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1.
Medicine (Baltimore) ; 100(14): e25400, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832135

RESUMO

ABSTRACT: Ultrasound (US)-guided core needle biopsy (CNB) has been recognized as a crucial diagnostic tool for breast cancer. However, there is a lack of guidance for hospitals that are not equipped with adjunctive US. The aim of this study was to assess the sensitivity, specificity, and experience of freehanded CNB in the outpatient department, and to determine the minimum number of tissue strips required to obtain concordance for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), and tumor grade with the excised specimen.A prospective study was performed on 95 patients undergoing CNB and subsequent surgical procedures. The reliability of immunohistochemical assessments of the pathological type, tumor grade, ER, PR, and HER2 status in CNBs was compared with that of surgical specimens. Concordance between the CNBs and surgical samples was estimated as a percentage agreement, and analyzed using the chi-square test. A P < .05 was considered significant.The concordance rates of ER, PR, and HER2 status and tumor grade status between CNBs and surgically excised specimens were 97.9%, 91.6%, 82.1%, and 84.2%, respectively. The reliability of taking 2 tissue strips was similar to that of taking six tissue strips in distinguishing malignancy from benignancy, and determining the pathological type without the aid of US. Four tissue strips obtained by CNB showed good accuracy comparable to those obtained by surgical specimens in assessing ER, PR, and HER2 status and tumor grade.Two tissue strips obtained by CNB showed good accuracy in differentiating malignancy from benignancy, while at least 4 strips are recommended to obtain overall conformity of pathological biomarkers.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/patologia , Biópsia Guiada por Imagem/instrumentação , Cuidados Pré-Operatórios/estatística & dados numéricos , Manejo de Espécimes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , China/epidemiologia , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Período Pós-Operatório , Estudos Prospectivos , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Manejo de Espécimes/tendências , Ultrassonografia de Intervenção/métodos
2.
Anticancer Res ; 41(4): 2183-2186, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813431

RESUMO

BACKGROUND/AIM: The aim of this study was to identify simple and reliable factors to detect clinically insignificant prostate cancer (PC) for avoiding immediate prostate biopsies using biparametric magnetic resonance imaging (MRI), which consists of T2-weighted and diffusion-weighted imaging. PATIENTS AND METHODS: We retrospectively evaluated 427 men with suspected PC, who underwent biparametric MRI and standard 12-core transrectal prostate biopsy. MRI and prostate specific antigen density (PSAD) were analysed. To evaluate the combination of the two parameters, patients were divided into three groups (Group A: MRI negative and PSAD <0.23, Group B: MRI positive or PSAD ≥0.23, Group C: MRI positive and PSAD ≥0.23). A grade of ≥2 was defined as clinically significant PC. RESULTS: Clinically significant PC was detected in 46.5% of men with positive MRI findings, and 60.0% of men with PSAD ≥0.23. When combining MRI and PSAD, detection rates of clinically significant PC were 10.0%, 28.4% and 65.3% in group A, B and, C, respectively. CONCLUSION: Negative biparametric MRI findings with PSAD <0.23 might be a reliable evidence for avoiding immediate prostate biopsies.


Assuntos
Imagem por Ressonância Magnética/métodos , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/métodos , Imagem de Difusão por Ressonância Magnética , Humanos , Biópsia Guiada por Imagem , Testes Imunológicos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/metabolismo , Estudos Retrospectivos , Carga Tumoral , Ultrassonografia de Intervenção
3.
AJR Am J Roentgenol ; 216(4): 1066-1073, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33566633

RESUMO

OBJECTIVE. Percutaneous imaging-guided core needle biopsies (CNBs) for cancer diagnosis in pediatric patients are gaining interest because of their availability, lower rate of complications, and high diagnostic power compared with traditional surgical biopsies. Nevertheless, their precise role in the diagnostic algorithm of pediatric oncology is still unknown. The purpose of this study was to report our accumulated 16-year experience with CNB; discuss the availability, safety, and diagnostic accuracy of the procedure and the adequacy of ancillary testing; and compare our findings with the available literature. MATERIALS AND METHODS. Pediatric ultrasound-guided CNBs performed in our hospital between November 2003 and December 2019 were retrospectively studied. Data collection included demographics, clinical and procedural parameters, complications, and final diagnosis. RESULTS. A total of 597 biopsies were performed in 531 patients (132 performed in known oncologic patients and 465 performed to establish diagnosis). The median time between the biopsy request and the procedure was 1 day. Of 432 biopsies performed in patients with malignancies, 12 (2.8%) had false-negative results. In 165 cases of benign pathologic findings, all had true-negative results. Ancillary testing was adequate in all malignant cases. Overall sensitivity, specificity, and accuracy rates were 97.2%, 100%, and 98.0%, respectively. Five biopsies (0.8%) resulted in complications, including one major bleed and one track seeding. CONCLUSION. Our experience shows that ultrasound-guided CNB for suspected malignancy in pediatric patients has a high safety profile, availability, and accuracy rate compared with surgical biopsy. Our fast-track strategy enables early initiation of designated therapy and has the potential to become the procedure of choice.


