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Diagnostic Usefulness of Tru-Cut Biopsy in the Diagnosis of Breast Lesions
Ammar Rikabi,Sufia Hussain
Oman Medical Journal , 2013,
Abstract: Objective: To evaluate the usefulness of Tru-Cut biopsy (TCB) in the diagnosis of breast lesions.Methods: An observational non-interventional cross-sectional review was performed of all TCB reports of a mass or lesion observed in patients admitted between January 2008 and December 2010, at King Khalid University Hospital, Riyadh, Saudi Arabia.Results: A total of 275 trucut biopsies were performed during the study period. Histopathology showed 92 (33.5%) malignant lesions, 177 (64.3%) benign lesions and 6 (2.2%) suboptimal or suspicious lesions. Repeat trucut biopsies were done in 29 (16.4%) of the benign cases, 12 (13%) of the malignant cases, and for 6 inconclusive specimens which showed 4 of the 29 benign cases to be malignant lesions, and 5 of the 6 inconclusive cases were also malignant lesions. All 12 malignant cases that had repeat trucut biopsy had a confirmed diagnosis of malignancy. Trucut biospy had a sensitivity of 95.1%, specificity of 100%, positive predictive value of 100%, negative predictive value of 97.2%, and an overall diagnostic accuracy of 98.2%.Conclusion: Trucut biopsy is an accurate alternative to fine needle aspiration cytology in the diagnosis of breast lesions with a high diagnostic accuracy of 98.2%.
Correct Pre-Operative Diagnosis of Breast Cancer by Tru-cut Biopsy: Key Point in Breast Cancer Management and a Part of Patient Right
A. Joulaee,M. Kalantari,M. Salamati
Iranian Journal of Radiology , 2009,
Abstract: The new revolutionary concept in breast cancer diagnosis and management during the last 3 decades significantly decreases invasion against patients while maximizing the accuracy of diagnosis and the effectiveness of treatment."n"n In this new concept team work multidisciplinary approach is the key. The presence of an interventional breast radiologist in this new approach is absolutely necessary. The role of an interventional and a non interventional breast radiologist in this team work is highlighted and must be respected, especially by surgeons. Now the surgeon performs surgery only to treat the patient either for malignant pathology or symptomatic benign masses. No surgery is acceptable for diagnosis or staging. Diagnosis is best done by preoperative Tru-cut biopsy is done by an interventional breast radiologist for non palpable lesions in the ideal situation. For palpable lesions depending on the situation either a radiologist or a surgeon would carry out office tru-cut biopsy. For non palpable lesions, the interventional radiologist and not the surgeon performs the diagnosis. Depending on the case, either the radiologist or the surgeon can peform Tru-cut biopsy for palpable lesions. The benefits of pre-operative diagnosis are both for the patients and the whole health care system. The patient would profit the most from this new concept: -No surgery would be done for non-cancerous non-symptomatic lesions. -In the case of cancer, diagnosis would be confirmed pre-operatively. Correct pre-operative diagnosis would eliminate unnecessary surgery for benign pathology for many non-palpable and non-symptomatic palpable lesions. The patient would profit from not having surgery for a benign condition and as a result there will be no endangered health. In the same time avoidance of surgery for non-symptomatic benign breast pathology would significantly decrease the overall health care price for breast disease to have more budgets to instruct standard breast units and to start mammography based screening. In the case of cancer, this approach would eliminate all pitfalls of intra-operative diagnosis by frozen section. There would be enough time for correct diagnosis of the cancer and surgical plan decision. The patient and her family would participate actively in the surgical and even the whole treatment plan. The surgical procedure including sentinel node biopsy would be done as a single procedure in the same session. Altogether these would significantly decrease the price of breast cancer treatment both for the patient and the government. The patient would rec
Superiority of laparoscopic guided needle biopsy over percutaneous blind needle biopsy in diagnosing hepatocellular carcinoma associated with cirrhosis  [cached]
Al-Saigh Abdulaziz
Saudi Journal of Gastroenterology , 1998,
Abstract: This is a retrospective study of 40 patients clinically suspected of having hepatocellular carcinoma. Group 1 (20) patients underwent laparoscopic Tru-cut needle liver biopsy and Group II (20 patients) underwent percutaneous blind needle liver biopsy. In the first group, in 17 (85%) of the patients, the diagnosis of hepatocellular carcinoma was confirmed by histopathology, direct observation of cirrhosis was seen in 8 (40%) patients, histopathology confirmation of cirrhosis was documented in 6 (35%) patients. In the second group, 14 (70%) of the patients were confirmed to have hepatocellular carcinoma histopathologically and no patients confirmed to have cirrhosis. Both procedures were safe. While ascitic leak from the infraumbilical incision was the only complication encountered in the 1st group, no complications were encountered in the 2nd group. The results support the premise that laparoscopy directed cutting needle biopsy is superior over other techniques in fulfilling all the diagnostic requirements for hepatocelullar carcinoma and associated liver cirrhosis which is important for surgical liver resection.
