The dawn of the future: 30 years from the first biopsy of a human embryo. The detailed history of an ongoing revolution.

Following early studies showing no adverse effects, cleavage stage biopsy by zona drilling using acid Tyrode's solution, and removal of single blastomeres for preimplantation genetic testing (PGT) and identification of sex in couples at risk of X-linked disease, was performed by Handyside and colleagues in late 1989, and pregnancies reported in 1990. This method was later used for specific diagnosis of monogenic conditions, and a few years later also for chromosomal structural and/or numerical impairments, thereby establishing a valuable alternative option to prenatal diagnosis. This revolutionary approach in clinical embryology spread worldwide, and several other embryo biopsy strategies developed over three decades in a process that is still ongoing. The rationale of this narrative review is to outline the different biopsy approaches implemented across the years in the workflow of the IVF clinics that provided PGT: their establishment, the first clinical experiences, their downsides, evolution, improvement and standardization. The history ends with a glimpse of the future: minimally/non-invasive PGT and experimental embryo micromanipulation protocols. This grand theme review outlines a timeline of the evolution of embryo biopsy protocols, whose implementation is increasing worldwide together with the increasing application of PGT techniques in IVF. It represents a vade mecum especially for the past, present and upcoming operators and experts in this field to (re)live this history from its dawn to its most likely future.

Pathology of liver disease: advances in the last 50 years.

Liver disease has been recognized in various forms for centuries. Incredible advances, however, have been made especially in the last 50 years, driven by improvements in histology, the development of immunostains, the development of high resolution imaging methods, improved biopsy and resection methods, and the emergence of the molecular era. With these tools, pathologists and their clinical and basic science colleagues moved from classifying liver disease using an observational, pattern-based approach to a refined classification of disease, one based on etiology for medical disease and tumor classification for neoplastic disease. Examples of liver specific diseases are used to illustrate these exciting advances. These impressive advances of the past provide the foundation for hope in the future, as liver pathology continues to play an important role in improving patient care through disease identification and classification and emerging roles in guiding therapy for cures.

Gerald Klatskin (1910-1986): A pioneer in hepato-biliary disorders and biopsy techniques.

The widespread use of liver biopsies underscores its utility and significance within the field of medicine. Dr. Gerald Klatskin's pioneering work on liver biopsy techniques, as well as his study of liver histopathology, paved the way for its diagnostic and therapeutic applications around the world. His attention to detail as well as meticulous account of hilar cholangiocarcinoma has had a lasting impact on the medical community. Eponymously, the tumor was named after him-Klatskin's tumor. Klatskin was also well known and respected for his commitment and devotion to his fellows who themselves went on to hold prestigious academic positions and make significant contributions of their own. The life and work of Klatskin documents a pioneering hepatologist and devoted teacher.

Story telling of myocarditis.

Myocarditis was discovered as heart disease at autopsy with the use of microscope. In 1900, with the name of acute interstitial myocarditis, Carl Ludwig Alfred Fiedler first reported the history of a sudden cardiac heart failure, in the absence of coronary, valve, pericardial disease or classical specific infections with multiorgan involvement. He postulated a peculiar isolated acute inflammation of the myocardium with poor prognosis due to invisible microorganisms, which years later would have been identified as viruses. Subsequent revision of Fiedler original histologic slides by Schmorl showed cases with either lymphocytic or giant cell infiltrates. The in vivo diagnosis became possible with the right heart catheterism and endomyocardial biopsy. Employment of immunohistochemistry and molecular techniques improved the diagnosis and etiology identification. The mechanism of myocyte injury by coxsackie virus was identified in protease 2A coded by the virus and disrupting the dystrophin in the cytoskeleton. Both RNA and DNA viruses may be cardiotropic, and coxsackie and adenovirus share a common receptor (CAR). Unfortunately, vaccination is not yet available. Cardiac Magnetic Resonance is a revolutionary diagnostic tool by detecting edema, of myocardial inflammation. However endomyocardial biopsy remains the gold standard for etiological and histotype diagnosis, with limited sensitivity due to sampling error. Viral lymphocytic fulminant myocarditis may not be fatal and the employment of mechanical assistant device - ECMO in acute phase for temporary support may be lifesaving with good prognosis.

Antecedents, development, adoption, and application of Duchenne's trocar for histopathologic studies of neuromuscular disorders in the nineteenth century.

Duchenne de Boulogne was one of the founders of clinical neurology. His name has been eponymically linked to the most common form of muscular dystrophy, originally described by him as pseudo-hypertrophic muscular paralysis or myo-sclerotic paralysis. Obtaining muscle biopsy specimens was essential to gain insight about the etiopathogenensis of the disease. Duchenne invented a novel instrument: l'emporte-pièce histologique, also known as "Duchenne's trocar," to perform muscle biopsies. Following Duchenne's design and instructions, a Parisian company, Charrière, constructed the first instrument probably in 1864. That instrument was essential for Duchenne's description of the histopathological abnormalities typical of pseudo-hypertrophic muscular paralysis. The innovative needle-biopsy technique enabled physicians to analyze the spectrum of pathological changes at varying stages of different neuromuscular diseases. Duchenne's trocar was a forerunner of several types of modern muscle-biopsy needles. His invention was instrumental in the development of the disciplines of muscle pathology and clinical myology.

