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1.
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
2.
J Urol ; 204(6): 1180-1186, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32614257

RESUMO

PURPOSE: Magnetic resonance imaging guided biopsy which reveals no cancer may impart reassurance beyond that offered by ultrasound guided biopsy. However, followup of men after a negative magnetic resonance imaging guided biopsy has been mostly by prostate specific antigen testing and reports of followup tissue confirmation are few. We investigated the incidence of clinically significant prostate cancer in such men who, because of persistent cancer suspicion, subsequently underwent a repeat magnetic resonance imaging guided biopsy. MATERIALS AND METHODS: Subjects were all men with a negative initial magnetic resonance imaging guided biopsy who underwent at least 1 further magnetic resonance imaging guided biopsy due to continued clinical suspicion of clinically significant prostate cancer (September 2009 to July 2019). Biopsies were magnetic resonance imaging-ultrasound fusion with targeted and systematic cores. Regions of interest from initial magnetic resonance imaging and any new regions of interest at followup magnetic resonance imaging guided biopsy were targeted. The primary end point was detection of clinically significant prostate cancer (Gleason Grade Group 2 or greater). RESULTS: Of 2,716 men 733 had a negative initial magnetic resonance imaging guided biopsy. Study subjects were 73/733 who underwent followup magnetic resonance imaging guided biopsy. Median (IQR) age and prostate specific antigen density were 64 years (59-67) and 0.12 ng/ml/cc (0.08-0.17), respectively. Baseline PI-RADS® scores were 3 or greater in 74%. At followup magnetic resonance imaging guided biopsy (median 2.4 years, IQR 1.3-3.6), 17/73 (23%) were diagnosed with clinically significant prostate cancer. When followup magnetic resonance imaging revealed a lesion (PI-RADS 3 or greater), clinically significant prostate cancer was found in 17/53 (32%). When followup magnetic resonance imaging was negative (PI-RADS less than 3), cancer was not found (0/20) (p <0.01). Overall 54% of men with PI-RADS 5 at followup magnetic resonance imaging guided biopsy were found to have clinically significant prostate cancer. CONCLUSIONS: Men with negative magnetic resonance imaging following an initial negative magnetic resonance imaging guided biopsy are unlikely to harbor clinically significant prostate cancer and may avoid repeat biopsy. However, when lesions are seen on followup magnetic resonance imaging, repeat magnetic resonance imaging guided biopsy is warranted.


Assuntos
Imagem por Ressonância Magnética Intervencionista/estatística & dados numéricos , Imagem Multimodal/estatística & dados numéricos , Próstata/patologia , Neoplasias da Próstata/epidemiologia , Idoso , Biópsia com Agulha de Grande Calibre/normas , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Reações Falso-Negativas , Humanos , Biópsia Guiada por Imagem/normas , Biópsia Guiada por Imagem/estatística & dados numéricos , Incidência , Imagem por Ressonância Magnética Intervencionista/normas , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/normas , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Medição de Risco/estatística & dados numéricos , Ultrassonografia de Intervenção/normas , Ultrassonografia de Intervenção/estatística & dados numéricos
3.
Lancet Child Adolesc Health ; 4(3): 232-241, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32007136

RESUMO

Imaging has a key role in the assessment of paediatric renal tumours, especially when the initial treatment approach is to proceed to standard chemotherapy without histological confirmation. In Europe, according to the International Society of Paediatric Oncology guidelines, core needle biopsy is not routinely done unless the child is older than 10 years. Between age 6 months and 9 years, the child is treated with a standard regimen of preoperative chemotherapy unless there are concerns about non-Wilms' tumour pathology. Atypical imaging findings could therefore stratify a child into a different treatment protocol, and can prompt the need for pretreatment histology. This review details the latest protocols and techniques used in the assessment of paediatric renal tumours. Important imaging findings are discussed, especially the features that might prompt the need for a pretreatment biopsy. Local radiology practices vary, but both MRI and CT are widely used as routine imaging tests for the assessment of paediatric renal tumours in Europe. Advances in imaging technology and MRI sequences are facilitating the development of new techniques, which might increase the utility of imaging in terms of predicting tumour histology and clinical behaviour. Several of these new imaging techniques are outlined here.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Oncologistas/organização & administração , Tumor de Wilms/patologia , Biópsia com Agulha de Grande Calibre/normas , Criança , Pré-Escolar , Tratamento Farmacológico/métodos , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Guias de Prática Clínica como Assunto/normas , Cuidados Pré-Operatórios/normas , Sociedades Médicas/organização & administração , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Tumor de Wilms/diagnóstico por imagem
4.
Urology ; 137: 133-137, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31758981

