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PubMed2025

Image-guided biopsy of breast lesions-when to use what biopsy technique.

In recent years, minimally invasive diagnostic options for breast lesions have expanded, but consensus on optimal biopsy techniques and imaging combinations remains lacking. This study, driven by an adapted RAND-UCLA Appropriateness Method and insights from eight experts in breast biopsy from across the world, aims to create consensus for selecting biopsy techniques. Highlighted findings suggest Vacuum-Assisted Biopsy (VAB) for lesions visible exclusively at mammography/tomosynthesis (with or without contrast enhancement) or MRI. Core-needle biopsy (CNB) takes precedence for masses over 5 mm visible under US. The selection of other biopsy techniques during US-guided procedures depends on lesion type, size, and sampling indication. VAB is preferred for smaller masses (< 5 mm), complex cystic and solid lesions with small solid parts, small intraductal masses, architectural distortions, and calcifications visible on US. In re-biopsy scenarios for inconclusive findings or high-risk lesions, the panel suggests two VAB extensions: Extended Vacuum-Assisted Biopsy (EVAB) for unambiguous lesion classification and Vacuum-Assisted Excision (VAE) for complete lesion removal. Furthermore, the panel provides detailed input on how to handle specific cases, such as re-biopsy for lobular neoplasia, flat epithelial atypia and atypical ductal hyperplasia. Surgical excision is advised for DCIS and benign or borderline phyllodes tumors found through initial CNB or VAB. In conclusion, an international expert group formulated recommendations on diagnostic breast biopsies under image guidance, aiming to ensure accurate diagnosis worldwide by providing practical advice on needle selection and biopsy approach. KEY POINTS: Evidence-based literature on the preferred biopsy technique and imaging combination for the diagnosis of breast lesions is sparse, and a general consensus is not available. The selection of biopsy technique for different image-guided procedures depends on lesion type, size, and sampling indication. This international expert panel consensus statement addresses standard approaches for varying biopsy indications.

Breast cancer↗

PubMed1976

Renal biopsy in children: analysis of 61 cases of open wedge biopsy and comparison with percutaneous biopsy.

Explore the source record for details and available documents.

Age Factors↗

PubMed1977

Retrospective analysis of 645 simultaneous perineal punch biopsies and transrectal aspiration biopsies for diagnosis of prostatic carcinoma.

Transrectal aspiration biopsy of the prostate has been recommended as method of choice for morphological diagnosis of prostatic malignancies. It is less inconvenient to the patient and with hardly any complications. A retrospective analysis of 645 simultaneous perineal punch biopsies and transrectal aspiration biopsies was carried out in order to elicit whether prostatic carcinoma can be detected with transrectal aspiration biopsy as frequently as with perineal punch biopsy, and whether a cytological diagnosis of prostatic cancer is reliable. Carcinoma of the prostate was found in a total of 39.1% either with both techniques or with only one of them. A concordant diagnosis has been obtained in only 25.1%. Prostatic carcinoma was diagnosed more often by perineal punch biopsy (36.1%) than by transrectal aspiration biopsy (27.7%). However, the diagnosis has been missed by perineal punch biopsy in 2.6% of the cases. Doubtful results and unsatisfactory preparations have been observed more frequently after transrectal aspiration biopsies. Definite 'false-positive' cystological findings have not been detected. Thus, cytological evaluation of aspirated prostatic cells appears reliable. A definite morphological diagnosis can be expected with this technique. Simultaneous application of perineal punch biopsy and transrectal aspiration biopsy can be recommended in order to diagnose prostatic carcinoma with a higher frequency.

Biopsy↗

PubMed1977

Liver biopsies from psoriatics related to methotrexate therapy. 3. Findings in post-methotrexate liver biopsies from 160 psoriatics.