Diagnostic histochemistry: A historical perspective.

Histochemistry has a history which, in some ways, goes back to ancient times. The desire for humans to understand the workings of their bodies, and the roles that various chemicals have in them, is long-standing. This review considers the evolution of histochemistry and cytochemistry as scientific disciplines, culminating in the pairing of those techniques with basic biochemistry. They have served as the bases for a synthesis of microscopy, chemistry, immunology, and molecular biology, particularly in the practice of anatomic pathology.

Alternative renal biopsies: past and present.

Renal biopsy techniques have been used commonly worldwide for more than 70 years. They play an important role in the diagnosis, treatment, and prognosis of various renal diseases. Percutaneous renal biopsy (PRB) is currently the most important and widely used renal biopsy method. Although >90% of renal biopsies are PRBs, in certain settings, alternative renal biopsy techniques must be used, such as open, laparoscopic, transjugular, and transurethral renal biopsies. This review describes the history, advantages, and disadvantages of the various renal biopsy methods and discusses their current and future uses.

Medio siglo de Patología con unas briznas de historia y autocrítica / Half a century of Patología with a smattering of history and self-criticism

No disponible

Decline in the Use of Surgical Biopsy for Diagnosis of Pulmonary Disease in Hematopoietic Cell Transplantation Recipients in an Era of Improved Diagnostics and Empirical Therapy.

Historically, diagnosis of enigmatic pulmonary disease after hematopoietic cell transplantation (HCT) required lung biopsy, but recent advancements in diagnosis and therapy for respiratory infections have changed how clinicians approach pulmonary abnormalities. We examined temporal trends in the use of lung biopsy after HCT. We retrospectively reviewed patients who underwent their first allogeneic HCT at the Fred Hutchinson Cancer Research Center between the years 1993 to 1997, 2003 to 2007, and 2013 to 2015 and subsequently underwent surgical lung biopsy for any reason. Lung biopsy between cohorts were analyzed using a Cox proportional hazards model with death and relapse considered competing risks. Of 1418 patients, 52 (3.7%) underwent 54 post-HCT surgical lung biopsies during 1993 to 1997 compared with 24 (2.1%) and 25 biopsies in the 2003 to 2007 cohort; 2 cases of surgical lung biopsies out of 786 HCT recipients occurred during the 2013 to 2015 cohort (.25%). The median time to biopsy post-HCT was 71.5 days (IQR, 31 to 89) for the early cohort and 97 days (IQR, 42 to 124) for the late cohort, for an overall biopsy incidence of .15 and .075 per 1000 patient days in the first year after HCT, respectively. Patients in the 2003 to 2007 cohort were less likely to undergo a lung biopsy (adjusted HR, .50; 95% CI, .29 to .83; P = .008) when compared with patients in the early cohort, but more patients in the early cohort underwent lung biopsy without antecedent bronchoscopy (25/54 [46%] versus 3/25 [12%], P = .005). Although infections were a more common finding at biopsy in the early cohort (35/1418 versus 8/1148, P < .001), the number of biopsies demonstrating noninfectious lesions was similar between the two cohorts (19/1418 versus 17/1148, P = .76). Fungal infections were the major infectious etiology in both cohorts (32/35 [91%] versus 5/8 [63%], P = .07), but there was a significant reduction in the number of Aspergillus species found at biopsy between the cohorts (30/54 versus 1/25, P < .001). A similar percentage underwent biopsy with therapeutic intent for invasive fungal disease in the 2 cohorts (8/54 [15%] versus 4/25 [16%]). Surgical evaluation of lung disease in HCT recipients significantly declined over a span of 2 decades. The decline from the years 1993 to 1997 compared with 2003 to 2007 was because of a reduction in the number of biopsies for post-transplant infections due to aspergillosis, which is temporally related to improved diagnostic testing by minimally invasive means and the increased use of empiric therapy with extended-spectrum azoles. This practice of primary nonsurgical diagnostic and treatment approaches to pulmonary disease post-HCT have continued, shown by low numbers of surgical biopsies over the last 3 years.

