is a case of a 50-yearold female patient who presented to the outpatient department with dry cough, weight loss and appetite loss since five months. Her chest radiograph revealed a right-sided homogeneous opacity involving the entire right hemithorax and left-sided pleural-based homogenous mass. Contrast Enhanced Computed Tomography (CECT) thorax revealed an enlarged hemithorax with evidence of large, ill-defined heterogeneously enhancing multilobulated soft-tissue density mass lesion occupying the entire right hemithorax. Biopsy was suggestive of Small Cell Carcinoma of Lung (SCLC), chemotherapy was given and patient is under regular follow-up.

Objectives: To evaluate the detection rate of prostate cancer (PCa) in patients who underwent to “in bore” Magnetic Resonance Imaging -guided prostate (MRI-GB) biopsy compared to the standard transrectal ultrasound guided prostate biopsy (TRUS-GB). Materials and methods: Between January 2017 and March 2015 a cohort of 39 consecutive patients was prospectively enrolled. All the patients underwent an "in-bore" guided MRI prostatic biopsy and subsequently ultrasound-guided standard prostate biopsy. Results: Median age of patients was 65.5 years (SD ± 6.6), median total PSA serum level was 6.6 ng/ml (SD ± 4.1), median prostate total volume was 51.1 cc (SD ± 26.7). Thirty of 39 (76.9%) were biopsy-naïve patients while 7/39 (17.9%) had at least one previous negative random TRUS-GB; 2/39 (5.1%) patients were already diagnosed as PCa and were on active surveillance. In 18/39 (53.8%) men Pca was diagnosed; as regards the MRI-GB results related to the PI-RADS score, biopsies of PIRADS 3 lesions were positive in 5/18 cases (27.8%), while the number of positive cases of PI-RADS 4 and 5 lesions was 7/11 (63.6%) and 6/10 (60%)respectively. At the histological examination, 4/39 (10.3%) had a PCa ISUP grade group 1, 11/39 (28.2%) had a ISUP 2, 6/39(15.4%) had a ISUP grade group 3 and 2/39 (5.1%) had a ISUP 4-5. Conclusions: MRI-GB represents a promising technique that may offer some of advantages compared to standard systematic TRUSGB. Our preliminary experience in MRI-GB resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of PCa.

Objectives: To evaluate the detection rate of prostate cancer (PCa) in patients who underwent to “in bore” Magnetic Resonance Imaging -guided prostate (MRI-GB) biopsy compared to the standard transrectal ultrasound guided prostate biopsy (TRUS-GB). Materials and methods: Between January 2017 and March 2015 a cohort of 39 consecutive patients was prospectively enrolled. All the patients underwent an "in-bore" guided MRI prostatic biopsy and subsequently ultrasound-guided standard prostate biopsy. Results: Median age of patients was 65.5 years (SD ± 6.6), median total PSA serum level was 6.6 ng/ml (SD ± 4.1), median prostate total volume was 51.1 cc (SD ± 26.7). Thirty of 39 (76.9%) were biopsy-naïve patients while 7/39 (17.9%) had at least one previous negative random TRUS-GB; 2/39 (5.1%) patients were already diagnosed as PCa and were on active surveillance. In 18/39 (53.8%) men Pca was diagnosed; as regards the MRI-GB results related to the PI-RADS score, biopsies of PIRADS 3 lesions were positive in 5/18 cases (27.8%), while the number of positive cases of PI-RADS 4 and 5 lesions was 7/11 (63.6%) and 6/10 (60%)respectively. At the histological examination, 4/39 (10.3%) had a PCa ISUP grade group 1, 11/39 (28.2%) had a ISUP 2, 6/39(15.4%) had a ISUP grade group 3 and 2/39 (5.1%) had a ISUP 4-5. Conclusions: MRI-GB represents a promising technique that may offer some of advantages compared to standard systematic TRUSGB. Our preliminary experience in MRI-GB resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of PCa. [ABSTRACT FROM AUTHOR]

Compartment syndrome in the thigh is rare and most frequently follows blunt trauma. Tissue biopsy is frequently performed to obtain a diagnosis for soft tissue lumps. We report a case of thigh compartment syndrome following an ultrasound guided biopsy for sarcoma in order to increase awareness of this rare complication amongst healthcare professionals.

