Caracterización de los resultados de biopsia por trucut en pacientes con BI-RADS 4 y 5 sin criterio quirúrgico

Introducción: La biopsia percutánea se ha convertido, en nuestros días, en el método diagnóstico más utilizado para la evaluación de las lesiones de mama sospechosas de malignidad. Objetivo: Caracterizar los resultados de biopsia por trucut en pacientes con categorías BI-RADS 4 y 5 sin criterio quirúrgico. Materiales y métodos: Se realizó un estudio observacional, descriptivo y transversal de 70 pacientes que presentaron lesión sospechosa de malignidad por ultrasonografía y que requirieron la realización de biopsia por aguja gruesa de la imagen reportada, entre enero de 2019 y diciembre de 2020. Se realizaron en la Consulta de Intervencionismo Mamario del Departamento de Imagenología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Se analizaron las variables edad, categoría BI-RADS, resultado histopatológico, tamaño tumoral y complicaciones. Resultados: El grupo etario predominante fue el de 70-79 años (27,1). Se clasificaron 48 pacientes con categoría BI-RADS 5, para un 68,6 %. El carcinoma ductal infiltrante resulto ser el tipo histológico predominante, con 40 pacientes, representando el 57,1 % del total. Se obtuvo una media de 28,91 mm de diámetro de las lesiones biopsiadas. Todas las muestras resultaron útiles, aun en diámetros transversales inferiores a 2 cm. En la serie, las complicaciones reportadas fueron escasas. Conclusiones: La biopsia realizada con aguja gruesa bajo guía ecográfica con técnica de manos libres, es un método confiable para el diagnóstico de cáncer de mama, seguro y sin complicaciones graves. Se confirma que la categoría BI-RADS 5 coincide con diagnóstico histopatológico de cáncer mamario.

Introduction: Percutaneous biopsy has become, nowadays, the most used diagnostic method to evaluate breast lesions suspected of malignancy. Objective: To characterize the Tru-cut biopsy results in patients with BI-RADS 4 and 5 categories without surgical criteria. Materials and methods: An observational, descriptive and cross-sectional study was carried out between January 2019 and December 2020 on 70 patients who presented who presented a lesion suspicious of malignancy by ultrasonography and required a thick-needle biopsy of the reported image. They were performed at the Breast Intervention Clinic of the Imaging Department of the Clinical Surgical University Hospital Comandante Faustino Pérez Hernández, from Matanzas. The variables age, BI-RADS category, histopathological result, tumor size and complications were analyzed. Results: The predominant age group was the 70-79 years-old one (27.1). 48 patients were classified with BI-RADS 5 category, for 68.6%. Infiltrating ductal carcinoma resulted the predominant histological type, with 40 patients representing 57.1% of the total. An average diameter of 28.91 mm was obtained from the biopsied lesions. All samples were useful, even in transverse diameters less than 2cm. In the series, few complications were reported. Conclusion: Biopsy performed with thick needle under ultrasound guidance with free-hands technique, is a reliable method for breast cancer diagnosis, safe and without serious complications. It is confirmed that BI-RADS 5 category coincides with breast cancer pathological diagnosis.

The utility of ultrasound-guided tru-cut biopsy in the diagnosis of occult breast carcinoma presenting as ovarian malignancy with multiple metastases: A case of unknown primary

@#This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.

Ultrasound‑guided tru‑cut biopsy of pelvic tumors: First reported case series in the Philippines / Philippine Journal of Obstetrics and Gynecology

@#This paper documents the first reported cases of patients in the country who underwent transvaginal ultrasound‑guided Tru‑cut biopsy of pelvic tumors in a tertiary level health institution in 2019. Different indications for Tru‑cut biopsy were demonstrated highlighting its clinical utility in the diagnosis and management of malignant pelvic tumors. All patients warranted histologic diagnosis for further planning of the most appropriate management. Adequate tissue samples were obtained from all three patients with no procedure‑related complications.

