Prognosis of Gleason score 8 prostatic adenocarcinoma in needle biopsies: a nationwide population-based study

A 5-tier grouping of Gleason scores has recently been proposed. Studies have indicated prognostic heterogeneity within these groups. We assessed prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) for men diagnosed with Gleason score 3 + 5 = 8, 4 + 4 = 8 and 5 + 3 = 8 acinar adenocarcinoma on needle biopsy in a population-based national cohort. The Prostate Cancer data Base Sweden 5.0 was used for survival analysis with PCSM and ACM at 5 and 10 years as endpoints. Multivariable Cox regression models controlling for socioeconomic factors, stage and primary treatment type were used for PCSM and ACM. Among 199,620 men reported with prostate cancer in 2000-2020, 172,112 were diagnosed on needle biopsy. In 18,281 (11%), there was a Gleason score of 8 in needle biopsies, including a Gleason score of 3 + 5, 4 + 4 and 5 + 3 in 11%, 86% and 2.3%, respectively. The primary treatment was androgen deprivation therapy (55%), deferred treatment (8%), radical prostatectomy (16%) or radical radiotherapy (21%). PCSM in men with Gleason scores of 3 + 5, 4 + 4 and 5 + 3 at 5 years of follow-up was 0.10 (95% CI 0.09-0.12), 0.22 (0.22-0.23) and 0.32 (0.27-0.36), respectively, and at 10 years 0.19 (0.17-0.22), 0.34 (0.33-0.35) and 0.44 (0.39-0.49), respectively. There was a significantly higher PCSM after 5 and 10 years in men with Gleason score 5 + 3 cancers than in those with 4 + 4 and in Gleason score 4 + 4 cancers than in those with 3 + 5. Grouping of Gleason scores will eliminate the prognostic granularity of Gleason scoring, thus diminishing the prognostic significance of this proposed grading system.

Prognosis of Gleason Score 9-10 Prostatic Adenocarcinoma in Needle Biopsies: A Nationwide Population-based Study

BACKGROUND

Since 2014, prostate cancer is reported using five-tier grouping of Gleason scores. Studies have suggested prognostic heterogeneity within the groups.

OBJECTIVE

We assessed the risk of prostate cancer death for men diagnosed with Gleason scores 4 + 5, 5 + 4, and 5 + 5 on needle biopsy in a population-based cohort.

DESIGN, SETTING, AND PARTICIPANTS

We used the data from Prostate Cancer data Base Sweden (PCBaSe) 4.0 for a survival analysis. Among 199 620 men reported to have prostate cancer in 2000-2020, 172 112 were diagnosed on needle biopsy. The primary treatment was classified as androgen deprivation therapy (66%), deferred treatment (5%), radical prostatectomy (7%), or radical radiotherapy (21%).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The risks of death from prostate cancer in men with Gleason score 9-10 at 5 and 10 yr were used as endpoints. Multivariable Cox regression models controlling for socioeconomic factors and primary treatment were used for time-to-event analyses of death from prostate cancer and death from any causes.

RESULTS AND LIMITATIONS

A total of 20 419 (12%) men had a Gleason score of 9-10, including Gleason scores of 4 + 5, 5 + 4, and 5 + 5 in 14 333 (70%), 4223 (21%), and 1863 (9%) men, respectively. The risks of prostate cancer death for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr of follow-up were 0.45 (confidence interval [CI] 0.44-0.46), 0.56 (0.55-0.58), and 0.66 (0.63-0.68), respectively. The risks of death of any cause for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr were 0.73 (CI 0.72-0.74), 0.81 (0.80-0.83), and 0.87 (0.85-0.89), respectively.

CONCLUSIONS

We demonstrate in the largest and most complete cohort analyzed to date that collapsing the Gleason scores by grouping results in loss of prognostic information in men with Gleason score 9-10 cancer.

PATIENT SUMMARY

Survival of prostate cancer patients with the highest tumor grades varies depending on grade composition.

Effects of preoperative needle biopsy for lung cancer on survival and recurrence: a systematic review and meta-analysis

Needle biopsy (NB) is used for the diagnosis of lung cancer, but there is still controversy about its effect on the prognosis after surgery. We conducted this meta-analysis to compare the prognosis of lung cancer patients who underwent preoperative NB with that of those who did not. We systematically searched seven databases and Google Scholar for eligible studies. Recurrence-free survival (RFS) and overall survival (OS) were analyzed as primary outcome measures. Nine articles with a collective total of 13,541 patients (NB group, n = 4550; non-NB group, n = 8991) were included in our meta-analysis. OS [hazard ratio (HR) = 1.43 (0.96, 2.12), p = 0.08] and RFS (HR = 1.59 [1.25, 2.01], p = 0.0001) tended to be better in the non-NB group than in the NB group. Pleural recurrence (risk ratio (RR) = 2.40 [1.42, 4.07], p = 0.001) was significantly lower in the non-NB group than in the NB group. The recurrence analysis data did not reach significance, but the overall trend was better for the non-NB group. These findings demonstrate that NB is detrimental to the survival prognosis of lung cancer patients and increases the chance of pleural recurrence.

Enhanced CT Findings in a Case of Recurrent Pelvic Follicular Dendritic Cell Sarcoma

INTRODUCTION

Follicular Dendritic Cell Sarcomas (FDCS)was first found in 1986; the specificity of the disease is its rarity, with an incidence of only 0.4%, numerous doctors for its lack of understanding, the accuracy of imaging diagnosis is not great, which is easy to delay the treatment. This article summarizes several characteristic imaging manifestations of FDCS to provide imaging physicians with an understanding of the imaging properties of this rare disease. When faced with complex cases, the radiologist can consider this disease and include it in the differential diagnosis. FDCS occurs mainly in lymph nodes, mainly in the head and neck. The main symptoms are fatigue, local pain, or painless mass. The treatment method is not uniform, but scholars agree that we should strive for the opportunity of surgery as much as possible.

CASE PRESENTATION

This paper reported a case of FDCS with pelvic recurrence 3 years after surgery. The patient was suspected to have lymphoma by postoperative pathology in the local hospital, and it is recommended that the patient be reexamined regularly. A soft tissue mass was recently found again in the left pelvic cavity. After an enhanced CT examination, the radiologist was skeptical of the previous diagnosis of lymphoma. Subsequently, a needle biopsy was performed at Peking University Shougang Hospital. The pathological results rejected the prior diagnosis of lymphoma after consultation with additional hospitals, and the patient was diagnosed with FDCS.

CONCLUSIONS

The imaging manifestations of FDCS lack absolute specificity, but it also has imaging characteristics, such as large areas of necrosis in the huge mass, rough mass calcification in the mass, enhanced scan showed "fast in and slow out" mode, and there were blood vessels in the tumor. FDCS mainly occurs in lymph nodes and is easily misdiagnosed as GIST, inflammatory myoblastoma, lymphoma, etc. Radiologists should continue to collect cases of this disease and include suspected cases in the differential diagnosis in clinical work.

Percutaneous ablation of renal tumors: Long-term outcomes

OBJECTIVE

To evaluate the long-term outcomes of renal tumor ablation, analyzing efficacy, long-term survival, and factors associated with complications and therapeutic success.

MATERIAL AND METHODS

We retrospectively reviewed 305 ablations (generally done with expandable electrodes) of 273 renal tumors between May 2005 and April 2019. We analyzed survival, primary and secondary efficacy, and complications according to various patient factors and tumor characteristics.

RESULTS

Mean blood creatinine was 1.14 mg/dL before treatment and 1.30 mg/dL after treatment (p < 0.0001). Complications were observed in 13.25% of the ablations, including major complications in in 4.97%. Complications were associated with age (p = 0.013) and tumor diameter (p < 0.0001). Primary efficacy was 96.28%. Incomplete ablation was more common in lesions measuring > 4 cm in diameter (p = 0.002). Secondary efficacy was 95.28%. The only factor associated with the risk of recurrence was the size of the tumor (p = 0.02). Overall survival was 95.26% at 1 year, 77.01% at 5 years, and 51.78% at 10 years, with no differences between patients with malignant and benign lesions. Mortality was higher in patients with creatinine >1 (p = 0.05) or ASA > 2 (p = 0.0001).

CONCLUSIONS

Percutaneous ablation is extremely efficacious for renal tumors; it improves the prognosis of renal carcinoma to the point where it does not differ from that of benign lesions. Complications are rare. Like survival, complications are associated with age and overall health status.

A cohort study of mammography-guided vacuum-assisted breast biopsy in patients with compressed thin breasts (≦ 3 cm)

OBJECTIVES

In the women with compressed thin thickness (≦ 3 cm), mammographic guiding vacuum-assist breast biopsy (MG-VABB) is a technical challenge. We herein report their performance of MG-VABB on suspicious microcalcification by modern mammography.

METHODS

We retrospectively reviewed the consecutive MG-VABB in our hospital from February 2019 to January 2021. All the patients received biopsy because of suspicious microcalcifications discovered by mammography and had at least one-year post-biopsy follow-up.