RESUMO

OBJECTIVE: To evaluate the number of needle cores combined with multiparametric magnetic resonance imaging (mpMRI) findings needed to diagnose all clinically significant cases of prostate cancer (csPCa) in men subject to transperineal saturation biopsy (SPBx; 30 cores). METHODS: From January 2016 to June 2019, 875 men (median age 63 years) underwent repeat SPBx (median 30 cores) for the suspicion of cancer. All of the patients underwent for the first time 3.0 Tesla pelvic mpMRI before SPBx, and the lesions with Prostate Imaging-Reporting and Data System category ≥3 underwent additional transperineal-targeted fusion prostate biopsies (TPBx). RESULTS: StageT1c PCa was found in 306/875 (34.5%), and 222/306 (72.5%) of them were classified as csPCa. SPBx missed 2/222 (1%) csPCa with International Society of Urologic Pathology Grade Group (GG) 3. TBPx missed 33/222 (14.9%) csPCa (21 vs 12 cases were GG1 vs GG3). The initial 20 needle SPBx cores obtained from the peripheric (16 cores) and anterior gland (4 cores) diagnosed all of the 222 (100%) csPCa only missing 84/129 (65.1%) indolent PCa thus presenting diagnostic accuracy, sensitivity, and specificity equal to 83.1%, 100%, and 65.1%, respectively. CONCLUSION: In men subject to mpMRI and/or TPBx, a maximum of 20 systematic transperineal needle cores detected all cases of csPCa and minimized the diagnosis of indolent cancers.


Assuntos
Biópsia Guiada por Imagem , Imagem por Ressonância Magnética Intervencionista/métodos , Próstata , Neoplasias da Próstata , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/normas , Erros de Diagnóstico/prevenção & controle , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/normas , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Avaliação de Processos e Resultados em Cuidados de Saúde , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia
5.
J Surg Res ; 247: 103-107, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31767281

RESUMO

BACKGROUND: Lipomatous masses are the most common soft tissue tumors. While the majority are benign lipomas, it is important to identify those masses that are malignant prior to excision. Current guidelines recommend core needle biopsy (CNB) for all lipomatous masses larger than 3-5 cm. The objective of this study was to determine if routine preoperative CNB based on mass size is necessary, or if radiographic features can guide the need for CNB. MATERIALS AND METHODS: Patients who underwent excision of extremity or truncal lipomatous masses at a single institution from October 2014 to July 2017 were retrospectively reviewed. By protocol, preoperative imaging was routinely obtained for all masses larger than 5 cm. High-risk radiographic features (intramuscular location, septations, nonfat nodules, heterogeneity, and ill-defined margins) and surgical pathology were evaluated to determine patients most likely to benefit from preoperative CNB. RESULTS: Of 178 patients, 2 (1.1%) had malignant tumors on surgical pathology. All masses smaller than 5 cm were benign and, if imaging was obtained, had two or fewer high-risk radiographic features. Both of the patients with malignant tumors had masses larger than 5 cm, preoperative imaging that showed at least four high-risk radiographic features, and underwent CNB prior to excision. CONCLUSIONS: The overall rate of malignancy is very low. The results of this study suggest that lipomatous masses smaller than 5 cm without concerning clinical characteristics do not require preoperative imaging or CNB. Conversely, lipomatous masses larger than 5 cm should undergo routine MRI with subsequent CNB if multiple high-risk radiographic features are present.