Assuntos
Biópsia com Agulha de Grande Calibre , Biópsia Guiada por Imagem , Neoplasias/patologia , Ultrassonografia de Intervenção , Biópsia com Agulha de Grande Calibre/métodos , Criança , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Neoplasias/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia de Intervenção/métodos
4.
AJR Am J Roentgenol ; 216(4): 997-1002, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33624523

RESUMO

OBJECTIVE. Diagnostic accuracy of core needle biopsy (CNB) for adipocytic tumors can be low because of sampling error from these often large, heterogeneous lesions. The purpose of this study was to evaluate the diagnostic accuracy of image-guided CNB for various adipocytic tumors in comparison with excisional pathology. MATERIALS AND METHODS. Adipocytic tumors (n = 77) of all adult patients undergoing image-guided CNB and subsequent surgical excision of an adipocytic tumor at a tertiary referral center between 2005 and 2019 were studied. To determine concordance, we compared pathologic diagnoses based on CNB to the reference standard of pathologic diagnoses after surgical excision. Tumors were divided into three categories (benign lipomatous tumors [lipoma, lipoma variants, hibernomas], atypical lipomatous tumors [ALTs] or well-differentiated liposarcomas [WDLs], and higher grade liposarcomas [myxoid, dedifferentiated, pleomorphic]), and diagnostic accuracy was calculated for each category. RESULTS. In 73 of 77 adipocytic tumors (95%), diagnosis at CNB and diagnosis after excision were concordant. Accuracy of diagnosis was poorer for ALTs and WDLs than for the other two categories, and the difference was statistically significant (p < .002). For the 29 benign lipomatous tumors and the 27 higher-grade liposarcomas, diagnoses at CNB and after excision were concordant in all cases (100%). Seventeen of the 21 tumors (81%) diagnosed as ALTs or WDLs at CNB had a concordant diagnosis after excision; four of the 21 were upgraded (dedifferentiated liposarcoma, n = 3; myxoid liposarcoma, n = 1). CONCLUSION. CNB provides high diagnostic accuracy for adipocytic tumors, particularly for benign lipomatous tumors and higher grade liposarcomas. However, though still high at 81%, diagnostic accuracy of CNB is not as high for tumors diagnosed as ALTs or WDLs. Awareness of this limitation is important when determining management, particularly of cases of ALT or WDL for which surgery is not planned.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias Lipomatosas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lipoma/diagnóstico por imagem , Lipoma/patologia , Lipossarcoma/diagnóstico , Lipossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Lipomatosas/diagnóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos
5.
Medicina (Kaunas) ; 57(1)2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-33435132

RESUMO

Background and objectives: Overdiagnosis, overtreatment, and the need for repeated procedures caused by transrectal ultrasound guided prostate biopsies and their related complications places a heavy burden on healthcare systems. This was a prospective cohort validating study to access the clinical accuracy of systematic and MRI-cognitive targeted transperineal prostate biopsies in detecting clinically significant prostate cancer after a previous negative biopsy and persistent suspicion of malignancy. The primary goal was to assess the ability of multiparametric magnetic resonance imaging (mpMRI) to detect clinically significant prostate cancer with an additional goal to assess the diagnostic value of systematic and MRI-cognitive transperineal biopsies. Materials and Methods: In total, 200 patients were enrolled who had rising serum prostate specific antigen (PSA) levels for at least 4 months after a previous negative transrectal ultrasound (TRUS) biopsy. All eligible men underwent 1.5T prostate mpMRI, reported using the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), followed by a 20-region transperineal prostate systematic biopsy and additional targeted biopsies. Results: Systematic 20-core transperineal prostate biopsies (TPBs) were performed for 38 (19%) patients. Systemic 20-core TPB with additional cognitive targeted biopsies were performed for 162 (81%) patients. Clinically significant prostate cancer (csPC) was detected for 31 (15.5%) patients, of which 20 (64.5%) cases of csPC were detected by systematic biopsy, eight (25.8%) cases were detected by targeted biopsy, and three (9.7%) both by systematic and targeted biopsies. Conclusions: Cognitive mpMRI guided transperineal target biopsies increase the detection rate of clinically significant prostate cancer after a previously negative biopsy. However, in a repeat prostate biopsy setting, we recommend applying a cognitive targeted biopsy with the addition of a systematic biopsy.