Background: Medical thoracoscopy increases the diagnostic yield in patients with undiagnosed pleural effusion. Ultrasound guided pleural biopsies are safe procedures with high diagnostic yields. Objective: To compare safety and efficacy of medical thoracoscopic versus ultrasound guided transthoracic needle biopsy in the diagnosis of pleural lesions. Patients and methods: 40 patients with undiagnosed pleural lesions were divided into 2 groups. After clinical, radiological examination and laboratory investigations; pleural biopsies were taken by ultrasound guided needle biopsy and medical thoracoscopy in group I and II respectively. Results: Complications in group I were in the form of pain in 2 patients (10%), hemoptysis in 1 (5%), while complications in group II were pain in 4 (20%), failure of the lung to expand in 5 (25%), pneumothorax in 5 (25%) and wound infection in 3 patients (15%). Final histopathological diagnosis in group I was parapneumonic effusion in 3 patients (15%), inflammatory lung lesion in 1 (5%), pleural fibroma in 2 (10%), malignant mesothelioma in 4 (20%), sarcoma in 1 (5%), adenocarcinoma in 1 (5%), squamous cell carcinoma in 4 (20%), and metastatic adenocarcinoma in 1 (5%). Final histopathological diagnosis in group II was pleural TB in 4 patients (20%), inflammatory lung lesions in 2 (10%), malignant mesothelioma in 6 (30%), adenocarcinoma in 5 (25%), and metastatic adenocarcinoma in 2 (10%). The diagnosed cases were 17 (85%) and 19 (95%) in groups I and II respectively. Conclusions: Medical thoracoscopy is an important diagnostic method for the diagnosis of undiagnosed pleural effusion while it is concluded that US guided pleural biopsy is more useful in cases of pleural lesions without effusion.

Introduction: In the Slovak Republic, breast cancer is the most common type of oncological disease in women, the leading cause of cancer mortality in all women. In the past 10 years, breast cancer mortality has continued to slowly decrease, the breast cancer incidence in the past 20 years has continued increase, likely due to program of preventive mammography. The Aim: The aim of this retrospective study was the asses the importance, the position of the interventional methods - core cut biopsy and fine needle aspiration biopsy under ultrasound control in the differential diagnostics of changes after surgical treatment for breast cancer. Patients and Methods: We evaluated examinations of 385 patients with newly diagnosed breast carcinoma after conservative surgical therapy in period between January 2005 and December 2016 from Clinic of Radiology in Trenčín. In all cases was performed ultrasound, mammography 2D and 3D examinations, ultrasound guided biopsy with free hand methods with needle 14, 16 and 20 G. Results: The major findings as postoperative changes were seromas, hematomas, fat necrosis, skin thickening, inflammatory changes, granulomas, postoperative scars and local tumor recurrence. Conclusion: The ultrasound guided interventional methods, fine needle aspiration cytology and core cut biopsy are reliable and perfect methods for the differential diagnosis of postoperative changes and the follow up of postoperative changes. [ABSTRACT FROM AUTHOR]

