Reliability of combined fine needle aspiration and core needle biopsies in the diagnosis of liver lesions: An 8-year institutional experience.

OBJECTIVE: Fine needle aspiration (FNA), followed by core needle biopsy (CNB) when needed, was adopted as the standard care for liver lesions in our institution. This study explores the diagnostic efficacy of combined image-guided FNA and CNB in liver lesion diagnosis. METHOD: We retrospectively reviewed all liver FNA cases performed in our institution between January 2010 and September 2018. A total of 550 cases from 531 patients (173 females) with a median age of 59 years (range, 13-90) were identified. All FNA cases were initially assessed with rapid on-site evaluation, and cell blocks were prepared. A total of 459 FNA specimens with concurrent CNBs were included in the study. Both FNAs and CNBs in the paired sampling were read by a cytopathologist, with expert consultation as needed. RESULTS: The concordance rate between FNA and CNB was 85.2%. Combined FNA/CNB showed higher sensitivity in detecting malignant tumours when compared to FNA or CNB alone (98%, vs 87% and 92%, p < 0.001), especially for detecting metastatic tumours, hepatocellular carcinoma, and haematopoietic neoplasms (98%, 97%, and 94%, respectively; all p < 0.001). Combined FNA/CNB showed a lower false negative rate in malignant tumours than FNA or CNB alone (2%, vs 13% and 8%, p < 0.001). There was no significant difference among FNA, CNB, and combined FNA/CNB in diagnosing benign liver lesions. CONCLUSIONS: Combined liver FNA/CNB has high diagnostic efficacy for malignancy and a lower false negative rate than either procedure alone, especially in metastatic tumours, hepatocellular carcinoma, and haematopoietic neoplasms.

Comparison of the Alere i Strep A Test and the BD Veritor System in the Detection of Group A Streptococcus and the Hypothetical Impact of Results on Antibiotic Utilization.

Rapid detection of group A Streptococcus (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% (n = 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement = 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index = 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the overutilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.

An Autopsy Case of Spontaneous Splenic Rupture Due to Isolated Splenic Peliosis and Review of the Literature.

Peliosis is a rare entity that is characterized by cystic or blood-filled spaces in the parenchyma of solid organs. It is most commonly seen in the spleen in patients who also have peliosis hepatis. Isolated splenic peliosis is very rare and spontaneous rupture due to splenic peliosis is even more uncommon. This diagnosis has high importance in forensic pathology as it is a rare cause of atraumatic splenic rupture. We present a case in which the diagnosis of isolated splenic peliosis with massive hemoperitoneum was made at autopsy.