Comparison of Outcomes Following Neuronavigation-Assisted Aspiration and Thrombolysis Using Single and Multiple Catheter Insertion for Moderate-Volume Supratentorial Spontaneous Intracerebral Hemorrhage: A Single-Center Retrospective Study of 102 Patients.

BACKGROUND This retrospective study from a single center aimed to investigate 102 patients with isolated moderate-volume (30-60 mL) supratentorial spontaneous intracerebral hemorrhage (sICH) treated with neuronavigation-assisted aspiration and thrombolysis to compare outcomes using single and multiple catheter insertion. MATERIAL AND METHODS We retrospectively enrolled 102 patients (58 single-catheter insertion recipients and 44 multi-catheter insertion recipients) diagnosed with isolated moderate-volume supratentorial sICH who underwent neuronavigation-assisted aspiration and thrombolysis surgery in a single center between March 2017 and December 2019. The impact of multi-catheter insertion on the radiologic and clinical outcomes and complications were compared with those of single-catheter insertion. RESULTS The baseline characteristics, clinical status, and outcomes of both groups were not significantly different, except for the number of inserted catheters and surgical time. The single-catheter group had a significantly shorter surgical time than the multi-catheter group (39.52±8.76 min vs 61.39±16.6 min; P<0.001). The surgery-related complication catheter tract hemorrhage (CTH) occurred significantly more frequently in the multi-catheter group than in the single-catheter group (8.6% vs 27.3%; P=0.019). In the regression analysis, international normalized ratio prolongation and multi-catheter insertion were independent risk factors for CTH. CONCLUSIONS Single-catheter insertion is not inferior to multi-catheter insertion for isolated moderate-volume (30-60 mL) supratentorial sICH in terms of radiologic and clinical outcomes and significantly shortened the surgical time and reduced the incidence of CTH.

Fine needle aspiration and the Bethesda system: Correlation with histopathology in 1,228 surgical patients.

BACKGROUND: Fine-needle aspiration combined with the Bethesda System for Reporting Thyroid Cytopathology is indispensable in the diagnostic evaluation of thyroid nodules. Their increased detection over the last few decades mandates the determination of which thyroid nodules require surgical management for malignancy. This study examines the correlation of fine-needle aspiration to final histopathology of dominant thyroid nodules in a large series of surgical patients undergoing thyroidectomy at a single academic institution. METHODS: A retrospective review of prospectively collected data of 1,228 patients who underwent fine-needle aspiration for a dominant thyroid nodule and thyroidectomy from a single institution between 2010 and 2019 was performed. The cases were stratified into all 6 Bethesda categories. Fine-needle aspiration results were compared to index thyroid nodule malignancy on final histopathology. RESULTS: Of 1,228 patients who underwent thyroidectomy, the overall malignancy rate was 53%. When fine-needle aspiration was stratified by the Bethesda System for Reporting Thyroid Cytopathology, malignancy rate was 29% for nondiagnostic; 11% for benign; 51% for atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); 47% for follicular neoplasm/suspicious for follicular neoplasm (FN/SFN); 84% for suspicious for malignancy (SFM); and 98% for malignant results on final histopathology. There was a false positive rate of 1% and false negative rate ranging from 7 to 11%. CONCLUSION: Fine-needle aspiration of a dominant thyroid nodule in patients who underwent thyroidectomy had an overall malignancy rate of 53%. False negative and false positive rates are within the reported range in surgical patient populations. The majority of patients with AUS/FLUS, FN/SFN and SFM results with underlying malignancy received the appropriate surgical resection.

Ultrasonic actuation of a fine-needle improves biopsy yield.

Despite the ubiquitous use over the past 150 years, the functions of the current medical needle are facilitated only by mechanical shear and cutting by the needle tip, i.e. the lancet. In this study, we demonstrate how nonlinear ultrasonics (NLU) extends the functionality of the medical needle far beyond its present capability. The NLU actions were found to be localized to the proximity of the needle tip, the SonoLancet, but the effects extend to several millimeters from the physical needle boundary. The observed nonlinear phenomena, transient cavitation, fluid streams, translation of micro- and nanoparticles and atomization, were quantitatively characterized. In the fine-needle biopsy application, the SonoLancet contributed to obtaining tissue cores with an increase in tissue yield by 3-6× in different tissue types compared to conventional needle biopsy technique using the same 21G needle. In conclusion, the SonoLancet could be of interest to several other medical applications, including drug or gene delivery, cell modulation, and minimally invasive surgical procedures.

