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Pöschel T, Blank V, Schlosser T, Lingscheidt T, Böhlig A, Wiegand J, Karlas T. Ultrasound-guided percutaneous biopsy for focal liver lesions: Adverse events and diagnostic yield in a single-centre analysis. PLoS One 2024; 19:e0304026. [PMID: 38776359 PMCID: PMC11111085 DOI: 10.1371/journal.pone.0304026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/05/2024] [Indexed: 05/24/2024] Open
Abstract
PURPOSE Ultrasound-guided biopsy of focal liver lesions (FLL) is a well-established procedure with crucial impact on therapeutic decisions. The safety and accuracy depend on needle type, tumour location and comorbidities. Modern oncological concepts often require large tumour specimens which may increase the procedural risk. MATERIALS AND METHODS We retrospectively collected data from consecutively scheduled ultrasound-guided FLL biopsies performed in an interdisciplinary ultrasound unit at a university hospital from 2015-2020. We analysed complication rates, diagnostic accuracy, and patient outcome in a one-year period. RESULTS Of 426 scheduled interventions, 339 were included: 322 primary biopsies (40% female, median age 65 years, median BMI 25.4 kg/m2) and 17 rebiopsies in cases with undetermined diagnosis. Indications comprised 309 (96%) cases with suspected malignant lesions. Important comorbidities were type 2 diabetes (n = 107, 33%) and cirrhosis (n = 64, 20%). A conclusive histopathological diagnosis was achieved in 270 (84%) cases with a weak association with lesion size (OR 1.12 per cm, 95%CI 0.99-1.27). Greater BMI (OR 0.60 per 10 BMI points, 95%CI 0.34-1.05) showed a trend towards an insufficient diagnosis. Relevant complications occurred in 8 (2.5%) cases (2 major; 1 life-threatening). Multiple passes showed a trend towards adverse events (OR 2.32 for > 1 pass, 95%CI 0.99-5.42). 93 (29%) patients died during a median follow-up of 171 days. CONCLUSION Ultrasound-guided FLL biopsy is an efficient and safe diagnostic measure. The limitations of the procedure and its associated risks should be considered in patients with advanced malignancies.
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Affiliation(s)
- Theresa Pöschel
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre, Leipzig, Germany
| | - Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre, Leipzig, Germany
- Division of Interdisciplinary Ultrasound, Department of Internal Medicine I (Gastroenterology, Pneumology), University Hospital Halle, Halle (Saale), Germany
| | - Tobias Schlosser
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre, Leipzig, Germany
| | - Thomas Lingscheidt
- Institute of Pathology, Leipzig University Medical Centre, Leipzig, Germany
| | - Albrecht Böhlig
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre, Leipzig, Germany
- Department of Internal Medicine, Community Hospital Delitzsch, Delitzsch, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre, Leipzig, Germany
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Li T, Xu G, Li W, Liu Y. A systematic review and meta-analysis of randomized controlled trials comparing low-dose versus standard-dose computed tomography-guided lung biopsy. J Cardiothorac Surg 2024; 19:297. [PMID: 38778306 PMCID: PMC11110412 DOI: 10.1186/s13019-024-02792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Despite the existence of several Randomized Controlled Trials (RCTs) investigating Low-Dose Computed Tomography (LDCT) as a guide in lung biopsies, conclusive findings remain elusive. To address this contention, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LDCT-guided lung biopsies. METHODS A comprehensive search across major databases identified RCTs comparing the effectiveness of LDCT-guided with Standard-Dose Computed Tomography (SDCT)-guided lung biopsies. Subsequently, we utilized a random-effects model meta-analysis to assess diagnostic accuracy, radiation dose, operation duration, and clinical complications associated with these procedures. RESULTS Out of 292 scrutinized studies, six RCTs representing 922 patients were included in the final analysis. Results indicated the differences between the LDCT and SDCT groups were not different with statistical significance in terms of diagnostic accuracy rates (Intent-to-Treat (ITT) populations: Relative Risk (RR) 1.01, 95% Confidence interval [CI] 0.97-1.06, p = 0.61; Per-Protocol (PP) populations: RR 1.01, 95% CI 0.98-1.04, p = 0.46), incidence of pneumothorax (RR 1.00, 95% CI 0.75-1.35, p = 0.98), incidence of hemoptysis (RR 0.95, 95% CI 0.63-1.43, p = 0.80), and operation duration (minutes) (Mean Differences [MD] -0.34, 95% CI -1.67-0.99, p = 0.61). Notably, LDCT group demonstrated a lower radiation dose (mGy·cm) with statistical significance (MD -188.62, 95% CI -273.90 to -103.34, p < 0.0001). CONCLUSIONS The use of LDCT in lung biopsy procedures demonstrated equivalent efficacy and safety to standard methods while notably reducing patient radiation exposure.
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Affiliation(s)
- Teng Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Guanghui Xu
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Wenjun Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Yun Liu
- Department of Hematology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China.
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3
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Li T, Zhang Q, Li W, Liu Y. Autologous blood patch intraparenchymal injection reduces the incidence of pneumothorax and the need for chest tube placement following CT-guided lung biopsy: a systematic review and meta-analysis. Eur J Med Res 2024; 29:108. [PMID: 38336678 PMCID: PMC10854056 DOI: 10.1186/s40001-024-01707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To assess the effectiveness of autologous blood patch intraparenchymal injection during CT-guided lung biopsies with a focus on the incidence of pneumothorax and the subsequent requirement for chest tube placement. METHODS A comprehensive search of major databases was conducted to identify studies that utilized autologous blood patches to mitigate the risk of pneumothorax following lung biopsies. Efficacy was next assessed through a meta-analysis using a random-effects model. RESULTS Of the 122 carefully analyzed studies, nine, representing a patient population of 4116, were incorporated into the final analysis. Conclusion deduced showed a noteworthy reduction in the overall incidence of pneumothorax (RR = 0.65; 95% CI 0.53-0.80; P = 0.00) and a significantly decline in the occasion for chest tube placement due to pneumothorax (RR = 0.45; 95% CI 0.32-0.64; P = 0.00). CONCLUSIONS Utilizing autologous blood patch intraparenchymal injection during the coaxial needle retraction process post-lung biopsy is highly effective in diminishing both the incidence of pneumothorax and consequent chest tube placement requirement.
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Affiliation(s)
- Teng Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China
| | - Qiang Zhang
- Department of Nuclear Medicine, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China
| | - Wenjun Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China
| | - Yun Liu
- Department of Hematology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China.
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Koh S, Kwon H, Hwangbo L, Kim CW, Kim S, Hong SB. Decreased Bleeding-Related Adverse Events Using Track Embolization with Gelatin Sponge Slurry after Percutaneous Liver Biopsy: A Propensity Score-Matched Study. J Vasc Interv Radiol 2023; 34:2128-2136. [PMID: 37652299 DOI: 10.1016/j.jvir.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of track embolization using gelatin sponge slurry in percutaneous ultrasound (US)-guided liver biopsy. MATERIALS AND METHODS Among the 543 patients who underwent percutaneous US-guided liver biopsies between September 2018 and August 2021, 338 who did not undergo track embolization and 105 who underwent track embolization were included in the analysis. All procedures were performed with 18-gauge coaxial core biopsy needles. Patients' laboratory data were reviewed. Patients in both groups were subdivided into the following 2 groups: (a) those with targeted biopsy for a focal liver lesion and (b) those with nontargeted biopsy for a liver parenchyma. Moreover, postbiopsy events, such as transfusion and transarterial embolization, were assessed. To minimize selection bias, propensity score matching (PSM) was performed. RESULTS After PSM, all factors that could affect bleeding risk were well-matched and well-balanced between the 2 groups (P > .474). In the non-track embolization group, 17 (16.2%) patients experienced major or minor bleeding-related adverse events (AEs). In contrast, in the track embolization group, only 5 (4.8%) patients experienced major or minor bleeding-related AEs, which was significantly lower than that in the non-track embolization group (P = .007). All 5 (4.8%) cases of major bleeding-related AEs were observed in the non-track embolization group (P = .024). CONCLUSIONS In this study, a retrospective analysis was performed using PSM for percutaneous US-guided liver biopsy. Track embolization using gelatin sponge slurry is significantly superior in the prevention of bleeding-related AEs after US-guided liver biopsy.