Aim of work: To study the diagnostic value of ultrasound guided biopsy in patients with malignant pleural effusion. Patients and methods: This study involved 40 patients with malignant pleural effusion of indeterminate aetiology. All patients had a contrast CT chest performed and were divided into 3 Groups according to their radiologic appearance: GROUP 1: 10 patients having pleural effusion only. GROUP 2: 15 patients having pleural effusion and pleural thickening. GROUP 3: 15 patients having pleural effusion and pleural mass lesions. All 3 groups of patients underwent ultrasound examination in the Radiology department. In patients of Groups 2 and 3, ultrasound fluid aspiration and ultrasound guided core biopsy of the pleura were attempted. Patients of all 3 Groups performed Medical thoracoscopy in the interventional pulmonology unit. Results: In Group 1 patients, US guided biopsy was contraindicated and could not be performed due to absence of pleural thickness, nodulation or masses. Thoracoscopy was performed in them all with a sensitivity reaching 90%. In Group 2, a malignant aetiology was reached in 5/10 cases whom had adequate tissue retrieval (sensitivity 50%). In Group 3, 12/15 patients were diagnosed by US guided biopsy (sensitivity 80%). The mean sensitivity of US guided biopsy in both Groups was 65%. Thoracoscopy was then performed successfully in all of patients in Groups 2 and 3 with a diagnostic sensitivity of 100% each. The mean diagnostic sensitivity of thoracoscopy for all 3 Groups was 96.7%. Conclusion: The US guided pleural biopsy with a Tru-cut needle is simple, safe and well tolerated. It is especially useful for patients with pleural tumour, thickened pleura, small amounts of pleural effusion or loculated pleural effusion.

Objective: Existing guidelines for ultrasound-guided fine-needle aspiration biopsy lack specifications on sampling sites, but the number of biopsies improves diagnostic reliability. We propose the use of class activation maps (CAMs) and our modified malignancy-specific heat maps that locate important deep representations of thyroid nodules for class predictions., Methods: We applied adversarial noise perturbations to the segmented concentric "hot" nodular regions of equal sizes to differentiate regional importance for the malignancy diagnostic performances of an accurate ultrasound-based artificial intelligence computer-aided diagnosis (AI-CADx) system using 2,602 retrospectively collected thyroid nodules with known histopathological diagnosis., Results: The AI system demonstrated high diagnostic performance with an area under the curve (AUC) value of 0.9302 and good nodule identification capability with a median dice coefficient >0.9 when compared to radiologists' segmentations. Experiments confirmed that the CAM-based heat maps reflect the differentiable importance of different nodular regions for an AI-CADx system to make its predictions. No less importantly, the hot regions in malignancy heat maps of ultrasound images in comparison with the inactivated regions of the same 100 malignant nodules randomly selected from the dataset had higher summed frequency-weighted feature scores of 6.04 versus 4.96 rated by radiologists with more than 15 years of ultrasound examination experience according to widely used ultrasound-based risk stratification American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) in terms of nodule composition, echogenicity, and echogenic foci, excluding shape and margin attributes, which could only be evaluated on the whole rather than on the sub-nodular component levels. In addition, we show examples demonstrating good spatial correspondence of highlighted regions of malignancy heat map to malignant tumor cell-rich regions in hematoxylin and eosin-stained histopathological images., Conclusion: Our proposed CAM-based ultrasonographic malignancy heat map provides quantitative visualization of malignancy heterogeneity within a tumor, and it is of clinical interest to investigate in the future its usefulness to improve fine-needle aspiration biopsy (FNAB) sampling reliability by targeting potentially more suspicious sub-nodular regions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wang, Wang, Lu, Xu, Yao, Wang and Xu.)

Objetivo: en el seno de la Asociación de Ecografía Digestiva se decidió realizar un estudio retrospectivo multicéntrico sobre la punción-aspiración con aguja fina (PAAF) de lesiones ocupantes de espacio pancreáticas, mediante control ecográfico y por vía percutánea, con el objetivo de valorar el rendimiento de dicha técnica y poder compararla con la punción mediante ultrasonografía endoscópica. Participantes: en el estudio han participado 10 hospitales con 222 pacientes con lesiones pancreáticas entre 8 y 120 mm, sospechosas de malignidad. Resultados: el análisis de los resultados muestra una sensibilidad del 89%, especificidad 98%, valor predictivo positivo 99% y negativo 74%, con precisión diagnóstica global 91%. No encontramos ninguna complicación significativa. Conclusión: la PAAF de lesiones pancreáticas por vía percutánea es de alta rentabilidad diagnóstica y con pocas y leves complicaciones.Objective: members of "Asociación de Ecografía Digestiva" decided to carry out a multicenter retrospective study on fine-needle aspiration biopsy for pancreatic space-occupying lesions under ultrasonographic guidance and via the percutaneous route in order to assess this technique's performance versus endoscopic ultrasound-guided biopsy. Subjects: 10 hospitals for a total of 222 patients with suspiciously malignant, 8-120-mm pancreatic lesions were included in the study. Results: the analysis of results shows a sensitivity of 89%, a specificity of 98%, a positive predictive value of 99%, and a negative predictive value of 74%, for an overall diagnostic accuracy of 91%. No major complications occurred. Conclusion: percutaneous fine-needle aspiration for pancreatic lesions is highly cost-effective and has few and mild complications.