Instrument Gauge and Type in Uveal Melanoma Fine Needle Biopsy: Implications for Diagnostic Yield and Molecular Prognostication.

PURPOSE: To systematically evaluate and compare the effects of using small-gauge needles and vitrectors on the ability to obtain adequate diagnostic and prognostic uveal melanoma biopsy specimens. DESIGN: Comparative evaluation of biopsy instruments. METHODS: Survival of uveal melanoma cells was evaluated in vitro following needle aspiration. Five therapeutically enucleated eyes were sampled in triplicate for ex vivo diagnostic biopsy experiments with 25 gauge (25 G) needle, 27 gauge (27 G) needle, and 27 G vitrector. During surgery in 8 patients, paired diagnostic transscleral fine needle aspiration biopsies were performed using both 25 G and 27 G needles. A review of cytologic specimens was performed by a panel of 3 expert cytopathologists. A retrospective chart review was performed to evaluate 100 consecutive tumors undergoing prognostic biopsy for gene expression profiling to assess the relationship between needle gauge and prognostic adequacy. RESULTS: No significant cell shearing of uveal melanoma cells occurred in vitro with 25 G, 27 G, or 30 G needles. For ex vivo biopsy samples, diagnostic yield was 100% using 25 G needle (5/5) or 27 G vitrector (5/5) but 60% using a 27 G needle (3/5). For in vivo samples, no difference in diagnostic yield was found between 25 G (75%, 6/8) or 27 G (75%, 6/8) needle sizes. Of 100 molecular prognostic biopsy samples evaluated, 65 were obtained using 27 G needles; for these biopsies, the prognostic yield was 65/65 (100%). CONCLUSIONS: For diagnostic biopsy of uveal melanoma, a larger-gauge needle or a 27 G vitrector may have better overall cellularity and diagnostic yield when compared to a 27 G needle. However, for much more common molecular prognostic testing, a 27 G needle provided adequate sample in 100% (65/65) of cases, and a larger needle provided no additional benefit.

A New Device for Fine-Needle Aspiration Cytology Consisting of a Vibrating Linear Resonant Actuator.

OBJECTIVE: To evaluate the efficacy of a new device for fine-needle aspiration cytology (FNAC) consisting of a vibrating linear resonant actuator (LRA). STUDY DESIGN: Prospective clinical study. METHODS: The LRA frequency was optimized by visualization of the needle motion using a high-speed camera. The FNAC device consists of a vibrating motor fixed to the stopper of a 5-ml syringe and piston. Upon insertion of the syringe needle into a thyroid nodule (with the stopper attached to the syringe piston), sufficient negative pressure with 1-ml suction was maintained. Subsequently, samples were obtained using vibration generated by an LRA or an eccentric rotating mass (ERM). Surgically resected thyroid specimens from 10 patients were evaluated. The number of follicular groups required for adequate diagnosis and the number of larger follicular groups were counted. Next, 254 thyroid nodules from 187 patients were also evaluated by FNAC. The inadequacy rate was determined, and final cytology was classified according to thyroid Bethesda categories. RESULTS: The optimized LRA frequency was 155 Hz. Both the LRA and ERM devices resulted in sufficient amounts of diagnostic material and achieved low inadequacy rates. The number of large follicular groups obtained was significantly greater with the LRA device compared with the ERM device. CONCLUSIONS: The vibrating device using an LRA for thyroid FNAC resulted in sufficient amounts of thyroid follicular groups and achieved low inadequacy rates. In addition, the LRA device allowed for collection of larger follicular groups sufficient to diagnose appropriate thyroid Bethesda categories. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E1393-E1399, 2021.

The Ability to Look: Management of Breast Disease in the Democratic Republic of the Congo Using Smart Ultrasound Technology.