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Affiliation(s)
- Sungho Koh
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea.
| | - Lee Hwangbo
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Suk Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Seung Baek Hong
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
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Sorensen AM, Zlevor AM, Kisting MA, Couillard AB, Ziemlewicz TJ, Toia GV, Hinshaw JL, Woods M, Stratchko LM, Pickhardt PJ, Foltz ML, Peppler WW, Lee FT, Knavel Koepsel EM. CT Navigation for Percutaneous Needle Placement: How I Do It. Tech Vasc Interv Radiol 2023; 26:100911. [PMID: 38071032 DOI: 10.1016/j.tvir.2023.100911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
CT navigation (CTN) has recently been developed to combine many of the advantages of conventional CT and CT-fluoroscopic guidance for needle placement. CTN systems display real-time needle position superimposed on a CT dataset. This is accomplished by placing electromagnetic (EM) or optical transmitters/sensors on the patient and needle, combined with fiducials placed within the scan field to superimpose a known needle location onto a CT dataset. Advantages of CTN include real-time needle tracking using a contemporaneous CT dataset with the patient in the treatment position, reduced radiation to the physician, facilitation of procedures outside the gantry plane, fewer helical scans during needle placement, and needle guidance based on diagnostic-quality CT datasets. Limitations include the display of a virtual (vs actual) needle position, which can be inaccurate if the needle bends, the fiducial moves, or patient movement occurs between scans, and limitations in anatomical regions with a high degree of motion such as the lung bases. This review summarizes recently introduced CTN technologies in comparison to historical methods of CT needle guidance. A "How I do it" section follows, which describes how CT navigation has been integrated into the study center for both routine and challenging procedures, and includes step-by-step explanations, technical tips, and pitfalls.
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Affiliation(s)
- Anna M Sorensen
- Departments of Radiology, University of Wisconsin, Madison, WI
| | - Annie M Zlevor
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | | | - Giuseppe V Toia
- Departments of Radiology, University of Wisconsin, Madison, WI; Medical Physics, University of Wisconsin, Madison, WI
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI
| | - Michael Woods
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | - Marcia L Foltz
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | - Fred T Lee
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI; Biomedical Engineering, University of Wisconsin, Madison, WI
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Moussa AM, Hui Y, Araujo Filho JA, Muallem N, Li D, Jihad M, Hsu M, Moskowitz CS, Travis WD, Solomon SB, Ginsberg MS, Maybody M. Radiologic and histopathologic features of hydrogel sealant after lung resection in participants of a prospective randomized clinical trial. Clin Imaging 2023; 95:92-96. [PMID: 36706641 PMCID: PMC10041988 DOI: 10.1016/j.clinimag.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To summarize imaging and histopathologic characteristics of hydrogel sealant (plug) in lung parenchyma and assess their correlation with time since deployment of sealant. MATERIALS AND METHODS Among a total of 208 participants randomized to the hydrogel sealant arm of a lung biopsy prospective randomized clinical trial, 51 underwent resection of the biopsied lesion. In 34 participants sealant material was present on histopathologic sections (n = 22), or they had cross-sectional imaging of chest between biopsy and resection (n = 23) or they had both imaging and histopathology (n = 11). Histopathologic and imaging findings were described. The association of these findings with time since sealant deployment was evaluated using the Wilcoxon rank sum test. RESULTS The mean time since sealant deployment for histopathology was 45.7 days (median 36, range 14-181) and for imaging studies was 99 days (median 32, range 4-527). The sealant was infiltrated by inflammatory cells in 20 (91%) participants. The main general histopathologic pattern of sealant was foamy in 12 (57%) and mesh in 8 (38%) participants. Imaging appearance of sealant was serpiginous in 18 (60%), linear in 10 (33%) or lobulated in 2 (6.7%) participants. In 2 participants the sealant was hypermetabolic with no histopathologic evidence of tumor. No correlation was found between time since sealant deployment and imaging or histopathologic appearances. CONCLUSION Hydrogel sealant appears as a serpiginous, linear, or lobulated opacity on cross-sectional imaging which can be metabolically active. It is associated with an inflammatory reaction with a foamy or mesh general pattern on histopathological assessment. No correlation was found between time since sealant deployment and imaging or histopathologic appearances.
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Affiliation(s)
- Amgad M Moussa
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Yiang Hui
- Department of Pathology, Division of Thoracic Pathology, Memorial Sloan Kettering Cancer Center, United States of America
| | - Jose A Araujo Filho
- Department of Radiology, Division of Thoracic Imaging, Memorial Sloan Kettering Cancer Center, United States of America
| | - Nadim Muallem
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, United States of America
| | - Duan Li
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Marwah Jihad
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, United States of America.
| | - William D Travis
- Department of Pathology, Division of Thoracic Pathology, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Stephen B Solomon
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Michelle S Ginsberg
- Department of Radiology, Division of Thoracic Imaging, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Majid Maybody
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, United States of America
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Baratella E, Cernic S, Minelli P, Furlan G, Crimì F, Rocco S, Ruaro B, Cova MA. Accuracy of CT-Guided Core-Needle Biopsy in Diagnosis of Thoracic Lesions Suspicious for Primitive Malignancy of the Lung: A Five-Year Retrospective Analysis. Tomography 2022; 8:2828-2838. [PMID: 36548528 PMCID: PMC9786845 DOI: 10.3390/tomography8060236] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest methods to obtain tissue specimens, even though there are relatively high rates of pneumothorax (0-60% incidence) and pulmonary hemorrhage (4-27% occurrence rates). The aim of this retrospective study is to assess the diagnostic accuracy of CT-guided core-needle biopsy in the diagnosis of primary lung malignancies and to compare our results with evidence from the literature. MATERIALS AND METHODS Our analysis included 350 thoracic biopsies, performed from 2017 to 2022 with a 64-row CT guidance and 16/18 G needles mounted on a biopsy gun. We included in the final cohort all samples with evidence of primary lung malignancies, precursor lesions, and atypia, as well as inconclusive and negative diagnoses. RESULTS There was sensitivity of 90.07% (95% CI 86.05-93.25%), accuracy of 98.87% (95% CI 98.12-99.69%), positive predictive value of 100%, and negative value of 98.74% (95% CI 98.23-99.10%). Specificity settled at 100% (93.84-100%). The AUC was 0.952 (95% CI 0.924-0.972). Only three patients experienced major complications after the procedure. Among minor complications, longer distances from the pleura, the presence of emphysema, and the lower dimensions of the lesions were correlated with the development of pneumothorax after the procedure, while longer distances from the pleura and the lower dimensions of the lesions were correlated with intra-alveolar hemorrhage. Immunohistochemistry analysis was performed in 51% of true positive cases, showing TTF-1, CK7, and p40 expression, respectively, in 26%, 24%, and 10% of analyzed samples. CONCLUSIONS The CT-guided thoracic core-needle biopsy is an extremely accurate and safe diagnostic procedure for the histological diagnosis of lung cancer, a first-level interventional radiology exam for peripheral and subpleural lesions of the lung, which is also able to provide adequate samples for advanced pathologic assays (e.g., FISH, PCR) to assess molecular activity and genetic sequencing.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
- Correspondence:
| | - Stefano Cernic
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Pierluca Minelli
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Giovanni Furlan
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Filippo Crimì