Utility of tru-cut biopsy in diagnosis of palpable pediatric soft tissue neoplasms

Context: Soft tissue neoplasms are infrequent in children with sarcomas accounting for approximately 7% of all pediatric malignancies. Morphologic diagnosis is challenging due to overlapping features. Subtyping and categorization of these lesions are difficult on fine-needle aspiration cytology (FNAC) alone owing to tumor heterogeneity and limited material in some cases. Tru-cut biopsies obtain adequate tumor tissue for ancillary studies besides conventional histology. Aim: The study aims to explore the role of tru-cut biopsy to arrive at a definitive diagnosis. The study also highlights the correlation between FNAC and histopathology on tru-cut biopsy besides explaining the significance of a panel of immunohistochemistry (IHC) markers for histological categorization and subtyping. Materials and Methods: A total of 61 children from infancy to 18 years were included in the study. Closed biopsy procedures like FNAC and tru-cut biopsy were performed, and the tru-cut biopsy specimen was subjected to a panel of immunohistochemical markers. Results: Fisher's exact test for sensitivity and specificity towards detection of malignancy was 83% and 86%, respectively for FNAC. For tru-cut biopsy, sensitivity was 94% and specificity was 91%. The two-sided P value (<0.0001) was extremely significant. Cohen's Kappa coefficient value for tru-cut biopsy was 0.772 suggesting a substantial strength of agreement. Tru-cut with IHC had a Kappa value of 0.866 suggesting greater agreement with histopathology. Conclusion: Tru-cut biopsy is a simple, safe, and reliable adjunct to the FNAC. Instead, immunohistochemistry enhances the diagnostic accuracy.

Evaluation of Role of Tru-Cut Biopsy in the Diagnosis of Clinically Palpable Breast Lumps

Many diseases affect the breast that range from inflammatory conditions, benign lesions to malignant lesions, most of which present as lumps in the breast. Breast lumps are one of the frequent complaints that we come across in surgical OPDs. Breast lumps not only create apprehension but also can cause unacceptable pain and impairment if they are found to be malignant. Fine Needle Aspiration Cytology (FNAC), Tru-Cut biopsy, incision biopsy and excision biopsy are the pathological investigations available for the diagnosis of breast lesions. This study is done to evaluate the role of Tru-Cut biopsy in diagnosing the breast lesions and compare it with FNAC and histopathology.METHODSThis prospective study is conducted in the Department of General Surgery at a tertiary care centre from September 2015 to November 2016 among patients attending surgical OPD and admitted in general surgical wards with clinically palpable breast lumps.RESULTSThe sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 86.36%, 93.75%, 90.47%, 90.90% and 90.74 % respectively. For Tru-Cut biopsy the values were 95.45%, 100%, 100%, 96.96 % and 98.14 % respectively.CONCLUSIONSTru-Cut biopsy has better efficacy over FNAC in our study. The superiority of Tru-Cut biopsy is particularly seen in Sclerosing, papillary, fibro-epithelial lesions and malignancies with inconclusive and suspicious FNAC results.

The utility of ultrasound-guided tru-cut biopsy in the diagnosis of Occult Breast Carcinoma presenting as Ovarian Malignancy with Multiple Metastases: A case of unknown primary

@#This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.

Lesions in 224 spleens of splenectomized dogs and evalution of alternative techniques for previous microscopic diagnosis / Lesões em 224 baços de cães esplenectomizados e avaliação de técnicas alternativas para diagnóstico microscópico prévio

When detecting a proliferative splenic lesion, veterinarians usually choose splenectomy before a conclusive diagnosis, which can provide a deleterious effect to the dog. The most appropriate would be to perform splenectomy as a therapeutic procedure only in cases with real surgical indication, which can be established after defining microscopic diagnosis and prognosis. The objectives of this study were: to determine the frequency of different types of lesions in spleens of splenectomized dogs in the period of 12 years (2006-2017); determine the representativity of neoplastic lesions (benign and malignant) and non-neoplastic lesions; to evaluate and compare the safety and efficiency of fine needle aspiration biopsy (FNA) and ultrasound-guided Tru-cut needle biopsy for cytological and histopathological diagnosis, respectively, of splenic nodular lesions. In the studied period 224 cases of lesions were found in splenectomized spleens. The frequency of non-neoplastic lesions (50,45%, 113/224) and neoplastic lesions (49,55%, 111/224) was very similar. Among the neoplastic lesions, the malignant ones were more frequent (79,27%, 88/111), and the hemangiosarcoma was the most common (52,25%, 58/111). The possibility of malignant neoplasm was about 74% greater than a benign one. In summary, it was verified that 60.71% (136/224) of the cases corresponded to benign lesions without indication to splenectomy. FNA techniques and Tru-cut biopsy showed a low risk of complications. Regarding the diagnostic efficacy, the FNA obtained 71.43% (15/21) of conclusive diagnoses, 60% (9/15) of which were compatible with the final result of the histopathological evaluation, after splenectomy (gold standard). The Tru-cut biopsy obtained 71.43% (5/7) of conclusive diagnoses and 28.57% (2/7) of inconclusive diagnoses. Among the conclusive one, in 100% of the cases the diagnosis was compatible with the gold standard. Thus, since the possibility of benign splenic lesions in dogs is 1.52 times greater than malignancies, splenectomy should be recommended as a therapeutic procedure only in cases with proven surgical indication, which can be established after definition of microscopic diagnosis and prognosis. The use of FNA and Tru-cut biopsy should be recommended, especially for small and focal splenic lesions, since such techniques are good alternatives for establishing diagnosis previously to splenectomy, which may reduce the number of unnecessary splenectomies. The importance of recommending such techniques is emphasized, especially for dogs with focal splenic lesions smaller than three centimeters.(AU)