Assuntos
Adenocarcinoma/patologia , Biópsia com Agulha de Grande Calibre/métodos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética Multiparamétrica , Próstata/patologia , Neoplasias da Próstata/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/metabolismo , Idoso , Estudos de Coortes , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Períneo , Estudos Prospectivos , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/metabolismo
6.
Radiol Clin North Am ; 58(6): 1085-1098, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040850

RESUMO

Fine-needle aspiration (FNA) and core biopsy of masses in the neck predominantly include samples from thyroid nodules, parathyroids and lymph nodes. The diagnostic rate of a thyroid nodule FNA improves up to 6 passes and then does not significantly change. Thyroid FNA can be performed on patients who are anticoagulated. Appropriate transducer selection is essential for visualization of the needle. Lymph node biopsies can be additionally sampled for thyroglobulin assay to improve sensitivity for detection of recurrent carcinoma. Parathyroid FNA usually involves additional estimation of parathyroid hormone concentration in needle washouts. Biopsies of the neck are simple procedures with minimal complications.


Assuntos
Biópsia por Agulha Fina/métodos , Biópsia com Agulha de Grande Calibre/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias das Paratireoides/patologia , Neoplasias da Glândula Tireoide/patologia , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Neoplasias das Paratireoides/diagnóstico por imagem , Melhoria de Qualidade , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia Doppler/métodos
7.
Medicine (Baltimore) ; 99(44): e22929, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126355

RESUMO

RATIONALE: The incidence of pregnancy-associated breast cancer (PABC) is increasing nowadays, and its diagnosis and treatment remain complicated due to the consideration of the fetus. The available data on PABC are primarily derived from case reports since there are ethical restrictions on conducting randomized clinical trials. In the present work, we reported a case of the human epidermal growth factor receptor 2 (HER2)-positive PABC and described the diagnosis and treatment for such type of breast cancer. PATIENT CONCERNS: A 27-year-old patient was admitted to our hospital with the complaints of right breast mass for 3 days, and she was a first-time pregnant woman with a single live intrauterine fetus at 26 + 3 weeks of gestation. Physical examination of the right breast revealed a palpable and hard mass with obscure boundaries (5.0 cm × 4.0 cm) in the upper outer quadrant. Significant axillary lymph nodes (2.0 cm) were also present. DIAGNOSIS: PABC. INTERVENTION: To protect the fetus, breast ultrasonography was used to test her breast mass, a core needle biopsy was adopted to confirm the diagnosis, and abdominal ultrasound and chest X-ray were used to evaluate the metastasis. The patient was scheduled for neoadjuvant therapy using bi-weekly pirarubicin in combination with cyclophosphamide (AC) without anti-HER2 therapy for consideration of the fetus's safety. After 4 cycles of AC, the patient delivered a healthy male infant. After the delivery, all the treatments were carried out according to the standard recommendation for HER2 + breast cancer as non-pregnant patients. OUTCOMES: After the surgery, the disease-free survival for the patient was 12 months until brain metastasis was diagnosed. She was still undergoing second-line anti-HER2 therapy and currently in a stable situation. Besides, the child was also healthy so far. LESSONS: The methods for the diagnosis and treatment of PABC that result in teratogenesis should be avoided to protect the fetus. Mammogram and chest X-ray were safe approaches for the fetus. Moreover, chemotherapy-based on pirarubicin in combination with cyclophosphamide had no risk to the fetus.


