Bone marrow biopsy morbidity and mortality: 2002 data

A survey of morbidity and mortality of bone marrow aspiration and trephine biopsy was carried out for the British Society of Haematology, covering the 12 months of 2002. Fifty-three centres reported 13,506 procedures, comprising 3927 aspiration biopsies and 9579 combined procedures. There were 17 adverse events including nine instances of haemorrhage, four infections and one haemorrhage complicated by infection. Two trephine biopsy needles broke during the procedure. One patient suffered considerable pain for 2 weeks. The adverse event may have contributed to death in two patients and in a third patient was life-threatening. Risk factors for adverse events were identified.

Local anesthesia during 10 core biopsy of the prostate: comparison of 2 methods

PURPOSE

We investigated the effectiveness of a new method, intraprostatic administration of local anesthesia vs traditional periprostatic injection for decreasing the discomfort caused by transrectal ultrasound guided, 10 core biopsy of the prostate.

MATERIALS AND METHODS

We studied 71 patients who received intraprostatic anesthesia between October 2002 and March 2003, and 99 who received periprostatic anesthesia between October 2001 and September 2002 before prostate biopsy. After biopsy patients were given a questionnaire, which consisted of 5 questions about pain and 3 about morbidity, and were asked to complete it and mail it to our department.

RESULTS

The mean score +/- SD for the degree of pain during biopsy in the periprostatic groups was 2.6 +/- 1.1 and that in the intraprostatic group was 1.9 +/- 1.1, which was significantly different (p <0.001). Other items, including the degree of pain after biopsy, duration and location of pain, and medicine intake for pain, were not significantly different between the 2 groups. There was no significant difference in morbidity, including hematuria, hemospermia and rectal bleeding, between the 2 groups.

CONCLUSIONS

Intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with periprostatic nerve block. It is a simple, safe and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.

Die Wertigkeit von präoperativer Punktion und arthroskopischer Synovialisprobenentnahme bei Knietotalendoprothesenwechsel

AIM

The accurate preoperative diagnosis of occult sepsis in endoprosthetic loosening of total knee arthroplasty is the key to successful management of revision total knee arthroplasties. The aim of this study was to evaluate the results of preoperative aspiration in comparison with preoperative arthroscopic biopsy of the synovial tissue.

METHOD

From 2000 to 2004 eighty-six revision total knee arthroplasties in 86 patients were performed. 60 patients had only a knee aspiration, 15 an arthroscopic biopsy and an aspiration, 11 only arthroscopic biopsy. The results of both methods were compared with the intraoperative cultures during revision surgery.

RESULTS

69 aseptic and 17 septic knee exchange arthroplasties were performed. The preoperative aspiration of the prosthetic knee joint had a sensitivity of 68.8 %, specificity of 96.6 %, positive predictive value of 84.5 % and a negative predictive value of 92.2 %. The preoperative arthroscopic biopsy had a sensitivity of 100 %, specificity of 94.7 %, positive predictive value of 87.4 % and a negative predictive value of 100 %.

CONCLUSION

Preoperative aspiration of the knee is a very helpful study for the diagnosis or exclusion of infection in a prosthetic knee joint and should be a standard procedure in the diagnosis of prosthetic loosening. If after aspiration a suspicion of infection remains, then the biopsy is an accurate procedure to diagnose or exclude periprosthetic sepsis.

Diagnóstico del cáncer de próstata mediante biopsia ampliada de 24 cilindros

OBJECTIVE

To determine the diagnostic performance of extended prostatic biopsy (PB) in prostate cancer (PC) and variables affecting positivity.

MATERIALS AND METHODS

Patients (n = 147) underwent 24 cylinder PB at the Arquitecto Marcide Hospital, Ferrol, La Coruña, between December 2002-September 2004. Inclusion criteria were the following: patients aged < or = 70 with one or more negative PB or aged < or = 75 with two or more negative PB. An univariate analysis was carried out using the chi-squared test for the qualitative variables and the t-Student and U Mann-Whitney tests in the case of the quantitative variables, plus a logistical regression analysis in order to identify those variables related to the extended PB positivity.

RESULTS

60 patients (40.82%) were identified as having PC. Significant differences were observed in prostatic volume, free/total PSA ratio in the initial PB, free/total PSA ratio in the extended PB, PSA-density in the extended PB as well as the existence of chronic prostatitis in previous PB. During the multivariate analysis it was found that the PSA-density and the presence of chronic prostatitis in previous PB independently predicted the positivity of the extended PB.