Rotineiramente, frente à detecção de uma lesão proliferativa esplênica, médicos veterinários costumam optar pela esplenectomia antes de se obter o diagnóstico definitivo da lesão esplênica, o que pode trazer consequências deletérias ao cão. O mais apropriado seria, contudo, a sua adoção, como medida terapêutica, apenas nos casos com comprovada indicação cirúrgica, o que pode ser estabelecido após o diagnóstico microscópico e prognóstico definidos. Os objetivos desse estudo foram: determinar a frequência dos diferentes tipos de lesão em baços de cães esplenectomizados no período de 12 anos (2006-2017); determinar a representatividade das lesões neoplásicas (benignas e malignas) e não neoplásicas; avaliar e comparar a segurança e a eficiência da punção aspirativa por agulha fina (PAAF) e da biópsia por agulha Tru-cut guiadas por ultrassom para o diagnóstico citológico e histopatológico, respectivamente, de lesões nodulares esplênicas. No período estudado foram encontrados 224 casos de lesões em baços esplenectomizados. A frequência de lesões não neoplásicas (50,45%, 113/224) e neoplásicas (49,55%, 111/224) esplênicas foi muito semelhante. Entre as neoplásicas, as de caráter maligno foram mais frequentes (79,27%, 88/111) e o hemangiossarcoma o mais comum (52,25%, 58/111). A possibilidade de ocorrência de uma neoplasia maligna foi cerca de 74% maior do que uma benigna. Em suma, verificou-se que em 60,71% (136/224) dos casos estudados, tratava-se de lesões benignas que não teriam indicação de esplenectomia. As técnicas de PAAF e a biópsia por agulha Tru-cut demonstraram ter baixo risco de complicações. Quanto à eficácia diagnóstica, pela PAAF obteve-se 71,43% (15/21) de diagnósticos conclusivos, sendo 60% (9/15) desses compatíveis com o resultado final realizado pela avaliação histopatológica, após a esplenectomia (padrão ouro). Já a biópsia por Tru-cut obteve 71,43% (5/7) de diagnósticos conclusivos e 28,57% (2/7) de inconclusivos. Dentre os conclusivos, em 100% dos casos o diagnóstico foi compatível com o padrão ouro. Desta maneira, visto a possibilidade de ocorrência de lesões esplênicas benignas em cães serem 1,52 vezes maior do que as malignas deve ser recomentado a adoção de esplenectomia, como medida terapêutica, apenas nos casos com comprovada indicação cirúrgica, o que pode ser estabelecido após o diagnóstico microscópico e prognóstico definidos. O uso da PAAF e da biópsia por Tru-cut deve ser recomentado, sobretudo, para lesões esplênicas pequenas e focais, uma vez que tais técnicas representam boas alternativas para o estabelecimento do diagnóstico prévio a esplenectomia, o que pode reduzir o número de esplenectomias desnecessárias. Enfatiza-se a importância da recomendação de tais técnicas, sobretudo para cães com lesões esplênicas focais menores do que três centímetros.(AU)

Evaluation of trans thoracic invasive diagnostic procedures in 50 adult patients of mediastinal diseases

Introduction: Mediastinum is a “Pandora’s box” with many neoplastic and nonneoplastic lesions. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, non-invasive approach to these cases sometimes leads to diagnostic dilemma. Aims: A prospective study was performed over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine‑needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and non-invasive imaging could not conclude the diagnosis. Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, nature of disease and complication and cost effectiveness ofthe procedures. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered. Results: Among 50 patients diagnostic yield of TTUS guided FNA and Tru-cut biopsy were 60% and 63.6% respectively. Diagnostic yield of Thoracic CT guided FNA and Tru-cut biopsy were 85% and 92.3% respectively. As a whole TTUS guided invasive procedure and Thoracic CT guided invasive procedure had a diagnostic yield of 61.5% and 87.9% respectively. Complication is less in CT guided invasive procedures (9.1%) compared to Transthoracic USG guided invasive procedures (11.5%) and complication is more common in Tru-Cut biopsy (16.7%) than fine needle aspiration (5.7%). Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and have added advantage of real time guidance and is comparable with CT guided invasive procedures in respect to risk and diagnostic yields.

