Repetición de la biopsia ante una falla en la amplificación / Repeat biopsy in case of amplification failure

Resumen OBJETIVO: Analizar los posibles factores asociados con las fallas en la amplificación, los desenlaces de la euploidia y clínicos entre los embriones con repetición de la biopsia y los de una sola (grupo control). MATERIALES Y MÉTODOS: Estudio retrospectivo y multicéntrico de análisis de biopsias de blastocistos practicadas en 22 centros de reproducción asistida (noviembre 2017 a febrero 2022). Se analizaron 4,106 blastocistos procedentes de 1,007 ciclos de ICSI con prueba genética para aneuplidias previa a la implantación. En los blastocistos reportados con falla en la amplificación se analizó el Centro donde se practicó la biopsia, el día en que ésta se tomó, la calidad embrionaria y la incidencia de complicaciones durante el procedimiento. Los resultados se compararon con la prueba genética para aneuploidias previa a la implantación y los desenlaces clínicos entre los embriones con repetición de la biopsia y el grupo control. RESULTADOS: En el 96.0% (3,942) de los embriones se obtuvo resultado y en el 4.0% (n = 164) se reportó falla en la amplificación. La biopsia se repitió en las 99 fallas en la amplificación y se obtuvo resultado en el 83.8% de los casos. Las tasas de euploidia fueron similares entre embriones con repetición de la biopsia y los controles (34.9 en comparación con 39.7%; p > 0.05). El Centro fue el único factor que mostró diferencias en las tasas de falla en la amplificación (p < 0.05). No se observaron diferencias en el día de la biopsia o la calidad embrionaria. Las tasas de embarazo (51.0 en comparación con 58.3%), implantación (63.9 en comparación con 61.5%) y aborto (16.9 en comparación con 28.6%) fueron similares entre embriones con una sola biopsia o repetición de ésta, respectivamente. CONCLUSIONES: El Centro fue el principal factor que influyó en las fallas en la amplificación. Las tasas de euploidia y los desenlaces clínicos no difirieron entre el grupo control y los embriones con repetición de la biopsia; por consiguiente, se recomienda repetir la biopsia en los embriones con falla en la amplificación.

Abstract OBJECTIVE: To analyze possible factors associated with amplification failures, euploidy and clinical outcomes between repeat and single biopsy embryos (control group). MATERIALS AND METHODS: Retrospective multicenter study involving 4,106 blastocysts from 1,007 ICSI cycles with preimplantation genetic testing for aneuploidy performed by next generation sequencing. In case of DNA amplification failure, the IVF center where biopsies were performed, the day of biopsy, the embryo quality and the incidence of complications during biopsy were analyzed. Preimplantation genetic testing for aneuploidy results and clinical outcomes were compared between re-biopsied embryos and the control group. RESULTS: Of the 4,106 blastocysts included in this study, 96.0% (3,942) obtained a result while 4.0% (164) had an amplification failure. Ninety-nine embryos with amplification failure were re-biopsied and 83.8% resulted in an informative diagnosis. Euploidy rates were equivalent between re-biopsied and control blastocysts (34.9% vs 39.7%, P>0.05). The only factor significantly affecting the amplification failure rates was the IVF center. No differences were observed between biopsy days or embryo quality. Pregnancy (51.0% vs 58.3%), implantation (63.9% vs 61.5%) and miscarriage rates (16.9% vs 28.6%) were similar between single and repeat biopsied embryos, respectively. CONCLUSIONS: The centre was the main factor influencing amplification failures. Euploidy rates and clinical outcomes did not differ between the control group and repeat biopsied embryos; therefore, repeat biopsy is recommended for embryos with amplification failure.