- Institute of Radiology, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy
| | - Simone Rocco
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
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Keshavamurthy KN, Dylov DV, Yazdanfar S, Patel D, Silk T, Silk M, Jacques F, Petre EN, Gonen M, Rekhtman N, Ostroverkhov V, Scher HI, Solomon SB, Durack JC. Evaluation of an Integrated Spectroscopy and Classification Platform for Point-of-Care Core Needle Biopsy Assessment: Performance Characteristics from Ex Vivo Renal Mass Biopsies. J Vasc Interv Radiol 2022; 33:1408-1415.e3. [PMID: 35940363 PMCID: PMC10204606 DOI: 10.1016/j.jvir.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate a transmission optical spectroscopy instrument for rapid ex vivo assessment of core needle cancer biopsies (CNBs) at the point of care. MATERIALS AND METHODS CNBs from surgically resected renal tumors and nontumor regions were scanned on their sampling trays with a custom spectroscopy instrument. After extracting principal spectral components, machine learning was used to train logistic regression, support vector machines, and random decision forest (RF) classifiers on 80% of randomized and stratified data. The algorithms were evaluated on the remaining 20% of the data set held out during training. Binary classification (tumor/nontumor) was performed based on a decision threshold. Multinomial classification was also performed to differentiate between the subtypes of renal cell carcinoma (RCC) and account for potential confounding effects from fat, blood, and necrotic tissue. Classifiers were compared based on sensitivity, specificity, and positive predictive value (PPV) relative to a histopathologic standard. RESULTS A total of 545 CNBs from 102 patients were analyzed, yielding 5,583 spectra after outlier exclusion. At the individual spectra level, the best performing algorithm was RF with sensitivities of 96% and 92% and specificities of 90% and 89%, for the binary and multiclass analyses, respectively. At the full CNB level, RF algorithm also showed the highest sensitivity and specificity (93% and 91%, respectively). For RCC subtypes, the highest sensitivity and PPV were attained for clear cell (93.5%) and chromophobe (98.2%) subtypes, respectively. CONCLUSIONS Ex vivo spectroscopy imaging paired with machine learning can accurately characterize renal mass CNB at the time of tissue acquisition.
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Affiliation(s)
| | - Dmitry V Dylov
- Skolkovo Institute of Science and Technology, Moscow, Russia
| | | | - Dharam Patel
- Novartis Pharmaceutical Corporation, East Hanover, New Jersey
| | - Tarik Silk
- New York University Langone Medical Center, New York, New York
| | - Mikhail Silk
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Howard I Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeremy C Durack
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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9
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Impact of risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy of space-occupying lesions. RADIOLOGIA 2022; 64:497-505. [DOI: 10.1016/j.rxeng.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022]
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10
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Heine V, Dey C, Bojarová P, Křen V, Elling L. Methods of in vitro study of galectin-glycomaterial interaction. Biotechnol Adv 2022; 58:107928. [DOI: 10.1016/j.biotechadv.2022.107928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 02/08/2023]
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11
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Handke NA, Koch DC, Muschler E, Thomas D, Luetkens JA, Attenberger UI, Kuetting D, Pieper CC, Wilhelm K. Bleeding management in computed tomography-guided liver biopsies by biopsy tract plugging with gelatin sponge slurry. Sci Rep 2021; 11:24506. [PMID: 34969958 PMCID: PMC8718535 DOI: 10.1038/s41598-021-04155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/13/2021] [Indexed: 01/12/2023] Open
Abstract
To evaluate the safety and impact of biopsy tract plugging with gelatin sponge slurry in percutaneous liver biopsy. 300 consecutive patients (158 females, 142 males; median age, 63 years) who underwent computed tomography-guided core biopsy of the liver in coaxial technique (16/18 Gauge) with and without biopsy tract plugging were retrospectively reviewed (January 2013 to May 2018). Complications were rated according to the common criteria for adverse events (NCI-CTCAE). The study cohort was dichotomized into a plugged (71%; n = 214) and an unplugged (29%; n = 86) biopsy tract group. Biopsy tract plugging with gelatin sponge slurry was technically successful in all cases. Major bleeding events were only observed in the unplugged group (0.7%; n = 2), whereas minor bleedings (4.3%) were observed in both groups (plugged, 3.6%, n = 11; unplugged, 0.7%, n = 2). Analysis of biopsies and adverse events showed a significant association between number of needle-passes and overall (P = 0.038; odds ratio: 1.395) as well as minor bleeding events (P = 0.020; odds ratio: 1.501). No complications associated with gelatin sponge slurry were observed. Biopsy tract plugging with gelatin sponge slurry is a technically easy and safe procedure that can prevent major bleeding events following liver biopsy.
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Affiliation(s)
- Nikolaus A Handke
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany.
- Department of Radiology, University Hospital Bonn, Bonn, Germany.
| | - Dennis C Koch
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany
| | - Eugen Muschler
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | | | | | - Daniel Kuetting
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Kai Wilhelm
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany
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Varela-Ponte R, Martínez-Lago N, Vieito-Villar M, Carreira-Villamor JM. Impact of risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy of space-occupying lesions. RADIOLOGIA 2020; 64:S0033-8338(20)30141-7. [PMID: 33257053 DOI: 10.1016/j.rx.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/30/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ultrasound-guided percutaneous liver biopsy is considered the technique of choice for the histological diagnosis of space-occupying lesions, given its high level of safety and diagnostic performance. However, since it is an invasive diagnostic procedure, complications can occur. Various clinical and radiological parameters have been analyzed as factors related with the efficacy of the technique or with its complications; however, the results have been contradictory. Thus, we aimed to evaluate the impact of various risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy in the diagnosis of space-occupying lesions in ordinary clinical practice. MATERIAL AND METHODS This retrospective observational study included all patients who underwent real-time ultrasound-guided percutaneous biopsies of space-occupying liver lesions with the free-hand technique between December 2012 and February 2018 in the diagnostic imaging department at the Hospital Clínico Universitario de Santiago de Compostela. We analyzed the following risk factors: location of the lesion in upper liver segments (II, IVa, VII, or VIII); proximity to the liver capsule, distance from the skin > 100mm, interposition of osseus or vascular structures, inability to go through healthy parenchyma, and lack of patient cooperation during the procedure. Efficacy was analyzed in terms of the number of cylinders obtained and the percentage of adequate biopsies; safety was analyzed in terms of the percentage of complications, which were classified as major or minor. RESULTS We included 295 biopsies in 278 patients (median age, 69 years; 64.1% male; 44.7% had prior neoplasms). In 61.4%, the biopsy was indicated for the initial diagnosis; 82.4% of biopsies were done in hospitalized patients, and 65% of the lesions were located in the right liver lobe. The median number of cylinders obtained was 3 (range 1-6); 91.2% of the biopsies were adequate and 92.2% were considered clinically useful. These percentages did not differ significantly according to the presence of risk factors. Complications occurred in 10 (3.4%) patients. Complications were considered major in 3 (0.9%) patients (2 (0.6%) bleeding complications and 1 (0.3%) infectious complication) and minor in 7 (2.4%). The percentage of complications was significantly higher in patients who did not cooperate during the procedure (p=0.04). CONCLUSIONS Ultrasound-guided percutaneous liver biopsy is an efficacious and safe technique for the histological diagnosis of space-occupying liver lesions. Our results confirm the increased rate of complications when patients fail to cooperate during the procedure.