Assuntos
Neoplasias da Mama , Ciclofosfamida/administração & dosagem , Doxorrubicina/análogos & derivados , Mastectomia Radical Extensa/métodos , Cuidado Pós-Natal/métodos , Complicações Neoplásicas na Gravidez , Receptor ErbB-2/antagonistas & inibidores , Trastuzumab/administração & dosagem , Adulto , Antineoplásicos/administração & dosagem , Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Doxorrubicina/administração & dosagem , Feminino , Idade Gestacional , Humanos , Estadiamento de Neoplasias , Gravidez , Complicações Neoplásicas na Gravidez/metabolismo , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/terapia , Resultado da Gravidez , Ultrassonografia Mamária/métodos
8.
AJR Am J Roentgenol ; 215(3): 523-533, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755186

RESUMO

OBJECTIVE. The purpose of this article is to provide a step-by-step guide for bone imaging-guided percutaneous core needle biopsy, including the armamentarium available and the most recent advances. CONCLUSION. Bone imaging-guided percutaneous core needle biopsies are well-established, minimally invasive, cost-effective interventions for histologic characterization of bone lesions with an excellent safety profile and diagnostic outcomes; they play a crucial role in management of patients. Radiologists involved in the care of patients with bone lesions must be familiar with the various steps involved in such procedures and their role in patient management.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Doenças Ósseas/patologia , Biópsia Guiada por Imagem/métodos , Radiografia Intervencionista/métodos , Humanos
9.
J Urol ; 204(6): 1202-1208, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32716686

RESUMO

PURPOSE: In this study we determined the optimal number of transperineal magnetic resonance imaging ultrasound fusion targeted biopsy cores per lesion needed for the detection of clinically significant prostate cancer. MATERIALS AND METHODS: A total of 101 patients with at least 1 lesion with a PI-RADS® (Prostate Imaging Reporting and Data System) score of 3 or greater were recruited prospectively. At least 4 transperineal magnetic resonance imaging ultrasound fusion targeted biopsy cores per lesion were performed, followed by systematic biopsy. The Kappa test was used to evaluate the consistency of the clinically significant prostate cancer detection rate between different targeted biopsy cores and 4 or more cores, which was regarded as reference standard. RESULTS: In the total cohort of 101 patients 49 (48.5%), 55 (54.5%) and 57 (56.4%) were diagnosed with clinically significant prostate cancer by systematic biopsy, targeted biopsy or targeted biopsy plus systematic biopsy, respectively. As for the total of 161 lesions, the clinically significant prostate cancer detection rate based on 1, 2, 3, or 4 or more targeted biopsy cores was made in 27.3%, 32.9%, 37.3% and 39.1%, respectively. Three cores showed great consistency with 4 or more cores in clinically significant prostate cancer detection rate (Kappa coefficient of 0.961, p <0.001) with a sensitivity of 95.2% (95% CI 85.8-98.8), and only missed 3 lesions harboring clinically significant prostate cancer. Similar results were obtained in cases with PI-RADS 3 or 4 or maximal diameter of less than 1.5 cm. CONCLUSIONS: Three targeted biopsies per lesion were suitable during transperineal magnetic resonance imaging ultrasound fusion biopsy, especially for lesions of PI-RADS 3 or 4, or small lesions (maximal diameter less than 1.5 cm), which may help to tailor targeted prostate biopsy procedures.


Assuntos
Biópsia com Agulha de Grande Calibre/normas , Biópsia Guiada por Imagem/normas , Guias de Prática Clínica como Assunto , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/estatística & dados numéricos , Calicreínas/sangue , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Períneo/cirurgia , Estudos Prospectivos , Próstata/diagnóstico por imagem , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção
10.
J Urol ; 204(6): 1141-1149, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32716687

RESUMO

PURPOSE: The Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) categorizes the likelihood of clinically significant prostate cancer on magnetic resonance imaging and determines the diagnostic pathway. We determined clinically significant prostate cancer and all prostate cancer detection rates in each PI-RADS v2 category. MATERIALS AND METHODS: MEDLINE®, EMBASE® and Cochrane databases were searched for prospective studies reporting the detection rates of clinically significant prostate cancer or all prostate cancer. Random effects models were used to determine pooled detection rates of clinically significant prostate cancer and all prostate cancer for each PI-RADS category. The risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2. Meta-regression analysis was performed to identify factors affecting study heterogeneity. RESULTS: Thirteen prospective studies including 4,265 men who underwent magnetic resonance imaging targeted biopsy and/or systematic biopsy for a PI-RADS v2 category 3 or greater, or systematic biopsy for PI-RADS 1-2 were included. The pooled detection rates of clinically significant prostate cancer monotonically increased for each PI-RADS v2 category, ie 4% (95% CI 2-8) for category 1-2, 17% (95% CI 13-21) for category 3, 46% (95% CI 38-55) for category 4 and 75% (95% CI 73-78) for category 5. Substantial study heterogeneity was noted in clinically significant prostate cancer detection rates for categories 1-2 and 4, which were significantly affected by study subject selection (biopsy naïve patients only or not) and studies with a high risk of bias. CONCLUSIONS: PI-RADS v2 can be useful for the stratification of the risk of clinically significant prostate cancer in patients at risk for prostate cancer but the limitations in category 4 still remain.