BACKGROUND: The vast majority of women with breast cancer in sub-Saharan Africa present with advanced stage disease, due primarily to the lack of opportunities for early detection and treatment. As part of a larger effort to increase access to diagnostic and therapeutic services for women's cancers in the Democratic Republic of Congo (DRC), we implemented a curriculum to train the local workforce and a program to build the supportive infrastructure for the diagnosis and treatment of breast cancer at a private sector health facility (Biamba Marie Mutombo Hospital) in Kinshasa. STUDY DESIGN: After onsite trainings in the DRC by a US breast surgeon (RT), Congolese surgeons, general physicians, physician assistants, and nurses used the Phillips Lumify smart-phone ultrasound device to perform and interpret the results of whole breast ultrasound on symptomatic women. Surgeons were trained to perform ultrasound-guided core needle biopsy on those who met the criteria for tissue diagnosis, after which they trained nurses to do the same. RESULTS: Over 3 years, 5,211 patients were identified as having a breast abnormality on clinical breast examination. Ultrasound abnormalities were noted in 1,493 (27%) patients, of which 632 (42%) met the criteria for ultrasound-guided core needle biopsy or fine needle aspiration. Pathology reports were available on 368 (58%) patients who underwent biopsy, of which 164 were malignant and 204 benign. CONCLUSIONS: We demonstrated how the "ability to look" using smart technology can be successfully used to augment clinical breast exam and triage patients for biopsy in a resource-constrained African setting.

North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients.

BACKGROUND: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. METHODS: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. RESULTS: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. CONCLUSION: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.

Capillary and wet techniques. A pilot study comparing two tissue sampling methods guided by endoscopic ultrasound.

BACKGROUND: There are different techniques for obtaining tissue using a fine needle guided by endoscopic ultrasound (EUS); all aim to obtain the most appropriate material, free of defects, of good quality and in sufficient quantity. OBJECTIVE: The objective of the study was to determine which of the two EUS-guided techniques (capillary and wet) provides better quality samples for cytopathological analysis and which should be used for obtaining tissue from pancreatic, bile duct, liver, and lymph node tumors. MATERIAL AND METHODS: We conducted a pilot prospective study that included 26 patients with evidence of pancreatic tumor, liver tumor, and/or lymph node metastasis of primary tumor. All patients were subjected to two different tissue sampling techniques, the capillary technique and the wet technique, during the same procedure. Both techniques relied on EUS guidance. The samples obtained for the cytopathological analysis were evaluated in blinded manner by two different pathologists. RESULTS: Pathologist A was able to make a diagnosis using the capillary technique in 96.15% of the cases and in 88.46% of the cases using the wet technique. Pathologist B was able to make a diagnosis using the capillary technique in 96.15% of the cases and in 92.30% of the cases using the wet technique. The kappa coefficient between observers for histopathological diagnosis was 1 for capillarity and 0.948 for wet technique. CONCLUSION: The capillary technique yielded better results than the wet technique in terms of sample quality and cellularity.

ANTECEDENTES: Existen diferentes técnicas para la obtención de tejido usando la aguja fina guiada por ultrasonido endoscópico. Todas ellas pretenden obtener el tejido mas apropiado, libre de defectos, con una buena calidad y una cantidad suficiente. OBJETIVO: Determinar cuál de las dos técnicas guiadas por ultrasonido endoscópico (capilar y húmeda) proporciona mejor calidad de la muestra para análisis citopatológico y biopsia de tejido pancreático, vías biliares, hígado y tumores de nodos linfáticos. MÉTODO: Estudio piloto, prospectivo, que incluyó 26 pacientes con evidencia de tumor pancreático, hepático o metástasis de nodos linfáticos. Durante el mismo procedimiento, los pacientes fueron sometidos a las dos técnicas de obtención de muestra tisular guiadas por ultrasonido endoscópico. Las muestras para el análisis citopatológico fueron evaluadas de forma cegada por dos patólogos diferentes. RESULTADOS: El patólogo A pudo hacer el diagnóstico usando la técnica de capilaridad en el 96.15% de los casos y en el 88.46% cuando se usó la técnica húmeda; el patólogo B realizó el diagnóstico en el 96.15% y el 92.30% de los casos, respectivamente. El coeficiente kappa entre los observadores para el diagnóstico histopatológico fue de 1 para la técnica de capilaridad y de 0.948 para la técnica húmeda. CONCLUSIÓN: La técnica de capilaridad mostró mejores resultados en términos de calidad de la muestra y celularidad.