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Affiliation(s)
- R Varela-Ponte
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España.
| | - N Martínez-Lago
- Servicio de Oncología Médica, Complexo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M Vieito-Villar
- Unidad de Sacorma y Neuroncología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - J Martin Carreira-Villamor
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
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O'Shea A, Tam AL, Kilcoyne A, Flaherty KT, Lee SI. Image-guided biopsy in the age of personalised medicine: strategies for success and safety. Clin Radiol 2020; 76:154.e1-154.e9. [PMID: 32896425 DOI: 10.1016/j.crad.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
Oncology has progressed into an era of personalised medicine, whereby the therapeutic regimen is tailored to the molecular profile of the patient's cancer. Determining personalised therapeutic options is achieved by using tumour genomics and proteomics to identify the specific molecular targets against which candidate drugs can interact. Several dozen targeted drugs, many for multiple cancer types are already widely in clinical use. Molecular profiling of tumours is contingent on high-quality biopsy specimens and the most common method of tissue sampling is image-guided biopsy. Thus, for radiologists performing these biopsies, the paradigm has now shifted away from obtaining specimens simply for histopathological diagnosis to acquiring larger amounts of viable tumour cells for DNA, RNA, or protein analysis. These developments have highlighted the central role now played by radiologists in the delivery of personalised cancer care. This review describes the principles of molecular profiling assays and biopsy techniques for optimising yield, and describes a scoring system to assist in patient selection for percutaneous biopsy.
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Affiliation(s)
- A O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - A L Tam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - A Kilcoyne
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - K T Flaherty
- Department of Medicine, Division of Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S I Lee
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
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Türk Y, Küskün A, Devecioğlu İ. Novel Use of Extrapleural Autologous Blood Injection in CT-Guided Percutaneous Lung Biopsy and its Comparison to Intraparenchymal Autologous Blood Patch Injection: A Single-Center, Prospective, Randomized, and Controlled Clinical Trial. Cardiovasc Intervent Radiol 2020; 43:1315-1322. [PMID: 32676959 DOI: 10.1007/s00270-020-02585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the rate of iatrogenic pneumothorax and the need for intervention with extrapleural autologous blood injection (EPABI) along with intraparenchymal autologous blood patch injection (IABPI) or IABPI-only in CT-guided percutaneous lung biopsy. MATERIALS AND METHODS One hundred and thirty-nine participants were referred for CT-guided percutaneous lung biopsy, and 81 were randomized into study (EPABI + IABPI, n = 40) and control (IABPI-only, n = 41) groups. In the study group, ~5 ml of autologous blood was injected into the extrapleural space before passing through the parietal and visceral pleura. The primary outcome was the incidence of pneumothorax in two cohorts within 2 weeks after the procedure. RESULTS In the per-protocol population, pneumothorax rates were 5.9% and 25.7% in the study and control groups, respectively. The difference between the two groups was -19.8% (95% CI: -36.3%, 3.32%) (p = 0.025). On the other hand, in the population with no intraprocedural deviations, pneumothorax rates were 3.2% and 17.2% in the study and control groups, respectively. The difference between the two groups was -14.0% (95% CI: -29.1%, 1.07%) (p = 0.083). In the control group, 3.45% of the cases required aspiration, while no intervention was required in the study group. CONCLUSION The EPABI application along with IABPI is a promising method to decrease the incidence of pneumothorax following CT-guided percutaneous lung biopsy.
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Affiliation(s)
- Yaşar Türk
- Radiology Department, Medical Faculty, Tekirdağ Namık Kemal University, Namik Kemal Mh., Kampus Cd., 59100, Suleymanpasa, Tekirdağ, Turkey.
| | - Atakan Küskün
- Radiology Department, Kırklareli State Hospital, Yayla Mh, 39000, Kırklareli, Turkey
| | - İsmail Devecioğlu
- Biomedical Engineering Department, Çorlu Engineering Faculty, Tekirdağ Namık Kemal University, Silahtaraga Mh., Çorlu, Tekirdağ, Turkey
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Bhagavatula SK, Upadhyaya K, Miller BJ, Bursch P, Lammers A, Cima MJ, Silverman SG, Jonas O. An interventional image-guided microdevice implantation and retrieval method for in-vivo drug response assessment. Med Phys 2019; 46:5134-5143. [PMID: 31494942 DOI: 10.1002/mp.13803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Recently developed implantable microdevices can perform multi-drug response assessment of cancer drugs in-vivo, with potential to develop highly optimized personalized cancer treatment strategies. However, minimally invasive/interventional image-guided methods of in-vivo microdevice implantation, securement, and retrieval are needed for broad clinical translation. Here we demonstrate proof-of-concept of an interventional microdevice implantation and retrieval method for personalized drug response assessment, using ex-vivo phantom, ex-vivo tissue, and in-vivo murine models. METHODS A method for minimally-invasive microdevice implantation and retrieval was developed, by which a custom-prototyped 6 mm retrievable microdevice can be implanted into a live tumor, deliver drugs into 10 discrete regions of adjacent tissue, and retrieved along with the adjacent drug-exposed tissue with a custom-prototyped retrieval needle device to allow in-vivo multi-drug response assessment. Computed tomography (CT) and ultrasound (US)-guided minimally invasive microdevice implantation and retrieval were tested in ex-vivo phantom and tissue models. Successful retrieval was defined as retrieval of the microdevice and adjacent core phantom/tissue sample containing at least 4/10 drug delivery sites. Subsequently, 10 implantation and retrieval trials in phantom models were performed using bi-axial and tri-axial retrieval needles; success rates were calculated and compared using a two-proportion z-test and the number of successfully retrieved drug release sites per microdevice was calculated and compared using a one-tailed independent t-test. Finally, five microdevices, each containing ten reservoirs preloaded with chemotherapy agent Doxorubicin, were implanted into mouse tumors in-vivo, secured for 24-h during drug release, and microdevice/tissue retrieval was performed under ultrasound guidance. Fluorescence microscopy of the retrieved tissue was used to confirm drug delivery and apoptosis staining assessed in-vivo tissue response; correlation of drug release and apoptosis staining were used to assess in-vivo drug efficacy. RESULTS Image-guided microdevice implantation and retrieval were successful in ex-vivo phantom and tissue models with both US and CT guidance. Bi-axial retrieval success rate was significantly higher than triaxial retrieval in ex-vivo phantom trials (90% vs 50%, z = 1.95, P = 0.026), and had nonsignificantly higher number of retrieved drug-release sites per microdevice (8.3 vs 7.0, t = 1.37, P = 0.097). Bi-axial retrieval was successful in all five in-vivo mouse tumor models, and allowed in-vivo drug response assessment at up to ten discrete drug delivery sites per microdevice. An average of 6.8/10 discrete tumor sites containing micro-doses of delivered drug were retrieved per in-vivo attempt (min 5, max 10, std 1.93). Tissue regions of drug delivery, as assessed with fluorescent Doxorubicin drug signal, correlated with regions of apoptosis staining in all in-vivo models, indicating drug efficacy. No bleeding, microdevice migration, or other complications were noted during implantation, 24-h observation, or retrieval. CONCLUSIONS The demonstrated image-guided minimally invasive microdevice implantation and retrieval method is similar to routine outpatient biopsy procedures, obviates the need for surgery, and can be performed at varying depths under CT and/or US guidance. There is potential for this method to enable clinical translation of in-vivo personalized drug response assessment/prediction in a much larger number of patients than currently possible.