The value of repeat kidney biopsy in lupus nephritis. A systematic review / La utilidad de la biopsia renal repetida en nefritis lúpica. Una revisión sistemática

ABSTRACT A renal biopsy is the 'gold standard' for diagnosis and classification of lupus nephritis (LN). The role of repeat renal biopsy in lupus nephritis (LN) to guide treatment or predict prognosis has been controversial. A systematic literature review was conducted based on retrospective and prospective studies. The studies were identified using English electronic scientific databases, including MEDLINE PUBMED, published between January 1990 and August 2020. The eligibility criteria were studies including adult LN patients with at least one follow-up renal biopsy with appropriate longitudinal information. Case reports, studies with incomplete information or including duplicate patients were excluded. Based on the inclusion and exclusion criteria, a total of 73 publications were identified. This study included a total of 1167 repeat biopsies in LN patients from 15 studies. The primary indication for a repeat biopsy was relapse in 44-78% of the cases, and lack of response in 13-51%. Additionally, several repeat biopsies were done according to the protocol, after induction and maintenance therapy. In terms of histopathological class switches, there was a higher frequency of changes from nonproliferative to proliferative lesions. Only two studies provide a definition of histological response. There were often changes in the therapeutic approach after a repeat biopsy. Repeat kidney biopsies are helpful in patients with LN flare/relapse, and in patients with poor treatment response. Histological transformation was a common finding. The histologic and clinical responses are discordant. A repeat biopsy could be of prognostic value for therapeutic decision-making.

RESUMEN La biopsia renal es el «estándar de oro¼ para el diagnóstico y la clasificación de la nefritis lúpica (NL). El papel de la biopsia renal repetida en nefritis lúpica para orientar el tratamiento o predecir el pronóstico ha sido controversial. Se llevó a cabo una revisión sistemática de la literatura basada en estudios retrospectivos y prospectivos. Los estudios se identificaron a través de bases de datos científicas electrónicas en inglés, incluyendo Medline PubMed, de publicaciones entre enero de 1990 y agosto del 2020. Los criterios de elegibilidad fueron estudios que incluyeran a pacientes adultos con NL, quienes tuvieran al menos una biopsia renal de seguimiento, con información longitudinal apropiada. Se excluyeron informes de casos, estudios con información incompleta o con pacientes duplicados. Basándose en los criterios de inclusión y exclusión, se identificaron 73 publicaciones. En la presente revisión se analizaron un total de 1.167 biopsias repetidas en pacientes con NL en 15 estudios. Las principales indicaciones para la biopsia repetida fueron: recidiva en 44-78% de los casos, y falta de respuesta en 13-51%. Adicionalmente, varias biopsias repetidas se hicieron conforme al protocolo, luego de la terapia de inducción y de mantenimiento. Con respecto a los cambios de clase histopatológica, hubo una mayor frecuencia de cambios de lesiones no proliferativas a lesiones proliferativas. Solamente dos estudios ofrecen una definición de respuesta histológica. Con frecuencia hubo cambios en el abordaje terapéutico después de realizar la biopsia repetida. Las biopsias renales repetidas son útiles en pacientes con exacerbación/recidiva y en pacientes con falta de respuesta a tratamiento. La transformación histológica fue un hallazgo frecuente; las respuestas histológicas y clínicas son discordantes. Una biopsia repetida puede ser de valor pronóstico para la toma de decisiones terapéuticas.

Serial Comparison of Cancer Detection Rate Between Transrectal Ultrasound Sonography Guided Biopsy and Magnetic Resonance Imaging for Repeat Biopsy by a Propensity Score Matching Cohort: A Single Center Experience

PURPOSE: To compare biopsy performance of 2 approaches for multiparametric magnetic resonance imaging (MRI) guided biopsy and transrectal ultrasonography (TRUS)-guided biopsy with 2nd and 3rd repeat biopsy patients in prostate cancer detection. MATERIALS AND METHODS: This retrospective study reviewed 2,868 patients who was performed prostate biopsy between September 2013 to March 2017 at Samsung Medical Center, Seoul, Korea with TRUS-guided random biopsy and MRI fusion, MRI cognitive, and MRI-guided biopsy as 2nd and 3rd repeat biopsy and propensity matching was applied to reduce bias. Detection rate of each study was compared with 1:1 matching. RESULTS: Among 265 patients who performed TRUS 2nd biopsy, positivity rate for prostate cancer (PCa) was 18.49% (n=49/265) while 54.72% (n=145/265) for MRI-guided biopsy. In 3rd biopsy, positivity rate for PCa of TRUS biopsy was 17.74% (n=11/62) while 56.45% (n=35/62) for MRI guided biopsy. There was no significant difference in the detection rate for the patient with Gleason score 8 or more. CONCLUSIONS: MRI-guided biopsy was associated with a higher detection rate of prostate cancer with especially in patients with prior negative biopsy.