Papilomatosis juvenil: revisión a propósito de 2 casos / Juvenile papillomatosis: Review of 2 cases

La papilomatosis juvenil (PJ) es una lesión mamaria benigna, poco frecuente y de carácter proliferativo. Se caracteriza por ser una proliferación exofítica multifocal de varios papilomas dentro de un segmento mamario. Generalmente afecta a mujeres jóvenes de menos de 30 años de edad. Suele presentarse como una tumoración mamaria indolora, simulando un fibroadenoma. La biopsia percutánea guiada por ecografía permitirá detectar la naturaleza de la lesión y descartar patología maligna asociada. Se describe una serie de 2 casos con similar presentación clínica pero difiriendo en el manejo una vez analizados los antecedentes familiares y las circunstancias individuales de cada uno de ellos

Juvenile papillomatosis (JP) is a rare breast lesion of a proliferative and benign nature. It is noted for being a multifocal exophytic proliferation of several papillomas within a breast segment. It usually affects young women under 30 years of age, and usually presents as a painless breast mass, simulating a fibrous adenoma. The ultrasound guided percutaneous biopsy will enable the diagnosis to be confirmed, as well as to rule out any associated malignant disease. A description is presented on series of 2 cases with similar clinical presentation, but differing in management after analysing the family history and the individual circumstances of each of them

Punción-aspiración con aguja fina ecoguiada de nódulos tiroideos con valoración citológica in situ: eficacia diagnóstica, prevalencia y factores predictores de los resultados de categoría Bethesda I / Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination: Diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results

Antecedentes y objetivo: El procedimiento de punción-aspiración con aguja fina ecoguiada de nódulos tiroideos con examen citológico in situ del material extraído puede reducir el número de citologías obtenidas de categoría Bethesda I. El objetivo del estudio ha sido evaluar nuestra experiencia del segundo año en dicha técnica para analizar la eficacia diagnóstica, la prevalencia y los factores predictores de los resultados de categoría Bethesda I. Pacientes y método: Estudio retrospectivo sobre 279 nódulos en 233 pacientes. La punción-aspiración se realizó según los criterios de 2015 de la American Thyroid Association. Una muestra de cada punción se fijó al aire y se procesó in situ mediante tinción con Diff-Quik y examen microscópico para valorar su idoneidad; en caso contrario, se repitió la punción hasta un total de 5veces. La eficacia diagnóstica se valoró en base a la sensibilidad y a la especificidad sobre las categorías citológicas Bethesda II y Bethesda VI. Resultados: La sensibilidad y la especificidad diagnóstica fueron del 100% en ambos casos. Obtuvimos un 5,4% de resultados de categoría Bethesda I y las variables independientemente asociadas fueron la edad (incremento del 4,7% por cada año de vida) y el volumen del nódulo (incremento del 2,3% por cada 1ml de volumen). Conclusiones: La punción-aspiración ecoguiada con aguja fina y examen citológico in situ del material extraído permite obtener una elevada eficacia diagnóstica y demuestra ser un procedimiento de gran validez por conseguir una tasa muy baja de resultados citológicos de categoría Bethesda I, cuyo riesgo ha sido superior en sujetos de mayor edad y en nódulos de mayor tamaño

Background and objective: Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda category I cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results. Patients and method: A retrospective study was conducted of 279 nodules from 233 patients. Ultrasound -guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5 times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories Bethesda II and Bethesda VI. Results: Diagnostic sensitivity and specificity were both 100%, 5.4% Bethesda category I results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1mL of volume). Conclusions: Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda category I, whose risk has been higher in older subjects and with larger nodules

Standard Needle Magnetization for Ultrasound Needle Guidance: First Clinical Experiences in Fine-Needle Aspiration Cytology of Thyroid Nodules.