RESULTS

We reviewed 745 consecutive patients revealing 195 with compressed thin breasts ≦ 3 cm (mean age: 50.12 ± 7.0; breast thickness: 24.99 mm range 11.6-30 mm). Of the 191 patients received biopsy, the microcalcification retrieval rate was 97.9%. Using the half-open notch biopsy or horizontal needle approach, the biopsies were technically achieved in 30.4% and 9.4% of patients respectively. Regarding to the gold standard of surgicohistology, the cancer sensitivities was 88.46% and the atypia upgrade rate was 16.67%. There was no statistical difference of the procedure time between stereotactic guided and tomosynthesis guided.

CONCLUSIONS

The modern MG-VABB has technically improve the performance of biopsy to the patients with compressed thin breasts (≦ 3 cm), revealing approximate results to those breasts > 3 cm. The diagnosis helps the management of suspicious microcalcifications discovered by mammography.

Clinical significance of tumor cell seeding associated with needle biopsy in patients with breast cancer

BACKGROUND/OBJECTIVE

The occurrence of iatrogenic tumor cell seeding (seeding) in needle tract scars formed by core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) is well known. Some risk factors for seeding have been reported, but the clinicopathological risk factors and its prognosis have not been fully investigated. We evaluated the clinical features and prognosis of seeding.

METHODS

We included 4405 patients who had undergone surgery (lumpectomy or mastectomy) with a diagnosis of breast cancer by preoperative CNB or VAB at our hospital between January 2012 and February 2021. Data of patients with confirmed presence of seeding in resected specimens were collected from pathological records. We analyzed the risk factors of seeding using logistic regression analysis and compared the ipsilateral breast tumor recurrence (IBTR) rate between cases based on the presence or absence of seeding in the lumpectomy group.

RESULTS

Of the 4405 patients, 133 (3.0%) had confirmed seeding. Univariate analysis revealed the association of clinicopathological features of seeding with lower nuclear grade (NG1 vs NG2-3; p = 0.043), lower Ki-67 (<30 vs. ≥30; p = 0.049), estrogen receptor (ER) positivity (positive vs negative; p<0.01), and human epidermal growth factor receptor 2 (HER2) negativity (negative vs positive; p = 0.016). Multivariate analysis showed ER positivity (odds ratio, 5.23; p<0.05) as an independent risk factor of seeding. The IBTR rate was not significantly different between the seeding and non-seeding groups.

CONCLUSIONS

Seeding was more likely to occur in ER positive, HER2 negative carcinomas with less aggressive features, and may remain subclinical if adequate adjuvant treatments are administered.

Porocarcinoma with orbital metastasis, a case report with review of literature

We present a patient who presented with an orbital mass lesion which was a metastatic lesion from a porocarcinoma of the scalp with progressive deterioration of the patient.A 78-year-old male presented with functional decline and a rapidly growing scalp lesion of 3 months duration. In addition to the scalp lesion, Computed Tomography showed an incidental finding of a left lateral orbital wall tumour. Fine-needle aspiration of the two lesions revealed malignant cells with similar morphologies. Punch biopsy of the scalp lesion showed histological features suggestive of a porocarcinoma. Patient underwent palliative radiotherapy and immunotherapy and subsequently succumbed to the disease.

Fabrication of a translational photoacoustic needle sensing probe for interstitial photoacoustic spectral analysis

In our previous study, we demonstrated the feasibility of using an all-optical interstitial photoacoustic (PA) needle sensing probe for quantitative study of tissue architectures with PA spectral analysis (PASA). In this work, we integrated the optical components into an 18 G steel needle sheath for clinical translation. The dimensions of the needle probe are identical to those of a core biopsy probe and are fully compatible with standard procedures such as prostate biopsy. To our knowledge, this is the first interstitial PA probe that can acquire signals with sufficient temporal length for statistics-based PASA. We treated the inner surface of the steel needle sheath and successfully suppressed the vibrational PA signals generated at the surface. Purposed at boosting the measurement sensitivity and extending sensing volume, we upgraded the Fabry-Pérot hydrophone with a plano-concave structure. The performance of the translational needle PA sensing probe was examined with phantoms containing microspheres. The trend of the linear spectral slopes shows negatively correlated to the microsphere dimensions while the midband-fits are positively correlated to microsphere diameters and concentrations. The PASA quantifications show the ability to differentiate microspheres with varied dimensions.

Efficacy of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal and hilar lesions

BACKGROUND

Mediastinal and hilar lesions may be benign or malignant. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis of these lesions as it is both minimally invasive and safe.

OBJECTIVE

To investigate the clinical efficacy of EBUS-TBNA in the diagnosis and differential diagnosis of mediastinal and hilar lesions.

METHODS

A retrospective observational study was undertaken to investigate patients diagnosed with mediastinal and hilar lymphadenopathy based on imaging at our hospital from 2020 to 2021. After evaluation, EBUS TBNA was used and data including the puncture site, postoperative pathology, and complications were recorded.

RESULTS

Data from 137 patients were included in the study, of which 135 underwent successful EBUS TBNA. A total of 149 lymph node punctures were performed, of which 90 punctures identified malignant lesions. The most common malignancies were small-cell lung carcinoma, adenocarcinoma, and squamous cell carcinoma. Forty-one benign lesions were identified, resulting from sarcoidosis, tuberculosis, and reactive lymphadenitis, amongst others. Follow-up findings showed that 4 cases were malignant tumors, with 1 case of pulmonary tuberculosis and 1 case of sarcoidosis). Four specimens where lymph node puncture was insufficient were subsequently confirmed by other means. The sensitivity of EBUS TBNA for malignant lesions, tuberculosis and sarcoidosis in mediastinal and hilar lesions was 94.7%, 71.4%, and 93.3%, respectively. Similarly, the negative predictive values (NPV) were 88.9%, 98.5%, and 99.2%, and the accuracy was 96.3%, 98.5%, and 99.3%.

CONCLUSION

EBUS TBNA is an effective and feasible approach for the diagnosis of mediastinal and hilar lesions that is minimally invasive and safe.

Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes

AIM

Summarized the incidence of bleeding after ultrasound-guided coarse needle biopsy (US-CNB) of benign cervical lymph nodes.

METHODS

We retrospectively examined the clinical and follow-up records of 590 patients with benign cervical lymph node disease who underwent US-CNB at our hospital during February 2015-July 2022 and were confirmed to have the disease by CNB and surgical pathology. The number of cases, types of diseases, and degree of bleeding of all patients with bleeding after US-CNB were statistically analyzed.

RESULTS

Of the 590 patients, bleeding was noted in 44 cases(7.46%), and the infectious lymph node bleeding rate was 9.48%. Infectious lymph nodes were more likely to bleed than noninfectious lymph nodes after CNB, ,x² = 8.771; P = 0.003, Lymph nodes with pus were more likely to bleed than solid lymph nodes after CNB, x² = 4.414; P = 0.036,.

CONCLUSION

The bleeding of all patients after CNB was minor bleeding. Infected lymph nodes bleed more frequently than noninfected lymph nodes. Lymph nodes with mobility and a large pus cavity, are more likely to bleed after CNB.

Third-look contrast-enhanced ultrasonography plus needle biopsy for differential diagnosis of magnetic resonance imaging-only detected breast lesions

Research has shown that in approximately 20-30% of cases, breast lesions that were not detected on mammography (MG) or ultrasonography (US) were incidentally found during preoperative magnetic resonance imaging (MRI) examination for breast cancer. MRI-guided needle biopsy is recommended or considered for such MRI-only detected breast lesions invisible on second-look US, but many facilities in Japan cannot perform this biopsy procedure because it is expensive and time consuming. Thus, a simpler and more accessible diagnostic method is needed. Two studies to date have shown that third-look contrast-enhanced US (CEUS) plus needle biopsy for MRI-only detected breast lesions (i.e., MRI + /MG-/US-) that were not detected on second-look US showed moderate/high sensitivity (57.1 and 90.9%) and high specificity (100.0% in both studies) with no severe complications. In addition, the identification rate was higher for MRI-only lesions with a higher MRI BI-RADS category (i.e., category 4/5) than for those with a lower category (i.e., category 3). Despite the fact that there are limitations in our literature review, CEUS plus needle biopsy is a feasible and convenient diagnostic tool for MRI-only lesions invisible on second-look US and is expected to reduce the frequency of MRI-guided needle biopsy. When third-look CEUS does not reveal MRI-only lesions, a further indication for MRI-guided needle biopsy should be considered according to the BI-RADS category.

Evaluation of the performance of robot assisted CT-guided percutaneous needle insertion: Comparison with freehand insertion in a phantom

PURPOSE

To evaluate the performance of a novel robot for CT-guided needle positioning procedures and compare it to the freehand technique in an abdominal phantom.

METHODS

One interventional radiology fellow and one experienced interventional radiologist (IR) performed twelve robot-assisted and twelve freehand needle positionings in a phantom over predetermined trajectories. The robot automatically aimed a needle-guide according to the planned trajectories, after which the clinician manually inserted the needle. Using repeated CT scans, the needle position was assessed and adjusted if the clinician deemed it necessary. Technical success, accuracy, number of position adjustments, and procedure time were measured. All outcomes were analyzed using descriptive statistics and were compared between the robot-assisted and freehand procedures using the paired t-test and Wilcoxon signed rank test.