The purpose of this paper is to report findings in post-MTX liver biopsies from 160 psoriatics treated with Methotrexate (MTX) in single biopsy and B. 68 patients with serial biopsies. At the time of liver biopsy the 92 patients had received a mehosis and six patients had fibrosis. Comparing these 7 patients with patients having normal liver histology (13 patients) revealed no statistically significant difference in cumulative doses of MTX, but a statistically significant higher admitted alcohol intake during MTX therapy (p less than 0.002) and an older age (p less than 0.01) in the patients with cirrhosis or fibrosis. in the 68 patients MTX had accumulated to a mean dose of 3940 mg (range 32k-8355 mg) at the time the latest liver biopsies were taken. Among the latest liver biopsies were 14 cirrhosis (21 per cent, 95 per cent confidence limits: 12-32 per cent) and 16 fibrosis (24 per cent, 95 per cent confidence limits: 14-35 per cent). The 14 patients with cirrhosis when compared to patients with normal histology (9 patients), had taken an equal total dose of MTX at the latest liver biopsy, but had consumed a statistically significant higher amount of alcohol (p less than 0.05) during MTX therapy and also tended to be older (p less than 0.006). Comparison of a material A and B indicates that the prevalence of cirrhosis and fibrosis among MTX treated psoriatics increases rapidly beyond a cumultative dose of two to four grams of MTX. No MTX treated psoriatics should thus be allowed to pass this dosage range without having a liver biopsy performed.

Adult↗

PubMed1975

Gastroscopic biopsy: reliability of histological diagnosis with special reference to the single biopsy.

For three years (1970-72) endoscopic gastric biopsies from 883 lesions in 862 patients were histologically examined, every single biopsy (4088) separately. In 38% of the cases, namely 142 malignant and 194 benign lesions, the diagnoses could be verified. If the criterion for a positive examination was that one of the biopsies showed unambigous carcinoma, the sensitivity of the examination was 76%, the specificity 99%, the PVpos 98%, and the PVneg 85% for the first examination, using the terms of Vecchio. If the biopsy diagnoses carcinoma with some uncertaincy and precancerous biopsies were considered positive too, and if all examinations prior to verification were included, the corresponding figures were 88%, 98%, 97%, and 91%. The most common number of biopsies used in an examination for diagnosing carcinoma was 4 (range 1-11). Fewer biopsies were used if the carcinomas were localized to the whole stomach, were protruded or had a largest diameter of more than 7 cm. The characteristic 'protruded' was the only tumour criterion which significantly was found most common among positive examinations. Ulcer-like carcinomas were common among the false negative. On the basis of pathoanatomy no special number of biopsies to be taken per examination could be recommended.

Autopsy↗

PubMed1976

Transbronchial biopsy for the diagnosis of lung transplant rejection. Comparison with needle and open-lung biopsy techniques in canine lung allografts.

The accurate diagnosis of lung transplant rejection requires histologic examination of the grafted lung. Because transbronchial lung biopsy has been advocated as an effective diagnostic procedure for a variety of lung diseases, it was elected to assess this technique in rejecting transplanted lungs. Twenty-two dogs received allografts and underwent simultaneous lung biopsy by 3 techniques when signs of rejection occurred. Open lung biopsy was diagnostic of rejection in all instances. Transthoracic needle biopsy correlated with the open biopsy in 59 per cent of the cases. No specimen obtained by transbronchial lung biopsy provided sufficient material to permit fulfillment of the strict histologic criteria needed to diagnose allograft rejection. Although transbronchial lung biopsy is successful in many pulmonary infiltrative processes, it appears to be inadequate for the diagnosis of lung allograft rejection.

Animals↗

PubMed2026

PCa Detection in PI-RADS 4 and 5 Lesions: Comparison of [68Ga]Ga-PSMA-11 PET/CT-Guided Robot-Assisted Biopsy Versus mpMRI Cognitive-Fusion TRUS-Guided Prostate Biopsy.

Lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 4 or greater on multiparametric MRI (mpMRI) indicate a high likelihood of prostate cancer (PCa), and guidelines recommend a targeted biopsy. We aimed to compare the diagnostic performance of robotic arm-assisted [68Ga]Ga-PSMA-11 PET/CT-guided prostate biopsy (PGPB) with mpMRI-directed cognitive-fusion transrectal ultrasound-guided biopsy (MCFB) in biopsy-naïve men with clinical findings suggestive of PCa. Methods: This prospective, single-center, randomized clinical trial (NCT05137561) enrolled biopsy-naïve men age 50-90 y with elevated levels of prostate-specific antigen (≥4 ng/mL) and abnormal digital rectal examination findings. All participants underwent mpMRI, and those with a PI-RADS score of 4 or greater were randomized into 2 arms. In arm 1, participants underwent PGPB for a [68Ga]Ga-PSMA-avid lesion, and participants in arm 2 underwent MCFB. Participants in arm 1 with PET-negative findings subsequently underwent MCFB, and participants with negative biopsy results underwent PET and PGPB. The primary outcome was the detection of PCa. Secondary outcomes included complication rates and participant-reported pain. Result: Of the 267 participants enrolled, 81.3% (217) had lesions with a PI-RADS score of 4 or greater and were randomized to either PGPB (n = 112) or MCFB (n = 105). PCa was detected in 97.1% of participants (101/104) in arm 1 and 81.0% (85/105) in arm 2 (P < 0.05). PGPB showed higher diagnostic accuracy for PI-RADS 5 lesions (100% vs. 95.1%, P = 0.09). Major complications were observed in arm 2 only (n = 5). Arm 1 had significantly fewer complications (10.8% vs. 51.4%, P < 0.01), a lower median visual analog scale score for pain (3 vs. 5), and shorter procedure times. The core positivity rate was higher in arm 1 (60% ± 20%), despite obtaining fewer cores. Conclusion: [68Ga]Ga-PSMA-11 PGPB demonstrated higher diagnostic performance, fewer complications, and better tolerability compared with MCFB. This approach enables integrated diagnosis and staging, offering a promising alternative for efficient, safe, and accurate evaluation of prostate cancer.

Humans↗

PubMed1975

Diagnostic reliability of needle biopsy of the parietal pleura. A review of 272 biopsies.

The clinical charts and histologic preparations from 245 patients who had pleural biopsies to evaluate pleural effusions of unknown etiology were reviewed. This represents an experience with 272 biopsies, as some patients underwent multiple biopsies. In 57 per cent of the cases of suspected or proven granulomatous disease involving the pleura, the pleural biopsy was positive. Similarly, in 48 per cent of the cases of suspected or proven pleural involvement by carcinoma, tumor was identified in the biopsy specimen. Only two false-positive diagnoses (one of granulomatous pleuritis and one of neoplastic disease) were made. The other 35 histologic diagnoses of granulomatous inflammation and 43 histologic diagnoses of carcinoma were verified. In this study, the authors found that the major limiting factor in establishing a diagnosis is the accuracy in random sampling of the parietal pleural surface. Thus, a negative pleural biopsy should not give the clinician a false sense of security.

Adolescent↗

PubMed1977

Malignancy grading of epithelial bladder tumours. Reproducibility of grading and comparison between forceps biopsy, aspiration biopsy and exfoliative cytology.

107 bladder tumours cystoscopically suspected to be malignant were examined morphologically by forceps biopsy, aspiration biopsy and exfoliative cytology. The malignancy was graded from 0 through 4. The reproducibility of each method was established, and was found to be 80%, 65% and 90%, respectively. Exfoliative cytology underestimated the malignancy grade as compared with histopathology (59% of the malignant tumours were not jduged as malignant in the cytological grading), but showed no tendency towards overestimation and gave no falsely postiive diagnoses of malignancy. It is concluded that diagnosis of bladder tumours requires both biopsy and cytological techniques, since they proved complementary in a number of cases. Grading by aspiration biopsy is less reliable but may be of benefit in selected cases where forceps biopsy is less suitable.