Assuntos
Lipoma/diagnóstico , Lipossarcoma/diagnóstico , Cuidados Pré-Operatórios/normas , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Biópsia com Agulha de Grande Calibre/normas , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Diagnóstico Diferencial , Feminino , Humanos , Lipoma/patologia , Lipoma/cirurgia , Lipossarcoma/cirurgia , Imagem por Ressonância Magnética/normas , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Carga Tumoral
6.
J Urol ; 203(4): 706-712, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31642740

RESUMO

PURPOSE: We update the prior standard operating procedure for magnetic resonance imaging of the prostate, and summarize the available data about the technique and clinical use for the diagnosis and management of prostate cancer. This update includes practical recommendations on the use of magnetic resonance imaging for screening, diagnosis, staging, treatment and surveillance of prostate cancer. MATERIALS AND METHODS: A panel of clinicians from the American Urological Association and Society of Abdominal Radiology with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and technique of magnetic resonance imaging for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus. RESULTS: Prostate magnetic resonance imaging should be performed according to technical specifications and standards, and interpreted according to standard reporting. Data support its use in men with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. Sufficient data now exist to support the recommendation of magnetic resonance imaging before prostate biopsy in all men who have no history of biopsy. Currently, the evidence is insufficient to recommend magnetic resonance imaging for screening, staging or surveillance of prostate cancer. CONCLUSIONS: Use of prostate magnetic resonance imaging in the risk stratification, diagnosis and treatment pathway of men with prostate cancer is expanding. When quality prostate imaging is obtained, current evidence now supports its use in men at risk of harboring prostate cancer and who have not undergone a previous biopsy, as well as in men with an increasing prostate specific antigen following an initial negative standard prostate biopsy procedure.


Assuntos
Programas de Rastreamento/normas , Imageamento por Ressonância Magnética Multiparamétrica/normas , Guias de Prática Clínica como Assunto , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/normas , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/normas , Calicreínas/sangue , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Imageamento por Ressonância Magnética Multiparamétrica/instrumentação , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Estadiamento de Neoplasias , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Radioterapia (Especialidade)/métodos , Radioterapia (Especialidade)/normas , Medição de Risco/métodos , Medição de Risco/normas
7.
J Urol ; 203(4): 727-733, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31651227

RESUMO

PURPOSE: In a large, prospective, multi-institutional active surveillance cohort we evaluated whether African American men are at higher risk for reclassification. MATERIALS AND METHODS: The Canary PASS (Prostate Active Surveillance Study) is a protocol driven, active surveillance cohort with a prespecified prostate specific antigen and surveillance biopsy regimen. Men included in this study had Gleason Grade Group 1 or 2 disease at diagnosis and fewer than 5 years between diagnosis and enrollment, and had undergone 1 or more surveillance biopsies. The reclassification risk, defined as an increase in the Gleason score on subsequent biopsy, was compared between African American and Caucasian American men using Cox proportional hazards models. In the subset of men who underwent delayed prostatectomy the rate of adverse pathology findings, defined as pT3a or greater disease, or Gleason Grade Group 3 or greater, was compared in African American and Caucasian American men. RESULTS: Of the 1,315 men 89 (7%) were African American and 1,226 (93%) were Caucasian American. There was no difference in the treatment rate in African American and Caucasian American men. In multivariate models African American race was not associated with the risk of reclassification (HR 1.16, 95% CI 0.78-1.72). Of the 441 men who underwent prostatectomy after a period of active surveillance the rate of adverse pathology was similar in those who were African American and Caucasian American (46% vs 47%, p=0.99). CONCLUSIONS: Of men on active surveillance who followed a standardized protocol of regular prostate specific antigen testing and biopsy those who were African American were not at increased risk for pathological reclassification while on active surveillance, or for adverse pathology findings at prostatectomy. Active surveillance appears to be an appropriate management strategy for African American men with favorable risk prostate cancer.


Assuntos
Afro-Americanos/estatística & dados numéricos , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Conduta Expectante/estatística & dados numéricos , Idoso , Biópsia com Agulha de Grande Calibre/normas , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estados Unidos , Conduta Expectante/normas
8.
Ann Diagn Pathol ; 43: 151407, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31634810

RESUMO

Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.


