Sectoral cancer detection and tolerability of freehand transperineal prostate biopsy under local anaesthesia.

BACKGROUND: To investigate the feasibility of a freehand transperineal (TP) systematic prostate biopsy protocol under local anaesthesia (LA) and the value of different sectors in diagnosing prostate cancer (PCa). METHODS: A total of 611 consecutive freehand TP biopsies under LA in 2 hospitals were prospectively evaluated. Cancer detection rate in each of the four different sectors (anterior, mid, posterior, basal) was recorded to evaluate the value of each sector. Procedure tolerability was assessed by pain score and complications were documented. RESULTS: Systematic biopsies were performed in 556 out of 611 men with a median of 20 (IQR 12-24) biopsy cores taken. The median PSA was 9.9 (Inter-quartile range[IQR] 6.4-16.2) ng/mL, and 89.0% were first biopsies. All PCa and ISUP grade group (GG) ≥ 2 PCa (HGPCa) were diagnosed in 41.4% (230/556) and 28.2% (157/556) biopsies respectively. 77.0% HGPCa was diagnosed in ≥2 sectors. Single-sector HGPCa was predominantly found in anterior or posterior sector. Omitting base sector would have missed 1.5% (1/65) HGPCa out of the 219 cases with ≥24-core biopsies performed. Further omission of mid sector would have missed 3.1% (2/65) HGPCa and 7.4% (7/94) ISUP GG1 PCa (in which 3/7 involved 2 sectors). LA TP biopsy was well tolerated and the mean pain scores of the different steps of the procedure were between 1.9-3.1 (out of 10). Post-biopsy fever occurred in 0.3% of patients (2/611) and no sepsis was reported. The risk of urinary retention in men with ≥20 cores in ≥60 ml prostate was 7.8% (14/179), compared with 1.7% (7/423) in other groups (p < 0.001). CONCLUSIONS: TP sectoral prostate biopsy under LA was well tolerated with minimal sepsis risk. Basal sector biopsies had minimal additional value to HGPCa detection and its omission can be considered.

The effect of low-level laser therapy on the healing of hard palate mucosa and the oxidative stress status of rats.

OBJECTIVE: The biostimulation effects of low-level laser therapy (LLLT) have been demonstrated recently. This study investigated the effects of LLLT on palatal mucoperiosteal wound healing and oxidative stress status in rats. MATERIAL AND METHOD: Forty-two male Wistar rats weighing 250-300 g were used in this study. A standardized full-thickness wound was created in the mucoperiosteum of the hard palates of the rats using a 3-mm-diameter biopsy punch. Treatment using a GaAlAs laser at a wavelength of 940 nm and a dose of 10 J/cm(2) was initiated after surgery and repeated on the 2nd, 4th, and 6th days post-surgery. Seven animals from each group were sacrificed on the 7th, 14th, and 21st days after surgery. Total antioxidant status and total oxidative status were measured in serum. RESULTS: The histopathological findings revealed reduced numbers of inflammatory cells on the 7th day, increased mitotic activity of fibroblasts on the 14th and 21st day, and the same degree of collagen synthesis and vascularization on the days 7, 14, and 21 in the LLLT group compared with the control group. No significant differences in total oxidative status and total antioxidant status were observed between the groups. CONCLUSION: LLLT using a GaAlAs laser at a wavelength of 940 nm and a dose of 10 J/cm(2) elicited a positive healing effect on palatal mucoperiosteal wounds likely via the induction of fibroblasts. The oxidative stress status was not affected by LLLT.

Formalin disinfection of biopsy needle minimizes the risk of sepsis following prostate biopsy.