Esclerosis hepatoportal como causa de hipertensión portal no cirrótica en un paciente colombiano infectado con VIH / Hepatoportal Sclerosis as a Cause of Portal Hypertension in a Colombian HIV patient without Cirrhosis

Antecedentes: la esclerosis hepatoportal se manifiesta como hipertensión portal no cirrótica. Su etiología parece estar relacionada con alteraciones idiopáticas en la microvasculatura hepática. Las manifestaciones de la esclerosis hepatoportal incluyen sangrado de vías digestivas altas, pancitopenia, esplenomegalia e hipertensión portal no cirrótica. Presentamos el primer caso reportado en Colombia de esclerosis hepatoportal en un paciente con serología positiva para el virus de la inmunodeficiencia humana (VIH). Métodos: paciente masculino de 60 años de edad, VIH-positivo, quien ingresa a nuestra institución por hemorragia de vías digestivas alta (várices esofágicas y fúndicas) y ascitis, cuyo manejo requirió la toma de biopsia hepática. Resultados: se realizó biopsia Trucut de hígado que evidenció la presencia de 6 a 8 espacios porta con parénquima arquitectónico conservado que demostró fibrosis perivenular y dilatación sinusoidal pericentral severa. Conclusión: la esclerosis hepatoportal es una causa de morbilidad en pacientes VIH-positivos. Debe considerarse en cada paciente que manifiesta hipertensión portal no cirrótica asociada con hemorragia de la vía digestiva alta. Sin embargo, una investigación adicional es imprescindible con el fin de describir la relación entre el desarrollo de alteraciones intrahepáticas (microtrombosis), la patogénesis del VIH y el uso de terapia antirretroviral, particularmente el uso de didanosina.

Background: Hepatoportal sclerosis manifests as non-cirrhotic portal hypertension. Its etiology appears to be related to alterations in the idiopathic micro-vasculature of the liver. Manifestations of hepatoportal sclerosis include upper gastrointestinal bleeding, pancytopenia, splenomegaly and non-cirrhotic portal hypertension. We present the first reported case of hepatoportal sclerosis in Colombia which occurred in an HIV positive patient. Methods: A 60-year-old male HIV patient positive was admitted to our institution because of ascites and upper digestive tract bleeding due to esophageal and fundal varices. Management required taking a liver biopsy. Results: A Tru-Cut biopsy needle was used to take a liver biopsy sample percutaneously. The biopsy revealed six to eight portal tracts with preserved architectural parenchyma, perivenular fibrosis and severe pericentral sinusoidal dilatation. Conclusions: Hepatoportal sclerosis is a cause of morbidity in HIV-positive patients and should be considered in each patient manifesting non-cirrhotic portal hypertension associated with upper gastrointestinal bleeding. However, further research is necessary to describe the relationship between the development of intrahepatic alterations (microthrombosis), HIV, and the use of anti-retroviral therapy, particularly the use of didanosine.

Primary pleuro-pulmonary synovial sarcoma.

Primary pleuro-pulmonary synovial sarcoma (PPSS) is a rare tumour and poses a diagnostic challenge particularly when unusual histological features are present. We report a case of a 30-year-old immunocompromised human immunodeficiency virus (HIV) sero-positive male who was referred to us with complaints of cough, breathlessness and left-sided chest pain for the past two months. The PPSS can be confirmed on tru-cut biopsy.