Transperineal biopsy under ultrasound guidance for prostate cancer detection as an initial and as a repeat biopsy strategy

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present the authors' experience on transperineal prostate sector biopsy (TPSB) in detecting prostate cancer, in identifying both low Gleason prostate cancers as well as clinically significant prostate cancer (Gleason 7 and higher), and in determining anatomical distributions of prostate cancer in both initial and repeat biopsy settings.<br /><strong>METHODS:</strong> All patients from June 2014 to September 2016 who underwent TPSB, as initial biopsy or repeat biopsy after previous negative transrectal ultrasound-guided biopsy (TRUSPNB) were included. Data for each patient were collected prospectively and subjected to statistical analysis. T test was used for continuous variables while Chi square test or Fisher exact test was used for categorical variables. Multiple logistic regression models were used to identify factors predictive of a positive result.<br /><strong>RESULTS:</strong> A total 130 patients were included in the study, 73 had TPSB as initial biopsy and 57 as repeat biopsy after previous negative TRUSPNB. The mean patient age of the Initial Biopsy Group (IBG) was 66 years while the mean age for the Repeat Biopsy Group (RBG) was 68 years. The IBG had a lower mean serum PSA level (9.07 ng/mL for IBG and 9.59ng/mL for RBG) and smaller prostate volumes (42.9 mL for the IBG and 44.3mL for the RBG). Prostate cancer was detected in 65.8% (48/73) of the IBG and 40.4% (23/57) of RBG, of which 77.1% (37/48) and 73.9% (17/23) respectively, were clinically significant, defined as a Gleason score of ?7. Of the cancers detected in IBG, 29.2% (14/48) exclusively involved the anterior sector (based on the Ginsburg Study Group's biopsy map), while 30.4% (7/23) were conned exclusively within the anterior sector for the RBG. Increasing PSA level and lower prostate volumes were predictive of cancer detection in RBG, while only increasing PSA level was predictive of a positive result in IBG.<br /><strong>CONCLUSION: </strong>Transperineal prostate sector biopsy demonstrated a high prostate cancer detection rate for both the initial and repeat biopsy settings. Likewise it provides for excellent sampling of the anterior region of the prostate, as it affords a more accurate sampling of the prostate gland based on a preplanned map and template to sample areas of interests. Similarly, it detects a high proportion of patients with clinically significant prostate cancer. This technique should therefore be highly considered as a first line option for all patients in whom a prostate biopsy is warranted.</p>

Transperineal biopsy under ultrasound guidance for prostate cancer detection as an initial and as a repeat biopsy strategy

OBJECTIVE: To present the authors' experience on transperineal prostate sector biopsy (TPSB) in detecting prostate cancer, in identifying both low Gleason prostate cancers as well as clinically significant prostate cancer (Gleason 7 and higher), and in determining anatomical distributions of prostate cancer in both initial and repeat biopsy settings.METHODS: All patients from June 2014 to September 2016 who underwent TPSB, as initial biopsy or repeat biopsy after previous negative transrectal ultrasound-guided biopsy (TRUSPNB) were included. Data for each patient were collected prospectively and subjected to statistical analysis. T test was used for continuous variables while Chi square test or Fisher exact test was used for categorical variables. Multiple logistic regression models were used to identify factors predictive of a positive result.RESULTS: A total 130 patients were included in the study, 73 had TPSB as initial biopsy and 57 as repeat biopsy after previous negative TRUSPNB. The mean patient age of the Initial Biopsy Group (IBG) was 66 years while the mean age for the Repeat Biopsy Group (RBG) was 68 years. The IBG had a lower mean serum PSA level (9.07 ng/mL for IBG and 9.59ng/mL for RBG) and smaller prostate volumes (42.9 mL for the IBG and 44.3mL for the RBG). Prostate cancer was detected in 65.8% (48/73) of the IBG and 40.4% (23/57) of RBG, of which 77.1% (37/48) and 73.9% (17/23) respectively, were clinically significant, defined as a Gleason score of ?7. Of the cancers detected in IBG, 29.2% (14/48) exclusively involved the anterior sector (based on the Ginsburg Study Group's biopsy map), while 30.4% (7/23) were conned exclusively within the anterior sector for the RBG. Increasing PSA level and lower prostate volumes were predictive of cancer detection in RBG, while only increasing PSA level was predictive of a positive result in IBG.CONCLUSION: Transperineal prostate sector biopsy demonstrated a high prostate cancer detection rate for both the initial and repeat biopsy settings. Likewise it provides for excellent sampling of the anterior region of the prostate, as it affords a more accurate sampling of the prostate gland based on a preplanned map and template to sample areas of interests. Similarly, it detects a high proportion of patients with clinically significant prostate cancer. This technique should therefore be highly considered as a first line option for all patients in whom a prostate biopsy is warranted.