Assuntos
Biópsia com Agulha de Grande Calibre/normas , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Mama/patologia , Imuno-Histoquímica/métodos , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Mama/ultraestrutura , Doenças Mamárias/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/ultraestrutura , Carcinoma Intraductal não Infiltrante/metabolismo , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Diagnóstico Diferencial , Feminino , Doença da Mama Fibrocística/patologia , Indicadores Básicos de Saúde , Humanos , Hiperplasia/patologia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Patologistas/ética , Prognóstico
10.
Eur Urol Oncol ; 2(5): 483-489, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31411970

RESUMO

BACKGROUND: Active surveillance (AS) is a safe treatment strategy for men with low-risk prostate cancer (PC) when performed in a research setting using strict follow-up. However, less is known about the protocol adherence and outcomes for AS in real-world practice. OBJECTIVE: To evaluate Prostate Cancer Research International Active Surveillance (PRIAS) protocol adherence in a real-world cohort and to relate follow-up intensity to oncological safety. DESIGN, SETTING, AND PARTICIPANTS: Patients with biopsy-detected PC diagnosed from 2008 to 2014 treated with AS at six teaching hospitals in The Netherlands. INTERVENTION: AS included regular prostate-specific antigen (PSA) testing (every 3-6mo) combined with a confirmatory biopsy 1yr after diagnosis and every 3yr thereafter. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The proportions of patients complying with the PRIAS biopsy and PSA monitoring protocol were determined. We assessed if PRIAS-discordant follow-up was associated with a higher risk of metastasis compared with PRIAS-concordant follow-up using Cox regression analysis. Analysis was performed for separate risk groups (PRIAS-eligible and PRIAS-ineligible) on the basis of the PRIAS inclusion criteria. RESULTS AND LIMITATIONS: Of all patients on AS for >6mo, 706/958 (74%) had PRIAS-concordant PSA monitoring. Overall concordant follow-up (PSA and repeat biopsy) was observed in 415/958 patients (43%). The percentage of patients with overall concordant follow-up varied between hospitals (range 34-60%; p<0.001). Among PRIAS-ineligible patients, PRIAS-discordant PSA monitoring was associated with a higher risk of developing PC metastases during AS compared with patients with concordant follow-up (hazard ratio 5.25, 95% confidence interval 1.02-27.1). In the PRIAS-eligible population, we found no significant differences regarding rates of metastases between patients with discordant and concordant follow-up. CONCLUSIONS: We observed substantial variation in AS follow-up intensity between large urological practices in the Netherlands. Overall, 43% of patients on AS in daily clinical practice receive PRIAS-concordant follow-up. Noncompliance with the PRIAS follow-up protocol was associated with a higher rate of metastasis among PRIAS-ineligible patients, indicating that strict protocol adherence is important when these patients opt for AS. PATIENT SUMMARY: Fewer than half of patients with prostate cancer on active surveillance are monitored according to the follow-up protocol of the largest ongoing active surveillance study. Lower-intensity monitoring may be less safe for patients who are not in the lowest risk group.


Assuntos
Assistência ao Convalescente/normas , Fidelidade a Diretrizes/normas , Neoplasias da Próstata/terapia , Conduta Expectante/normas , Idoso , Biópsia com Agulha de Grande Calibre/normas , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Progressão da Doença , Definição da Elegibilidade , Seguimentos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Guias de Prática Clínica como Assunto , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Fatores de Risco , Conduta Expectante/estatística & dados numéricos
11.
Acta Vet Scand ; 61(1): 27, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196125

RESUMO

The aim of this study was to describe a core needle biopsy technique in the guinea pig (Cavia porcellus) and to assess the incidence of complications when applying this method. Biopsies were taken from the right hepatic lobe of 36 healthy guinea pigs under ultrasound guidance using a Tru-Cut needle. There were no immediate complications in 35 animals but ultrasound images showed a haemorrhage from the biopsy site in one guinea pig. The haemorrhage stopped after administering a sterile cooling dressing. One guinea pig died 13 days after the biopsy due to late complications. The procedure is in some animals associated with severe, potential life-threatening, complications. Assessment of the biopsy site by ultrasonography for 30 min after the procedure is recommended to allow timely handling of haemorrhage. The procedure is not recommended in animals with a suspected coagulopathy. Due to the risk of severe complications, this procedure should be restricted to guinea pigs where the result of the biopsy examination is expected to be valuable for the choice of treatment or prognosis. Owners should be made aware of the risks associated with the procedure.


