Image-Guided Percutaneous Biopsy for Pancreatic Lesions: 10-Year Experience in a Tertiary Cancer Center.

INTRODUCTION: Image-guided biopsy is an important tool in the diagnosis of solid pancreatic masses. This study aims to evaluate the accuracy and complications associated with this procedure. METHODS: We conducted a retrospective cohort study of all patients referred to interventional radiology for pancreatic biopsy at our institution from July 2004-July 2015. Two radiologists independently reviewed the images, technical aspects, and clinical characteristics. RESULTS: A total of 82 patients underwent pancreatic biopsy using a combination of computed tomography (CT) and/or ultrasound guidance. Mean age was 67.8 years with 56% males. Most lesions were located in the head (63.4%), followed by the tail (19.5%), and the body (17.1%). The procedures were performed using the anterior (79.3%), lateral (7.3%), or posterior (13.4%) approach, with direct access in 85.4% of the patients and indirect access (transgastric or transhepatic) in 14.6% of cases. Core biopsies were obtained in 81.7% of cases, and fine needle aspiration was performed in 18.3% of cases. Needle size varied from 18-22 gauge (median 20 gauge). The median number of samples collected was 3 (range 1-8). A conclusive result was obtained in 82.9% of cases. There were 9 (11%) patients with minor complications: minor bleeding, pain, and inadvertent bowel puncture with no clinical repercussion. There were no deaths or major complications. CONCLUSION: Percutaneous image-guided pancreatic mass biopsy can be performed safely with excellent accuracy. Our results are comparable with endoscopic biopsy/aspiration, and percutaneous biopsy may be used as an alternative, particularly at institutions where endoscopy facilities are limited.

Measurement of blood E2F3 mRNA in prostate cancer by quantitative RT-PCR: a preliminary study.

The use of serum prostate-specific antigen (PSA) measurements necessitates biopsies for accurate prostate cancer (CaP) diagnosis. Overall efficiency of accurate diagnosis, when PSA levels are used alone, is less than 60%. E2F3 was evaluated as an alternative biomarker using patient blood samples. Expression levels were measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and correlated with accurate clinicopathological data. Statistical analysis demonstrated significant differences in E2F3 expression levels (p<0.0001), and high levels of discrimination (receiver operator curve/area under curve analysis values (AUC) >0.88), in particular at early stages of disease development, between benign disease and localized CaP. Limited levels of discrimination were observed at the later stages of disease development, between localized and metastatic disease (p=0.076, AUC=0.633). A cut-off point of 0.34 with high specificity for benign disease (92.3%) and sensitivity for CaP diagnosis (81.0%) was identified. At this cut-off point, 85% patients were correctly diagnosed with either malignant or benign disease. This study demonstrates the strength of E2F3 as a potential marker for discriminating benign and malignant disease, addressing the current limitations of serum PSA measurements.

An unusual case of stroke in a young patient.

The patent foramen ovale (PFO) has been increasingly implicated in the aetiology of stroke, particularly in young patients with no other identifiable cause (cryptogenic stroke). A case of Parinaud's syndrome secondary to thromboembolism from a PFO is reported here.