Fine-needle aspiration cytology using a novel ultrasound needle guidance system on the basis of standard needle magnetization was consecutively performed in 30 (15 in-plane and 15 out-of-plane) suspicious thyroid nodules. Nondedicated, commercially available needles were used. The technical effectiveness and safety of the system were satisfying; system failures were observed in 2 cases. The needle tip could be (at least occasionally) visualized inside the thyroid nodule in 96%, and the subjective procedure ratings were excellent in 57%. The out-of-plane technique was significantly superior in both respects (P = .021 and .027, respectively). Standard needle magnetization ultrasound needle guidance was easy to apply and cost-effective and has the potential to improve fine-needle aspiration cytology performance.

[Usefulness of endoscopic ultrasound guided elastography in the assessment of solid pancreatic lesions]. / Utilidad de la elastografía guiada por ultrasonografía endoscópica en la evaluación de lesiones sólidas pancreáticas.

INTRODUCTION: endoscopic ultrasonography (EUS) elastography is considered a useful tool for the evaluation of solid pancreatic lesions (SPL). OBJECTIVE: The aim of our study was to evaluate the diagnostic performance of elastography in patients with SPL. MATERIAL AND METHODS: A prospective, cross-sectional study was performed at the Rebagliati Hospital between July 2017 and June 2018. Patients with a diagnosis of SPL and echoendoscopic study, elastography and FNA were included. Qualitative and quantitative elastography: strain ratio (SR) and strain histogram, were performed and analyzed with histopathological results. The diagnostic accuracy of EUS elastography in detecting malignancy was calculated using receiver operating curve analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the detection of malignancy were calculated. RESULTS: Out of 832 EUS examinations performed, 46 patients with SPL (mean age, 64.6 years; 29 women) were included in the study. Pancreatic adenocarcinoma was diagnosed in 36 cases. In qualitative elastography, score 3 was most frequent (n = 39, 84.8%) with sensitivity, specificity and accuracy of 88.9%, 30% and 76.1%, respectively, for predict adenocarcinoma. A strain ratio of 15 or higher (100% sensitivity, 66.7% specificity and 97.8% accuracy) and a histogram of less than 49 (66.7% sensitivity, 97.6% specificity and 95.6% accuracy) predicts malignancy in SPL, with area under a ROC curve of 0.941 (95% CI, 0.82 - 1.0). CONCLUSIONS: EUS elastography provides information to predict the malignant nature of the pancreatic lesion. In our study, the elastographic detection of a score 3, SR≥15 or a histogram <49 predicts the presence of malignancy in LSP.

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care.

CONTEXT.­: Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources. OBJECTIVE.­: To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine. DATA SOURCES.­: PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies. CONCLUSIONS.­: Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.

Virtual touch tissue imaging quantification shear wave elastography for determining benign versus malignant cervical lymph nodes: a comparison with conventional ultrasound.

PURPOSE: We aimed to prospectively examine virtual touch tissue imaging quantification (VTIQ) shear wave elastography (SWE) and conventional (B-mode and Doppler) ultrasonography (US), individually and combined, for their ability to differentiate benign and malignant cervical lymph nodes (CLNs). METHODS: One hundred enlarged lymph nodes (LNs) from 72 patients, confirmed by histopathologic diagnoses, were included in the present study. B-mode US, Doppler US, and SWE were performed before histopathologic sampling of the LNs. The LN shear wave velocity (SWV, m/s) was assessed by VTIQ. RESULTS: Using a 3.03 m/s cutoff value, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of SWVmax for differentiating benign and malignant CLNs were 93%, 59%, 68%, 91%, and 75%, respectively. B-mode and Doppler had a sensitivity, specificity, PPV, NPV, and accuracy of 79.2%, 71.2%, 71.6%, 78.7%, and 75%, respectively. B-mode, Doppler, and VTIQ SWE combined had 87.5%, 75%, 76.3%, 86.6%, and 81% for the same parameters, respectively. CONCLUSION: VTIQ SWE is a promising noninvasive diagnostic imaging technique for differentiating benign and malignant CLNs. VTIQ SWV can improve the diagnostic performance of conventional US for differentiating benign and malignant CLNs.