RESULTS

Compared with the freehand technique, the robot system improved the number of technically successfully needle targeting (20/24 vs 14/24), with higher accuracy (mean Euclidean deviation from target center: 3.5 ± 1.8 mm vs 4.6 ± 2.1 mm, p = 0.02) and required fewer needle position adjustments (0.0 ± 0.2 steps vs 1.7 ± 0.9 steps, p < 0.001), respectively. The robot improved the needle positioning for both, the fellow and the expert IR, compared to their freehand performances, with more improvement for the fellow than for the expert IR. The procedure time was similar for the robot-assisted and freehand procedures (19.5 ± 9.2 min. vs 21.0 ± 6.9 min., p = 0.777).

CONCLUSIONS

CT-guided needle positioning with the robot was more successful and accurate than freehand needle positioning and required fewer needle position adjustments without prolonging the procedure.

Orientation of the ultrasound probe to identify the taller-than-wide sign of thyroid malignancy: a registry-based study with the Thyroid Imaging Network of Korea

PURPOSE

Although the taller-than-wide (TTW) sign has been regarded as one of the most specific ultrasound (US) features of thyroid malignancy, uncertainty still exists regarding the US probe's orientation when evaluating it. This study investigated which US plane would be optimal to identify the TTW sign based on malignancy risk stratification using a registry-based imaging dataset.

METHODS

A previous study by 17 academic radiologists retrospectively analyzed the US images of 5,601 thyroid nodules (≥1 cm, 1,089 malignant and 4,512 benign) collected in the webbased registry of Thyroid Imaging Network of Korea through the collaboration of 26 centers. The present study assessed the diagnostic performance of the TTW sign itself and fine needle aspiration (FNA) indications via a comparison of four international guidelines, depending on the orientation of the US probe (criterion 1, transverse plane; criterion 2, either transverse or longitudinal plane).

RESULTS

Overall, the TTW sign was more frequent in malignant than in benign thyroid nodules (25.3% vs. 4.6%). However, the statistical differences between criteria 1 and 2 were negligible for sensitivity, specificity, and area under the curve (AUC) based on the size effect (all P<0.05, Cohen's d=0.19, 0.10, and 0.07, respectively). Moreover, the sensitivity, specificity, and AUC of the four FNA guidelines were similar between criteria 1 and 2 (all P>0.05, respectively).

CONCLUSION

A longitudinal US probe orientation provided little additional diagnostic value over the transverse orientation in detecting the TTW sign of thyroid nodules.

Comparison of clinical efficacy, subjective user experience, and safety for two different core biopsy needles, the Achieve® and Marquee®

PURPOSE

To compare clinical efficacy, subjective radiologist preference, and complication rates for two different core biopsy needles, the Achieve® and Marquee®.

METHODS

Retrospective review included consecutive patients who underwent 18 gauge non-targeted core liver biopsy, 30 with Achieve® (Merit Medical) and 30 with Marquee® (BD Bard) Pathologist (blinded to needle type) reviewed specimen total length, maximum width, and portal triad count. Sixteen radiologists subjectively rated (1 to 5(best)) each needle for cocking, firing, recoil, chamber exposure, handling, and overall. A medical records search of all (targeted and non-targeted) core liver biopsies 1/1/17-9/30/2020 compared rates of major (requiring transfusion and/or embolization) and minor (self-limited bleeding) hemorrhagic complications. Comparison between needle types was performed using t-test.

RESULTS

For Achieve® and Marquee® needles, the respective mean (SD) for total length(mm) was 29.7(7.0) and 31.9(4.6), p = 0.1; max width(mm) was 0.78(0.1) and 0.85(0.1), p < 0.01; and number of portal triads was 15.3(5.3) and 17.3(5.3), p = 0.2. Radiologists subjectively preferred the Marquee® for several measures including cocking, chamber exposure, and overall (p < 0.02 for each), while the needles were rated similarly for firing, recoil, and handling. Review of 800 cases showed no difference in major (1.0% Achieve®, 1.9% Marquee®, p = 0.5) or minor (1.5% Achieve®, 0.5% Marquee®, p = 0.3) rates of hemorrhagic complications.

CONCLUSION

Liver biopsy specimens were significantly wider with Marquee® compared to Achieve®. Radiologists preferred the Marquee® for multiple tactile measures, while the major complication rate was not significantly different. While both needles have a similar side-notch design, the Marquee® needle demonstrates better sample quality and higher user preference, without compromising safety.

Fabrication of SEBS Block Copolymer-Based Ultrasound Phantom Containing Mimic Tumors for Ultrasound-Guided Needle Biopsy Training

The creation of various phantoms is important in medical education, especially for intern physicians who need to practice their skills. Ultrasound phantoms are particularly useful for training in ultrasound-guided needle biopsy. SEBS, or poly(styrene-ethylene-butylene-styrene), is a thermoplastic elastomer that can be used with mineral oil to make ultrasound phantoms and a tumor-like structure. SEBS block copolymer-based phantoms are inexpensive, non-toxic and shelf-stable, and are easy to modulate. Most importantly, such ultrasound phantoms have acoustic and mechanical properties similar to those of human soft tissues. The quality of ultrasound images of phantoms and mimic tumors is excellent and can be maintained even after several biopsy needle punctures, making them excellent ultrasound phantoms for physician practice as needed.

Sustained Inflammation of Breast Tumors after Needle Biopsy

INTRODUCTION

Needle biopsy is essential for definitive diagnosis of breast malignancy. Significant histologic changes due to tissue damage have been reported in solid tumors. This study investigated the association between time from needle biopsy and inflammation in breast tumors.

METHODS

A total of 73 stage I-II invasive breast cancer cases diagnosed by image-guided needle biopsy who had surgery as their first definitive treatment were retrospectively analyzed. Time from biopsy to surgical excision ranged from 8 to 252 days. Histological sections of surgically resected tumors with a visible needle tract were reviewed by histologic evaluation. Data were analyzed by McNemar's test for proportional differences, and the Benjamini-Hochberg procedure was used to assess the association between immune cell prevalence and clinical variables.

RESULTS

Characteristic histology changes, including foreign body giant-cell reaction, synovial-cell metaplasia, desmoplastic repair changes, granulation tissue, fat necrosis, and inflammation, were frequently detected adjacent to the needle tract. Spatial comparison indicated that a higher proportion of cases had neutrophils, eosinophils, and macrophages adjacent to the needle tract than tumors distant from it. The presence of inflammatory cells adjacent to the needle tract was not associated with time from biopsy or subtype. Still, plasma cells were associated with residual carrier material from biopsy markers.

CONCLUSION

Macrophages and eosinophils are highly abundant and retained adjacent to the needle tract regardless of time from the biopsy.

Effect of intraoperative needle biopsy on the survival of nonsmall cell lung cancer patients: a propensity score matching analysis

Purpose

It is unknown whether intraoperative needle biopsy (INB) predisposes to the postoperative recurrence of lung cancer and compromises the prognosis of these patients. We conducted this study to identify the effect of INB before lobectomy on the postoperative recurrence rate and prognosis of patients with nonsmall cell lung cancer (NSCLC).

Methods

The subjects of this retrospective study were 953 patients with pathological stage I–III NSCLC who underwent lobectomy between 2001 and 2016. The patients were divided into two groups: the INB group (n = 94) and the non-INB group (n = 859). After propensity score matching (PSM), we compared the postoperative cumulative recurrence rate, recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) between the two groups.

Results

After PSM, 94 patient pairs were matched. The cumulative recurrence rate was significantly higher in the INB group than in the non-INB group (P = 0.01). The 5-year RFS rate was significantly lower in the INB group than in non-INB group (48% vs 68%), as were the 5-year DSS (76% vs 92%) and 5-year OS rates (67% vs 84%) (all P < 0.05).

Conclusions

The findings of this analysis suggest that INB before lobectomy may increase the cumulative recurrence rate and worsen the prognosis of patients with resectable NSCLC. Thus, we believe that INB should be avoided unless a lung lesion cannot be diagnosed by another type of biopsy.

Noncontact measurement of puncture needle angle using augmented reality technology in computed tomography-guided biopsy: stereotactic coordinate design and accuracy evaluation

PURPOSE

This study aims to introduce a new handheld device application for noncontact and real-time measurements of the angle of a biopsy needle using augmented reality (AR) image tracking technology. Furthermore, this study discusses the methods used to optimize the related coordinate design for computed tomography (CT)-guided biopsy procedures.

METHODS

An in-house noncontact angle measurement application was developed using AR platform software. This application tracks the position and direction of a printed texture located on the handle of a biopsy needle. The needle direction was factorized into two directions: tilting or rolling. Tilting was defined following the tilting of the CT gantry so that rolling would match the angle measured in CT images. In this study, CT-guided tumor biopsies were performed using a conventional guiding method with a protractor. The true value of needle rolling was measured by CT imaging and was then compared to the rolling measurement provided by the application developed in the current study using a mobile phone.

RESULTS

This study enrolled 18 cases of tumor biopsy (five renal tumors, five lung tumors, four retroperitoneal tumors, one soft tissue tumor, one thyroid tumor, one mesentery tumor, and one bone tumor). The measurement accuracy was - 0.2°, which was the average difference between AR and CT, and the measurement precision was 2.0°, which was the standard deviation of the difference between AR and CT measurements. The coefficient of determination (R²) was 0.996.