PURPOSE: We describe a simple and effective method to reduce the risk of infection after prostate biopsy. MATERIALS AND METHODS: A total of 1,642 consecutive prostate biopsy procedures during a 4-year period (2008 to 2012) were included in the study. Inclusion criteria consisted of pre-biopsy negative urine culture, bisacodyl enema and fluoroquinolone antibiotics (3 days). Formalin (10%) was used to disinfect the needle tip after each biopsy core. All patients were monitored for post-biopsy infection. The rate of infection was compared to that of a historical series of 990 procedures. Two ex vivo experiments were conducted to test the disinfectant effectiveness of formalin against fluoroquinolone resistant Escherichia coli, and another experiment was performed to quantitate formalin exposure. RESULTS: Post-biopsy clinical sepsis with positive urine and blood cultures (quinolone resistant E. coli) developed in 2 patients (0.122%). Both patients were hospitalized, treated with intravenous antibiotics and had a full recovery without long-term sequelae. Mild uncomplicated urinary infection developed in 3 additional patients (0.183%). All were treated with outpatient oral antibiotics and had a complete recovery. The overall rate of urinary infection and sepsis using formalin disinfection was approximately a third of that of a prior series (0.30% vs 0.80%, p=0.13). Ex vivo experiments showed a complete lack of growth of fluoroquinolone resistant E. coli on blood and MacConkey agars after exposure to formalin. The amount of formalin exposure was negligible and well within the safe parameters of the Environmental Protection Agency. CONCLUSIONS: Formalin disinfection of the biopsy needle after each prostate biopsy core is associated with a low incidence of urinary infection and sepsis. This technique is simple, effective and cost neutral.

Strategies of pain reduction during the bone marrow biopsy.

Examination of the bone marrow biopsy and aspirate allows diagnosis and assessment of various conditions such as primary hematologic and metastatic neoplasms, as well as nonmalignant disorders. Despite being performed for many years, according to many different protocols, the procedure still remains painful for the majority of patients. This paper summarizes the current knowledge of pain reduction measures in the bone marrow biopsy and aspiration.

Optimizing prostate biopsy.

Prostate biopsy (PBx) techniques have changed significantly since the original Hodge's scheme. Although the use of transrectal ultrasound (TRUS) guided (PBx) is considered the gold standard for the diagnosis of prostate cancer (Pca), the strategies for initial and repeat biopsies remain controversial. Even with the widespread application of extended prostate biopsy (ePBx) protocols, the false negative rate remains substantial and early PCa detection remains limited. Optimization of the PBx procedures reduce the likelihood of facing a "repeat biopsy dilemma". The aim of this review is to provide an evidence-based update on current methods of PBx and discuss the strategies to optimise biopsy procedures.

[MR-guided interventions of the prostate gland: a literature review]. / Aktueller Stand der MR-gesteuerten Prostata-Interventionen.

In recent years MR imaging has played an increasingly important role in the diagnosis and treatment of prostate cancer. MR imaging of the prostate allows clear delineation of the anatomic structures and prostate tumors using T 2-weighted images combined with spectroscopy and dynamic examinations. The advantages of MRI make it possible to perform interventions, like biopsies, brachytherapy or different local therapies of the prostate gland. MRI robotic assistance will improve the accuracy of the interventions. Due to the advantages of MR imaging, MR-guided prostate interventions will play a greater role in the future.

Does washing the biopsy needle with povidone-iodine have an effect on infection rates after transrectal prostate needle biopsy?

PURPOSE: To determine the effect of washing the biopsy needle with povidone-iodine solution on infection rates after transrectal ultrasonography-guided prostate biopsy. PATIENTS AND METHODS: 180 patients with transrectal prostate biopsy were included. Infection was excluded with midstream urine culture before biopsy, and patients were divided into two groups. In group 1 (n = 84), the needle was washed with povidone-iodine after each material reception during biopsy, and in group 2 (n = 96), it was not. At day 3 and 2 weeks after the biopsy, patients were checked. On day 3, midstream urine was cultured and patients were checked for fever, hematuria, rectal hemorrhagia, hematospermia and urinary retention. Also, the effect of rectal preparation on infection rate was evaluated. RESULTS: There was no significant difference between the patients' ages, PSA levels and prostate volumes. In total, 11 patients (6.1%; 4 from group 1 and 7 from group 2) developed infectious complications. There was no statistically significant difference between the groups. Fever, asymptomatic bacteriuria and urinary system infection rates were also not statistically different between the groups. The most frequent complication was hematuria with 83 cases (46.1%), but they did not need hospitalization and no patient had acute urinary obstruction. CONCLUSIONS: Washing the biopsy needle with povidone-iodine did not have an effect on the infection rates. Antibiotic prophylaxis and cleaning the biopsy equipment is adequate for low infection rates.