Assuntos
Biópsia com Agulha de Grande Calibre/veterinária , Cobaias , Fígado/cirurgia , Medicina Veterinária/métodos , Animais , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/normas , Hemorragia/etiologia , Hemorragia/veterinária , Ultrassonografia
12.
Breast Cancer Res Treat ; 177(2): 507-511, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31168757

RESUMO

PURPOSE: The objective of this study was to examine the diagnostic accuracy of sonographically guided core needle biopsy (CNB) of breast lesions in men. METHODS: This was a retrospective study where we analyzed consecutive sonographically guided 14-gauge CNB results on 234 male breast lesions. The CNB accuracy is determined by the comparison between the CNB and its corresponding excisional biopsy or to long-term follow-up imaging. RESULTS: Sonographically guided CNB was effective to collect satisfactory samples from all 234 lesions. Out of those, 58.55% (137/234) were benign, 38.0% (89/234) were malignant, 1.71% (4/234) were papilloma with atypia and 1.71% (4/234) were atypical ductal hyperplasia lesions. Underestimation occurred in 3.4% (8/234) of the lesions. As for the detection of breast malignancy, the sensitivity of the CNB is 98.9%, specificity is 100%, negative predictive value is 99.3%, positive predictive value is 100%, false positive is 0% and false negative is 1.1%. The overall accuracy of sonographically guided CNB as a diagnostic tool is 99.6%. CONCLUSION: Sonographically guided 14-gauge CNB is an accurate, reliable and low invasive procedure for assessing breast lesions in men. Triple tests and follow-up checks of benign cases are essential for a successful breast biopsy program in men.


Assuntos
Biópsia com Agulha de Grande Calibre , Doenças Mamárias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/normas , Neoplasias da Mama Masculina/diagnóstico , Seguimentos , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia , Adulto Jovem
13.
J Am Soc Cytopathol ; 8(3): 165-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31097293

RESUMO

INTRODUCTION: Previous investigations have studied the importance of imprint cytology (IC) testing of core needle biopsy (CNB) from various organs. We have presented the largest series, to the best of our knowledge, of IC testing of CNB for patients with kidney tumors. MATERIALS AND METHODS: The present retrospective study (January 1, 2015, through January 30, 2016) identified laboratory information through a computer search of the cytology archived reports for 200 consecutive IC testing with CNB for renal tumors cases. A board-certified cytopathologist and cytology-trained fellow reviewed the IC testing and CNB slides and rendered them as nondiagnostic, positive for malignancy, negative for malignancy, positive for neoplasm, or atypical. The tumors were graded using the International Society of Urological Pathology grading system. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: The IC testing cases classified as atypical (n = 53) or positive for neoplasm (n = 28) were evaluated separately because of the ambiguous morphologic characteristics. Of the other 119 cases, IC testing classified 95 (80%) as positive for malignancy, 5 (4%) as negative for malignancy, and 19 (16%) as nondiagnostic. The corresponding CNB histologic diagnoses showed that 85 of 95 cases (89%) were true positive for malignancy. Of these 85 cases, 45 (53%) were low grade, 21 (25%) were high grade, and 19 (22%) were ungraded. The corresponding sensitivity, specificity, and accuracy were 85%, 11%, and 58%, respectively. The 53 IC-identified atypical cases were more likely to be malignant (n = 40; 75%). Of the remaining IC testing atypical cases, 12 (23%) were negative for malignancy and 1 (2%) was nondiagnostic. Of the 28 cases positive for neoplasm using IC, 13 (46%) were positive and 15 (54%) were negative for malignancy. CONCLUSIONS: The relatively low diagnostic value of IC testing for renal tumors showed it to be less powerful for screening than its use in other organs.


Assuntos
Carcinoma/patologia , Neoplasias Renais/patologia , Idoso , Biópsia com Agulha de Grande Calibre/normas , Carcinoma/classificação , Erros de Diagnóstico , Feminino , Humanos , Neoplasias Renais/classificação , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
14.
Prostate Cancer Prostatic Dis ; 22(4): 609-616, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30988407