CONCLUSIONS

Extended PB allows for the detection of PC in 40.82% of patients with previous negative PB. The increase in PSA density is associated with a greater probability of PC, whilst the existence of chronic prostatitis in prior PB significantly reduces the probability of PC in the extended PB.

Incidence of associated events during the performance of invasive procedures in healthy human volunteers

Metabolic investigations often utilize arteriovenous sampling and muscle biopsy. These investigations represent some risk to the subject. We examined 369 studies performed in the General Clinical Research Center between January 1994 and May 2003 for events related to femoral catheterization and muscle biopsies. Incidents were further examined by age (younger: 18-59 yr, n=133; and older: 60-76 yr, n=28). There were no clinically defined major complications associated with either procedure. The incidence of femoral catheter repositioning or reinsertion was higher in the older group (25.5 vs. 9.7%). There was no difference in the incidence of premature removal of catheters, ecchymosis or hematoma, or the persistence of pain after discharge. The occurrence of all incidents did not increase with multiple catheterizations. Muscle biopsy was associated with infrequent ecchymosis or hematoma in both groups (1.1 and 3.6% in younger and older groups, respectively). Both procedures entail a small likelihood of a vagallike response (3.3% overall), resulting in nausea, dizziness, and rarely a loss of consciousness. These results indicate that, in skilled hands and a defined clinical setting, the incidents associated with femoral catheterization and muscle biopsy in healthy volunteers are reasonable and largely controllable.

[Clinical evaluation of transbronchial needle aspiration for histological specimens]

Specimens were obtained from 10 patients with radiological abnormalities involving mediastinal or hilar areas, for histological examination using 19 G transbronchial needle aspiration (TBNA). The tissues examined proved diagnostic in 6 patients (60%) including one with a benign condition (sarcoidosis). Clinical characteristics (sex, age, puncture site, number of specimens, size of radiological abnormalities) in the 6 positive patients were compared with those for the 4 negative patients. No significant differences in the number of specimens or the size of radiological abnormalities were observed between groups. However, a punctured trachea was seen in significantly more cases in the negative group (3/4, 75%) than in the positive group (1/6, 17%; p<0.05). Few minor complications were encountered. The use of a 19 G TBNA appears effective for obtaining tissue for histological examination and diagnosis of benign conditions. Training in this technique should increase the diagnostic utility of the histology needle.

Relating biopsy and clinical variables to radical prostatectomy findings: Can insignificant and advanced prostate cancer be predicted in a screening population?

OBJECTIVES

To assess the capacity of several clinical and needle biopsy pathologic parameters to predict insignificant and advanced prostate carcinoma (CaP) in radical prostatectomy tissue from men enrolled in a prostate-specific antigen screening program.

METHODS

We captured multiple clinical variables and measures of needle biopsy tumor extent from 152 men with Stage T1c CaP with a mean of six biopsy cores who were treated with radical prostatectomy. Insignificant CaP was defined as a tumor volume of less than 0.5 cm(3) that was organ confined with a Gleason score less than 7. Advanced CaP was defined by a formula that combined the Gleason score, pathologic stage, and margin status. Bivariate and logistic regression analyses were used to identify variables predictive of either insignificant or advanced CaP.

RESULTS

Of the cases of CaP, 25.7% were pathologically insignificant, and 14.5% were pathologically advanced. The best model for predicting insignificant CaP was less than 10% tumor as the greatest percentage of carcinoma in any core and a biopsy Gleason score of less than 7, yielding a sensitivity of 76.9% and specificity of 75.2%. For predicting advanced CaP, the best model was a total biopsy length of CaP greater than 3 mm, Gleason high-grade pattern 4 or 5 disease, perineural invasion in the biopsy, and more than one in six biopsy cores containing CaP, yielding a sensitivity of 13.6% and specificity of 100%.

CONCLUSIONS

The prediction of insignificant and advanced CaP on an individual basis in patients from a prostate-specific antigen screening study is a challenging problem. However, several histopathologic features of CaP in needle biopsy tissue contain useful information about the severity of disease.

Breast Cancer Care: Changing Community Standards

A community hospital-based program was developed to improve breast cancer care in the community. A consensus was developed for what should be optimal care; a database was established to document the care being delivered in the community; and the data were analyzed to document changes in practice patterns over time. The major clinical benefits to patients included a significant improvement in needle biopsy rates, decreased utilization of second operative procedures, increased breast conservation surgery, conformity to guidelines for adjuvant chemotherapy administration, and a sizable increase in discovery of small breast cancers by screening mammography.

Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States

BACKGROUND

The aim of this study was to determine the frequency and the severity of pancreatitis after EUS-guided FNA of solid pancreatic masses. A survey of centers that offer training in EUS in the United States was conducted.

METHODS

A list of centers in which training in EUS is offered was obtained from the Web site of the American Society for Gastrointestinal Endoscopy. Designated program directors were contacted via e-mail. The information requested included the number of EUS-guided FNA procedures performed for solid pancreatic masses, the number of cases of post-procedure pancreatitis, and the method for tracking complications. For each episode of pancreatitis, technical details were obtained about the procedure, including the location of the mass, the type of fine needle used, the number of needle passes, and the nature of the lesion.

RESULTS

Nineteen of the 27 programs contacted returned the questionnaire (70%). In total, 4909 EUS-guided FNAs of solid pancreatic masses were performed in these 19 centers over a mean of 4 years (range 11 months to 9 years). Pancreatitis occurred after 14 (0.29%): 95% CI[0.16, 0.48] procedures. At two centers in which data on complications were prospectively collected, the frequency of acute pancreatitis was 0.64%, suggesting that the frequency of pancreatitis in the retrospective cohort (0.26%) was under-reported (p=0.22). The odds that cases of pancreatitis would be reported were 2.45 greater for the prospective compared with the retrospective cohort (95% CI[0.55, 10.98]). The median duration of hospitalization for treatment of pancreatitis was 3 days (range 1-21 days). The pancreatitis was classified as mild in 10 cases, moderate in 3, and severe in one; one death (proximate cause, pulmonary embolism) occurred after the development of pancreatitis in a patient with multiple comorbid conditions.

CONCLUSIONS

EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis.

Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy

PURPOSE

To determine whether number of specimens obtained at stereotactic 11-gauge vacuum-assisted breast biopsy with the patient prone influences diagnostic accuracy and to determine whether this number varies depending on mammographic appearance of lesions as masses or microcalcifications.

MATERIALS AND METHODS

Biopsy was prospectively performed in 100 patients (median age, 55 years; range, 31-81 years) with 100 lesions that were mammographically evident as masses (n = 50) and microcalcifications (n = 50) with standardized protocol to acquire 20 specimens per lesion in three 360 degrees probe rotations at one skin entry site. Specimens were histologically evaluated sequentially, and findings were compared with results of surgical excision or of mammographic follow-up for at least 24 months. Differences in diagnostic yield after each probe rotation and differences in diagnostic yield between masses and microcalcifications were determined with chi(2) test.

RESULTS

Up to 12 specimens harvested within two 360 degrees probe rotations were necessary to yield correct diagnosis in 96% of patients with masses and 92% of patients with microcalcifications. Diagnostic yield was not improved with more than 12 specimens for masses or microcalcifications. In two (4%) of 47 patients with lesions that were eventually diagnosed as cancer, results at stereotactic biopsy indicated they were benign. Underestimation of diagnosis of lesions as atypical ductal hyperplasia and ductal carcinoma in situ occurred in two (50%) of four and two (17%) of 12 lesions, respectively. With 20 specimens harvested during three probe rotations, there was no statistically significant difference in diagnostic yield between patients with masses and those with microcalcifications (P =.68).

CONCLUSION

At 11-gauge vacuum-assisted biopsy, highest diagnostic yield was achieved with 12 specimens per lesion, independent of mammographic appearance of the lesion. Even with standardized retrieval of 20 specimens per lesion, underestimation of disease still occurs.

Optimized prostate biopsy via a statistical atlas of cancer spatial distribution

A methodology is presented for constructing a statistical atlas of spatial distribution of prostate cancer from a large patient cohort, and it is used for optimizing needle biopsy. An adaptive-focus deformable model is used for the spatial normalization and registration of 100 prostate histological samples, which were provided by the Center for Prostate Disease Research of the US Department of Defense, resulting in a statistical atlas of spatial distribution of prostate cancer. Based on this atlas, a statistical predictive model was developed to optimize the needle biopsy sites, by maximizing the probability of detecting cancer. Experimental results using cross-validation show that the proposed method can detect cancer with a 99% success rate using seven needles, in these samples.