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Affiliation(s)
- Sharath K Bhagavatula
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Kunj Upadhyaya
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Brendyn J Miller
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Boston, MA, 02139, USA
| | - Patrick Bursch
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Boston, MA, 02139, USA
| | - Alex Lammers
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael J Cima
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Boston, MA, 02139, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Oliver Jonas
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Boston, MA, 02139, USA
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Dalag L, Fergus JK, Zangan SM. Lung and Abdominal Biopsies in the Age of Precision Medicine. Semin Intervent Radiol 2019; 36:255-263. [PMID: 31435134 DOI: 10.1055/s-0039-1693121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Image-guided percutaneous needle biopsies (PNBs) are one of the most common procedures performed in radiology departments today. Rapid developments in precision medicine, which identifies molecular and genomic biomarkers in cancers, have ushered a new paradigm of oncologic workup and treatment. PNB has conventionally been used to establish a benign or malignant nature of a lesion during initial diagnosis or in suspected metastatic or recurrent disease. However, increasing amounts of tissue are being required to meet the demands of molecular pathologic analysis, which are now being sought at multiple time points during the course of the disease to guide targeted therapy. As primary providers of biopsy, radiologists must be proactive in these developments to improve diagnostic yield and tissue acquisition in PNB. Herein, we discuss the important and expanding role of PNB in the age of precision medicine and review the technical considerations of percutaneous lung and intra-abdominal biopsy. Finally, we examine promising state-of-the-art techniques in PNB that may safely increase tissue acquisition for optimal molecular pathologic analysis.
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Affiliation(s)
- Leonard Dalag
- Department of Radiology, University of Chicago, Chicago, Illinois
| | | | - Steven M Zangan
- Department of Radiology, University of Chicago, Chicago, Illinois
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Lee K, Lee SJ, Yoon S, Ryoo BY, Kim SW, Choi SH, Lee SM, Chae EJ, Park Y, Jang SJ, Park SY, Yoon YK, Park SH, Kim TW. Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center. PLoS One 2019; 14:e0221065. [PMID: 31404103 PMCID: PMC6690517 DOI: 10.1371/journal.pone.0221065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Research biopsies are an essential component of cancer clinical trials for studying drug efficacy and identifying biomarkers. Site-level clinical investigators, however, do not have access to results on the adequacy of research biopsies for histological or molecular assays, because samples are sent to central labs and the test results are seldom reported back to site-level investigators unless requested. We evaluated the feasibility, safety, and adequacy of research biopsies performed at an academic medical center. Materials and methods We retrospectively reviewed the data on 122 research biopsy sessions conducted in 99 patients via percutaneous core needle biopsy for 39 clinical trials from January 2017 to February 2018 at a single institute. We asked the sponsors of each clinical trial for the adequacy of the biopsy samples for histological or molecular assays. Results The biopsy success rate was 93.4% (113/122), with nine samples categorized as inadequate for obtaining pathologic diagnosis. Post-biopsy complications occurred in 9.8% (12/122) of biopsies, all of which were mild and completely recovered by the day after the biopsy. The sponsors of clinical trials provided feedbacks on the adequacy of 76 biopsy samples, and noted that a total of 8 biopsy samples from 7 patients were inadequate for analysis, resulting in an adequacy rate of 89.5% (68/76): the reasons for inadequacy were insufficient tumor content for immunohistochemistry (n = 3) and low RNA yield for sequencing (n = 5). Conclusion Research biopsies performed at an experienced, multidisciplinary center had acceptable safety for patients as well as practicality in terms of obtaining adequate tissue samples for molecular studies.
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Affiliation(s)
- Kyoungmin Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So Jung Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se-Jin Jang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Yeon Park
- Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Kwang Yoon
- Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (TWK); (SHP)
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (TWK); (SHP)
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Incidence of major hemorrhage after aggressive image-guided liver mass biopsy in the era of individualized medicine. Abdom Radiol (NY) 2019; 44:2067-2073. [PMID: 29774381 DOI: 10.1007/s00261-018-1637-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To analyze a large volume of image-guided liver mass biopsies to assess for an increased incidence of major hemorrhage after aggressive liver mass sampling, and to determine if coaxial technique reduces major hemorrhage rate. METHODS Patients who underwent image-guided liver mass biopsy over a 15-year period (December 7, 2001-September 22, 2016) were retrospectively identified. An aggressive biopsy was defined as a biopsy event in which ≥ 4 core needle passes were performed. Association of major hemorrhage after aggressive liver mass biopsy and other potential risk factors of interest were assessed using logistic regression analysis. For the subset of aggressive biopsies, Fisher's exact test was used to compare the incidence of major hemorrhage using coaxial versus noncoaxial techniques. RESULTS Aggressive biopsies constituted 11.6% of biopsy events (N =579/5011). The incidence of major hemorrhage with <4 passes was 0.4% (N =18/4432) and with ≥4 passes 1.2% (N =6/579). In univariable models, aggressive biopsy was significantly associated with major hemorrhage (OR 3.0, 95% CI 1.16-6.92, p =0.025). After adjusting for gender and platelet count, the association was not significant at the p =0.05 level (OR 2.58, 95% CI 0.927-6.24, p =0.067). The rate of major hemorrhage in the coaxial biopsy technique group was 1.4% (N =3/209) compared to 1.1% (N =4/370) in the noncoaxial biopsy technique group, which was not a significant difference (p =0.707). CONCLUSIONS Although aggressive image-guided liver mass biopsies had an increased incidence of major hemorrhage, the overall risk of bleeding remained low. The benefit of such biopsies will almost certainly outweigh the risk in most patients.
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Krokidis M, Hungerbühler M, Hewer E, Heverhagen J, von Tengg-Kobligk H. Ex vivo performance comparison of three percutaneous biopsy needle systems. Eur Radiol 2019; 29:4044-4049. [DOI: 10.1007/s00330-018-5960-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
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Prospective Evaluation of Unprocessed Core Needle Biopsy DNA and RNA Yield from Lung, Liver, and Kidney Tumors: Implications for Cancer Genomics. Anal Cell Pathol (Amst) 2018; 2018:2898962. [PMID: 30652067 PMCID: PMC6311765 DOI: 10.1155/2018/2898962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/29/2018] [Indexed: 01/05/2023] Open
Abstract
Context Targeted needle biopsies are increasingly performed for the genetic characterization of cancer. While the nucleic acid content of core needle biopsies after standard pathology processing (i.e., formalin fixation and paraffin embedding (FFPE)) has been previously reported, little is known about the potential yield for molecular analysis at the time of biopsy sample acquisition. Objectives Our objective was to improve the understanding of DNA and RNA yields from commonly used core needle biopsy techniques prior to sample processing. Methods We performed 552 ex vivo 18 and 20G core biopsies in the lungs, liver, and kidneys. DNA and RNA were extracted from fresh-frozen core samples and quantified for statistical comparisons based on needle gauge, biopsy site, and tissue type. Results Median tumor DNA yields from all 18G and 20G samples were 5880 ng and 2710 ng, respectively. Median tumor RNA yields from all 18G and 20G samples were 1100 ng and 230 ng, respectively. A wide range of DNA and RNA quantities (1060–13,390 ng and 370–6280 ng, respectively) were acquired. Median DNA and RNA yields from 18G needles were significantly greater than those from 20G needles across all organs (p < 0.001). Conclusions Core needle biopsy techniques for cancer diagnostics yield a broad range of DNA and RNA for molecular pathology, though quantities are greater than what has been reported for FFPE processed material. Since non-formalin-fixed DNA is advantageous for molecular studies, workflows that optimize core needle biopsy yield for molecular characterization should be explored.