Assuntos
Imagem por Ressonância Magnética Intervencionista , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Biópsia com Agulha de Grande Calibre/métodos , Procedimentos Clínicos , Estudos de Viabilidade , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Estudos Prospectivos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Medição de Risco/métodos , Ultrassonografia de Intervenção
11.
J Urol ; 204(6): 1209-1215, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32628099

RESUMO

PURPOSE: Several transperineal biopsy series have proven feasibility under local anesthesia. However, there is a lack of large analyses detailing pain outcomes and factors influencing pain. MATERIALS AND METHODS: From 2016 to 2019 we performed a multicenter prospective study in men undergoing multiparametric magnetic resonance imaging-transperineal fusion biopsies (target+systematic cores) under local anesthesia. Primary outcomes were 1) pain scores (assessed through a 0 to 10-point numeric rating scale) and 2) identification of factors associated with severe pain. The secondary outcome was to evaluate pain influence on clinically significant prostate cancer target cores detection. RESULTS: We included 1,008 men undergoing transperineal fusion biopsies under local anesthesia. Mean±SD numeric rating scale pain scores were 3.9±2.1 at local anesthesia administration and 3.1±2.3 when performing biopsies. Pain was not associated with lower clinically significant prostate cancer detection on targeted cores (p=0.23 and p=0.47 depending on clinically significant prostate cancer definition). On multivariate analysis age (OR 0.96, 95% CI 0.94-0.99) and severe anxiety (OR 2.99, 95% CI 1.83-4.89) were a protective and risk factor, respectively, for severe biopsy pain. Procedural time was also associated with an increased risk of experiencing severe biopsy pain (OR 1.04, 95% CI 1.00-1.08). If aiming to test the possible effects of anxiety preventive measures on pain, an anxiety cutoff greater than 6 on a numeric rating scale would decrease to 13% the number of patients being treated while identifying 56% of those experiencing severe pain. CONCLUSIONS: Transperineal fusion biopsies under local anesthesia result in moderate pain. Pain does not influence clinically significant prostate cancer target detection. Patient anxiety predicts pain. A numeric rating scale based anxiety assessment may be used to identify those at higher risk for experiencing severe pain in men undergoing transperineal fusion biopsies.


Assuntos
Anestesia Local , Ansiedade/epidemiologia , Dor Processual/epidemiologia , Neoplasias da Próstata/diagnóstico , Idoso , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/psicologia , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/psicologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/psicologia , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Imageamento por Ressonância Magnética Multiparamétrica , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Dor Processual/prevenção & controle , Períneo/cirurgia , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/patologia , Medição de Risco/métodos , Fatores de Risco , Ultrassonografia de Intervenção
13.
Medicine (Baltimore) ; 99(26): e20869, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590790

RESUMO

RATIONALE: Pulmonary sclerosing pneumocytoma (PSP) is a rare benign tumor of the lung, mostly presented in Asian middle-aged women. Initially, it was considered as a vascular origin tumor, but then research evidence showed that it was derived from natural epithelial tissue. On imaging, this tumor may be found as a solitary well-circumscribed lung parenchymal lesion, and is often located in juxtapleural or juxtafissural positions. On histopathology, it consists of cuboidal surface cells and stromal round cells, both of which are positive for thyroid transcription factor-1. Here we report a case of a young PSP male patient and review the relevant literature in order to improve our understanding of this disease. PATIENT CONCERNS: An 18-year-old man was referred to our hospital after accidentally finding a lesion on chest X-ray. Contrast-enhanced computed tomography showed a soft tissue mass with homogeneous enhancement in the left lower lobe posterior segment. DIAGNOSES: The diagnosis of PSPs was confirmed by histopathological examination. INTERVENTIONS AND OUTCOMES: The patient underwent a thoracoscopic wedge resection and was followed-up after that. One month later, he had good performance status with no recurrent tumors. LESSONS: PSP in a young man is really uncommon, and is confused with malignant tumors. A histopathological examination is considered as the diagnostic gold standard for this uncommon tumor. Surgery is the main treatment.