[Evaluation of an interactive breath-hold control system in CT-guided lung biopsy]. / Evaluation eines interaktiven Atemkontrollsystems bei der CT-gesteuerten Lungenbiopsie.

PURPOSE: In this study we assessed the effect of an interactive breath-hold control system on procedure time and technical success in transthoracic CT-guided lung biopsies. MATERIALS AND METHODS: In 36 patients (4 female, 32 male, mean age 65 years; range 33 - 88) with a pulmonary nodule, we performed CT-guided biopsy using a 18G Tru-cut needle (Cardinal Health, Dublin, UK) in a 64 row dual-source CT scanner (Somatom Definition, Siemens, Forchheim, Germany) using intermittent imaging of the needle. In half of the patients (2 female, 16 male, mean age 67 years), an interactive breath-hold control system (IBC) (Mayo Clinic Medical Devices, USA) was applied. No additional device was used in the control group. RESULTS: The biopsy was visually successful in all patients. The diameter of the target lesion was comparable in both groups (IBC: 30 +/- 19 mm; control: 28 +/- 15 mm). The number of imaging steps was significantly smaller (p < 0.05) and the intervention time was significantly shorter (p < 0.05) in the IBC group (IBC: 9 +/- 5 steps 17 +/- 10 min; control: 13 +/- 5 steps 26 +/- 12 min). CONCLUSION: Application of the IBC unit reduced the intervention time and radiation exposure in CT-guided Tru-cut biopsy of pulmonary nodules.

[Linear endobronchial ultrasound as the initial diagnostic tool in patients with indications of mediastinal disease]. / La ultrasonografía endobronquial lineal como instrumento de diagnóstico inicial en el paciente con ocupación mediastínica.

BACKGROUND AND OBJECTIVE: Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has proven useful for sampling mediastinal masses and nodes and for staging lung cancer. The aim of this study was to assess the usefulness of this diagnostic tool in patients with indications of mediastinal disease that could not be diagnosed by noninvasive methods or white light bronchoscopy. PATIENTS AND METHODS: All patients undergoing linear EBUS-TBNA for the diagnosis of mediastinal masses and/or adenopathy at our endoscopy unit were included in the study. Diagnoses obtained by linear EBUS-TBNA or any surgical technique performed after a nondiagnostic EBUS-TBNA were considered as final. RESULTS: In the study population of 128 patients with a mean (SD) age of 62.0 (11.2) years, a total of 294 TBNAs were performed on 12 masses and 282 nodes. Satisfactory samples were obtained in 11 cases (91.7%) from masses and in 233 cases (82.6%) from nodes. Linear EBUS-TBNA was diagnostic, obviating the need for mediastinoscopy in 115 patients (diagnostic sensitivity, 89.8%). The technique confirmed the diagnosis in 85 of the 94 patients with cancer (90.4%), in 8 of the 10 patients with tuberculosis (80.0%), and in the 5 patients with sarcoidosis. CONCLUSIONS: Linear EBUS-TBNA is a useful diagnostic tool in patients with mediastinal disease for whom a pathologic diagnosis is not achieved by noninvasive methods or white light bronchoscopy.