CONCLUSION

The noncontact needle measurement software using AR technology is sufficiently reliable for use in clinical settings. A real-time display of the needle angle that also shows the direction of the CT gantry is expected to enable a simple biopsy needle navigation.

Diagnosis and guidance of treatment of breast cancer cutaneous metastases by multiple needle biopsy: A case report

BACKGROUND

Breast cancer patients have a high skin metastasis rate. However, reports on treatment of cutaneous metastases of breast cancer are scarce.

CASE SUMMARY

We report the treatment process for one breast cancer case with bone, lung, and skin metastases. The patient was a 43-year-old woman with advanced breast cancer and skin metastasis. She underwent pathological diagnosis by needle biopsy to guide the treatment. When the disease progressed, a new pathological diagnosis was determined by needle biopsy to guide the treatment. The patient received chemotherapy, endocrine therapy, and photodynamic dynamic therapy, followed by sonodynamic therapy.

CONCLUSION

Repeated puncture should be performed for advanced breast cancer with skin metastasis, in order to obtain the pathology and directly determine diagnosis when the disease progresses. The treatment should focus on controlling the systemic metastasis, rather than the local disease.

Primary hyperoxaluria diagnosed after kidney transplantation: a case report and literature review

Background

Primary hyperoxaluria (PH) is a rare inherited autosomal recessive disease caused by disturbed glyoxylate metabolism. The disease is characterized by calcium oxalate crystal deposition in various organs, especially in the kidney. Due to the lack of current understanding of PH, nearly all patients are only initially diagnosed with PH when recurrent lithiasis and progressive end-stage renal disease occur. Many cases are not diagnosed in patients until renal allograft insufficiency occurs after renal transplantation. This case report and literature review aim to emphasize the need for careful pre-transplant PH screening of patients with bilateral nephrocalcinosis or nephrolithiasis.

Case presentation

Renal allograft insufficiency was diagnosed as PH after kidney transplantation. Here, we detail the complete clinical course, including computed tomography images of the original kidney and renal graft, histopathological images of a biopsy of the transplanted kidney, the results of laboratory and molecular genetic tests, and the treatment. In addition, we reviewed the literature from 2000 to 2021 and analyzed 19 reported cases of PH diagnosed after kidney transplantation, and provide a summary of the characteristics, complications, treatment, and prognosis of these cases.

Conclusions

By reviewing and analyzing these cases, we concluded that patients with a history of nephrocalcinosis or nephrolithiasis in both kidneys need preoperative screening for PH and appropriate treatment before kidney transplantation. Delayed graft function caused by PH is easily misdiagnosed as acute rejection, and needle biopsy should be performed at an early stage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02546-0.

Bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) for intubated patients with severe lung diseases

BACKGROUND

Examinations based on lung tissue specimen can play a significant role in the diagnosis for critically ill and intubated patients with lung infiltration. However, severe complications including tension pneumothorax and intrabronchial hemorrhage limit the application of needle biopsy.

METHODS

A refined needle biopsy technique, named bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB), was performed on four intubated patients between August 2020 and April 2021. BUS-PTNB was done at bedside, following an EPUBNOW (evaluation, preparation, ultrasound location, bronchus blocking, needle biopsy, observation, and withdrawal of blocker) workflow. Parameters including procedure feasibility, sample acquisition, perioperative conditions, and complications were observed. Tissue specimens were sent to pathological examinations and microbial tests.

RESULTS

Adequate specimens were successfully obtained from four patients. Diagnosis and treatment were correspondingly refined based on pathological and microbial tests. Intrabronchial hemorrhage occurred in patient 1 but was stopped by endobronchial blocker. Mild pneumothorax happened in patient 4 due to little air leakage, and closed thoracic drainage was placed. During the procedure, peripheral capillary hemoglobin oxygen saturation (SPO2), blood pressure, and heart rate of patient 4 fluctuated but recovered quickly. Vital signs were stable for patient 1-3.

CONCLUSIONS

BUS-PTNB provides a promising, practical and feasible method in acquiring tissue specimen for critically ill patients under intratracheal intubation. It may facilitate the pathological diagnosis or other tissue-based tests for intubated patients and improve clinical outcomes.

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications

Objective

To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses.

Materials and Methods

This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up.

Results

We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%.

Conclusion

Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer

PURPOSE

Persistent breast cancer disparities, particularly geographic disparities, may be explained by diagnostic practice patterns such as utilization of needle biopsy, a National Quality Forum-endorsed quality metric for breast cancer diagnosis. Our objective was to assess the relationship between patient- and facility-level factors and needle biopsy receipt among women with non-metastatic breast cancer in the United States.

METHODS

We examined characteristics of women diagnosed with breast cancer between 2004 and 2015 in the National Cancer Database. We assessed the relationship between patient- (e.g., race/ethnicity, stage, age, rurality) and facility-level (e.g., facility type, breast cancer case volume) factors with needle biopsy utilization via a mixed effects logistic regression model controlling for clustering by facility.

RESULTS

In our cohort of 992,209 patients, 82.96% received needle biopsy. In adjusted models, the odds of needle biopsy receipt were higher for Hispanic (OR 1.04, Confidence Interval 1.01-1.08) and Medicaid patients (OR 1.04, CI 1.02-1.08), and for patients receiving care at Integrated Network Cancer Programs (OR 1.21, CI 1.02-1.43). Odds of needle biopsy receipt were lower for non-metropolitan patients (OR 0.93, CI 0.90-0.96), patients with cancer stage 0 or I (at least OR 0.89, CI 0.86-0.91), patients with comorbidities (OR 0.93, CI 0.91-0.94), and for patients receiving care at Community Cancer Programs (OR 0.84, CI 0.74-0.96).

CONCLUSION

This study suggests a need to account for sociodemographic factors including rurality as predictors of utilization of evidence-based diagnostic testing, such as needle biopsy. Addressing inequities in breast cancer diagnosis quality may help improve breast cancer outcomes in underserved patients.

Malignant melanoma without primary, presenting as solitary pulmonary nodule: a case report

Background

Solitary pulmonary nodules are the most common incidental finding on chest imaging. Their management is very well defined by several guidelines, with risk calculators for lung cancer being the gold standard. Solitary intramuscular metastasis combined with a solitary pulmonary nodule from malignant melanoma without a primary site is rare.

Case presentation

A 57-year-old white male was referred to our lung cancer service with solitary pulmonary nodule. After positron-emission tomography, we performed an ultrasound-guided core needle biopsy of an intramuscular solitary lesion, not identified on computed tomography scan, and diagnosed metastatic malignant melanoma. The solitary pulmonary nodule was resected and also confirmed metastatic melanoma. There was no primary skin lesion. The patient received oral targeted therapy and is disease-free 5 years later.

Conclusions

Clinicians dealing with solitary pulmonary nodules must remain vigilant for other extrathoracic malignancies even in the absence of obvious past history. Lung metastasectomy may have a role in metastatic malignant melanoma with unknown primary.

Diagnostic Utility of p62 Expression in Intranuclear Inclusions in Thyroid Core Needle Biopsy Specimens

BACKGROUND/AIM

Core needle biopsy (CNB) has been widely used as an alternative method to ultrasound-guided fine-needle aspiration cytology for histological diagnosis of thyroid specimens. However, nuclear artifactual vacuoles (NuVas) produced during tissue processing can be very difficult and sometimes impossible to distinguish from intranuclear inclusions (NuIns). P62 is an autophagy receptor that recognizes, targets, and eliminates toxic cellular materials during autophagy. Herein, we examined the utility of p62 immunohistochemical staining to detect NuIns in thyroid core needle biopsy specimens.

PATIENTS AND METHODS

Thirty-five thyroid CNB slides from 32 patients and corresponding resection specimens stained with hematoxylin and eosin were reviewed by two pathologists. The immunohistochemical staining pattern of p62 was used to differentiate NuIns from NuVas. The diameter of each nucleus (A) and NuIn (B) was measured, and the number of p62-expressing NuIn-positive (p62In) cells was counted using 1/2 (B/A) and 1/3 (B/A) criteria. The criterion of 1/3 includes NuIns larger than 1/3 and smaller than 1/2 of the nuclear diameter. The criteria of 1/2 includes NuIns larger than 1/2 of the nuclear diameter.

RESULTS

By applying the 1/2 criterion, there were no p62In cells in follicular adenoma (FA) samples. However, in papillary thyroid carcinoma (PTC) samples, 22 of 25 specimens exhibited p62In cells. The sensitivity and specificity to distinguish FA from PTC using the 1/2 criterion were 0.88 and 1.00, respectively. By applying the 1/3 criterion, there was one p62In cell hit in FA samples. However, 23 of 25 PTC specimens showed p62In cells. The sensitivity and specificity to distinguish FA from PTC using the 1/3 criterion were 1.00 and 0.90, respectively.

CONCLUSION

P62 is a useful marker for distinguishing FA and PTC based on CNB specimens. We suggest the 1/2 criteria for identifying p62In cells.