The article reports a study which was conducted to determine whether ultrasonography can help in diagnosis of pericarditis in bovine and examine the histopathological changes in liver associated with pericarditis. Histopathology of ultrasonography (USGB) samples confirmed sinusoidal dilatation in all the animals along with chronic active hepatitis and fatty liver. This indicates that ultrasonography is a reliable non-invasive tool to describe nature and severity of the pericardial effusions.

The most common cause of an opaque hemithorax is pleural effusion, it is a rare occurrence to find patients with extensive mass leading to an opaque hemithorax. Thorough search of literature did not yield any case with such a large lung mass leading to opaque hemithorax, without the presence of pleural effusion. Lung cancer is the most common cancer diagnosed worldwide and has predominantly been attributed to tobacco smoke exposure. Of the several types, small cell lung cancer differs from others by its early spread and extensive dissemination leading to metastatic classification at the time of diagnosis. Here, is a case of a 50-yearold female patient who presented to the outpatient department with dry cough, weight loss and appetite loss since five months. Her chest radiograph revealed a right sided homogeneous opacity involving the entire right hemithorax and left-sided pleural based homogenous mass. Contrast Enhanced Computed Tomography (CECT) thorax revealed an enlarged hemithorax with evidence of large, ill-defined heterogeneously enhancing multilobulated soft-tissue density mass lesion occupying the entire right hemithorax. Biopsy was suggestive of Small Cell Carcinoma of Lung (SCLC), chemotherapy was given and patient is under regular follow-up. [ABSTRACT FROM AUTHOR]

An investigation of patient satisfaction with ultrasound-guided breast procedures (fine needle biopsy and cyst aspiration) was performed. The research was designed around a proposed imaging loop added to the Health Related Quality of Life model. A patient questionnaire, devised to assess three areas of the imaging loop—preanalytical, postanalytical, and overall satisfaction with the procedure—was administered. Results show a population of patients satisfied with these invasive procedures. Study patients' satisfaction levels were comparable with those of control subjects. Procedure anxiety was identified as a patient perception, but did not hamper level of satisfaction. Study patients also reported that ultrasound-guided breast procedures contributed to a perception of favorable overall health and gave a high level of patient satisfaction. [ABSTRACT FROM PUBLISHER]

Two hundred and one biopsies of the pancreas and/or extrahepatic bile ducts were performed in 173 patients using primarily ultrasound (US) or fluoroscopic guidance. Computed tomographic (CT) guidance was used twice. The success rate for detecting malignancy was 82.4%. Patients with primary ductal carcinoma had the lowest success rate. Seven complications occurred: five vasovagal reactions, one fever, and one acute pancreatitis in a patient with a normal variation, which resembled a mass. In this large series, aspiration biopsy of the pancreas and extrahepatic bile ducts proved to be a safe and reliable procedure that often can be performed on an outpatient basis. Fluoroscopic and US guidance are satisfactory for the majority of biopsies. CT guidance probably should be reserved for patients who undergo a repeat biopsy, or when US fails to adequately demonstrate the pancreas. [ABSTRACT FROM AUTHOR]