Utilidad y complicaciones de la biopsia percutánea esplénica con aguja tru-cut guiada por imágenes: Review of 13 procedures Ultrasound guided needle biopsy of the spleen  [cached]
Revista Chilena de Cirugía , 2010,
Abstract: Objetivo: Reportar la experiencia de biopsias percutáneas esplénicas con aguja tru-cut guiadas por imágenes. Materiales y Métodos: Revisión retrospectiva de biopsias esplénicas con aguja tru-cut guiadas por ultrasonido (US) y tomografía computada (TC) realizadas en nuestro hospital desde Enero de 2005 a Abril de 2009. Resultados: Se identificaron un total de 13 procedimientos. La biopsia percutánea logró un diagnóstico específi co en 9 (69%) de las 13 intervenciones. Los diagnósticos fueron linfoma (n = 4), melanoma (n = 2), sarcoma (n = 1), hematopoyesis extramedular (n = 1) y criptococosis esplénica (n = 1). De las biopsias no diagnósticas 3 casos correspondieron a patología neoplásica y uno a patología benigna. Se reportaron 2 complicaciones (15%). Discusión: La biopsia esplénica percutánea guiada por imágenes con aguja tru-cut es un procedimiento útil y seguro, capaz de determinar el diagnóstico definitivo en la mayoría de los pacientes y evitar la mayoría de las esplenectomías diagnósticas. Background: Needle biopsies of the spleen were avoided due to the fear of bleeding in a highly vas-cularized organ. However their safety, even using 18 gauge needles, has been demonstrated. Aim: To report the experience with ultrasound guided needle biopsies of the spleen. Material and Methods: Retrospective review of records of ultrasound guided biopsies of the spleen using Tru-cut needles, performed between 2005 and 2009. Results: Thirteen procedures performed in 12 patients were identified. A specific diagnosis was achieved in nine (69%) procedures (lymphoma in four, melanoma in 2, sarcoma in 1, extremedullary erythropoiesis in one and splenic cryptococcosis in one. Two patients with negative results were subjected to a new biopsy, which yielded the diagnosis of lymphoma. A third patient was studied elsewhere, finding a malignant tumor. Two patients had complications, one had a vagal reaction and other had a perisplenic hematoma without clinical repercussion. Conclusions: Ultrasound guided needle biopsy of the spleen is a safe and useful procedure.
Technical Note: Facilitating Laparoscopic Liver Biopsy by the Use of a Single-Handed Disposable Core Biopsy Needle  [PDF]
M. I. Trochsler,Q. Ralph,F. Bridgewater,H. Kanhere,Guy J. Maddern
HPB Surgery , 2013, DOI: 10.1155/2013/462498
Abstract: Despite the use of advanced radiological investigations, some liver lesions cannot be definitely diagnosed without a biopsy and histological examination. Laparoscopic Tru-Cut biopsy of the liver lesion is the preferred approach to achieve a good sample for histology. The mechanism of a Tru-Cut biopsy needle needs the use of both hands to load and fire the needle. This restricts the ability of the surgeon to direct the needle into the lesion utilising the laparoscopic ultrasound probe. We report a technique of laparoscopic liver biopsy using a disposable core biopsy instrument (BARD (R) disposable core biopsy needle) that can be used single-handedly. The needle can be positioned with laparoscopic graspers in order to reach posterior and superior lesions. This technique can easily be used in conjunction with laparoscopic ultrasound. 1. Introduction Increased availability of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) has resulted in incidental hepatic masses being reported more frequently. Indeterminate lesions especially in the cirrhotic liver often pose a diagnostic challenge. Specific radiological features such as a central scar in focal nodular hyperplasia or venous washout in hepatocellular carcinoma (HCC) are not always present. Colli et al. estimated 68% sensitivity and 93% specificity of spiral CT in diagnosing HCC compared with pathologic examination in their systematic review [1]. In a small number of cases—even with the use of 4-phase multidetector CT and contrast-enhanced MRI—a conclusive answer as to whether the lesion is benign or malignant or has a malignant potential might not be possible [2]. Laparoscopic Tru-Cut biopsy provides a definitive approach to determine the nature of a liver lesion. Percutaneous biopsy carries the risk of needle track or peritoneal seeding especially in the setting of a hepatocellular carcinoma [3, 4]. Laparoscopy and laparoscopic liver biopsy present an alternative and allows assessment of the peritoneal cavity to exclude advanced disease and gross liver cirrhosis in the same sitting. Lesions in the superior (2, 4a, 8) and posterior (6, 7) segments of the liver are technically challenging to biopsy during laparoscopy. A low lying and shallow rib cage combined with location of the lesions in the superior liver segments further increases the technical difficulty of laparoscopic liver biopsy. The biopsy needle may need to be introduced through the abdominal wall angled cephalad in order to reach the superior segments. A Tru-Cut biopsy needle often lacks the length to reach the lesion