Dermatofibrosarcoma protuberans: the diagnosis of high-grade fibrosarcomatous transformation

OBJECTIVES

Dermatofibrosarcoma protuberans (DFSP) is an intermediate-grade tumour which may undergo fibrosarcomatous transformation to a high-grade sarcoma (DFSP-FST). DFSP-FST requires wide local resection, and therefore, pre-operative identification is important. The aims of this study are to see if DFSP and DFSP-FST can be differentiated based on MRI appearances, and to determine the ability of ultrasound-guided core needle biopsy (US-CNB) to identify DFSP-FST.

MATERIALS AND METHODS

Retrospective review of patients with a histological diagnosis of DFSP with/without transformation to DFSP-FST. Patient age, gender, lesion location and maximal size were recorded, as were several MRI features. MRI studies were reviewed independently by 2 musculoskeletal radiologists and the assessed features were then compared with final surgical resection histology. Histological results of US-CNB were also compared with final surgical pathology.

RESULTS

A total of 42 patients were included, 26 males and 16 females with a mean age of 41.3 years (range 3-78 years). The upper limb was involved in 12 cases, the lower limb in 17 and the trunk in 13. Final surgical histological diagnosis was DFSP in 21 (50%) cases and DFSP-FST in 21 (50%) cases. Mean tumour dimension for DFSP was 32 mm and DFSP-FST 68 mm (p < 0.001). MRI features indicative of DFSP-FST included multi-lobular morphology (p = 0.03), T2W hypointensity compared with fat (p = 0.03), internal flow voids (p = 0.03) and peri-tumoral oedema (p < 0.001). Only 3 cases of DFSP-FST were correctly diagnosed on US-CNB.

CONCLUSIONS

Various MRI findings can suggest a diagnosis of DFSP-FST, but US-CNB is unreliable at identifying high-grade fibrosarcomatous transformation.

Needle biopsy compared with surgical biopsy: pitfalls of small biopsy in histologial diagnosis of IgG4-related disease

Objective

The growing utilization of needle biopsy has challenged the current pathology consensus of IgG4-related disease (IgG4-RD). The aims of this study were to identify the histological characteristics of needle biopsy and surgical specimens and evaluate the ability of needle biopsy in histological diagnosis of IgG4-RD.

Methods

Biopsies from patients who were referred to as IgG4-RD by the 2019 ACR/EULAR IgG4-RD classification criteria in Peking University People’s Hospital from 2012 to 2019 were re-evaluated. Typical histological features and diagnostic categories were compared between needle biopsy and surgical biopsy.

Results

In total, 69 patients met the 2019 ACR/EULAR classification criteria and 72 biopsies of them were re-evaluated. All cases showed lymphoplasmacytic infiltrate, while storiform fibrosis and obliterative phlebitis were only present in 35 (48.6%) and 23 (31.9%) specimens, respectively. Storiform fibrosis was more likely to be seen in retroperitoneum lesion (P = 0.033). Surgical biopsy showed significantly higher IgG4+ plasma cells/high-power field (IgG4/HPF) count (P < 0.01) and higher proportion of IgG4/HPF > 10 (P < 0.01). No significant difference was observed with regard to the ratio of IgG4+ plasma cells/IgG+ plasma cells (IgG4/IgG) (P = 0.399), storiform fibrosis (P = 0.739), and obliterative phletibis (P = 0.153). According to the 2011 comprehensive diagnostic criteria, patients who performed a needle biopsy were less likely to be probable IgG4-RD (P = 0.045). Based on the 2011 pathology consensus, needle biopsy was less likely to be diagnosed as IgG4-RD (P < 0.01), especially to be highly suggestive IgG4-RD (P < 0.01). Only 1/18 (5.6%) needle salivary specimens fulfilled the cutoff of IgG4/HPF > 100, which was significantly less than 15/23 (65.2%) of surgical ones (P < 0.01).

Conclusions

Needle biopsy shows an inferiority in detecting IgG4/HPF count but not in IgG4/IgG ratio, storiform fibrosis, and obliterative phlebitis. Compared with surgical samples, needle biopsy is less likely to obtain a histological diagnosis of IgG4-RD. A different IgG4/HPF threshold for needle biopsy of the salivary glands may be considered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-021-02432-y.

Review article: the current status of CT-guided needle biopsy of the spine

CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.

Standardization of reporting discontinuous tumor involvement in prostatic needle biopsy: a systematic review

Discontinuous tumor involvement (DTI) is a not uncommon finding in the tumor in prostate needle core biopsies undertaken for diagnosis of prostate cancer (PCa). The objective of this review is to establish a clear definition of DTI in order to provide a standardized method of measurement which reliably reflects pathologic features and disease progression following radical prostatectomy (RP). A systematic literature search was performed using PubMed up to March 2020 to identify studies of PCa patients which included needle biopsies containing DTI and matched subsequent RP treatment with or without follow-up information. The methodology and quality of reporting of DTI are reviewed, compared, and summarized. DTI is a frequent finding in diagnostic biopsy for PCa (up to 30%). Six studies were compared by methods of measurement used for predicting pathologic features and outcomes which are observed in subsequent RP. In most cases with DTI (> 90%), intervening benign tissue in the tumor core was less than 5 mm. DTI found in the biopsy was likely to be associated with a single, irregular tumor nodule going in and out of the plane of the section, but DTI was not associated with multiple small foci of the tumor. Immunohistochemistry (IHC) also demonstrated that about 75% of cases of DTI shared an IHC profile which supports the concept that DTI most likely comes from a homogeneous tumor nodule. Furthermore, DTI was associated with positive surgical margin (PSM) and bilateral tumor in RP specimens. Compared to additive measurement (with the subtraction of intervening benign tissue), linear measurement (including intervening benign tissue) of DTI was more accurately predictive of aggressive disease in the RP including higher pT stage, PSM, and greater actual extent of the tumor. However, the advantage of linear measurement was lost in cases where there was an upgrade from the biopsy to the RP which may result from undersampling. For cases with either very small tumor foci or very extensive cancer volume, no difference was observed in these two methods of measurement. DTI in core biopsies may represent undersampling of a larger irregular nodule but likely does not result from multifocality and is similarly unlikely to represent multiclonality. Linear measurement of DTI was more accurately predictive of post-RP pathologic findings and oncologic prognosis. This method should be applied for patient selection for AS.

Hemorrhagic shock necessitating resuscitation and damage control surgery after needle biopsy: A report of two cases

Percutaneous needle biopsy is minimally invasive and widely performed. Bleeding is an important complication of needle biopsy. Because the wound created by the needle is small, the recognition of bleeding in the body may be delayed, and this delay can lead to hemorrhagic shock and death. We report two cases of hemorrhagic shock in which the trauma triad of death developed after needle biopsy and the patients required resuscitation and damage control surgery. Needle biopsy is less invasive but cannot stop bleeding, and so surgery should be considered to ensure hemostasis in a compromised patient.

Suspected intra-articular soft-tissue tumours and tumour-like lesions: Performance of image-guided core needle biopsy

PURPOSE

To determine the efficacy of image-guided core needle biopsy (IGCNB) in patients presenting with suspected intra-articular soft tissue tumours or tumour-like lesions.

METHODS

Retrospective study of patients referred to a musculoskeletal oncology service between January 2019 and May 2020 with a suspected intra-articular soft tissue tumour over a 16-month period. Data collected included patient age, gender, joint involved and maximal lesion size. Type of image-guidance (ultrasound or computed tomography), type of needle and type of anaesthesia, general anaesthetic (GA) or local anaesthetic (LA), were recorded, as was the histological diagnosis. For patients who proceeded to surgical excision, the IGCNB histology result was correlated with resection histology. Descriptive statistics were used and complications were also noted.

RESULTS

By the termination of data collection 91 patients underwent IGCNB, 32 (35.2 %) males and 59 (64.8 %) females with a mean age of 41.4 years (age range 3-86 years). The joints involved were the knee (n = 73; 80.2 %), ankle (n = 12; 13.2 %), hip (n = 3; 3.3 %), shoulder (n = 1; 1.1 %), elbow (n = 1; 1.1 %) and wrist (n = 1; 1.1 %). Biopsy types were as follows: US-guided GA (n = 29; 31.9 %), US-guided LA (n = 37; 40.7 %), CT-guided GA, (n = 23; 25.3 %), CT-guided LA (n = 2; 2.2 %). Mean maximal tumour dimension for 76 focal lesions was 36.5 mm (range 18-113 mm). IGCNB yielded a definitive histological result in 85 of 91 cases (93.4 %), 44 of whom went on to surgical resection. Concordance between IGCNB and resection histology was achieved in 42 of 44 cases (95.5 %). The commonest diagnosis was tenosynovial giant cell tumour, with only a single malignant lesion identified. There were no recorded immediate or delayed complications.

CONCLUSIONS

IGCNB of suspected intra-articular tumours or tumour-like lesions is a highly effective and safe technique.

Usefulness of ultrasonography for diagnosing iatrogenic spinal accessory nerve palsy after lymph node needle biopsy: a case report

Background

Spinal accessory nerve (SAN) palsy is rare in clinical settings. Iatrogenicity is the most common cause, with cervical lymph node biopsy accounting for > 50% of cases. However, SAN palsy after lymph node needle biopsy is extremely rare, and the injury site is difficult to identify because of the tiny needle mark.