Prostate needle biopsies

BACKGROUND

Tumor volume is one of the most powerful predictors of patient outcome in prostatic adenocarcinoma. It is uncertain as to which preoperative variables are most predictive of final tumor volume at radical prostatectomy, especially among patients who have had positive biopsies at multiple biopsy sites. The current study attempted to identify the biopsy variables that are most predictive of final tumor volume.

METHODS

The authors examined prostate biopsy specimens from 151 consecutive patients with at least 2 positive biopsy sites. The following data were collected: highest percentage of adenocarcinoma at any biopsy site, percentage of adenocarcinoma at the biopsy site with the highest Gleason score, highest percentage of cores positive for adenocarcinoma at any biopsy site, percentage of positive cores with carcinoma at the site with the highest Gleason score, number of positive sites, tumor bilaterality, and percentage of biopsy sites positive for disease. All patients underwent radical prostatectomy. The prostatectomy specimens were entirely embedded and whole mounted. Tumor volume was measured using the grid method. Logarithmic transformation was applied to tumor volumes for the purposes of the analysis.

RESULTS

Highest percentage of adenocarcinoma at any biopsy site (P = 0.012), percentage of adenocarcinoma at the biopsy site with the highest Gleason score (P = 0.021), number of positive biopsy sites (P = 0.026), tumor bilaterality (P = 0.008), and percentage of biopsy sites positive for disease (P = 0.0001) all were significant predictors of tumor volume on linear regression analysis. Highest percentage of cores positive for adenocarcinoma (P = 0.081) and percentage of positive cores with carcinoma at the site with the highest Gleason score (P = 0.240) were not significant predictors of tumor volume. Based on the model F statistic, percentage of biopsy sites positive for tumor, tumor bilaterality, and highest percentage of adenocarcinoma at any biopsy site were the variables that were most predictive of tumor volume.

CONCLUSIONS

Highest percentage of adenocarcinoma at any biopsy site, percentage of adenocarcinoma at the biopsy site with the highest Gleason score, number of positive biopsy sites, tumor bilaterality, and percentage of biopsy sites positive for disease all are useful preoperative predictors of tumor volume in radical prostatectomy specimens. Although these preoperative biopsy parameters were significant in linear regression models, none was sufficient as a single predictor of tumor volume.

Effectiveness of percent free prostate specific antigen as a predictor of prostate cancer detection on repeat biopsy

BACKGROUND

The aim of this study was to identify predictors that can increase the accuracy of detecting prostate cancer on subsequent biopsies.

METHODS

Between 1998 and 2003, a total of 235 men with prostate specific antigen (PSA) levels between 4.0 and 20 ng/mL underwent one or more systematic needle biopsies of the prostate. Of these men, 73 (31.1%) underwent one repeat biopsy and 26 (11.1%) underwent two or more repeat biopsies. We evaluated the results of prostate biopsies in relation to the morbidity of prostate cancer detected on repeat biopsies.

RESULTS

Of the 73 men who underwent repeat biopsy, 16 (21.9%) had prostate cancer. Twenty-six men with one negative re-biopsy underwent two or more repeat biopsies, and five of these patients were found to have early stage prostate cancer. On repeat biopsy, there was a significant difference in percent free PSA between the cancer-detected group and the no-cancer-detected group (P < 0.01). A receiver operating characteristics (ROC) curve gave an optimal cut-off value for percent free PSA of 11%, demonstrating a significant difference in the cancer detection rate on repeat biopsy (P = 0.0009). Analysis of the data for re-biopsies showed that cancer-detected cases showed a raised PSA value and a simultaneously reduced percent free PSA (these differences were statistically significant).

CONCLUSIONS

A low percent free PSA level increased the probability of a positive result in repeat biopsy. An increase in the accuracy of detecting cancer, especially on repeat biopsy, will promote the detection of more early stage prostate cancer.

Stereotactic core-needle biopsy of non-mass calcifications: outcome and accuracy at long-term follow-up

Objective

To determine, by means of long-term follow-up evaluation, the outcome and accuracy of stereotactic core-needle biopsy (SCNB) of non-mass calcifications observed at mammography, and to analyze the factors contributing to false-negative findings.