Assuntos
Hemangioma Esclerosante Pulmonar/diagnóstico , Adolescente , Biópsia com Agulha de Grande Calibre/métodos , Humanos , Masculino , Hemangioma Esclerosante Pulmonar/fisiopatologia , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos
14.
J Urol ; 204(6): 1187-1194, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32496160

RESUMO

PURPOSE: We assessed whether the visibility of Grade Group (GG) 1 prostate cancer on baseline multiparametric magnetic resonance imaging affects clinical outcomes. MATERIALS AND METHODS: We evaluated 454 men who underwent multiparametric magnetic resonance imaging between 2006 and 2018 with maximum GG1 prostate cancer inclusive of magnetic resonance imaging targeted biopsy. Multiparametric magnetic resonance imaging was graded as negative, equivocal or positive. Assessed outcomes were treatment-free survival, biopsy upgrade-free survival and unfavorable disease at radical prostatectomy (pT 3 or greater and/or GG3 or greater). Kaplan-Meier and multivariable Cox proportional hazard analyses were used to estimate the impact of multiparametric magnetic resonance imaging and clinicopathological variables (age, year, prostate specific antigen density and measures of tumor volume on biopsy) on outcomes. RESULTS: During followup (median 45.2 months) 61 men had disease upgraded on followup biopsy and 139 underwent definitive treatment. In men with negative, equivocal and positive baseline multiparametric magnetic resonance imaging at 5 years, treatment-free survival was 79%, 73% and 49% (p <0.0001), treatment-free survival was 89%, 82% and 70% (p=0.002), and survival without unfavorable disease at radical prostatectomy was 98%, 98% and 86% (p=0.007), respectively. At multivariable analysis positive (HR 1.93, 95% CI 1.21-3.09, p=0.006) and equivocal multiparametric magnetic resonance imaging (HR 2.02, 95% CI 1.11-3.68, p=0.02) were associated with shorter treatment-free survival, and positive multiparametric magnetic resonance imaging was a significant prognostic factor for upgrade-free survival (HR 2.03, 95% CI 1.06-3.86, p=0.03) and unfavorable disease at radical prostatectomy (HR 4.45, 95% CI 1.39-18.17, p=0.01). CONCLUSIONS: Men with positive multiparametric magnetic resonance imaging and GG1 prostate cancer on magnetic resonance imaging targeted biopsy are at increased risk for intervention, upgrading and unfavorable disease at radical prostatectomy compared to those with multiparametric magnetic resonance imaging invisible GG1 prostate cancer.


Assuntos
Imagem por Ressonância Magnética Intervencionista/estatística & dados numéricos , Imageamento por Ressonância Magnética Multiparamétrica/estatística & dados numéricos , Próstata/diagnóstico por imagem , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/mortalidade , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Progressão da Doença , Intervalo Livre de Doença , Seguimentos , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/estatística & dados numéricos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Próstata/patologia , Próstata/cirurgia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
15.
J Urol ; 204(6): 1195-1201, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32516029