Utilidad de la elastografía guiada por ultrasonografía endoscópica en la evaluación de lesiones sólidas pancreáticas / Usefulness of endoscopic ultrasound guided elastography in the assessment of solid pancreatic lesions

Introducción: La elastografía guiada por ultrasonografía endoscópica es considerada una herramienta útil en la evaluación de las lesiones solidas pancreáticas (LSP). Objetivo: El objetivo del estudio fue evaluar el rendimiento diagnóstico de la elastografia en pacientes con LSP. Material y métodos: Se realizó un estudio transversal prospectivo en el hospital Rebagliati durante julio 2017 a junio 2018. Se incluyeron pacientes con diagnóstico de LSP y estudio ecoendoscópico, elastografía y toma de PAAF. Se realizó elastografia cualitativa y elastografia cuantitativa (SR e histograma) y se analizó con resultados histopatológicos para determinar la sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN) y exactitud diagnostica en la detección de malignidad. Resultados: De 846 ecoendoscopías, se estudiaron 46 pacientes con LSP con una edad promedio de 64,6 años, 29 (63%) sexo femenino. El adenocarcinoma pancreático fue diagnosticado en 36 casos (78,3%). En elastografía cualitativa predominó el score 3 (n=39, 84,8%) con una sensibilidad, especificidad y exactitud de 88.9%, 30% y 76,1% respectivamente para predecir adenocarcinoma. Elastografía cuantitativa de SR≥ 15 (sensibilidad 100%, especificidad 66,7% y exactitud 97,8%) y un valor de histograma menor de 49 (sensibilidad 66,7%, especificidad 97,6% y exactitud 95,6%) predice malignidad en una LSP con área bajo de la curva ROC de 0,941 (IC 95%, 0,82 - 1,0). Conclusiones: La elastografía brinda información para predecir la naturaleza maligna de la lesión. En nuestro estudio la detección elastográfica de un score 3, SR≥ 15 o un histograma < 49 predice la presencia de malignidad en la LSP estudiada.

Introduction: endoscopic ultrasonography (EUS) elastography is considered a useful tool for the evaluation of solid pancreatic lesions (SPL). Objective: The aim of our study was to evaluate the diagnostic performance of elastography in patients with SPL. Material and methods: A prospective, cross-sectional study was performed at the Rebagliati Hospital between July 2017 and June 2018. Patients with a diagnosis of SPL and echoendoscopic study, elastography and FNA were included. Qualitative and quantitative elastography: strain ratio (SR) and strain histogram, were performed and analyzed with histopathological results. The diagnostic accuracy of EUS elastography in detecting malignancy was calculated using receiver operating curve analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the detection of malignancy were calculated. Results: Out of 832 EUS examinations performed, 46 patients with SPL (mean age, 64.6 years; 29 women) were included in the study. Pancreatic adenocarcinoma was diagnosed in 36 cases. In qualitative elastography, score 3 was most frequent (n = 39, 84.8%) with sensitivity, specificity and accuracy of 88.9%, 30% and 76.1%, respectively, for predict adenocarcinoma. A strain ratio of 15 or higher (100% sensitivity, 66.7% specificity and 97.8% accuracy) and a histogram of less than 49 (66.7% sensitivity, 97.6% specificity and 95.6% accuracy) predicts malignancy in SPL, with area under a ROC curve of 0.941 (95% CI, 0.82 - 1.0). Conclusions: EUS elastography provides information to predict the malignant nature of the pancreatic lesion. In our study, the elastographic detection of a score 3, SR≥15 or a histogram <49 predicts the presence of malignancy in LSP.

A novel simulator model and standardized assessment tools for fine needle aspiration cytology training.