RESUMO

BACKGROUND: Prostate cancer risk prediction models and multiparametric magnetic resonance imaging (mpMRI) are used for individualised pre-biopsy risk assessment. However, biparametric MRI (bpMRI) has emerged as a simpler, more rapid MRI approach (fewer scan sequences, no intravenous contrast-media) to reduce costs and facilitate a more widespread clinical implementation. It is unknown how bpMRI and risk models perform conjointly. Therefore, the objective was to develop a predictive model for significant prostate cancer (sPCa) in biopsy-naive men based on bpMRI findings and clinical parameters. METHODS: Eight hundred and seventy-six biopsy-naive men with clinical suspicion of prostate cancer (prostate-specific antigen, <50 ng/mL; tumour stage,

Assuntos
Tomada de Decisão Clínica/métodos , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Nomogramas , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/normas , Reações Falso-Negativas , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/normas , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Período Pré-Operatório , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Padrões de Referência , Medição de Risco/métodos , Ultrassonografia de Intervenção
15.
Eur J Radiol ; 113: 1-6, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927932

RESUMO

PURPOSE: To evaluate if subgroups of patients assigned to MRI category PI-RADS 4 regarding clinical and MRI imaging aspects have distinct risks of prostate cancer (PCa) to facilitate adequate clinical management of this population, especially after negative targeted biopsy. METHODS: This prospective, IRB approved single center cross-sectional study includes 931 consecutive patients after mp-MRI at 3 T for PCa detection. 193 patients with PI-RADS assessment category 4 received subsequent combined targeted MRI/US fusion-guided and systematic 12-core TRUS-guided biopsy as reference standard and were finally analyzed. The primary endpoint was PCa detection of PI-RADS 4 with MRI subgroup analyses. Secondary endpoints were analyses of clinical data, location of PCa, and detection of targeted biopsy cores. RESULTS: PCa was detected in 119 of 193 patients (62%) including clinically significant PCa (csPCa; Gleason score ≥3 + 4 = 7) in 92 patients (48%). MRI subgroup analysis revealed 95% PCa (73% csPCa) in unambiguous PI-RADS 4 index lesions without additional, interfering signs of prostatitis in the peripheral zone or overlaying signs of severe stromal hyperplasia in the transition zone according to PI-RADS v2. Transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia showed PCa only in 11% (4% csPCa). Targeted biopsy cores missed the csPCa index lesion in 7% of the patients. PSA density (PSAD) was significantly higher in PCa patients. CONCLUSIONS: Small csPCa can reliably be detected with mp-MRI by experienced readers, but can be missed by targeted MR/US fusion biopsy alone. Targeted re-biopsy of unambiguous (peripheral) PI-RADS-4-lesions is recommended; whereas transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia might be followed-up by re-MRI primarily.


Assuntos
Próstata/patologia , Neoplasias da Próstata/patologia , Prostatite/patologia , Idoso , Biópsia com Agulha de Grande Calibre/normas , Estudos Transversais , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/normas , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Prospectivos
16.
Eur Radiol ; 29(9): 4889-4896, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30783787

RESUMO

OBJECTIVE: To evaluate the performance of core-needle biopsy (CNB) in thyroid using a cohort of patients in which it was used as first choice. METHODS: Our institutional review board approved this retrospective study. We reviewed all CNB performed in our center over a period of 11 years. Ultrasound-guided CNBs were performed using a spring-loaded 18-gauge biopsy needle. We used a classification with four diagnostic categories for CNB results: insufficient, benign, follicular lesion (indeterminate), and malignant. Final diagnosis was based on surgical diagnosis or follow-up of at least 2 years in non-operated patients. RESULTS: The study included 4412 CNB in 4112 nodules of 3768 patients, 300 of them repeated biopsies. Results were 148 insufficient (3.4%), 3706 benign (84%), 278 follicular lesions (6.3%), and 280 malignant (6.3%). Considering follicular lesion and malignancy CNB results as positive (both lead to the recommendation of surgery) sensitivity was 96% (CI 93.2-97.8) and specificity 93.7% (CI 92.9-94.5). Predictive positive value for a follicular lesion diagnosis was 12.2% and for a malignancy diagnosis, 98.6%. CNB likelihood ratio for malignancy of a malignant diagnosis was 841.9 (CI 315.8-2313.3), of a malignant/follicular lesion diagnosis was 23.4 (CI 20.1-27.3), and of a benign diagnosis was 0.04 (CI 0.02-0.07). Repeated CNB in 53 insufficient biopsies obtained 50 diagnostic results. Minor complications occurred in 2.2% of CNB, and major in four procedures (0.09%). CONCLUSIONS: CNB in thyroid nodules is accurate and has few complications and a low rate of non-diagnostic and indeterminate diagnoses. It can be an alternative method when FNAC has poor performance. Repeating biopsy is useful after non-diagnostic biopsies. KEY POINTS: • Core-needle biopsy of thyroid has a low ratio non-diagnostic and indeterminate results. • Core-needle biopsy results are highly reliable, especially benign results. • Complication rate of core-needle biopsy of thyroid is low.