RESUMO

PURPOSE: The added value of nontargeted systematic prostate biopsies when performed alongside magnetic resonance imaging targeted biopsies in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal nontargeted systematic prostate biopsies, when performed alongside targeted systematic prostate biopsies, using pre-biopsy multiparametric magnetic resonance imaging. MATERIALS AND METHODS: Consecutive patients referred with a suspicion of prostate cancer (April 2017 to October 2019) underwent pre-biopsy multiparametric magnetic resonance imaging. A transperineal biopsy was advised if multiparametric magnetic resonance imaging PI-RADS® (v.2.0) score was 4 or 5, and score 3 required a prostate specific antigen density 0.12 ng/ml or greater. Primary threshold for clinically significant prostate cancer was defined as any Gleason 3+4 or greater. Multivariable logistic regression analysis identified pre-biopsy predictors of clinically significant prostate cancer in nontargeted systematic prostate biopsies, regardless of targeted pathology (p <0.05, R, version 3.5.1). RESULTS: A total of 1,719 men underwent a pre-biopsy multiparametric magnetic resonance imaging, with 679 (39.5%) proceeding to combined targeted systematic prostate biopsies and nontargeted systematic prostate biopsies. In these men clinically significant prostate cancer was detected in 333 (49%) and 139 (20.5%) with targeted systematic prostate biopsies and nontargeted systematic prostate biopsies, respectively. In those men with clinically significant prostate cancer in targeted systematic prostate biopsies, clinically significant prostate cancer was also present in nontargeted systematic prostate biopsies in 117 (17.2%); Gleason 3+3 was present in 50 (7.4%). In 287 men without any cancer in the targeted systematic prostate biopsies, 13 (1.9%) had clinically significant prostate cancer in nontargeted systematic prostate biopsies. In addition 18/679 (2.7%) had Gleason 3+3 disease and no Gleason greater than 4+3 was detected. Predictors associated with clinically significant prostate cancer in nontargeted systematic prostate biopsies were prostate specific antigen 5 ng/ml or greater (OR 2.05, 95% CI 1.13-3.73, p=0.02), PI-RADS score 5 (OR 2.26, 95% CI 1.51-3.38, p <0.001) and prostate volume less than 50 cc (OR 2.47, 95% CI 1.57-3.87, p <0.001). CONCLUSIONS: Detection of clinically significant prostate cancer in exclusively nontargeted transperineal systematic biopsies in a pre-biopsy multiparametric magnetic resonance imaging pathway was low (1.9%).


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/estatística & dados numéricos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Estudos Prospectivos , Próstata/diagnóstico por imagem , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia
16.
In Vivo ; 34(3 Suppl): 1651-1659, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503825

RESUMO

BACKGROUND/AIM: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19. PATIENTS AND METHODS: Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason. RESULTS: BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients. CONCLUSION: COVID-19-related anxiety could affect patients' decision-making process.


Assuntos
Ansiedade/psicologia , Biópsia com Agulha de Grande Calibre/psicologia , Neoplasias da Mama/psicologia , Infecções por Coronavirus/psicologia , Tomada de Decisões , Procedimentos Cirúrgicos Eletivos/psicologia , Medo/psicologia , Mastectomia/psicologia , Pneumonia Viral/psicologia , Recusa do Paciente ao Tratamento/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Atitude Frente a Saúde , Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Itália , Mamografia , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Fatores Socioeconômicos , Ultrassonografia Mamária , Vácuo
17.
Clin Imaging ; 65: 18-23, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32353714

RESUMO

PURPOSE: Interventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety. MATERIALS AND METHODS: This randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann-Whitney U test. RESULTS: Baseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 control, p = .11). Patients in both groups showed lower state anxiety levels after the biopsy (45.6 to 34.3 music, 41.0 to 33.8 control, p < .001 for both). Patients who listened to music showed a greater reduction in anxiety (mean decrease 11.2 music, 7.3 control, p = .03). Post-biopsy anxiety levels were similar to normative values for working women in the same age group. CONCLUSION: Listening to self-selected music reduces anxiety in patients undergoing breast biopsy.


Assuntos
Ansiedade/terapia , Biópsia com Agulha de Grande Calibre/métodos , Música , Adulto , Transtornos de Ansiedade , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Ultrassonografia
18.
J Surg Oncol ; 122(3): 382-387, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32396665

RESUMO

OBJECTIVE: The purpose of this study is to determine the role of clinico-sonographic features of breast cellular fibroepithelial lesions (CFELs) diagnosed on core needle biopsy (CNB) in the differentiation between fibroadenoma (FA) and phyllodes. MATERIALS AND METHODS: Results of consecutive women with a CNB showing CFEL from 2005 to 2010 were retrospectively reviewed. Clinical and sonographic findings were compared with surgical outcomes. Chi-square and Fisher's exact tests were used followed by a regression model for statistical analysis. RESULTS: A total of 131 women with 134 CFEL were included in the study; 89 (66%) were FAs and 45 (34%) were phyllodes (32 benign; 13 malignant). Significant predictors of increased risk of phyllodes tumor were patient age equal to or greater than 50 years (P = .021) and lesion size less than 2 cm at sonography (P = .043). No other imaging or clinical features were able to differentiate FA from phyllodes tumors. CONCLUSION: CFEL with a larger size in older women is associated with the surgical pathological result of phyllodes tumor and management should be tailored accordingly. Younger patients with small size nodules might be approached less aggressively, depending on a personalized discussion with the surgeons, taking into account the results obtained in this study.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Fibroadenoma/diagnóstico por imagem , Tumor Filoide/diagnóstico por imagem , Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Fibroadenoma/patologia , Humanos , Biópsia Guiada por Imagem/métodos , Pessoa de Meia-Idade , Tumor Filoide/patologia , Estudos Retrospectivos , Ultrassonografia/métodos
19.
Sci Rep ; 10(1): 4969, 2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-32188891