Comparison of Biopsy Results and Surgical Outcomes of Magnetic Resonance Imaging-Guided and Transrectal Ultrasonography-Guided Repeat Biopsy

PURPOSE: We compared biopsy results and surgical outcomes of magnetic resonance imaging (MRI)-guided biopsy with transrectal ultrasonography (TRUS)-guided biopsy to demonstrate efficacy of MRI-guided biopsy on previous biopsy negative patients. MATERIALS AND METHODS: We retrospectively reviewed data of 120 patients who were categorized into MRI-guided biopsy groups (n=20) and TRUS-guided biopsy groups (n=100). All patients were diagnosed with prostate cancer (PCa) and had undergone radical prostatectomy (RP) after MRI-guided or TRUS-guided repeat biopsy between January 2010 and March 2016. Detection rate of significant cancer and Gleason score upgrading and downgrading were examined, in addition to biopsy results and subsequent RP outcomes. RESULTS: Median values for prostate-specific antigen level of the TRUS-guided biopsy group and the MRI-guided biopsy group were 6.67 and 5.86 ng/mL (p=0.303), respectively. Median prostate volume of each group (34.1 mL vs. 23.5 mL, p=0.007), number of positive cores (2.0 vs. 3.0, p=0.001) and maximum cancer/core rate (30.0% vs. 60.0%, p<0.001) were statistically different. Positive core rates of each group were 21.9% and 87.1%, respectively. Pathologic T stage was the only variable that showed difference in surgical outcomes (p=0.002). Most of PCa was confirmed as clinically significant PCa after RP in MRI-guided biopsy group (95%). CONCLUSIONS: MRI-guided biopsy showed higher positive core rate and detection rate of clinically significant PCa than TRUS-guided biopsy in repeat biopsy setting. Prospective multicenter large-scale study and accumulation of data is expected to further define superiority of the MRI-guided biopsy.

An analysis of 4,514 cases of renal biopsy in Korea

To evaluate the distribution and changing patterns of renal diseases in Korea, a total of 4,514 cases of renal biopsy collected over a 23-year period between 1973 and 1995 were reviewed. Of 4,200 cases excluding 314 unsatisfactory biopsies, adult cases comprised 59.5% and pediatric cases, 40.5%. The male to female ratio was 1.5:1 in adults and 2.2:1 in children. Glomerulonephritis (GN) comprised 80.0% of the total. The most common primary GN in adults was minimal change disease (MCD) (26.6%), followed by IgA nephropathy (IgAN) (22.1%), membranous GN (MGN) (11.8%), and membranoproliferative GN (MPGN) (5.9%). In children, the primary GN incidence rates were MCD (24.8%), IgAN (10.3%), poststreptococcal (including postinfectious) GN (PSGN) (8.6%), and focal segmental glomerulosclerosis (FSGS) (4.0%). The most common secondary GN in adults was lupus nephritis and in children Henoch-Schonlein purpura nephritis. The most common cause of nephrotic syndrome was MCD in both adults and children, followed by MGN and FSGS. The elderly, aged sixty years and older, comprised 2.7% of cases and recorded equal numbers of MCD and MGN. The proportion of the biopsies found to be seropositive for HBs antigen was 27.9%, and these showed either MGN or MPGN pattern. Repeat biopsy was performed in 168 patients, due to previous biopsy failure in 15.5%. When the primary GN cases were analyzed at 5-year intervals, the prevalence of PSGN, which was greater than 25% during the 1973-1982 period, decreased abruptly in children thereafter, whereas the prevalence of FSGS increased slowly since the 1988-1992 period in both adults and children. The decrease of PSGN and the increase of FSGS suggest a role for socioeconomic and environmental factors in Korea.