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Maybody M, Muallem N, Brown KT, Moskowitz CS, Hsu M, Zenobi CL, Jihad M, Getrajdman GI, Sofocleous CT, Erinjeri JP, Covey AM, Brody LA, Yarmohammadi H, Deipolyi AR, Bryce Y, Alago W, Siegelbaum RH, Durack JC, Gonzalez-Aguirre AJ, Ziv E, Boas FE, Solomon SB. Autologous Blood Patch Injection versus Hydrogel Plug in CT-guided Lung Biopsy: A Prospective Randomized Trial. Radiology 2018; 290:547-554. [PMID: 30480487 DOI: 10.1148/radiol.2018181140] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the effect of autologous blood patch injection (ABPI) with that of a hydrogel plug on the rate of pneumothorax at CT-guided percutaneous lung biopsy. Materials and Methods In this prospective randomized controlled trial ( https://ClinicalTrials.gov , NCT02224924), a noninferiority design was used for ABPI, with a 10% noninferiority margin when compared with the hydrogel plug, with the primary outcome of pneumothorax rate within 2 hours of biopsy. A type I error rate of 0.05 and 90% power were specified with a target study population of 552 participants (276 in each arm). From October 2014 to February 2017, all potential study participants referred for CT-guided lung biopsy (n = 2052) were assessed for enrollment. Results The data safety monitoring board recommended the trial be closed to accrual after an interim analysis met prespecified criteria for early stopping based on noninferiority. The final study group consisted of 453 participants who were randomly assigned to the ABPI (n = 226) or hydrogel plug (n = 227) arms. Of these, 407 underwent lung biopsy. Pneumothorax rates within 2 hours of biopsy were 21% (42 of 199) and 29% (60 of 208); chest tube rates were 9% (18 of 199) and 13% (27 of 208); and delayed pneumothorax rates within 2 weeks after biopsy were 1.4% (three of 199) and 1.5% (three of 208) in the ABPI and hydrogel plug arms, respectively. Conclusion Autologous blood patch injection is noninferior to a hydrogel plug regarding the rate of pneumothorax after CT-guided percutaneous lung biopsy. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Majid Maybody
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Nadim Muallem
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Karen T Brown
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Chaya S Moskowitz
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Meier Hsu
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Christina L Zenobi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Marwah Jihad
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - George I Getrajdman
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Constantinos T Sofocleous
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Joseph P Erinjeri
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Anne M Covey
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Lynn A Brody
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Hooman Yarmohammadi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Amy R Deipolyi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Yolanda Bryce
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - William Alago
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Robert H Siegelbaum
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Jeremy C Durack
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Adrian J Gonzalez-Aguirre
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Etay Ziv
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - F Edward Boas
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Stephen B Solomon
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
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22
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Allaway RJ, Fischer DA, de Abreu FB, Gardner TB, Gordon SR, Barth RJ, Colacchio TA, Wood M, Kacsoh BZ, Bouley SJ, Cui J, Hamilton J, Choi JA, Lange JT, Peterson JD, Padmanabhan V, Tomlinson CR, Tsongalis GJ, Suriawinata AA, Greene CS, Sanchez Y, Smith KD. Genomic characterization of patient-derived xenograft models established from fine needle aspirate biopsies of a primary pancreatic ductal adenocarcinoma and from patient-matched metastatic sites. Oncotarget 2017; 7:17087-102. [PMID: 26934555 PMCID: PMC4941373 DOI: 10.18632/oncotarget.7718] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/13/2016] [Indexed: 12/12/2022] Open
Abstract
N-of-1 trials target actionable mutations, yet such approaches do not test genomically-informed therapies in patient tumor models prior to patient treatment. To address this, we developed patient-derived xenograft (PDX) models from fine needle aspiration (FNA) biopsies (FNA-PDX) obtained from primary pancreatic ductal adenocarcinoma (PDAC) at the time of diagnosis. Here, we characterize PDX models established from one primary and two metastatic sites of one patient. We identified an activating KRAS G12R mutation among other mutations in these models. In explant cells derived from these PDX tumor models with a KRAS G12R mutation, treatment with inhibitors of CDKs (including CDK9) reduced phosphorylation of a marker of CDK9 activity (phospho-RNAPII CTD Ser2/5) and reduced viability/growth of explant cells derived from PDAC PDX models. Similarly, a CDK inhibitor reduced phospho-RNAPII CTD Ser2/5, increased apoptosis, and inhibited tumor growth in FNA-PDX and patient-matched metastatic-PDX models. In summary, PDX models can be constructed from FNA biopsies of PDAC which in turn can enable genomic characterization and identification of potential therapies.
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Affiliation(s)
- Robert J Allaway
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Dawn A Fischer
- Department of Surgery, Division of Surgical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Francine B de Abreu
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Timothy B Gardner
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Stuart R Gordon
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Richard J Barth
- Department of Surgery, Division of Surgical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.,Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH 03756, USA
| | - Thomas A Colacchio
- Department of Surgery, Division of Surgical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.,Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH 03756, USA
| | - Matthew Wood
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA.,Current location: Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Balint Z Kacsoh
- Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH 03756, USA
| | - Stephanie J Bouley
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Jingxuan Cui
- Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH 03756, USA
| | - Joanna Hamilton
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Jungbin A Choi
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Joshua T Lange
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Jason D Peterson
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | | | - Craig R Tomlinson
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA.,Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH 03756, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Gregory J Tsongalis
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.,Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH 03756, USA
| | - Arief A Suriawinata
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Casey S Greene
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH 03756, USA.,Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH 03756, USA.,Institute for Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH 03755, USA
| | - Yolanda Sanchez
- Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA.,Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH 03756, USA
| | - Kerrington D Smith
- Department of Surgery, Division of Surgical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.,Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH 03756, USA
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23
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Faiella E, Frauenfelder G, Santucci D, Luppi G, Schena E, Beomonte Zobel B, Grasso RF. Percutaneous low-dose CT-guided lung biopsy with an augmented reality navigation system: validation of the technique on 496 suspected lesions. Clin Imaging 2017; 49:101-105. [PMID: 29207301 DOI: 10.1016/j.clinimag.2017.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To validate a CT-navigation system during percutaneous lung biopsy (PLB). METHODS Four hundred-ninety-six patients underwent low-dose CT-guided PLB. Lesion diameter (LD), procedural time (PT), histologic validity, lesion distance from pleural surface (DPS), needle distance travelled during procedure (DTP), complications and radiation exposure were recorded. RESULTS Hysto-patological diagnosis was obtained in 96.2% cases. Mean PT, DPS, DTP, LD were respectively 29.5min, 12.4mm, 17.9mm, 20.7mm. In cases of major complications (4.6%), higher values of DTP were measured. CONCLUSIONS CT-navigation system allowed a good success in terms of diagnosis in small lesions and when a long DTP is required.
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Affiliation(s)
- Eliodoro Faiella
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Giulia Frauenfelder
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Domiziana Santucci
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Giacomo Luppi
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Emiliano Schena
- Department of Measurement and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - Bruno Beomonte Zobel
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Rosario Francesco Grasso
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
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24
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Abstract
Recent advances in the molecular characterization of cancers have triggered interest in developing a new taxonomy of disease in oncology with the goal of using the molecular profile of a patient's tumor to predict response to treatment. Image-guided needle biopsy is central to this "precision medicine" effort. In this review, we first discuss the current role of biopsy in relation to clinical examples of molecular medicine. We then outline important bottlenecks to the advancement of precision medicine and highlight the potential role of image-guided biopsy to address these challenges.
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Affiliation(s)
- Etay Ziv
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
| | - Jeremy C. Durack
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
| | - Stephen B. Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
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25
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Abstract
The clinical development of molecularly targeted cancer therapies is enhanced by proof of mechanism of action as well as proof of concept, which relate molecular pharmacodynamics to efficacy via changes in cancer cell biology and physiology resulting from drug action on its intended target. Here, we present an introduction to the field of clinical pharmacodynamics, its medical and laboratory aspects, and its practical incorporation into clinical trials. We also describe key success factors that are useful for judging the quality of clinical pharmacodynamic studies, including biopsy quality and suitability, specimen handling, assay fitness-for-purpose, and reagent quality control. This introduction provides not only context for the following articles in this issue, but also an appreciation of the role of well-conducted clinical pharmacodynamic studies in oncology drug development.