Materials and Methods

Using a 14-gauge needle, SCNB was performed in cases involving 271 non-mass calcified lesions observed at mammography in 267 patients aged 23-72 (mean, 47) years. We compared the SCNB results with those of long-term follow-up which included surgery, mammography performed for at least six months, and reference to Korean Cancer Registry listings. We investigated the retrieval rate for calcifications observed at specimen mammography and histologic evaluation, and determined the incidence rate of cancer, sensitivity, and the underestimation rate for SCNB. False-negative cases were evaluated in terms of their mammographic findings, the effect of the operators' experience, and the retrieval rate for calcifications.

Results

For specimen mammography and histologic evaluation of SCNB, the retrieval rate for calcifications was, respectively, 84% and 77%. At SCNB, 54 of 271 lesions (19.9%) were malignant [carcinoma in situ, 45/54 (83%)], 16 were borderline, and 201 were benign. SCNB showed that the incidence of cancer was 5.0% (6/120) in the benign mammographic category and 31.8% (48/151) in the malignant category. The findings revealed by immediate surgery and by long-term follow-up showed, respectively, that the sensitivity of SCNB was 90% and 82%. For borderline lesions, the underestimation rate was 10%. For false-negative cases, which were more frequent among the first ten cases we studied (p = 0.01), the most frequent mammographic finding was clustered amorphous calcifications. For true-negative and false-negative cases, the retrieval rate for calcifications was similar at specimen mammography (83% and 67%, respectively; p = 0.14) and histologic evaluation (79% and 75%, respectively; p = 0.47).

Conclusion

In this study group, most diagnosed cancers were in-situ lesions, and long-term follow-up showed that the sensitivity of SCNB was 82%. False-negative findings were frequent during the operators' learning period.

Changing Role of Imaging-Guided Percutaneous Biopsy of Adrenal Masses:Evaluation of 50 Adrenal Biopsies

OBJECTIVE

Prior series of percutaneous imaging-guided biopsies of adrenal masses before the advent of dedicated CT and MRI of the adrenal glands have shown that 40-57% of adrenal masses biopsied were adenomas-benign lesions requiring no further evaluation or treatment. This study was performed to assess the effect of dedicated adrenal imaging with CT and MRI on the rate of percutaneous imaging-guided biopsies of adrenal masses.

MATERIALS AND METHODS

We reviewed 50 consecutive adrenal mass biopsies performed during a 48-month period. The patient demographics, technique of biopsy, pathology results, and results of any prior dedicated adrenal imaging with MRI or CT protocols were noted.

RESULTS

Only six (12%) of 50 biopsies were adenomas. Five of these six cases were preceded by dedicated adrenal CT or MRI. Thirty-five cases were metastatic disease, four were adrenal cortical carcinoma, three were pheochromocytoma, and two biopsies were nondiagnostic. Overall, 20 of 50 cases were preceded by a dedicated adrenal CT or MRI examination to exclude an adenoma; in 21 of the remaining 30 cases, the imaging characteristics before biopsy were inconsistent with the potential diagnosis of an adenoma and dedicated adrenal CT or MRI was not recommended.

CONCLUSION

The number of adrenal adenomas biopsied has declined markedly with the introduction of dedicated adrenal CT and MRI for adrenal adenomas. Percutaneous imaging-guided biopsy is useful in confirming the presence and nature of suspected metastatic deposits to the adrenal gland and in diagnosing or excluding adrenal adenomas in patients with equivocal imaging characteristics.

Ethnic differences in distribution of serum prostate-specific antigen: a study in a healthy chinese male population

OBJECTIVES

To evaluate the normal distribution of serum prostate-specific antigen (PSA) levels in healthy Chinese men, because, until recently, studies conducted to establish normal serum PSA values have not involved a Chinese population.

METHODS

Between September 1999 and December 2001, 1096 healthy Chinese men aged 23 to 85 years, who had undergone a routine health examination, were recruited to this study. All underwent detailed clinical examinations, including serum PSA determination and digital rectal examination. All men with abnormal digital rectal examination findings and/or an abnormal serum PSA level (greater than 4.0 ng/mL) underwent transrectal ultrasound-guided sextant biopsy.