Endoscopic Ultrasonography-guided Tru-Cut Biopsy for Differential Diagnosis in the Gastrointestinal Mesenchymal Neoplasm / 대한소화기내시경학회지

BACKGROUND/AIMS: Risk assessment by mitotic count in the gastrointestinal stromal tumor (GIST), the most common mesenchymal neoplasm, is important. EUS-guided fine- needle aspiration cannot obtain sufficient tissue for determination of mitotic count, but An EUS-guided Tru-Cut biopsy (EUS-TCB) can. The aim of this study was to evaluate clinical role of EUS-TCB in differential diagnosis of mesenchymal neoplasm and risk assessment of GIST. METHODS: We prospectively enrolled 18 patients who were diagnosed with submucosal hypoechoic tumors, 2~5 cm, in the muscular layer by EUS in Seoul National University Hospital from November, 2005, to July, 2007. The rates of adequate biopsy and possibility of risk assessment were evaluated. RESULTS: EUS-TCB was performed in 16 patients. The median tumor size was 2.7 cm, and adequate diagnosis was possible in 8 patients. Tumor size in the adequate specimen group was larger than in the inadequate group (p=0.021). The number of needle passes was higher in the adequate specimen group (p=0.012). Risk assessment by mitotic count was possible in only one case. CONCLUSIONS: EUS-TCB in the diagnosis and risk assessment of GIST was inadequate, in part because of insufficient operator experience and small tumors. Development of a new instrument is needed to obtain sufficient tissue.

A Prospective Comparative Study Between Manual and Automated Renal Biopsy by Randomized Sampling / 대한신장학회잡지

OBJECTIVES: Percutaneous renal biopsy may be carried out in several ways. Recently, the use of a spring-loaded biopsy gun has become popularized. There have been much controversies on the tissue adequacy and the incidence of complications when compared to the manual biopsy. The present study was performed to compare tissue adequacy and the incidence of complications between manual biopsy and automated biopsy. METHODS: We have studied 108 patients in whom the method of renal biopsy was assigned to one of the two methods[14G Tru-cut needle manual bx (group I) and 18G automated gun biopsy(group II)] according to their national resident's identification number in a randomized and prospective manner. RESULTS: There were 50 patients in group I and 58 patients in group II. There was no difference in gender, age, hemoglobin, prothrombin time, partial thromboplastin time, diastolic and systolic blood pressure pre-biopsy in group I and II. Indications for biopsies were proteinuria accompained by hematuria (37%), proteinuria(34.3%), acute renal failure (9.3%), SLE (8.3%), chronic renal failure (5.6%), hematuria only (5.6%). In Group I the number of passes was 2.4+/-0.8, the glomeruli obtained were 25.3+/-13.2 and the number of glomeruli per pass were 11.6+/-6.5, and in Group II 3.4+/-1.1, 19.4+/-10.8, and 6.8+/-4.0, respectively. These showed a significant difference (p<0.05). In all cases pathological diagnosis were possible. The histology showed IgA nephropathy in 27.8%, MCNS in 14.8%, lupus nephritis in 11.1, MGN in 11.1%, MPGN in 7.4%, and others. The incidence and area of perinephric hematoma demonstrated on ultrasound 24 hours post-biopsy was increased in group I (24%, 937.7+/-640.0mm2 compared to 10.3%, 372.4+/-327.4mm2 in group II) although no statistically significant difference existed. There was no significant difference in gender, age, prothrombin time, partial thromboplastin time, systolic and diastolic blood pressure between the group with and without hematomas. Hematocrit levels before and after biopsy showed a significant difference (34.5+/-8.2, 33.5+/-8.1, p<0.05) in group I, but no significant difference was observed in group II (34.7+/-6.4, 34.8+/-6.4). CONCLUSION: Both techniques rendered adequate tissue sampling, but the extent of bleeding seems to be more severe with manual 14G Tru-cut needle biopsy.

Testicular Biopsy: Comparison of Open Surgical and Percutaneous Needle Biopsy Techniques / 대한비뇨기과학회지

Testicular biopsy has been known as very useful diagnostic procedure for the male infertility. For the past 9 months percutaneous testicular biopsy procedures were attempted on 64 patients with azoospermia or atrophic testis using a new Tru-Cut biopsy needle. In addition surgical testicular open biopsy procedure on one side and percutaneous testicular needle biopsy procedure on the other side were performed in comparison with two techniques. Biopsy specimens were fixed in Bouin solution. They were stained and histologically examined. Results were summarized as follows: Numbers of seminiferous tubules obtained by needle biopsy technique were found to be fewer than that of the tubules obtained by open biopsy technique. But diagnostic accuracy was not compromised by the needle biopsy technique. There was no bleeding either from the testis or scrotum, no extusion of testicular tissue from the puncuate site. In conclusion percutaneous testicular biopsy using Tru-Cut biopsy needle has been proved to be simple, time saving, less expensive and accurate method for testicular biopsy.