Estudio comparativo entre la eficacia analgésica y seguridad de la meperidina intravenosa frente a la infiltración periprostática con lidocaína en biopsias transrectales de próstata / Comparative study between analgesic efficacy and safety of meperidine compared with lidocaine periprostatic infiltration in transrectal ultrasound guided prostate biopsy

Objetivo: Evaluar la eficacia de la analgesia intravenosa con meperidina frente a la infiltración del plexo periprostático con lidocaína, y seguridad de la anestesia local periprostática. Material y métodos: Estudio prospectivo aleatorizado con 100 pacientes sometidos a primera o segunda biopsia de próstata. Distribuimos a los pacientes en dos grupos; grupo A (50 pacientes) al que se le administra 50 mg de meperidina intravenosa y grupo B (50 pacientes) que reciben 5 mL de lidocaína al 2% en el ángulo prostatoseminal. El dolor fue evaluado mediante la Escala Analógico Visual (VAS) y un cuestionario a cerca del impacto emocional de la prueba. La seguridad del procedimiento se obtuvo mediante cuestionario telefónico sobre las complicaciones aparecidas tras la biopsia. Para el análisis estadístico se uso el test de chi cuadrado, la t de Student y test no paramétrico de Kruskal-Wallis. Resultados: La mediana de edad fue 66 años (47-80) siendo ambos grupos homogéneos respecto a: PSA, volumen prostático, número de cilindros y nivel de estudios, sin diferencias significativas. Se trató de una primera biopsia en 74 pacientes (74%) y 26 (26%) de una segunda. El número medio de cilindros fue de 10,9±2. La puntuación media del VAS para el grupo A fue 3,6±1,8 frente a 3,2±2 del grupo B sin diferencias significativas (p>0,05). Si comparamos el dolor con la introducción del transductor (grupo A 3,9±1,9 / grupo B 4,3±2,2) frente a la toma de cilindro (grupo A 3,6±1,8/grupo B 3,2±22) sí encontramos diferencias significativas (p<0,05). No se observan diferencias ente los datos obtenidos con el test de impacto emocional, la edad y el nivel de estudios frente al dolor producido por la prueba. Respecto al número de cilindros obtenidos tampoco existen diferencias (p>0,05). Aparecieron complicaciones en 12 pacientes (12%); 5 en el grupo de meperidina frente a 7 en el de lidocaína sin observar diferencias entre ambos. Conclusión: El bloqueo del plexo periprostático con lidocaína no ofrece ventajas analgésicas respecto a la meperidina, a pesar de que se trata de un método seguro que no aumenta el número de complicaciones. El paso del transductor transrrectal produce más dolor que la propia toma de los cilindros (AU)

Objectives: To assess the efficacy of intravenous analgesia with meperidine compared to periprostatic plexus infiltration with lidocaine, and safety of periprostatic local anesthesia. Materials and methods: A prospective randomized study with 100 patients undergoing first or second prostate biopsy. We distribute patients in two groups, group A (50 patients) which was administered 50 mg of intravenous meperidine and group B (50 patients) receiving 5 mL of lidocaine 2% in the angle between prostate and seminal vesicles. Pain was assessed by Visual Analog Scale (VAS) and a questionnaire about the emotional impact. Procedure safety was obtained by telephone questionnaire about prostate biopsy complications. The statistical analysis used was chi square test, Student’s t test and Kruskal-Wallis no parametric test. Results: Median age was 66 years (47-80) and both groups were homogeneous with regard to: PSA, prostate volume, core’s number and educational level without significant differences. 74 patients (74%) had their first biopsy and 26 (26%) had their second one. The average number of core biopsy was 10,9±2, and VAS mean score for group A was 3,6±1,8 versus 3,2±2 Group B without significant differences (p>0,05). We found significant differences (p<0,05) between transducer introduction (3,9±1,9 group A/B group 4,3±2,2) and core biopsy (3,6±1,8 group A/B group 3,2±2,2). There were no differences between the data obtained with emotional impact test, age and educational level comparing to pain caused by prostate biopsy. Regard to the number of cores obtained there were no differences (p>0,05). Complications appeared in 12 patients (12%), 5 in the group of meperidine compared with 7 in the lidocaine without differences between them. Conclusion: Periprostatic plexus blocked with lidocaine does not offer advantages respect to meperidine, despite the fact that this is a safe method that does not increase the number of complications. Placing transrectal transducer causes more pain than biopsy cores (AU)

[Computer-assisted navigation system for interventional CT-guided procedures: results of phantom and clinical studies]. / Computergestütztes Navigationssystem für CT-gesteuerte Interventionen: Ergebnisse am Phantom und im klinischen Einsatz.