Case presentation

A 26-year-old woman was referred to our hospital with left neck pain and difficulty abducting and shrugging her left shoulder after left cervical lymph node needle biopsy. Five weeks earlier, a needle biopsy had been performed at the surgery clinic because of suspected histiocytic necrotizing lymphadenitis. No trace of the needle biopsy site was found on the neck, but ultrasonography (US) showed SAN swelling within the posterior cervical triangle. At 3 months after the injury, her activities of daily living had not improved. Therefore, we decided to perform a surgical intervention after receiving informed consent. We performed neurolysis because the SAN was swollen in the area consistent with the US findings, and nerve continuity was preserved. Shoulder shrugging movement improved at 1 week postoperatively, and the trapezius muscle manual muscle testing score recovered to 5 at 1 year postoperatively. The swelling diameter on US gradually decreased from 1.8 mm preoperatively to 0.9 mm at 6 months.

Conclusion

We experienced a rare case in which US was useful for iatrogenic SAN palsy. Our results suggest that preoperative US is useful for localization of SAN palsy and that postoperative US for morphological evaluation of the SAN can help assess recovery.

The differentiation between aneurysmal bone cyst and telangiectatic osteosarcoma: a clinical, radiographic and MRI study

OBJECTIVES

Aneurysmal bone cyst (ABC) and telangiectatic osteosarcoma (TOS) share several clinical and imaging features, including young presentation, long bone involvement, lytic appearance on radiography and fluid-fluid levels on MRI. Therefore, they may be difficult to differentiate. The aim of this study is to identify clinical, radiological and MRI features which aid differentiation of the two lesions.

MATERIALS AND METHODS

Retrospective review of all histologically confirmed ABC and TOS over an 11-year period. Data recorded include age at presentation, sex, skeletal location and various radiographic and MRI features.

RESULTS

This retrospective study included 183 patients, 92 males and 91 females. Mean age at presentation of 18.4 years (range 1-70 years); 152 cases of ABC and 31 TOS. No significant difference between age and sex. TOS was significantly less likely to involve the axial skeleton; no difference related to location within the bone. Radiographic findings significantly favouring ABC included a less aggressive pattern of bone destruction, a purely lytic appearance, an expanded but intact cortex, no periosteal response and no soft tissue mass. MRI features significantly favouring ABC included smaller tumour size (maximum mean dimension 46 mm compared to 95 mm for TOS), absence of soft tissue mass, > 2/3 of the lesion filled with fluid levels and thin septal enhancement following contrast.

CONCLUSIONS

Several radiographic and MRI features aid in the differentiation between ABC and TOS. Lesions with a geographic Type 1A or IB pattern of bone destruction which are completely filled with FFLs on MRI can confidently be diagnosed as ABC.

Two cases of spindle cell variant diffuse large B-cell lymphoma of the uterine cervix

Lymphoma with prominent spindle cell features is a morphological variant of diffuse large B-cell lymphoma (DLBCL) and is categorized as a rare variant by the WHO classification. Most cases arise from the skin, with only two cases reported in the uterine cervix to date. Here, we report two cases of spindle cell variant DLBCL of the uterine cervix. Although these cases might be rare, we believe that, as gynecologists and pathologists increase their knowledge of this variant type, more cases will be diagnosed properly.

From Wilms to kidney tumors: which ones require a biopsy?

Ninety percent of childhood renal tumors are Wilms tumors (nephroblastoma). While the Children's Oncology Group (COG) recommends primary surgery, the International Society of Paediatric Oncology (SIOP) recommends neoadjuvant chemotherapy, which can be initiated without histological confirmation if the presentation is typical for Wilms tumor. This review article describes the clinical, biological and radiologic criteria used by the SIOP community to consider diagnostic biopsy, i.e. when the renal origin is doubtful, when a pseudotumor is suspected or when a non-Wilms histology may be anticipated.

Deep learning algorithm for surveillance of pneumothorax after lung biopsy: a multicenter diagnostic cohort study

OBJECTIVES

Pneumothorax is the most common and potentially life-threatening complication arising from percutaneous lung biopsy. We evaluated the performance of a deep learning algorithm for detection of post-biopsy pneumothorax in chest radiographs (CRs), in consecutive cohorts reflecting actual clinical situation.

METHODS

We retrospectively included post-biopsy CRs of 1757 consecutive patients (1055 men, 702 women; mean age of 65.1 years) undergoing percutaneous lung biopsies from three institutions. A commercially available deep learning algorithm analyzed each CR to identify pneumothorax. We compared the performance of the algorithm with that of radiology reports made in the actual clinical practice. We also conducted a reader study, in which the performance of the algorithm was compared with those of four radiologists. Performances of the algorithm and radiologists were evaluated by area under receiver operating characteristic curves (AUROCs), sensitivity, and specificity, with reference standards defined by thoracic radiologists.

RESULTS

Pneumothorax occurred in 17.5% (308/1757) of cases, out of which 16.6% (51/308) required catheter drainage. The AUROC, sensitivity, and specificity of the algorithm were 0.937, 70.5%, and 97.7%, respectively, for identification of pneumothorax. The algorithm exhibited higher sensitivity (70.2% vs. 55.5%, p < 0.001) and lower specificity (97.7% vs. 99.8%, p < 0.001), compared with those of radiology reports. In the reader study, the algorithm exhibited lower sensitivity (77.3% vs. 81.8-97.7%) and higher specificity (97.6% vs. 81.7-96.0%) than the radiologists.

CONCLUSION

The deep learning algorithm appropriately identified pneumothorax in post-biopsy CRs in consecutive diagnostic cohorts. It may assist in accurate and timely diagnosis of post-biopsy pneumothorax in clinical practice.

KEY POINTS

• A deep learning algorithm can identify chest radiographs with post-biopsy pneumothorax in multicenter consecutive cohorts reflecting actual clinical situation. • The deep learning algorithm has a potential role as a surveillance tool for accurate and timely diagnosis of post-biopsy pneumothorax.

Needle deflection and tissue sampling length in needle biopsy

This study investigates the effect of needle tip geometry on the needle deflection and tissue sampling length in biopsy. Advances in medical imaging have allowed the identification of suspicious cancerous lesions which then require needle biopsy for tissue sampling and subsequent confirmatory pathological analysis. Precise needle insertion and adequate tissue sampling are essential for accurate cancer diagnosis and individualized treatment decisions. However, the single-bevel needles in current hand-held biopsy devices often deflect significantly during needle insertion, causing variance in the targeted and actual locations of the sampled tissue. This variance can lead to inaccurate sampling and false-negative results. There is also a limited understanding of factors affecting the tissue sampling length which is a critical component of accurate cancer diagnosis. This study compares the needle deflection and tissue sampling length between the existing single-bevel and exploratory multi-bevel needle tip geometries. A coupled Eulerian-Lagrangian finite element analysis was applied to understand the needle-tissue interaction during needle insertion. The needle deflection and tissue sampling length were experimentally studied using tissue-mimicking phantoms and ex-vivo tissue, respectively. This study reveals that the tissue separation location at the needle tip affects both needle deflection and tissue sampling length. By varying the tissue separation location and creating a multi-bevel needle tip geometry, the bending moments induced by the insertion forces can be altered to reduce the needle deflection. However, the tissue separation location also affects the tissue contact inside the needle groove, potentially reducing the tissue sampling length. A multi-bevel needle tip geometry with the tissue separation point below the needle groove face may reduce the needle deflection while maintaining a long tissue sampling length. Results from this study can guide needle tip design to enable the precise needle deployment and adequate tissue sampling for the needle biopsy procedures.

Complications after frame-based stereotactic brain biopsy: a systematic review

Stereotactic frame-based brain biopsy is one of the most used procedures to obtain brain tissue. This procedure is usually considered as mini-invasive, quick, efficient, and safe even if results of the different studies are widely heterogenous. The objective of this review of the literature is to describe and analyze the complications of stereotactic frame-based brain biopsy. About 132 articles were found after a research in the Medline database. We only considered English references published between 1994 and June 2019. Additional studies were found by using the references from articles identified in the original search. This systematic review was conducted according to PRISMA guidelines. After applying exclusion criteria, we eventually considered 25 relevant studies. The mortality rate varies from 0.7 to 4%. Overall morbidity ranges from 3 to 13%. Most of the complications are revealed by the following symptoms: neurological impairment (transient or permanent), seizure, and unconsciousness. Symptomatic hemorrhage range varies from 0.9 to 8.6%, whereas considering asymptomatic bleeding, the range may be up to 59.8%. Complications were clinically evident within minutes to a few hours after the biopsy. Corrective surgeries are very rare (< 1%). Complications occurring after a frame-based stereotactic brain biopsy are rare but with serious side effects. It rarely leads to death or to permanent neurological impairment. Description and classification of complications are often heterogeneous in the literature. The use of a grading scale could help comparisons between series from around the world. Future studies should establish a score that allows neurosurgeon to predict post-biopsy complications.

Income disparities in needle biopsy patients prior to breast cancer surgery across physician peer groups

OBJECTIVE

Evaluate income disparities in receipt of needle biopsy among Medicare beneficiaries and describe the magnitude of this variation across physician peer groups.