Biopsy↗

PubMed1976

Peroral small-intestinal biopsy: experience with the hydraulic multiple biopsy instrument in routine clinical practice.

Experience of the peroral, hydraulic, multiple, small-bowel biopsy instrument is recorded and compared with reported experience of other peroral biopsy instruments. It is concluded that, in routine clinical practice, there is no particular danger associated with this instrument despite warnings to the contrary. Furthermore, biopsies are obtained at least as quickly as with other instruments and with great reliability. Since this instrument also enables multiple, precisely located biopsies to be taken from various levels of the small intestine, it could be considered the instrument of choice for peroral jejunal biopsy.

Adolescent↗

PubMed1978

Hepatitis B surface antigen carriers--to biopsy or not to biopsy.

In order to assess the frequency of significant liver disease in hepatitis B surface antigen carriers with normal liver tests, 54 such individuals were identified and prospectively followed for 4 to 48 months with monthly liver tests. Upon testing, 4 were found to carry e antigen and 14 carried e antibody (anti-e). During follow-up, only 4 patients, none of whom were e antigen-positive, developed persisting abnormalities in liver tests. Of the 23 patients who underwent percutaneous liver biopsies, normal histologies were found in 2, nonspecific changes (ground glass hepatocytes, focal necrosis, fatty changes, etc.) in 18, and chronic persistent hepatitis (with or without other nonspecific changes) in 3. Chronic active hepatitis and/or cirrhosis, lesions which may carry more serious prognostic implications, were not seen in any biopsies. Two of the 4 e antigen-positive patients consented to biopsy, both of whom had chronic persistent hepatitis. All 6 patients with anti-e who underwent biopsy had ground glass hepatocytes, which were found in only about 50% of the remaining patients. It is concluded that hepatitis B surface antigen carriers should be followed with serial liver tests, and those whom tests remain normal should not be considered for liver biopsy.

Adult↗

PubMed2026

Endoscopic ultrasound-guided biopsy of left and right adrenal metastases enabling pathological diagnosis and genomic profiling after nondiagnostic conventional biopsies: two case reports.

Obtaining adequate tissue for histologic diagnoses and genomic testing can be challenging in metastatic lung cancer, particularly when conventional biopsy approaches are nondiagnostic. The study reports an effective salvage strategy using endoscopic ultrasound (EUS)-guided adrenal tissue acquisition in two cases. A 66-year-old woman (case 1) developed recurrent lung adenocarcinoma with progressive metastases to the left adrenal, liver, and lungs following multiple lines of systemic therapy. A percutaneous biopsy of a suspected liver metastasis proved nondiagnostic. Subsequently, transgastric EUS-guided biopsy was performed, which confirmed metastatic adenocarcinoma originating in the lung. Oncomine-based genomic testing detected a human epidermal growth factor receptor 2 exon 20 insertion. Trastuzumab deruxtecan was subsequently introduced, resulting in disease stabilization for 6 months. A 75-year-old man (case 2) developed bilateral pulmonary nodules and a right adrenal mass detected on positron emission tomography. Bronchoscopy failed to yield diagnostic tissue. Following careful review of cross-sectional anatomy, EUS-guided biopsy of the right adrenal gland was safely performed via the duodenal bulb, confirming metastatic squamous cell carcinoma and yielding adequate tissue for genomic testing. EUS-guided adrenal biopsy, including transduodenal sampling of the right adrenal gland, may provide tissue for histopathologic and precision oncology testing, facilitating definitive diagnoses.

Adrenal metastasis↗

PubMed1975

A new technique of endoscopic esophageal biopsy using multipurpose biopsy tube in the diagnosis of reflux esophagitis.