Assuntos
Nódulo da Glândula Tireoide/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/normas , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/normas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia de Intervenção/métodos , Ultrassonografia de Intervenção/normas , Adulto Jovem
17.
Eur J Radiol ; 110: 97-104, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599880

RESUMO

PURPOSE: To investigate the factors that could cause a misdiagnosis in virtual touch tissue imaging and quantification (VTIQ) when differentiating benign and malignant breast lesions, and to analyze the imaging characteristics of those lesions with incorrect findings. METHODS: The conventional ultrasound (CUS) features and the VTIQ parameters of 153 benign lesions and 99 malignant lesions were retrospectively analyzed and compared with histopathological and/or core-needle biopsy (CNB)-proven results. Independent variables that led to inaccurate VTIQ results were selected by binary logistic regression analysis. RESULTS: The maximum shear wave speed (SWS-max), the mean SWS (SWS-mean), the minimum SWS (SWS-min), the lesion-to-fat SWS ratio (SWS-L/F), and the lesion-to-gland SWS ratio (SWS-L/G) in malignant lesions were significantly higher than those in benign lesions (all P < 0.001). The false-positive rate (FPR) of benign lesions and the false-negative rate (FNR) of malignant lesions were 9.8% and 19.2%, respectively, using an SWS-max cut-off value of 4.46 m/s. Diameter, depth, and posterior acoustic features were independent variables related to false-positive VTIQ findings (P: 0.049, 0.010 and 0.032, respectively). The invasive status and the histologic grade of infiltrating carcinoma were significantly associated with false-negative VTIQ findings (P: 0.026 and 0.015). CONCLUSION: Diameter, depth, posterior acoustic features, invasive status, and histologic grade have a significant influence on the accuracy of VTIQ results, and these characteristics of breast lesions should be taken into account when interpreting the results of VTIQ examinations.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Erros de Diagnóstico , Técnicas de Imagem por Elasticidade/métodos , Adolescente , Adulto , Idoso , Biópsia com Agulha de Grande Calibre/normas , Feminino , Humanos , Pessoa de Meia-Idade , Exame Físico/normas , Estudos Retrospectivos , Adulto Jovem
18.
Parkinsonism Relat Disord ; 58: 35-39, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30340912

RESUMO

OBJECTIVE: To validate the role of α-synuclein (AS) pathology in submandibular gland (SMG) as a biomarker for Parkinson disease (PD). METHODS: We performed ultrasonography (USG) guided core needle biopsy of SMG in PD patients and procured SMG biopsy tissues or surgical excision specimens from non-PD patients as controls. Then, we compared AS deposition in the SMG tissues between the PD patients and the controls. We recruited 16 PD patients in this study. In each individual, two core needle biopsy tissues were obtained from the left submandibular gland under USG guidance. Fourteen sex and age-matched controls who did not have PD and dementia but received a core needle biopsy or surgical resection of the SMG due to SMG diseases were procured from the pathology archive. Biopsy tissues and surgical specimens were immuno-stained with serine 129 phosphorylated AS (pAS) antibody for microscopic examination. pAS deposition in neural structures such as ganglion cells and neurites was considered as positive. RESULTS: No serious complication occurred during and after the SMG biopsy. We found glandular parenchyma and neural structures in all biopsied SMG tissues from the patients and the controls. Nine out of 16 PD patients (56.2%) were positive for pAS staining, while none of the controls were positive (0%). CONCLUSIONS: SMG core needle biopsy can reliably and safely obtain sufficient glandular parenchyma and neural structures to evaluate the α-synuclein pathology. AS pathology in SMG has high specificity and good sensitivity as a biomarker for PD.