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Affiliation(s)
- Ralph E Parchment
- Clinical Pharmacodynamics Program, Applied/Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD.
| | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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26
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Sturgis CD, Marshall CB, Barkan GA, Booth CN, Kurtycz DFI, Souers RJ, Keylock JB, Tabatabai ZL, Russell DK, Moriarty AT, Doyle MA, Thomas N, Yildiz-Aktas IZ, Collins BT, Laucirica R, Crothers BA. Respiratory Cytology--Current Trends Including Endobronchial Ultrasound-Guided Biopsy and Electromagnetic Navigational Bronchoscopy: Analysis of Data From a 2013 Supplemental Survey of Participants in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med 2016; 140:22-8. [PMID: 26717056 DOI: 10.5858/arpa.2014-0635-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Nongynecologic cytology (NGC) practices are expanding in relationship to historical gynecologic cytology screening programs. Bronchopulmonary cytology is experiencing an evolution regarding new procedural types. The College of American Pathologists (CAP) tracks practice patterns in NGC by developing questionnaires, surveying participants, and analyzing respondent data. OBJECTIVE To analyze responses to a 2013 CAP supplemental survey from the Interlaboratoy Comparison Program on bronchopulmonary NGC. DESIGN The "NGC 2013 Supplemental Questionnaire: Demographics in Performance and Reporting of Respiratory Cytology" was mailed to 2074 laboratories. RESULTS The survey response rate was 42% (880 of 2074) with 90% of respondents (788 of 880) indicating that their laboratories evaluated cytology bronchopulmonary specimens. More than 95% of respondents indicated interpreting bronchial washings (765 of 787) and bronchial brushings (757 of 787). A minority of laboratories (43%, 340 of 787) dealt with endobronchial ultrasound-guided samples, and an even smaller fraction of laboratories (14%, 110 of 787) saw cases from electromagnetic navigational bronchoscopy. Intraprocedural adequacy assessments by pathologists (and less often by cytotechnologists or pathologists-in-training) were routinely performed in percutaneous transthoracic aspiration cases (74%, 413 of 560) with less involvement for other case types. Most laboratories reported that newly diagnosed primary pulmonary adenocarcinomas were triaged for molecular testing of epidermal growth factor receptor and anaplastic lymphoma kinase. CONCLUSIONS The parameters examined in this 2013 survey provide a snapshot of current pulmonary cytopathology practice and may be used as benchmarks in the future.
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Affiliation(s)
- Charles D Sturgis
- From the Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Drs Sturgis and Booth); the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Marshall); the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Wisconsin State Laboratory of Hygiene and the Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison (Dr Kurtycz); the Departments of Biostatistics (Ms Souers) and Surveys (Mses Doyle and Thomas), College of American Pathologists, Northfield, Illinois; the Puget Sound Institute of Pathology, Seattle, Washington (Dr Keylock); the Department of Pathology, University of California San Francisco, San Francisco (Dr Tabatabai); the Department of Pathology, University of Rochester Medical Center, Rochester, New York (Ms Russell); the Department of Esoteric Testing, AmeriPath, Indianapolis, Indiana (Dr Moriarty); the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Yildiz-Aktas); the Department of Pathology, Washington University School of Medicine, St Louis, Missouri (Dr Collins); the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); and the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers). Dr Yildiz-Aktas is now with the Department of Pathology, Greenwich Hospital, Greenwich, Connecticut
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27
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Calero García R, Garcia-Hidalgo Alonso M. Intervencionismo básico en abdomen. RADIOLOGIA 2016; 58 Suppl 2:29-44. [DOI: 10.1016/j.rx.2016.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/16/2016] [Accepted: 03/28/2016] [Indexed: 02/08/2023]
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28
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Abstract
PET can be used to guide percutaneous needle biopsy to the most metabolic lesion, improving diagnostic yield. PET biopsy guidance can be performed using visual or software coregistration, electromagnetic needle tracking, cone-beam computed tomography (CT), and intraprocedural PET/CT guidance. PET/CT-guided biopsies allow the sampling of lesions that may not be clearly visible on anatomic imaging, or of lesions that are morphologically normal. PET can identify suspicious locations within complex tumors that are most likely to contain important diagnostic and prognostic information.
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Affiliation(s)
- Ghassan El-Haddad
- Division of Interventional Radiology, Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612-9416, USA.
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29
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Factors influencing the diagnostic yield and accuracy of image-guided percutaneous needle biopsy of pediatric tumors: single-center audit of a 26-year experience. Pediatr Radiol 2016; 46:372-82. [PMID: 26589305 DOI: 10.1007/s00247-015-3484-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/16/2015] [Accepted: 10/19/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Image-guided percutaneous core needle biopsy is a common procedure for diagnosis of both solid tumors and hematological malignancies in children. Despite recent improvements, a certain rate of non-diagnostic biopsies persists. OBJECTIVE To assess the factors influencing the diagnostic yield and accuracy of percutaneous core needle biopsies of pediatric tumors. MATERIALS AND METHODS We conducted a single-center retrospective study of a 26-year experience with image-guided biopsies in children and young adults. Using uni- and multivariate analysis, we evaluated the association of diagnostic yield and accuracy with technical factors (image-guided procedure, pathological technique) and clinical factors (complication rate, histological type and anatomical location). RESULTS We retrieved data relating to 396 biopsies were performed in 363 children and young adults (mean age: 7.4 years). Overall, percutaneous core needle biopsy showed a diagnostic yield of 89.4% (95% confidence interval [CI] 85.9-92.2) and an accuracy of 90.9% (CI 87.6-93.6) with a complication rate of 2.5% (CI 1.2-4.6).The diagnostic yield increased with the use of advanced tissue assessment techniques (95.7% with immunohistochemistry versus 82.3% without immunohistochemistry; P < 0.0001) and an increased number of passes (mean: 3.96 for diagnostic biopsies versus 3.62 for non-diagnostic biopsies; P = 0.044). CONCLUSION The use of advanced pathological techniques and an increased number of passes are the two main factors influencing the diagnostic success of biopsies in pediatric tumors.