A very easily performed new technique of simultaneous introduction of Rubin's multipurpose biopsy tube and gastrofiberscope in the diagnosis of reflux esophagitis is described. This technique will obviate the need of taking multiple biopsies and adds the advantage of direct observation of abnormal mucosa. As the biopsy is obtained under direct vision, there is no need of x-ray or manometric localization and one can avoid inadvertently biopsying a varix or a friable ulcer.

Biopsy↗

PubMed1978

Transvenous (transjugular) liver biopsy. An experience based on 100 biopsies.

Transvenous (transjugular) liver biopsy consists in taking a liver specimen through a needle introduced into the liver parenchyma from the lumen of a hepatic vein. This procedure was attempted 104 times in 98 patients in whom percutaneous needle liver biopsy was contraindicated because of massive ascites and/or bleeding tendency. A liver specimen was obtained in 100 out of these 104 attempts; the tissue specimens were unfragmented and large enough to allow correct evaluation of liver architecture in 57 biopsies. The procedure was followed by no or only minor complications in all out patients except one who suffered a fatal intraperitoneal hemorrhage in relation to perforation of liver capsule; perforation was due to an excessive front rotation applied to the needle, a maneuver which therefore must be avoided. It is concluded that transvenous liver biopsy is a workable, efficient, and acceptably safe procedure for obtaining liver specimens in patients with massive ascites and/or bleeding tendency.

Adult↗

PubMed1979

Ultrastructural artefacts in biopsied normal myocardium and their relevance to myocardial biopsy in man.

Biopsy specimens, as a source of myocardial tissue, are being used increasingly in the appraisal of various myocardial diseases. A study of myocardial tissue, biopsied and processed in various ways, and obtained from normal healthy experimental animals, showed that a variety of artefacts may be found. These artefacts develop in reactive, beating myocardium but not in non-reactive hearts. The artefacts are in many instances similar to, or mimic, changes previously described as pathological in origin. This is most unsatisfactory, and if valid pathological appraisals of myocardial biopsies are to be made, a technique allowing the recovery of tissue, free of biopsy artefact, is required. Such a technique is described.

Animals↗

PubMed1975

[Endoscopic biopsy using the electrocautery snare (macro particle biopsy)].

The biopsy snare has greatly improved the diagnostic and therapeutic possibilities in gastro-intestinal endoscopy. Experience with endoscopic polypectomy in the digestive tract has stimulated the use of the biopsy snare for the excision of larger particles. Thus, besides that larger particles can be obtained, also deeper excisions are possible. Usually muscularis mucosae and parts of the submucosal layers are included. Mucosal hyperplasia and submucosal processes can be recognized and analysed preoperatively. Even the resection of inoperable stenosing neoplasms is now possible. The results of 93 gastro-intestinal big particle biopsies are reported. The risk of big particle biopsy proved to be minimal; once bleeding occurred and was managed conservatively.

Biopsy↗

PubMed1978

[Clinical experiences with a disposable biopsy set according to Menghini for percutaneous liver biopsy (author's transl)].

The handling and reliability of a new disposable biopsy set (Hepafix) have been evaluated in 170 percutaneous liver biopsies according to the technique of Menghini. In comparison with the conventional multiple biopsy set the new set provides several advantages discussed in the paper. The wider use of the disposable liver biopsy set may contribute to the prevention of transmission of hepatitis.

Biopsy, Needle↗

PubMed1978

Transthoracic aspiration biopsy. Occurrence of non-neoplastic cells in biopsies from malignant and non-malignant lesions.

In the search for a possible distinction between false and true negative biopsies, an analysis of the distribution of the non-neoplastic cells has been performed in 100 randomized transthoracic aspiration biopsies in so many histologically verified cases. Aspiration biopsies from malignant lesions often contain many giant cells, alveolar epithelial cells, and mast cells, but a significant differences was only found for the mast cells. A negative biopsy containing many inflammatory cells and mast cells and showing a pronounced degree of necrosis may represent a chronic obstructive pneumonitis, and such a finding should always prompt further investigation.

Biopsy, Needle↗