PURPOSE: To evaluate the technical applicability and accuracy of a navigation system for CT-guided interventional procedures in a phantom and a patient study. MATERIALS AND METHODS: A novel navigation tool (CAPPA IRAD, CAS innovations AG, Erlangen, Germany) was employed for CT-guided biopsies in a phantom and in patients. The entire system consists of a PC, navigation software, an optical tracking system and a patient frame. For the phantom study, a spine phantom in wax was used. The phantom as well as the patients were placed on the CT table in a stable position and fixed within a double vacuum device. The patient frame equipped with optical and CT markers was placed above the target region, followed by acquisition of a planning scan. All data were transferred to the navigation system inside the scanning room, and with the aid of the above mentioned navigation software, the biopsy pathway was planned. Hereafter, the needle holder was aligned accordingly, and a coaxial biopsy needle was pushed forward to the planned target. An additional control scan confirmed needle position, and the navigation software was used to evaluate the distance between the target and needle tip. RESULTS: In the phantom study (n = 60) the average deviation between the planned and documented needle tip position was 1.1 mm. In the clinical study (n = 15), we performed biopsies of the lung, the mediastinal area, the pancreas and liver and some bone biopsies as well as a therapeutic nerve root infiltration. 12 of 15 cases required oblique needle access. In 9 / 15 cases merely a single planning and control scan were required, whereas in 5 / 15 cases additional safety or correction scans were performed. In the case of pancreas biopsy, the lesion (diameter 1 centimeter) visible during the arterial phase only could not be punctured even following repeated corrections due to severe breathing artifacts and pronounced peristaltic movement of the adjacent bowel. The time between planning CT and correct needle position was about 30 minutes. CONCLUSION: The navigation system allows for safe interventions in case of angulated needle access with high accuracy and little tissue trauma. However, insufficient corrections for respiration movement constitute a substantial limitation of the tool.

Infiltración anestésica periprostática para biopsia de próstata por punción: estudio randomizado, doble ciego y controlado con placebo / Periprostatic anaesthesic infiltration for prostatic biopsy: a prospective, randomized, double blind and placebo-controlled study

Estudio prospectivo, randomizado, doble ciego y controlado con placebo evaluando la efectividad de la infiltración periprostática de lidocaína en disminuir el dolor de la biopsia por punción. En un período de trece meses, 115 pacientes fueron randomizados para recibir 10 ml de lidocaína al 1% (n=60) o suero fisiológico (n=55).Evaluando el dolor mediante escala visual análoga (0-10), el primer grupo refirió dolor promedio de 3,83 y el segundo de 6,87, siendo esta diferencia significativa (p<0,005). No hubo complicaciones derivadas del anestésico. La infiltración periprostática es fácil de realizar, no presenta complicaciones y es efectiva en reducir el dolor del procedimiento. Debiera ser usada en forma rutinaria durante biopsia por punción (AU)

A prospective, randomized, double blind and placebo-controlled study to evaluate the effectiveness of periprostatic infiltration with lidocaine to reduce pain of prostatic biopsy. In a thirteen months period of time, 115 patients were randomized to receive 10 ml of lidocaine 1% (n=60) or saline (n=55). Evaluating the pain with visual analogue scale (0-10), the first group referred average pain of 3,83 and the second group of 6,87, being this difference clearly significant (p<0,005). There were not complications from anesthesic puncture. The periprostatic infiltration is easy to perform without complications and it is effective in reducing the pain of this procedure. It should be used as a routine procedure in prostatic biopsy (AU)

A pathologist's perspective on bone marrow aspiration and biopsy: I. Performing a bone marrow examination.