Diagnosing multiple opportunistic infections: the value of a liver biopsy
JG Peter, MW Sonderup
Southern African Journal of HIV Medicine , 2008,
Abstract: Liver function test abnormalities are prevalent in patients with HIV, and in particular advanced HIV.1 Opportunistic infections, drug hepatotoxicity and viral hepatitis co-infections are frequently encountered.2-4 We present a patient with advanced HIV and abnormal liver function tests in whom the definitive diagnosis of multiple opportunistic infections was made by liver biopsy. This case illustrates the diagnostic value of liver biopsy in our local patient population, where diagnostic uncertainty is common and empiric therapy is often the standard of care. Southern African Journal of HIV Medicine Vol. 9 (4) 2008: pp. 51-52
Diagnosing celiac disease by video capsule endoscopy (VCE) when esophogastroduodenoscopy (EGD) and biopsy is unable to provide a diagnosis: a case series
Matthew S Chang, Moshe Rubin, Suzanne K Lewis, Peter H Green
BMC Gastroenterology , 2012, DOI: 10.1186/1471-230x-12-90
Abstract: We report a single center case series of 8 patients with suspected celiac disease who were diagnosed by VCE.EGD and biopsy had been performed in 4 patients resulting in a negative biopsy, declined by 2, and contraindicated in 2 due to hemophilia and von Willebrand disease. In all patients, mucosal changes of scalloping, mucosal mosaicism and reduced folds were seen in either the duodenum or jejunum on VCE. Follow-up in 7 patients demonstrated improvement in either their serological abnormalities or their presenting clinical features on a gluten-free diet.Our case series demonstrates that VCE and the visualization of the characteristic mucosal changes of villous atrophy may replace biopsy as the mode of diagnosis when EGD is either declined or contraindicated, or when duodenal biopsies are negative and there remains a high index of suspicion. Further study is needed to clarify the role and cost of diagnosing celiac disease with VCE.
Diagnosing a Gastric Submucosal Tumor Using Jumbo Biopsy “Unroofing” Technique: A Case Report and Review of the Literature  [PDF]
Sakshi Kapur,Pradeep Mahal,Levin Miles,Adnan Hussain
Case Reports in Oncological Medicine , 2013, DOI: 10.1155/2013/414518
Abstract: We report a case of a 40-year-old female who presented with dyspeptic symptoms for six months. Upper GI endoscopy revealed a submucosal nodule in gastric antrum. Using “jumbo biopsy unroofing technique” we were able to get adequate tissue for analysis. Histopathology revealed a type III gastric carcinoid. Patient was treated with laparoscopic distal subtotal gastrectomy with Roux-en-Y reconstruction and partial omentectomy. Although there was no evidence of metastasis on initial presentation, eighteen months later, patient was found to have multiple metastatic lesions in her liver. Patient’s lesions were treated with intra-arterial (hepatic artery) Yttrium-90. 1. Introduction Gastric submucosal tumors are a common incidental finding occurring on routine upper GI endoscopies. Although different modalities for diagnosing these tumors are available, definitive diagnosis requires tissue analysis. Tissue acquisition for gastric submucosal tumors can be challenging. We report a case of a 40-year-old female who presented with dyspeptic symptoms. Upper GI endoscopy revealed a submucosal nodule in gastric antrum. Histopathology was compatible with a type III gastric carcinoid. Although there was no evidence of metastasis on initial presentation, eighteen months later, patient was found to have multiple metastatic lesions in her liver. Our case highlights the malignant potential of a gastric submucosal nodule, which may otherwise present as an incidental finding on upper GI endoscopy. 