Introduction While computed tomography (CT) guided lung biopsy has been standard in histological diagnosis of pulmonary lesions, its use is limited to the interventional radiologists only. Ultrasound (US) guided biopsy of pulmonary lesions, which can be performed in-clinic by the pulmonologists only, is becoming a more popular technique. It also has the edge of real-time techniques, multi-planar imaging, and no radiation exposure to the patients. Methods This is a retrospective review of all the patients presenting with pleural-based lung lesions who underwent US-guided biopsy for diagnosis in the Department of Pulmonology, Liaquat University of Medical and Health Sciences Hospital, Hyderabad, Pakistan from 1 st January 2013 till 31 st December 2017. The diagnostic yield, sensitivity, specificity, and accuracy of US-guided biopsies were evaluated for diagnoses of peripheral lung malignancies. Results Ultrasound-guided biopsies for lung lesions has a diagnostic yield of 88.3%, sensitivity of 95.80%, and specificity of 90% with an accuracy of 95.35%. Pneumothorax as an immediate complication was seen only in 1.5% cases. Conclusion US-guided biopsies are a much safer diagnostic alternative to CT-guided biopsy for lung lesions and have high diagnostic yield. It doesn't require special radiological interventionists, can be performed at patients' bedsides, and the equipment is not as expensive., Competing Interests: The authors have declared that no competing interests exist.

Genital tuberculosis mimicking carcinoma ovary is a well-known dilemma as there is no definitive serological or imaging modality for diagnosing abdominopelvic tuberculosis. A 20-years-old unmarried girl presented with complex adnexal mass, mild ascites and CA 125 >1000. Her staging laparotomy and frozen section was planned. Laparotomy revealed miliary tuberculosis and frozen section confirmed the diagnosis of tuberculosis. Patient was started with anti-tuberculosis treatment and follow up showed resolution of cysts. Another case is of 31 years old unmarried lady presented with history of abdominal pain. Her ultrasound revealed complex adnexal mass. CT scan revealed bilateral adnexal masses with solid and cystic lesion, ascites, para aortic lymphadenopathy; features suggestive of mitotic lesion. Her CA 125 was >1000. Family history of tuberculosis was positive. Keeping her age group and family history in view; workup of tuberculosis was performed. X ray chest was normal. Tuberculin skin test was 10mm and Quantiferon gold test was negative. In this case a decision of ultrasound guided biopsy was made. Result of biopsy showed granulomatous inflammation confirming pelvic tuberculosis. Ultrasound guided biopsy is a minimally invasive procedure with high diagnostic yield can be very helpful in such case. Clear guidelines should be developed nationally owing to the high prevalence of tuberculosis in our country to avoid unnecessary laparotomies.

Objectives: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using standard needles has a high diagnostic value in the evaluation of solid pancreatic masses. Fenestrated needles have been developed to improve the quality of EUS-guided tissue sampling by providing core biopsies (FNB)., Methods: Patients with solid pancreatic masses of >2 cm were prospectively included in our study and randomized to receive EUS sampling, using either a standard 22G FNA or a 22G Procore® FNB needle. The main study endpoint was the number of needle passes required to obtain a diagnosis in more than 90% of cases., Results: We included 100 patients (male = 63, female = 37; mean age = 68.4 years) in our study. We found that 88% of the lesions were malignant, with a mean size of 32 mm. A sample adequate for diagnosis was obtained in more than 90% of cases after the second needle pass in the FNB group, versus the third needle pass in the FNA group. Slide cellularity and presence of tissue microfragments were significantly higher in the FNB group. Sensitivity for the diagnosis of malignancy was 88.4% versus 97.8% for the EUS-FNA and EUS-FNB group, respectively, while specificity for both techniques was 100%. No complications were recorded., Conclusions: Although the accuracy of both needle types for proving malignancy was similar, a lower number of passes was required with the FNB needles to achieve the same contributive sample rate as with the FNA needles. FNB also improved the histopathological quality of specimens, suggesting an overall superiority of FNB sampling.