Biopsia transrectal ecodirigida convencional. Papel actual, indicaciones, técnicas y limitaciones / Conventional transrectal ultrasound guided biopsy. Current role, indications, techniques and limitations

OBJETIVO: El objetivo del presente trabajo es evaluar el papel actual de la Biopsia transrectal eco-dirigida convencional de la próstata en el diagnóstico de cáncer. Para ello repasaremos sus indicaciones, las diferentes técnicas, las complicaciones que comporta y las limitaciones de esta prueba. MÉTODOS: Para cumplir nuestros objetivo hemos realizado una revisión de la literatura utilizando como herramienta el PubMed-NCBI. También se ha valorado la información y recomendaciones de las guías clínicas disponibles, con su respectivo nivel de evidencia. Por último, alguna de las apreciaciones reflejadas se basan en la experiencia personal de nuestro grupo que ha practicado más de 7000 biopsias prostáticas con diferentes protocolos y metodologías a lo largo de dos décadas de trabajo asistencial. RESULTADOS: Las biopsias prostáticas convencionales son poco precisas, poco cercanas a la realidad en cuanto a la cantidad, ubicación y gradación de tumores. No está claro el número y localización de los cilindros a tomar, existiendo demasiados esquemas, lo que las hace menos fiables y reproductibles de lo requerido. Aunque son una buena herramienta, comportan un riesgo obvio de sobre-diagnóstico de tumores clínicamente insignificantes. La falta de estandarización de los diferentes esquemas de biopsias tiene claras implicaciones pronósticas y en la toma de decisiones. Otra limitación son los escasos resultados atribuibles a las biopsias dirigidas a las lesiones visualizables por ecografía. Evidentemente, las complicaciones, el disconfort y la angustia que generan los programas de biopsias y rebiopsias convencionales constituyen una de sus limitaciones y de los motivos de rechazo por parte de los pacientes. Nos hallamos en una encricijada en la que múltiples grupos intentan demostrar la sensibilidad y reproductibilidad de dirigir mediante diferentes técnicas las biopsias hacia los hallazgos de la resonancia multiparamétrica. CONCLUSIONES: La biopsia prostática ecodirigida sigue siendo el método principal de diagnóstico del cáncer de la próstata. La información que proporciona es de gran relevancia en el estadiaje, en la evaluación pronóstica y en la toma de decisiones terapéuticas. No obstante, son patentes sus limitaciones: baja sensibilidad, el sobrediagnóstico, las complicaciones, la angustia de los pacientes, etc. Existen dos líneas de desarrollo para mejorar su eficiencia. La que busca reducir el número de biopsias y de cores persiguiendo selectivamente los hallazgos de las resonancias y la que sigue sistematizando esquemas con aumento del número de cores para conseguir el muestreo óptimo. Los avances técnicos, como la fusión de imágenes, tal vez nos permitirán en un futuro traducir los hallazgos de las resonancias en resultados clínicos contrastados y reproducibles. Debemos estandarizar en nuestros Centros las técnicas convencionales de biopsia de próstata, protocolizándolas y haciéndolas seguras para los pacientes. Hemos de revisar nuestros resultados para asegurar tasas de detección razonables, así cmo nuestras indicaciones, teniendo en cuenta la edad, la comorbilidad y la expectativa de tratamiento de los pacientes. Debemos incluir, en la medida de lo posible, otras herramientas, como la RMN multiparamétrica, para permitir racionalizar las biopsias y aumentar su eficacia

OBJECTIVES: The objective of this work is to evaluate the current role of conventional transrectal ultrasound guided biopsy of the prostate in the diagnosis of cancer. With this aim we review its indications, the various techniques, associated complications and limitations of this test. METHODS: We performed a bibliographic review through NCBI-PUBMED. We also evaluated the information and recommendations of the available clinical guidelines with their respective evidence levels. Lastly, some of the appraisals included are based on our group's personal experience that has performed more than 7000 prostate biopsies with various protocols and methodologies over two decades of health care practice. RESULTS: Conventional prostatic biopsies lack precision; they are not close to reality in terms of tumor amount, localization and grading. The number and localization of the cores to be taken is not clear; there are too many biopsy schemes, making it less reliable and reproducible than expected. Although it is a good tool, there is an obvious risk of over diagnosis of clinically non-significant tumors. The lack of standardization of the various biopsy schemes has clear prognostic and decision-making implications. Another limitation is the scarce number of results attributable to biopsies targeted at ultrasound visible lesions. Obviously, the complications, discomfort, and distress generated by conventional biopsy and repeated biopsy programs are some of their limitations and the reasons for patient rejection. We are in a crossroad where multiple groups try to demonstrate the sensitivity and reproducibility of targeting the biopsy, by means of various techniques, to the lesions found in multiparametric MRI. CONCLUSIONS: Ultrasound guided prostatic biopsy is the main diagnostic method for prostate cancer yet. The information it gives is greatly relevant for staging, prognostic evaluation and therapeutic decision-making. Nevertheless, its limitations are evident: low sensitivity overdiagnosis, complicacions, patient`s distress, etc. There are two lines of development to improve its effi- ciency. The one aiming to reduce the number of biopsies and cores by selectively targeting the findings of the MRI and the one that continues systematizing schemes with increasing number of cores to achieve the optimal sampling. Technical advances , such as image fusion, will maybe allow us in the future to translate the MRI findings into verified and reproducible clinical results. We must standardize the conventional techniques of prostate biopsy in our centers, using protocols and making them safe for patients. We must review our results to ensure reasonable detection rates, as well as our indications, considering patient's age, comorbidities and expectations about therapy. We must include, as far as possible, other tools, such as multiparametric MRI to enable biopsy rationalization and improve their efficacy