2. Case Presentation A 40-year-old female presented with dyspeptic symptoms for six months. She denied any nausea, vomiting, or change in bowel habits. There was no history of hematemesis, melena, or weight loss. Physical examination revealed an obese female with normal vital signs. Head and neck exam was positive for mild pallor but no icterus, thyromegaly, or lymph node enlargement was noted. Abdomen was soft, nontender with no hepatosplenomegaly. Workup revealed a Hb of 11?gm/dL, white blood count of 11000/ L, and a platelet count of 2.26 × 103/ L. Blood urea nitrogen, creatinine, and electrolytes were normal. Patient underwent an esophagogastroduodenoscopy and was found to have a Helicobacter pylori related chronic active gastritis. Concurrently, a submucosal mass measuring about 2.0?cm was noted in the gastric antrum (Figure 1). Figure 1: Esophagogastroduodenoscopy showing a submucosal nodule in gastric antrum. Using jumbo biopsy “unroofing” technique, we were able to get extensive biopsies of this mass, and results revealed a well differentiated neuroendocrine tumor (NET)
Physics Features of TRU-Fueled VHTRs  [PDF]
Tom G. Lewis III,Pavel V. Tsvetkov
Science and Technology of Nuclear Installations , 2009, DOI: 10.1155/2009/214285
Abstract: The current waste management strategy for spent nuclear fuel (SNF) mandated by the US Congress is the disposal of high-level waste (HLW) in a geological repository at Yucca Mountain. Ongoing efforts on closed-fuel cycle options and difficulties in opening and safeguarding such a repository have led to investigations of alternative waste management strategies. One potential strategy for the US fuel cycle would be to make use of fuel loadings containing high concentrations of transuranic (TRU) nuclides in the next-generation reactors. The use of such fuels would not only increase fuel supply but could also potentially facilitate prolonged operation modes (via fertile additives) on a single fuel loading. The idea is to approach autonomous operation on a single fuel loading that would allow marketing power units as nuclear batteries for worldwide deployment. Studies have already shown that high-temperature gas-cooled reactors (HTGRs) and their Generation IV (GEN IV) extensions, very-high-temperature reactors (VHTRs), have encouraging performance characteristics. This paper is focused on possible physics features of TRU-fueled VHTRs. One of the objectives of a 3-year U.S. DOE NERI project was to show that TRU-fueled VHTRs have the possibility of prolonged operation on a single fuel loading. A 3D temperature distribution was developed based on conceivable operation conditions of the 600 MWth VHTR design. Results of extensive criticality and depletion calculations with varying fuel loadings showed that VHTRs are capable for autonomous operation and HLW waste reduction when loaded with TRU fuel.
Biópsia hepática com agulha tru-cut guiada por videolaparoscopia em caprinos
Duarte, A.L.L.;Cattelan, J.W.;Bezerra, M.B.;Vicente, W.R.R.;Cordeiro, M.F.;
Arquivo Brasileiro de Medicina Veterinária e Zootecnia , 2009, DOI: 10.1590/S0102-09352009000100003
Abstract: the videolaparoscopic guided hepatic biopsy with tru-cut needle is described in 12 healthy, no defined breed, castrated male goats. animals were distributed in two groups: g1 (n=5) 12-month-old animals; and g2 (n=7) six-month-old animals. the procedure was performed with the animal in left lateral recumbency and under total intravenous anesthesia. pneumoperitoneum and laparoscopy were performed in the right flank, approximately 10cm ventral to the transverse processes of the lumbar vertebrae. the tru-cut needle was inserted into the right eleventh intercostal space, around 12cm ventral to the spinal column, for punching and removal of a fragment from the right hepatic lobe. the average time spent in the surgical procedure was 23 minutes and five seconds. the hemorrhage caused by the liver biopsy ceased in two minutes (75%) and in three minutes in the other animals (25%). in the clinical evaluations performed during the pre-fasting period and 24, 48, and 72 hours after the biopsy procedure, neither group presented alterations (p>0.05) evaluated by rectal temperature; and cardiac, respiratory, and rumen frequencies. the videolaparoscopic guided hepatic biopsy with tru-cut needle was considered efficacious to be used in goats, providing hepatic tissue fragments suitable for histological examination.
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