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30
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Hata N, Song SE, Olubiyi O, Arimitsu Y, Fujimoto K, Kato T, Tuncali K, Tani S, Tokuda J. Body-mounted robotic instrument guide for image-guided cryotherapy of renal cancer. Med Phys 2016; 43:843-53. [PMID: 26843245 PMCID: PMC4723400 DOI: 10.1118/1.4939875] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/10/2015] [Accepted: 01/02/2016] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Image-guided cryotherapy of renal cancer is an emerging alternative to surgical nephrectomy, particularly for those who cannot sustain the physical burden of surgery. It is well known that the outcome of this therapy depends on the accurate placement of the cryotherapy probe. Therefore, a robotic instrument guide may help physicians aim the cryotherapy probe precisely to maximize the efficacy of the treatment and avoid damage to critical surrounding structures. The objective of this paper was to propose a robotic instrument guide for orienting cryotherapy probes in image-guided cryotherapy of renal cancers. The authors propose a body-mounted robotic guide that is expected to be less susceptible to guidance errors caused by the patient's whole body motion. METHODS Keeping the device's minimal footprint in mind, the authors developed and validated a body-mounted, robotic instrument guide that can maintain the geometrical relationship between the device and the patient's body, even in the presence of the patient's frequent body motions. The guide can orient the cryotherapy probe with the skin incision point as the remote-center-of-motion. The authors' validation studies included an evaluation of the mechanical accuracy and position repeatability of the robotic instrument guide. The authors also performed a mock MRI-guided cryotherapy procedure with a phantom to compare the advantage of robotically assisted probe replacements over a free-hand approach, by introducing organ motions to investigate their effects on the accurate placement of the cryotherapy probe. Measurements collected for performance analysis included accuracy and time taken for probe placements. Multivariate analysis was performed to assess if either or both organ motion and the robotic guide impacted these measurements. RESULTS The mechanical accuracy and position repeatability of the probe placement using the robotic instrument guide were 0.3 and 0.1 mm, respectively, at a depth of 80 mm. The phantom test indicated that the accuracy of probe placement was significantly better with the robotic instrument guide (4.1 mm) than without the guide (6.3 mm, p<0.001), even in the presence of body motion. When independent organ motion was artificially added, in addition to body motion, the advantage of accurate probe placement using the robotic instrument guide disappeared statistically [i.e., 6.0 mm with the robotic guide and 5.9 mm without the robotic guide (p = 0.906)]. When the robotic instrument guide was used, the total time required to complete the procedure was reduced from 19.6 to 12.7 min (p<0.001). Multivariable analysis indicated that the robotic instrument guide, not the organ motion, was the cause of statistical significance. The statistical power the authors obtained was 88% in accuracy assessment and 99% higher in duration measurement. CONCLUSIONS The body-mounted robotic instrument guide allows positioning of the probe during image-guided cryotherapy of renal cancer and was done in fewer attempts and in less time than the free-hand approach. The accuracy of the placement of the cryotherapy probe was better using the robotic instrument guide than without the guide when no organ motion was present. The accuracy between the robotic and free-hand approach becomes comparable when organ motion was present.
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Affiliation(s)
- Nobuhiko Hata
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Sang-Eun Song
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Olutayo Olubiyi
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | | | | | - Takahisa Kato
- Healthcare Optics Research Laboratory, Canon U.S.A., Cambridge, Massachusetts 02144
| | - Kemal Tuncali
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Soichiro Tani
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Junichi Tokuda
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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Tam AL, Lim HJ, Wistuba II, Tamrazi A, Kuo MD, Ziv E, Wong S, Shih AJ, Webster RJ, Fischer GS, Nagrath S, Davis SE, White SB, Ahrar K. Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel. J Vasc Interv Radiol 2015; 27:8-19. [PMID: 26626860 DOI: 10.1016/j.jvir.2015.10.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 10/23/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023] Open
Affiliation(s)
- Alda L Tam
- Departments of Interventional Radiology, Houston, Texas.
| | - Howard J Lim
- Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Anobel Tamrazi
- Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael D Kuo
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Etay Ziv
- Departments of Interventional Radiology and Computational Biology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephen Wong
- Department of Systems Medicine & Bioengineering, Houston Methodist Research Institute, Houston, Texas
| | - Albert J Shih
- Departments of Mechanical and Biomechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Gregory S Fischer
- Automation and Interventional Medicine Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Sunitha Nagrath
- Chemical and Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Suzanne E Davis
- Division of Cancer Medicine, Research Planning and Development, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sarah B White
- Department of Systems Medicine & Bioengineering, Houston Methodist Research Institute, Houston, Texas; Departments of Radiology, Neuroscience, Pathology & Laboratory Medicine, Weill Cornell Medical College of Cornell University, New York, New York; Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kamran Ahrar
- Departments of Interventional Radiology, Houston, Texas
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Kennedy SA, Milovanovic L, Midia M. Major bleeding after percutaneous image-guided biopsies: frequency, predictors, and periprocedural management. Semin Intervent Radiol 2015; 32:26-33. [PMID: 25762845 DOI: 10.1055/s-0034-1396961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Major bleeding remains an uncommon yet potentially devastating complication following percutaneous image-guided biopsy. This article reviews two cases of major bleeding after percutaneous biopsy and discusses the frequency, predictors, and periprocedural management of major postprocedural bleeding.
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Affiliation(s)
- Sean A Kennedy
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lazar Milovanovic
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mehran Midia
- Department of Diagnostic Imaging, McMaster University, Hamilton, Ontario, Canada
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Gene expression in hepatocellular carcinoma: pilot study of potential transarterial chemoembolization response biomarkers. J Vasc Interv Radiol 2015; 26:723-32. [PMID: 25724086 DOI: 10.1016/j.jvir.2014.12.610] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/16/2014] [Accepted: 12/20/2014] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To perform a feasibility study to explore the relationship between hepatocellular carcinoma genetics and transarterial chemoembolization treatment response to identify potential biomarkers associated with enhanced treatment efficacy. MATERIALS AND METHODS In this single-institution study, pretreatment hepatocellular carcinoma biopsy specimens for tumors in 19 patients (14 men, five women; mean age, 59 y) treated with chemoembolization between 2007 and 2013 were analyzed for a panel of 60 chemotherapy-sensitivity, hypoxia, mitosis, and inflammatory genes with the QuantiGene Plex 2.0 mRNA detection assay. Demographic, disease, and procedure data and tumor response outcomes were collected. Quantitative mRNA levels were compared based on radiologic response between tumors exhibiting complete response (CR) versus partial response (PR). RESULTS The study sample included 19 biopsy specimens from tumors (mean size, 3.0 cm; grade 1, n = 6; grade 2, n = 9; grade 3, n = 4) in patients treated with a mean of two conventional chemoembolization sessions. Thirteen and six tumors exhibited CR and PR, respectively, at a mean of 116 days after treatment. Tumors with CR showed a significant increase in (P < .05) or trend toward (P < .1) greater (range, 1.49-3.50 fold) pretreatment chemotherapy-sensitivity and mitosis (ATF4, BAX, CCNE1, KIF11, NFX1, PPP3CA, SNX1, TOP2A, and TOP2B) gene mRNA expression compared with tumors with PR, in addition to lower CXCL10 levels (0.48-fold), and had significantly (P < .05) higher (1.65-fold) baseline VEGFA levels. CONCLUSIONS Genetic signatures may allow prechemoembolization stratification of tumor response probability, and gene analysis may therefore offer an opportunity to personalize locoregional therapy by enhancing treatment modality allocation. Further corroboration of identified markers and exploration of their respective predictive capacity thresholds is necessary.
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Reimers MS, Engels CC, Kuppen PJK, van de Velde CJH, Liefers GJ. How does genome sequencing impact surgery? Nat Rev Clin Oncol 2014; 11:610-8. [PMID: 24958181 DOI: 10.1038/nrclinonc.2014.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cancer is a leading cause of death worldwide. Great efforts are dedicated to the development of prognostic and predictive biomarkers to improve diagnosis and achieve optimal treatment selection, thereby, introducing precision medicine in the multimodality treatment of cancer. Genomic aberrations are the basis of tumour development, representing excellent candidates for the development of promising clinical biomarkers. Over the past decade, single-gene mutations and genomic profiling have been increasingly used in multidisciplinary consultations for risk-assessment and treatment planning for patients with cancer. We discuss the impact of such genetic-based information on surgical decision-making. Single-gene mutations have already influenced surgical decision-making in breast, colorectal and thyroid cancer. However, the direct impact of genomic profiling on surgical care has not yet been fully established. We discuss the direct and indirect influences of genomic profiling on surgery, and analyse the limitations and unresolved issues of a genotypic-approach to the surgical management of cancer.
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Affiliation(s)
- Marlies S Reimers
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands
| | - Charla C Engels
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands
| | | | - Gerrit J Liefers
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands
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Concerning the feasibility of obtaining biopsies for research in relapsed ovarian cancer. Int J Gynecol Cancer 2013; 24:2-3. [PMID: 24356410 DOI: 10.1097/igc.0000000000000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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