The bone marrow aspirate and biopsy is an important medical procedure for the diagnosis of hematologic malignancies and other diseases, and for the follow-up evaluation of patients undergoing chemotherapy, bone marrow transplantation, and other forms of medical therapy. During the procedure, liquid bone marrow is aspirated from the posterior iliac crest or sternum with a special needle, smeared on glass microscope slides by one of several techniques, and stained by the Wright-Giemsa or other techniques for micro-scopic examination. The bone marrow core biopsy is obtained from the posterior iliac crest with a Jamshidi or similar needle and processed in the same manner as other surgical specimens. Flow cytometric examination, cytochemical stains, cytogenetic and molecular analysis, and other diagnostic procedures can be performed on bone marrow aspirate material, while sections prepared from the bone marrow biopsy can be stained by the immunoperoxidase or other techniques. The bone marrow procedure can be performed with a minimum of discomfort to the patient if adequate local anesthesia is utilized. Pain, bleeding, and infection are rare complications of the bone marrow procedure performed at the posterior iliac crest, while death from cardiac tamponade has rarely occurred from the sternal bone marrow aspiration. The recent development of bone marrow biopsy needles with specially sharpened cutting edges and core-securing devices has reduced the discomfort of the procedure and improved the quality of the specimens obtained.

A simple phantom for learning EUS-guided FNA.

BACKGROUND: The learning curve for EUS-guided FNA (EUS-FNA) is formidable. Development of a phantom to assist in teaching the technique may be beneficial. This study assessed the feasibility of using a low-cost phantom made of commonly available materials to practice EUS-FNA. METHODS: A 2500-mL barium enema bag was modified by running a plastic tube (3-mm inner diameter) through it and sealing one end. One hundred grams of standard agar were suspended in 4 liters of tap water. The broth was heated slowly to boiling. The dissolved agar was then transferred to the barium enema bag after mixing in diced carrots, elbow macaroni, peas, and fingertips of surgical gloves filled with 5 mL of normal saline solution (6 of each) to simulate solid and cystic lesions. Immersion of the phantom in a basin of water provided acoustic coupling. One end of the 3-mm plastic tubing was attached to the nozzle of a water jet device and the other end to its reservoir to create a closed system allowing water recirculation. A linear array echoendoscope and a fine needle were used to perform EUS-FNA. The analysis is descriptive. OBSERVATIONS: The phantom was readily made with inexpensive components (total cost <$50). With refrigeration the phantom was used repetitively during a 4-month period. It produced EUS images with an echotexture comparable with liver. The solid and cystic components resembled hepatic cysts and solid masses encountered when performing EUS in humans. Under EUS-guidance, fine-needle aspirates of selected lesions could be performed allowing targeting, aspiration, and sampling of selected lesions. The Doppler flow effect allowed examination of a simulated vascular structure during FNA. CONCLUSIONS: Once validated, an EUS phantom made of simple components may become an invaluable educational tool for teaching EUS-FNA. Further studies are needed to determine how it affects the skills of gastroenterologists with and without EUS experience.

[Evaluation of an electromagnetic virtual target system (CT-guide) for CT-guided interventions]. / Evaluation eines elektromagnetischen virtuellen Zielsystems (CT-Guide) für die Durchführung von CT-Interventionen.

PURPOSE: Evaluation of the accuracy of a new electromagnetic target system for interventional CT-guided procedures with virtual navigation in a previously acquired helical CT. MATERIAL AND METHODS: The new target system CT-Guide 1010 (Ultraguide, Tirat Hacarmel, Israel) for CT-guided interventions was adapted to the video signal of the Somatom Plus 4 and Volume Zoom (Siemens, Erlangen, Germany). A helical CT-dataset including skin-based sensor cubes was transferred to the integrated navigation system inside the scanner room. 50 image-guided interventions and biopsies were performed outside the gantry using virtual navigation to reach the lesion. The accuracy of the procedures was evaluated using documentation of the needle tip with CT-fluoroscopy, results of histology, and follow-up. RESULTS: The deviation between planned and documented needle tip was 2.2 +/- 2.1 mm in 50 procedures. Time between the end of planning-CT and needle positioning using the system was 13 minutes. There were no complications due to the use of the system. CONCLUSION: The CT-Guide allows for virtual real-time navigation with high accuracy. Advantages are the free needle angulation without gantry tilt, use of optimal CT perfusion phase for virtual navigation, and reduction of radiation exposure to the patient and interventionalist.