OBJECTIVES: Fine needle aspiration (FNA) is an invaluable diagnostic procedure for evaluation of lesions; however, acquisition of diagnostic material is dependent on the skill of the practitioner. We report a novel patient simulator for teaching the FNA procedure and structured assessment tools for educators and learners. METHODS: We created a novel simulator model for FNA training, employed a standardized teaching module, and assessed procedure utility in medical students. Groups of students completed training using a commercial version of the model, and underwent structured evaluation using an Objective Structured Assessment of Technical Skills (OSATS) form, and the Debriefing Assessment for Simulation in Healthcare (DASH) tool. RESULTS: In the initial phase, 178 students rated the training workshop between valuable and essential (4.2 on a 5-point Likert scale). In the second phase, for students evaluated with the OSATS form, the mean overall score was 33 out of 50 (range 26-43). The areas of weakness for the participants were: (a) compression after the FNA procedure, (b) completion of the informed consent, and (c) correct explanation of the procedure to the patient. For the group of students that completed the DASH questionnaire, the results were: 6.2 (assessment by students) and 6.7 (assessment by instructor) out of a maximum of 7. CONCLUSION: A realistic simulation model, in combination with a standardized training program with formal assessment methods is a valuable tool to teach FNA. We here describe a process for teaching the FNA procedure to interested educators and learners.

Optimal needle size for thyroid fine needle aspiration cytology.

Concerning the needle size for thyroid fine needle aspiration cytology (FNAC), 25-27-gauge needles are generally used in Western countries. However, in Japan, the use of larger needles (21-22-gauge needles) is common. The aim of our study was to determine the optimal needle size for thyroid FNAC. We performed ultrasound-guided FNAC for 200 thyroid nodules in 200 patients using two different-sized needles (22 and 25 gauge). For each nodule, two passes with the different-sized needles were performed. The order of needle sizes was reversed for the second group of 100 nodules. The second aspiration was more painful than the first, regardless of the needle size. An association with more severe blood contamination was more frequently observed with the use of 22-gauge needles (32.0%) than with the use of 25-gauge needles (17.5%) and in the second aspiration (37.5%) than in the initial aspiration (12.0%). The initial aspiration samples were more cellular than the second aspiration samples. Regarding the unsatisfactory and malignancy detection rates, there was no statistical difference between the needles. In three of seven markedly calcified nodules, it was difficult to insert 25-gauge needles into the nodules. In terms of the diagnostic accuracy and pain, either needle size can be used. We recommend using 22-gauge needles for markedly calcified nodules because 25-gauge needles bend more easily in such cases. We demonstrated that the initial aspiration tended to obtain more cellular samples and to be less contaminated. Thus, the initial aspiration is more important and should be closely attended.

Feasibility of fine-needle aspiration for assessing responses to chemotherapy in metastatic nodes marked with clips in breast cancer: A prospective registry study.

BACKGROUND: Clips are often placed to mark axillary nodes with biopsy-confirmed metastases in patients with breast cancer. The evaluation of clipped nodes after chemotherapy can identify patients who have eradication of nodal disease. The goal of this study was to determine whether preoperative fine-needle aspiration (FNA) of clipped nodes after neoadjuvant chemotherapy (NAC) could predict the presence of residual disease. METHODS: This prospective registry study enrolled 50 patients with a clip placed to mark nodes with biopsy-confirmed metastases who had completed NAC. Participants underwent FNA of the clipped node before seed-localized lymph node excision. FNA pathology was compared with surgical pathology. RESULTS: There were 36 patients (72%) with residual disease on surgical pathology: 3 (8%) had a nondiagnostic aspirate, carcinoma was seen in 14 (39%), and 19 (53%) had a false-negative result. The sensitivity of FNA was 42.4%, its specificity was 100%, and its negative predictive value was 40.6%. In a univariate analysis, the odds of a true-positive result increased significantly with the mean initial size of the clipped node (odds ratio [OR], 4.3; P = .004) and the size of the metastatic focus after NAC (OR, 1.3; P = 0.003), whereas normalization of nodes after chemotherapy (OR, 0.1) and a lack of response on ultrasound (OR, 0.11) were associated with a false-negative result (P = .01). CONCLUSIONS: FNA of marked nodes after chemotherapy has a high false-negative rate. This highlights the need for surgical staging of the axilla after NAC to assess the response.

Todo empezó con un enojo. La nueva aguja de punción de acceso vascular Cutneedle(R) / It all started with an annoyance. The new vascular access needle. Cutneedle(R)

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