METHODS

The Surveillance, Epidemiology and End Results (SEER)-Medicare database was queried from 2007-2009. Physician peer groups were constructed. The magnitude of income disparities and the patient-level and physician peer group-level effects were assessed.

RESULTS

Among 9770 patients, 65.4% received needle biopsy. Patients with low income (median area-level household income < $33K) were less likely to receive needle biopsy (58.5%) compared to patients with high income (≥ $50K) (68.6%; adjusted odds ratio 0.77; 95% confidence interval (CI) 0.65-0.91). Needle biopsy varied substantially across physician peer groups (interquartile range 43.4-81.9%). The magnitude of the disparity ranged from an odds ratio (OR) of 0.50 (95% CI 0.23-1.07) for low vs. high income patients to 1.27 (95% CI 0.60-2.68). The effect of being treated by a physician peer group that treated mostly low-income patients on receipt of needle biopsy was nearly three times the effect of being a low-income patient.

CONCLUSIONS

Needle biopsy continues to be underused and disparities by income exist. The magnitude of this disparity varies substantially across physician peer groups, suggesting that further work is needed to improve quality and reduce inequities.

Safety and Success of Repeat Lung Needle Biopsies in Patients with Epidermal Growth Factor Receptor-Mutant Lung Cancer

BACKGROUND

Postprogression repeat biopsies are critical in caring for patients with lung cancer with epidermal growth factor receptor (EGFR) mutations. However, hesitation about invasive procedures persists. We assessed safety and tissue adequacy for molecular profiling among repeat postprogression percutaneous transthoracic needle aspirations and biopsies (rebiopsies).

MATERIALS AND METHODS

All lung biopsies performed at our hospital from 2009 to 2017 were reviewed. Complications were classified by Society of Interventional Radiology criteria. Complication rates between rebiopsies in EGFR-mutants and all other lung biopsies (controls) were compared using Fisher's exact test. Success of molecular profiling was recorded.

RESULTS

During the study period, nine thoracic radiologists performed 107 rebiopsies in 75 EGFR-mutant patients and 2,635 lung biopsies in 2,347 patients for other indications. All biopsies were performed with computed tomography guidance, coaxial technique, and rapid on-site pathologic evaluation (ROSE). The default procedure was to take 22-gauge fine-needle aspirates (FNA) followed by 20-gauge tissue cores. Minor complications occurred in 9 (8.4%) rebiopsies and 503 (19.1%; p = .004) controls, including pneumothoraces not requiring chest tube placement (4 [3.7%] vs. 426 [16.2%] in rebiopsies and controls, respectively; p < .001). The only major complication was pneumothorax requiring chest tube placement, occurring in zero rebiopsies and 38 (1.4%; p = .4) controls. Molecular profiling was requested in 96 (90%) rebiopsies and successful in 92/96 (96%).

CONCLUSION

At our center, repeat lung biopsies for postprogression molecular profiling of EGFR-mutant lung cancers result in fewer complications than typical lung biopsies. Coaxial technique, FNA, ROSE, and multiple 20-gauge tissue cores result in excellent specimen adequacy.

IMPLICATIONS FOR PRACTICE

Repeat percutaneous transthoracic needle aspirations and biopsies for postprogression molecular profiling of epidermal growth factor receptor (EGFR)-mutant lung cancer are safe in everday clinical practice. Coaxial technique, fine-needle aspirates, rapid on-site pathologic evaluation, and multiple 20-gauge tissue cores result in excellent specimen adequacy. Although liquid biopsies are increasingly used, their sensitivity for analysis of resistant EGFR-mutant lung cancers remains limited. Tissue biopsies remain important in this context, especially because osimertinib is now in the frontline setting and T790M is no longer the major finding of interest on molecular profiling.

Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry

Background

Accurate grading at the time of diagnosis if fundamental to risk stratification and treatment decision making in patients with prostate cancer. Whilst previous studies have demonstrated significant pathological upgrading and downgrading following radical prostatectomy (RP), these were based on historical cohorts and do not reflect contemporary patient selection and management practices. The aim of this national, multicentre observational study was to characterise contemporary rates and risk factors for pathological upgrading after RP in the United Kingdom (UK).

Methods

All RP entries on the British Association of Urological Surgeons (BAUS) Radical Prostatectomy Registry database of prospectively entered cases undertaken between January 2011 and December 2016 were extracted. Those patients with full preoperative PSA, clinical stage, needle biopsy and subsequent RP pathological grade information were included. Upgrade was defined as any increase in Gleason grade from initial needle biopsy to pathological assessment of the entire surgical specimen. Statistical analysis and multivariate logistic regression were undertaken using R version 3.5 (R Foundation for Statistical Computing, Vienna, Austria).

Results

A total of 17,598 patients met full inclusion criteria. Absolute concordance between initial biopsy and pathological grade was 58.9% (n = 10,364), whilst upgrade and downgrade rates were 25.5% (n = 4489) and 15.6% (n = 2745) respectively. Upgrade rate was highest in those with D’Amico low risk compared with intermediate and high-risk disease (55.7% versus 19.1 and 24.3% respectively, P < 0.001). Although rates varied between year of surgery and geographical regions, these differences were not significant after adjusting for other preoperative diagnostic variables using multivariate logistic regression.

Conclusions

Pathological upgrading after RP in the UK is lower than expected when compared with other large contemporary series, despite operating on a generally higher risk patient cohort. As new diagnostic techniques that may reduce rates of pathological upgrading become more widely utilised, this study provides an important benchmark against which to measure future performance.

Value of CT-guided percutaneous needle biopsy of bone in the diagnosis of lymphomas based on PET/CT results

Background

To evaluate the value of CT-guided percutaneous needle biopsy of bone in the diagnosis of lymphomas based on PET/CT results.

Methods

A retrospective analysis of the records of all patients with percutaneous bone biopsies based on PET/CT results and a final diagnosis of lymphoma between January 2012 and August 2017 was performed. Thirty-one patients were included in this study. The success and complication rates were assessed.

Results

The mean age of the 31 patients was 46.6 ± 21.2 years, and there were 16 men and 15 women. A definite diagnosis and accurate histological subtype were obtained in 26 patients, for a success rate of 84%. The most common subtype was diffuse large B cell lymphoma (n = 18). The remaining subtypes included three cases of marginal-zone lymphoma, two cases of follicular lymphoma, one case of Hodgkin’s lymphoma, one case of peripheral T cell lymphoma, and one case of B cell lymphoblastic lymphoma. No serious complications occurred in any of the patients.

Conclusions

CT-guided needle biopsy based on PET/CT results is a reliable means of diagnosing and classifying lymphomas.

Applying the PRECISION approach in biopsy naïve and previously negative prostate biopsy patients

OBJECTIVES

The PRECISION trial provides level 1 evidence supporting prebiopsy multiparametric magnetic resonance imaging (mpMRI) followed by targeted biopsy only when mpMRI is abnormal [1]. This approach reduced over-detection of low-grade cancer while increasing detection of clinically significant cancer (CSC). Still, important questions remain regarding the reproducibility of these findings outside of a clinical trial and quantifying missed CSC diagnoses using this approach. To address these issues, we retrospectively applied the PRECISION strategy in men who each underwent prebiopsy mpMRI followed by systematic and targeted biopsy.

METHODS AND MATERIALS

Clinical, imaging, and pathology data were prospectively collected from 358 biopsy naïve men and 202 men with previous negative biopsies. To apply the PRECISION approach, a retrospective analysis was done comparing the cancer yield from 2 diagnostic strategies: (1) mpMRI followed by targeted biopsy alone for men with Prostate Imaging Reporting and Data System ≥ 3 lesions and (2) systematic biopsy alone for all men. Primary outcomes were biopsies avoided and the proportion of CSC cancer (Grade Group 2-5) and non-CSC (Grade Group 1).

RESULTS

In biopsy naïve patients, the mpMRI diagnostic strategy would have avoided 19% of biopsies while detecting 2.5% more CSC (P= 0.480) and 12% less non-CSC (P< 0.001). Thirteen percent (n= 9) of men with normal mpMRI had CSC on systematic biopsy. For previous negative biopsy patients, the mpMRI diagnostic strategy avoided 21% of biopsies, while detecting 1.5% more CSC (P= 0.737) and 13% less non-CSC (P< 0.001). Seven percent (n= 3) of men with normal mpMRI had CSC on systematic biopsy.

CONCLUSIONS

Our results provide external validation of the PRECISION finding that mpMRI followed by targeted biopsy of suspicious lesions reduces biopsies and over-diagnosis of low-grade cancer. Unlike PRECISION, we did not find increased diagnosis of CSC. This was true in both biopsy naïve and previously negative biopsy cohorts. We have incorporated this information into shared decision making, which has led some men to choose to avoid biopsy. However, we continue to recommend targeted and systematic biopsy in men with abnormal MRI.

Desmopressin for the prevention of bleeding in percutaneous kidney biopsy: efficacy and hyponatremia

BACKGROUND

Desmopressin is used to reduce bleeding complications for kidney biopsies with azotemia but little is known about desmopressin-induced hyponatremia in these individuals. We aimed to evaluate the impact of desmopressin prophylaxis on severe hyponatremia and bleeding after kidney biopsies in individuals with renal impairment.