[Percutaneous biopsy in the definition of breast lesions: fine needle vs. 14-gauge]. / La biopsia percutanea nella definizione delle lesioni mammarie: ago sottile vs 14 gauge.

INTRODUCTION: Any breast lesion/abnormality detected at mammography must be characterized as (non)-neoplastic before surgery. Fine needle aspiration cytology (FNAC) permits a precise diagnosis in over 70% of cases but exhibits many inadequate, false negatives or questionable findings. This makes surgical biopsy mandatory in many cases. An alternative is offered by fine needle biopsy (FNB: 16-18 G needles) or by large core biopsy (LCB: 14 G needles), which procedures can reduce the number of questionable diagnoses with no major discomfort or side-effects for the patient. MATERIAL AND METHODS: January, 1996, to October, 1997, we performed 422 microhistologic biopsies on breast lesions at the Unità Integrata di Senologia, Azienda Ospedaliera Careggi, Florence, Italy. 383 of these lesions were nonpalpable. FNB was performed in 221 cases and LCB in 201. Most biopsies (65%) were carried out under US guidance and some others (25%) under stereotactic guidance. RESULTS: Microhistologic biopsy allowed accurate lesion characterization in most cases, even though LCB obviously performed much better. Samples were inadequate in 5.88% of cases with FNB and only in 2.98% of cases with LCB. The false negative rate was 1.92% for FNB and 0.99% for LCB. Surgical biopsy was needed for an unquestionable diagnosis only in 9.5% of FNB and 3.9% of LCB cases. CONCLUSIONS: Our results confirm the literature data on how LCB can be considered a valid alternative to surgical biopsy (and, to some extent, to FNAC); in particular, its advantages are: moderate invasiveness, little patient discomfort and high diagnostic accuracy. Moreover, the procedure is short (5-10 minutes) and costs much less than surgical biopsies (1/2 to 1/4).

Investigation of pleural effusion: an evaluation of the new Olympus LTF semiflexible thoracofiberscope and comparison with Abram's needle biopsy.

STUDY OBJECTIVES: Recently, pulmonologists have performed thoracoscopy under local anesthesia using rigid thoracoscopes or flexible bronchoscopes. The latter allow greater access within the pleural cavity but are difficult to manipulate. The Olympus LTF semiflexible fiberoptic thoracoscope combines features of both instruments, having a solid body and a flexible terminal section. In the first study with this instrument, we evaluated ease of use and compared diagnostic yield with closed needle biopsy. PATIENTS: Twenty-four patients with pleural effusion were investigated. SETTING: Scottish University Hospital. DESIGN: Thoracoscopy was performed in the bronchoscopy suite after premedication with atropine and papaveretum. Following a standard Abram's needle biopsy, the LTF thoracoscope was inserted through a flexible introducer (Olympus Optical Co Ltd; Tokyo, Japan). The pleura was inspected and biopsy specimens were taken of suspicious areas. RESULTS: The final diagnosis was malignant pleural effusion in 16 of 24 patients. Ten of 16 were positive by Abram's biopsy, giving a sensitivity of 62%. Thirteen of 16 were positive by fiberoptic thoracoscopy, giving an improved sensitivity of 81%. The LTF thoracoscope was easy to use for pulmonologists experienced in rigid thoracoscopy and flexible bronchoscopy. Excellent views of the pleura were obtained from a single entry point. The procedure was well tolerated and no complications were encountered. CONCLUSION: The LTF thoracoscope allows excellent pleural access but a larger biopsy channel (currently 2 mm) might increase the accuracy of diagnosis.