Transbronchial needle aspiration with rapid on-site evaluation: A prospective study on efficacy, feasibility and cost effectiveness.

Background. Transbronchial needle aspiration (TBNA) has an established role in diagnosis of hilar and mediastinal lesions. Rapid on-site evaluation (ROSE) of TBNA smears can determine the adequacy of TBNA smears that can obviate the need for repeat procedures, thus avoiding added cost. There is paucity of data from India showing efficacy and cost-effectiveness of ROSE. Hence, this study was carried out to assess the efficacy, feasibility and cost implications of ROSE assisted TBNA. Methods. Forty consecutive patients undergoing TBNA were enrolled and ROSE was performed on TBNA smears. The results were analysed using a comparative study design. Results. It was found that 45% of patients would have required a repeat bronchoscopy due to inadequacy of material, if ROSE was not used. Inadequate smears were more common in benign aetiologies than malignant ones. TBNA of mass lesions and lesions with endoluminal bulge give better results than TBNA of lymph nodes and without endoluminal bulge. Conclusions. ROSE was found to increase the yield of TBNA and help to prevent repeat procedures. It proved to be simple, cost-effective and feasible in Indian settings.

Biopsia hepática por punçäo em ambulatório / Hepatic biopsy by

Estudo prospectivo sobre a biopsia hepática por punçäo, realizada em ambulatório, em pacientes portadores de hepatopatia crônica do ambulatório de Hepatologia do Serviço de Gastroenterologia do Hospital Universitário da Universidade Federal de Juiz de Fora, MG. Em 16 meses, 61 biopsias hepáticas ambulatoriais foram realizadas, utilizando a técnica descrita por Menghini. Os critérios de inclusäo utilizados foram aqueles estabelecidos pelo Comitê de Cuidados ao Paciente da Associaçäo Americana de Gastroenterologia. Ultra-sonografia abdominal era realizada antes e após a biópsia hepática ambulatorial. Os pacientes permaneciam no ambulatório por seis horas, sendo interrogados sobre a existência de dor e submetidos a controle clínico, com medida da pressäo e freqüência cardíaca. Após 24 horas, novo controle clínico, laboratorial e ultra-sonográfico era realizado. A principal complicaçäo foi a dor local ou em ombro direito, que ocorreu em 32 pacientes (52,5 por cento). A ultra-sonografia abdominal, realizada 24 horas após a biopsia, revelou hematoma de parede abdominal em apenas um paciente (1,8 por cento). Este estudo demonstra que a biopsia hepática por punçäo em ambulatório é um procedimento seguro, com baixa incidência de complicaçöes, desde que seja realizada de modo criterioso, por pessoal especializado e com controle clínico rigoroso.

Outpatient percutaneous blind needle liver biopsy, safety and cost analysis

To determine the safety, complication rate and cost saving of outpatient percutaneous blind needle liver biopsy in a single tertiary care center, we retrospectively reviewed the records of all 117 patients who had had outpatient percutaneous blind needle liver biopsy from March 1994 to September 1995. We reviewed data including demography, Child's classification, histopathology report and complications, and attempted to compare the cost involved with inpatient liver biopsy. Of the 117 records studied, two were incomplete. Of the 115 patients who had complete records, 43 [37.4%] had minor complications, 2 [1.7%] required overnight hospitalization for pain and hypotension, and the procedure failed in one patient [0.9%]. There was no correlation between complications and Child's classification, or concomitant chronic renal failure. In comparison to inpatient liver biopsy, we calculated that the saving made is about 1800 Saudi Rivals [Dollar 478.70] per operation, if performed on an outpatient basis. We conclude that outpatient percutaneous blind needle liver biopsy is safe, successful in more than 99% of cases, associated with no mortality, has negligible major complications requiring hospital admission, and results in considerable savings per biopsy. We therefore strongly recommend performing most liver biopsies on an outpatient basis, in the appropriate hospital setting, unless hospital admission is otherwise indicated

A citologia do material obtido por punçäo aspirativa da tiróide como método único indicativo de cirurgia: análise de custo-benefício / The cytology of materila obtained for aspirative puncture of the thyroid with single method indicative of the surgery: analysis and cost-benefit

Realizamos a análise custo-benefício da citologia aspirativa obtida porpunçao aspirativa com agulha fina da tiróide (PAAF) como método único indicativo de cirúrgia, calculando os dados reais obtidos em 172 pacientes portadores de nódulo tiroideano que foram submetidos à cirúrgia. Comparando-se os dados citológicos com a histologia, a PAAF apresentou sensibilidade de 87 por cento, especificidade de 74 por cento e acurácia de 77 por cento. O estudo de custo-benefício comparou os gastos com os benefícios auferidos pela PAAF em relaçao à cintilografia. Nosso trabalho demonstra que a PAAF apresenta razao benefício/custo altamente satisfatória, da ordem de 10,3 a 13,1 para o paciente previdenciário do INAMPS e da ordem de 8,5 a 11,7 para o paciente proveniente da clínica particular. Desta maneira, além das vantagens de simplicidade, especificidade e sensibilidade, a punçao aspirativa da tiróide é econômica.

Aspiration liver biopsy.

BACKGROUND: Traditional and disposable liver biopsy needles are expensive and add to economic burden in developing countries where the prevalence of liver disease requiring liver biopsy is high. AIM: To compare the technique of suction aspiration using a disposable syringe and an ordinary 40 mm long 18 gauge needle (internal diameter 1.27 mm), with Vim-Silverman's needle in obtaining liver tissue in patients with liver disease of various etiology. METHODS: Liver biopsy was performed in 60 patients each using either technique. The size of the biopsy tissue obtained and the number of times a diagnosis was reached with the two techniques were compared. RESULTS: The mean size of tissue obtained by suction aspiration (11.2 mm) was greater than that by the Vim-Silverman technique (6.3 mm) (p = 0.001). The tissue sample was inadequate for opinion in 3 patients in the aspiration group and in 10 patients in the Vim-Silverman group (p = ns). CONCLUSION: Suction aspiration liver biopsy can be done satisfactorily using disposable syringe and 18 gauge needle.

Costo beneficio de la punción aspiración con aguja fina de masas sólidas abdominales / Cost-benefit analysis of fine needle aspiration biopsy of solid abdominal masses

Se presenta el análisis costo-beneficio de la biopsia por punción aspiración con aguja fina de masas sólidas abdominales. Se compararon los costos de la punción con guía ecográfica, con los de la tomografía computada, los de la laparotomía exploradora y con su uso intraoperatorio. En una serie de 158 punciones con control ecográfico la sensibilidad fue de 85.9%y la exactitud de 88.6%sin falsos positivos ni complicaciones. La tomografía computada como guía representa un costo 349%mayor que la ecografía, con parecida sensibilidad, como fue demostrado en otras series. En pacientes con tumores de cuerpo de páncreas la punción evita los costos de una laparotomía exploradora, y en aquellos que deben operarse posibilita estudios anatomopatológicos diferidos y disminución del tiempo operatorio. Se concluye que la punción de masas abdominales con guía ecográfica es un método sencillo, rápido, eficaz, ambulatorio y con una favorable relación costo-beneficio