RESULTS

The median serum PSA concentration was 0.50 ng/mL (95th percentile 1.20) for men 23 to 29 years old (n = 77); 0.55 ng/mL (95th percentile 1.21) for men 30 to 39 years old (n = 189); 0.54 ng/mL (95th percentile 1.23) for men 40 to 49 years old (n = 233); 0.82 ng/mL (95th percentile 2.35) for men 50 to 59 years old (n = 177); 0.93 ng/mL (95th percentile 3.20) for men 60 to 69 years old (n = 265); and 1.17 ng/mL (95th percentile 3.39) for men 70 years old or older (n = 155). The serum PSA concentration correlated with age (P <0.001), with an increase of approximately 1.1% annually. No change occurred in the median serum PSA value and 95th percentile in men younger than 50 years old; a gradual increase was observed in men older than 50 years. In those 50 years old or older, the median and 95th percentile serum PSA values for Chinese men were significantly lower than those for other races and even for other Asian men.

CONCLUSIONS

These findings further confirm that the serum PSA level correlates with age. Moreover, the distribution and cutoff value of the serum PSA level differs along ethnic lines. In addition, our findings raise the question of whether lowering the PSA cutoff may enhance the detection of cancer in Chinese men who have the lowest prostate cancer rate.

Prognostic implications of histologic patterns in multiple surgical lung biopsies from patients with idiopathic interstitial pneumonias

STUDY OBJECTIVES

To determine the prevalence and prognostic significance of histologic discordance in multiple lung biopsy specimens obtained from patients investigated for suspected cryptogenic fibrosing alveolitis (CFA)/idiopathic pulmonary fibrosis (IPF).

METHODS

and results: Between 1984 and 2001, 64 patients undergoing investigation for CFA/IPF were identified in whom multiple biopsies were performed that showed either a pattern of usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP). These cases were classified into three groups: concordant UIP-UIP (n = 25, 39.1%), discordant UIP-NSIP (n = 8,12.5%), and concordant NSIP-NSIP (n = 31, 48.4%). The discordant UIP group had survival, clinical, and physiologic features similar to those of the concordant UIP group, and prognosis in both concordant and discordant UIP groups was significantly worse than that of the concordant NSIP group (p = 0.02 and p = 0.04, respectively). The age of the concordant UIP group was higher than that of the concordant NSIP group, with the mean age of the discordant group being intermediate. There were no significant differences among the three groups in smoking history, duration of dyspnea, presence or absence of crackles, FVC, diffusion capacity of the lung for carbon monoxide, or PaO(2).

CONCLUSIONS

Patients with discordant UIP-NSIP results on multiple biopsies show clinical behavior similar to those with concordant UIP-UIP and should be regarded as having CFA/IPF in the correct clinical context, rather than "idiopathic NSIP" for the purposes of management. Multiple biopsies should be considered in all patients in order to improve the prognostic information provided by lung biopsy.

[Transbronchial needle aspiration in bronchogenic carcinoma with visible lesions: diagnostic yield and cost]

BACKGROUND

Transbronchial needle aspiration (TBNA) is a bronchoscopic technique whose usefulness in diagnosing endobronchial lesions has not yet been clearly established.

OBJECTIVE

We aimed to determine whether the diagnostic yield of fiberoptic bronchoscopy could be increased, without a negative impact on diagnostic costs, if TBNA were used in combination with conventional diagnostic techniques (bronchial washings and bronchial brushings and forceps biopsy).

PATIENTS AND METHODS

The cases of 130 patients diagnosed with bronchogenic carcinoma with endoscopically visible lesions were analyzed retrospectively. All had undergone conventional diagnostic procedures; TBNA was also performed if the bronchoscopist considered it was indicated. The final cost was calculated in euros for each diagnosis as the sum of the cost of the procedures needed to reach the diagnosis, including both endoscopic procedures and others (transthoracic needle aspiration, lymph node biopsy). Diagnostic yield and costs in cases diagnosed using only conventional techniques were compared to the yield and costs in cases in which both conventional techniques and TBNA were used.

RESULTS

TBNA was performed in 49 patients and provided the diagnosis in 85.7%. Conventional techniques led to cytological and histological diagnosis in 80.2% of the cases, and the combination of conventional techniques and TBNA gave a diagnosis in 89.7% (P=.01). Significant differences were observed in extrinsic compression (conventional 37.5%; conventional+TBNA 100%; P=.01), submucosal infiltration (conventional 54.6%; conventional+TBNA 85%; P=.03), and exophytic mass with necrosis (conventional 80%; conventional+TBNA 100%; P=.01). The mean (SD) cost of diagnosis was euros 381.60 (euros 156.53) using conventional techniques and euros 413.25 (euros 112.91) for conventional techniques in combination with TBNA. By adding TBNA, costs decreased for diagnoses of submucosal infiltration, exophytic mass with necrosis and extrinsic compression, although the saving was significant only for extrinsic compression.