RESUMO

Thyroid nodules are initially handled by fine needle aspiration (FNA). However, the stance of thyroid core needle biopsy (CNB) still is a challenge. This study aimed to compare the diagnostic performances and conclusive rates of FNA and CNB for the diagnosis of thyroid nodules and to define effective indications of CNB. This retrospective study enrolled 1,060 consecutive thyroid nodules in 1,037 patients who underwent FNA from January 2008 to May 2008, and 462 consecutive nodules in 453 patients who underwent CNB from January 2014 to December 2015 at our institution. Ultrasound (US) features were classified according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and Korean TIRADS (K-TIRADS). We compared diagnostic performances and conclusive rates between FNA and CNB groups. Propensity score matching was conducted to match FNA patients with CNB patients. After matching, the diagnostic performances for selecting surgical candidates and predicting malignancy were comparable between the two biopsy groups. Based on US findings, conclusive results were obtained significantly more in CNB than in FNA when thyroid nodules were classified as ACR TI-RADS or K-TIRADS category 4 and measured larger than 2 cm. Diagnostic performances between FNA and CNB were comparable. Superiority of CNB to FNA was found for thyroid nodules larger than 2 cm and classified as ACR TI-RADS or K-TIRADS category 4.


Assuntos
Biópsia por Agulha Fina/métodos , Biópsia com Agulha de Grande Calibre/métodos , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/classificação , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/diagnóstico por imagem
20.
AJNR Am J Neuroradiol ; 41(3): 387-392, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32029464

RESUMO

BACKGROUND AND PURPOSE: There is scarcity of data on the comparative efficacy between bone biopsy drill systems across various types of bone lesions. Our aim was to investigate differences in diagnostic yield, scanning time, and radiation dose between manual and battery-powered bone biopsy systems in CT-guided biopsies of lytic, sclerotic, and infectious bone lesions. MATERIALS AND METHODS: This was a retrospective single-center institutional review board-approved study. A total of 585 CT-guided core needle biopsies were performed at 1 institution from May 2010 to February 2019. Classification of bone lesions, location, bone biopsy system, suspected origin of primary disease, final pathologic diagnosis, diagnostic yield, presence of crush artifacts, radiation dose, and scanning times were collected. For the battery-powered system, OnControl was used. For the manual drill system, Bonopty, Osteo-site, and Laurane drill systems were used. Comparisons in lytic and sclerotic lesions and suspected discitis/osteomyelitis were made using the Fisher exact test. Subgroup analysis of the drill systems for scanning time and radiation dose was performed by 1-way ANOVA. RESULTS: Our patient cohorts consisted of a total of 585 patients with 422 lytic, 110 sclerotic, and 53 suspected infectious lesions. The mean age was 62 ± 13 years with a male/female ratio of 305:280 for all lesions. The diagnostic yield was 85.5% (362/422) for lytic, 82.7% (91/110) for sclerotic, 50.9% (27/53) for infectious lesions, and 82.1% (480/585) for all lesions. No statistical difference was found when comparing diagnostic yields of powered drills with the manual systems for lytic, sclerotic, and infectious lesions. However, in a subgroup analysis, radiation dose and scanning time were significantly lower for powered drill compared with manual drill systems in lytic (P = .001 for both) and sclerotic lesions (P = .028 and P = .012, respectively). No significant differences were seen between the drill systems for suspected infectious lesions. CONCLUSIONS: Our findings demonstrate that there was no statistically significant difference in diagnostic yield when comparing battery-powered and manual bone biopsy systems for CT-guided bone biopsies; however, the use of the power drill system resulted in significantly reduced scanning time and radiation dose in lytic and sclerotic lesions.


Assuntos
Biópsia com Agulha de Grande Calibre/instrumentação , Doenças Ósseas/diagnóstico por imagem , Biópsia Guiada por Imagem/instrumentação , Radiografia Intervencionista/instrumentação , Adulto , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Doenças Ósseas/patologia , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
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