Assuntos
Biópsia com Agulha de Grande Calibre/normas , Doença de Parkinson/diagnóstico , Glândula Submandibular/patologia , alfa-Sinucleína/metabolismo , Idoso , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biomarcadores Ambientais , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/metabolismo , Doença de Parkinson/patologia , Reprodutibilidade dos Testes , Glândula Submandibular/metabolismo , Ultrassonografia
19.
Pediatr Dev Pathol ; 22(2): 137-141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30428273

RESUMO

Core biopsy (CB) is increasingly popular for assessing solid lesions in children. To date, pediatric literature is limited regarding factors contributing to diagnostically inadequate or inaccurate CB. Therefore, we retrospectively examined radiologic/pathologic factors associated with adequacy/accuracy of CB in pediatric patients. A search of the surgical pathology database for CB between January 2007 and December 2014 yielded 134 CB from 99 patients. Age, sex, anatomic site of lesion, CB diagnosis, and final diagnosis were acquired from the electronic medical record. Image guidance modality, lesion size, and CB sampling device were obtained from radiology records. CB hematoxylin and eosin slides were reviewed for fragmentation, percentage of fibrosis, and percentage of necrosis. Overall, CB length was measured using cellSens software and a DP71 camera. Groups were compared using 2-sided homoscedastic Student's t tests; 87.3% (117/134) CB were diagnostic; final diagnosis was available for 105 cases, with a concordance rate of 80.0% (84/105). Image guidance modality, lesion site (extremity vs nonextremity), and CB needle gauge did not significantly differ between diagnostic versus nondiagnostic CB or concordant versus discordant CB. Diagnostic CB had less necrosis and fibrosis than did nondiagnostic CBs (6.8% vs 29.7%, P = .0002 and 10.3% vs 29.1%, P = .0006). Nondiagnostic and discordant CB were more likely to be from bony lesions than soft tissue ( P = .01 and P = .0248). CB is valuable for diagnosing solid lesions in children, with good overall diagnostic rates regardless of lesion size, location, or imaging modality used for biopsy. Nondiagnostic and discordant CB were more often obtained from bony lesions; sampling via open biopsy may be more useful in that setting. Nondiagnostic and discordant CB have more necrosis and fibrosis, suggesting that on-site evaluation of CB tissue viability-for example, by touch imprint or fine needle aspiration-may be useful in further enhancing CB utility.


Assuntos
Biópsia com Agulha de Grande Calibre/normas , Neoplasias Ósseas/patologia , Neoplasias de Tecidos Moles/patologia , Adolescente , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Criança , Pré-Escolar , Correlação de Dados , Confiabilidade dos Dados , Feminino , Humanos , Lactente , Masculino , Patologia Cirúrgica , Pediatria , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia , Adulto Jovem
20.
Am J Clin Pathol ; 151(2): 205-208, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30265272

RESUMO

Objectives: Renal biopsy is the gold standard for the diagnosis of both native and allograft renal diseases. We studied the impact of tissue procurement at bedside (TPB) omission on the adequacy of renal biopsies. Methods: We compared 120 renal biopsies collected during 2015 using TPB with 111 renal biopsies collected during 2016 when TPB was discontinued. Adequacy criteria were applied as follows: by light microscopy, 10 glomeruli and two arteries for allograft biopsies and seven glomeruli for native biopsies. At least one glomerulus was considered adequate for immunofluorescence and electron microscopy in both groups. Results: The rate of inadequacies in allograft biopsies increased significantly, from 12.50% to 21.61% (P < .05), when TPB was discontinued. Conclusions: Elimination of TPB service had a negative impact on allograft specimen adequacy. Repeat biopsies add cost and delay patient care. Institutions should take this into consideration when considering omission of TPB.


Assuntos
Biópsia com Agulha de Grande Calibre/normas , Nefropatias/diagnóstico , Guias de Prática Clínica como Assunto , Obtenção de Tecidos e Órgãos/normas , Aloenxertos/normas , Aloenxertos/cirurgia , Imunofluorescência , Humanos , Rim/cirurgia , Nefropatias/cirurgia , Glomérulos Renais/cirurgia , Transplante de Rim , Microscopia Eletrônica , Nefrectomia , Estudos Retrospectivos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
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