CONCLUSION

The diagnostic yield of TBNA is high for endoscopically visible bronchial anomalies suggesting neoplasm, particularly when the lesion is due to extrinsic compression, submucosal infiltration, or exophytic mass with necrosis.

Interobserver Reproducibility of Percent Gleason Grade 4/5 in Prostate Biopsies

PURPOSE

Percent Gleason grade 4/5 (GG4/5) has been proposed as a predictor of prognosis in prostate cancer and it has been shown to add prognostic information to that given by Gleason score (GS). We recently noted that the interobserver reproducibility of percent GG4/5 in total prostatectomy specimens is at least as good as that of the GS. However, to our knowledge the reproducibility of percent GG4/5 in needle biopsies has not yet been investigated.

MATERIALS AND METHODS

A consecutive series of needle biopsies from 69 men with prostate cancer was reviewed. Biopsies were taken according to a standardized octant protocol. All 279 slides containing cancer were circulated among 4 genitourinary pathologists, who assessed GS and percent GG4/5. Results were compared pairwise and weighted kappa was calculated.

RESULTS

The 4 observers had a mean weighted kappa for GS and percent GG4/5 of 0.48 to 0.55 (overall mean 0.51) and 0.52 to 0.68 (overall mean 0.60), respectively. There was less disagreement in percent GG4/5 when a single biopsy was positive for cancer than when 6 or more biopsies were positive. The number of positive biopsies showed a stronger correlation with a discrepancy in percent GG4/5 than cancer length. Disagreement was worse when cribriform or fusion patterns were present.

CONCLUSIONS

Interobserver reproducibility of percent GG4/5 on prostate biopsies is at least as good as that of GS. Hence, concern about interobserver variability should not deter pathologists from using percent GG4/5. Grading appears to be most difficult when cancer is present in multiple biopsies or it contains cribriform or fusion patterns.

Representación del “score” gleason en la biopsia prostática del “score” gleason definitivo de la prostatectomía radical

INTRODUCTION

The Gleason score (Gs) for prostatic cancer has a good prognosis correlation after radical prostatectomy, for this reason its correlation with the Gs in the biopsy can be useful.

PATIENTS AND METHODS

Two hundred fifteen patients with blind evaluation among three pathologists of their Gs in biopsy and in the corresponding radical prostatectomy specimen are presented.

RESULTS

The exact coincidence is present in 49.7% of cases, 38.6% of cases are under graded in the biopsy and 11.6% of them over graded in the biopsy. No cases of Gs 2 in the biopsy are found. Any case with Gs 3 and 4 in the biopsy are reproduced in the radical prostatectomy specimen. The exact coincidence for biopsy Gs 5, 6, 7, 8 and 9 are 25%, 45%, 72.7%, 36.6% and 60% respectively (kappa 0.32 +/- 0.047, p<0.0001 in Gs 5 to 8). The Gleason pattern 4 is the less diagnosed in prostate biopsies [40% of cases with this pattern in the excision specimen it is missing in the biopsy).

CONCLUSIONS

The Gs in the needle prostatic biopsy has a good correspondence with the Gs in the radical prostatectomy specimen. For an increase of the reproducibility it is recommendable avoid the diagnosis of Gs 2, 3 and 4 in biopsy and a scrupulous search for the patterns 4 and 5.

Valor diagnóstico de segundas biopsias prostáticas en varones de riesgo. estudio estratificado por valor de psa

OBJECTIVE

[corrected] To value the diagnostic yield of the second prostate biopsy (BP).

PATIENTS AND METHODS

To 116 males with BP previous to kindliness surrendered to 2 or more BP for sextants guided with ultrasounds (US). The criteria of inclusion were: BP previous suspicious (PIN), high PSA, TR or suspicious US.

RESULTS

The average time passed between the first and following biopsy was 13 +/- 11 months. 35 malignant and 4 premalignant ones were obtained in the second realized biopsies, which gives a diagnostic global yield of 33.6%. When we stratify for value of PSA, we obtain that with PSA <4 ng/ml the yield was 23%, for PSA 4-10 ng/ml the yield was 32% and for PSA >10 ng/ml of 34.6%.

CONCLUSION

The repetition of the serial biopsy of prostate in patients of risk, improves the diagnostic yield and eliminates the false negatives of prostate carcinoma.