METHOD

This is a single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 150 µmol/L and had ultrasound-guided percutaneous native or transplant kidney biopsies between June 2011 and July 2015. Data were retrieved from electronic medical records. Primary outcomes were the use of desmopressin prophylaxis and severe hyponatremia (serum sodium ≤ 125 mmol/L) within 7 days post-biopsy. Secondary outcome was post-biopsy bleeding.

RESULTS

240 native kidney and 196 allograft biopsies were performed. Median age was 51 (IQR 42.3, 60) years and eGFR was 21.9 (12.9, 30.1) ml/min/1.73 m². Although patients prescribed desmopressin prophylaxis (n = 226) had higher serum creatinine [279 (201, 392) vs. 187 (160, 241), p < 0.001], bleeding (15.0% vs. 13.3%, p = 0.60) was not significantly different with and without desmopressin. Severe hyponatremia occurred in 30 biopsies (6.9%) with nadir serum sodium level of 122 (119, 124) mmol/L at 3 (2, 5) days after biopsy, more frequently among those with desmopressin prophylaxis (10.7% vs. 3.0%, p = 0.002). Multi-variate analysis found that pre-biopsy serum sodium level [adjusted OR 0.80 (95% CI 0.72, 0.90), p < 0.001] and desmopressin prophylaxis [adjusted OR 4.02 (95% CI 1.58, 10.21), p = 0.003] were independently associated with severe hyponatremia after kidney biopsy.

CONCLUSION

Pre-biopsy desmopressin was associated with severe hyponatremia in individuals with renal impairment; hence, susceptible patients given desmopressin should be closely monitored.

Direction of the Biopsy Needle in Ultrasound-Guided Renal Biopsy Impacts Specimen Adequacy and Risk of Bleeding

INTRODUCTION

Although medical factors such as hypertension and coagulopathy have been identified that are associated with hemorrhage after renal biopsy, little is known about the role of technical factors. The purpose of our study was to examine the effects of biopsy needle direction on renal biopsy specimen adequacy and bleeding complications.

METHODS

Two hundred and forty-two patients who had undergone ultrasound-guided renal biopsies were included. A printout of the ultrasound picture taken at the time of the biopsy was used to measure the biopsy angle ("angle of attack" [AOA]) and to determine if the biopsy needle was aimed at the upper or lower pole and if the medulla was targeted or avoided.

RESULTS

Of the 3 groups of biopsy angle, an AOA of between 50°-70° yielded the most glomeruli per core (P = .001) and the fewest inadequate specimens (4% vs 15% for > 70°, and 9% for < 50°, P = .038). Biopsy directed at a pole vs an interpolar region resulted in fewer inadequate specimens (8% vs 23%, P = .005), while biopsies that were medulla-avoiding resulted in fewer inadequate specimens (5% vs 16%, P = .004) and markedly reduced bleeding complications (12% vs 46%, P < .001) compared to biopsies where the medulla was entered.

DISCUSSION

An AOA of approximately 60°, aiming at the poles, and avoiding the medulla were each associated with fewer inadequate biopsies and bleeding complications. While biopsy of the medulla is necessary for some diagnoses, the increased bleeding risk emphasizes the need for communication between nephrologist, pathologist, and radiologist.

Rare case of primary extranodal marginal zone lymphoma of the thorax

Primary lymphoma presenting a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumors arise from metastasis. We report a case of a 64-year-old man with no history of HIV infection or pyothorax who presented with dry cough, right pleuritic pain and dyspnea. A computed tomography scan revealed an irregular pleural mass invading his right chest wall with pleural effusion. CT-guided needle biopsy revealed extranodal marginal zone B-cell lymphoma. The patient was treated with chemotherapy and radiotherapy. The patient has 9 years of follow up with 2 relapse's episodes.

Factors predicting the need for tube thoracostomy in patients with iatrogenic pneumothorax associated with computed tomography-guided transthoracic needle biopsy

Objectives

Traumatic iatrogenic pneumothorax occurs most often after a transthoracic needle biopsy. Since this procedure has become a common outpatient intervention, emergency department admissions of post-biopsy pneumothorax patients have increased. The aim of this study was to determine the factors that predict the need for tube thoracostomy in patients with post-biopsy pneumothorax in the emergency department.

Methods

A retrospective cross-sectional study was conducted on 191 patients with post-biopsy pneumothorax who were admitted to the emergency department between 2010 and 2017. Patient characteristics, clinical findings at the emergency department presentation, and procedural and radiological features were reviewed. A multivariate logistic regression model was constructed using the variables from univariate comparisons to determine the need for tube thoracostomy in patients with iatrogenic pneumothorax, and the effect sizes were demonstrated with odds ratios.

Results

Tube thoracostomies were performed on 69 out of 191 patients (36.1%). A total of 122 patients (63.9%) were treated with supplemental oxygen therapy without any other intervention, and 126 patients (66.0%) were hospitalized. In the multivariate model, the variables predicting the need for a tube thoracostomy were decreased breath sounds, dyspnea, decreased systolic blood pressure, decreased oxygen saturation and increased pleura–lesion distance. A distance of 19.7 mm predicted the need with a sensitivity of 69.6% and a specificity of 62.3%.

Conclusion

Decreased breath sounds, dyspnea, decreased systolic blood pressure, decreased oxygen saturation, and increased pleura-lesion distance may predict the need for a tube thoracostomy in patients with post-biopsy pneumothorax.

Predictors of adverse pathologic features after radical prostatectomy in low-risk prostate cancer

BACKGROUND

Prostate-specific antigen (PSA) screening more frequently detects early stage prostate cancer (PC). However, adverse pathologic features (APFs) after radical prostatectomy (RP) in low-risk PC occur. Previous related studies had utilized outdated staging criteria or small sample cohorts. In this study, we analyzed predictors of APFs after RP in low-risk PC using classification under the current criteria.

MATERIALS AND METHODS

We retrospectively reviewed medical records of 546 low-risk PC patients who had undergone RP. Low-risk PC was defined as PC with clinical T1-T2a, Gleason score ≤ 6, and PSA levels < 10 ng/mL. Clinical and pathological parameters were analyzed to predict APFs. APFs were defined as extracapsular extension (ECE), seminal vesicle invasion (SVI), or positive surgical margins (PSM). We analyzed our data using univariable and multivariable logistic regression analyses, as well as receiver operator characteristics to predict APFs.

RESULTS

Among 546 patients, ECE, SVI, and PSM were present in 199 (36.4%), 8 (1.5%), and 179 cases (32.8%), respectively. PSM had a significant correlation with preoperative high PSA levels and number of positive cores obtained. ECE/SVI was also significantly correlated with PSA levels and number of positive cores. As a result, presence of APFs after RP was associated with high PSA levels and large number of positive cores. PSA > 4.5 ng/mL and number of positive cores > 2 in low-risk PC were significantly associated with APFs, and suggested as cut-off values for predicting APFs.

CONCLUSIONS

PSA > 4.5 ng/mL and number of positive cores > 2 in low-risk PC were associated with presence of APFs and patients with such records should be considered carefully to provide active surveillance.

Diagnostic performance of CT-guided percutaneous transthoracic core needle biopsy using low tube voltage (100 kVp): comparison with conventional tube voltage (120 kVp)

Background Computed tomography (CT)-guided percutaneous transthoracic core needle biopsy (PTNB) is typically performed at 120 kVp tube voltage. However, there is no study that has demonstrated diagnostic performance including ground-glass nodules and radiation dose reduction at lower tube voltage in large population. Purpose To retrospectively compare the diagnostic performance and radiation dose between 100 kVp and 120 kVp during CT-guided PTNB. Material and Methods This study included 393 PTNBs performed in 385 patients (Group I; 120 kVp) from March 2011 to September 2011 and 1368 PTNBs performed in 1318 patients (Group II; 100 kVp) from October 2011 to December 2013. The patients underwent CT-guided PTNB with the coaxial technique. Diagnostic performance, complication rate, and radiation dose were compared between two groups. Results Technical success was achieved in 391 of 393 PTNBs (99.5%) in Group I and in 1344 of 1368 PTNBs (98.2%) in Group II ( P = 0.09). The diagnostic accuracies for pulmonary lesions were not significantly different between two groups (97.1% [362/373] versus 96.2% [1202/1249], P = 0.458). Complication rate showed no significant differences between two groups in terms of pneumothorax (19.7% [77/391] versus 19.4% [261/1344], P = 0.904) and hemoptysis (2.3% [9/391] versus 3.2% [43/1344], P = 0.360). Among patients who developed pneumothorax, three patients (3.9%, 3/77) in Group I and eight patients (3.1%, 8/261) in Group II required treatment with drainage catheter. Nobody needed further treatment for hemoptysis in the two groups. The mean radiation dose was 1.5 ± 1.9 mSv in Group I and 0.7 ± 0.3 mSv in Group II ( P < 0.001). Conclusion The 100-kVp protocol for CT-guided PTNB showed significant benefit of radiation dose reduction while maintaining high diagnostic accuracy and safety.