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Biopsy Processing Protocol
Published in Maher Kurdi, Neuromuscular Pathology Made Easy, 2021
For decades, muscle biopsy was commonly performed through open surgical excision under local or general anesthesia. This practice changed in 1861. An alternative option to perform a localized needle biopsy became a common rout, not because it is safer and less time-consuming, but because patients prefer this option. A Bergstrom needle with a sliding cannula should be inserted into the muscle while the other hand holds the thigh. The window is opened by sliding the cannula while the muscle is gently squeezed to slide into the window of the needle. The needle can be reintroduced multiple times through the same incision, if necessary. An average tissue fragment of 0.5–1.0 cm size is enough for tissue processing. It is better to orient the tissue specimen. The muscle should either be kept in an empty container or on a moist saline gauze, ready to transfer to the lab (Figure 6.1a).
Carcinoma of unknown primary
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
A balance has to be struck between the need to confirm the histological diagnosis, how it will affect ultimate management and what treatment is reasonable for the patient to undergo. The general principle is to obtain an adequate piece of tissue from a representative part of the tumour that is not necrotic. This should ensure sufficient tissue for immunocytochemistry so that an accurate analysis is possible. If several sites of bulk disease are accessible, the safest and least traumatic route of access should be followed. A needle biopsy is usually the optimum means of getting enough tissue to perform the required histological testing. The lesion for biopsy might need to be localized using CT or ultrasound depending on its anatomical location and accessibility.
Pneumocystis Carinii Pneumonia *
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
A definitive diagnosis requires the finding of P. carinii in lung tissue. Several approaches have been utilized to obtain specimens of pulmonary parenchyma or bronchoalveolar fluids. The open lung biopsy is probably overall the most dependable approach, since the extent of the infection can be viewed and relatively large amounts of tissue can be obtained for several histopathological preparations and cultures for bacteria, fungi, viruses, mycoplasma, Chlamydia, etc. Imprints of biopsy specimens can be made on microscope slides and stained for a rapid diagnosis, although definitive conclusions may require completion of histological sections. A transbronchial biopsy also provides an excellent diagnostic approach in the hands of a skilled operator. The percutaneous needle biopsy has been fraught with hazardous complications and should not be used. The transthoracic percutaneous needle aspirate is more safe and has been useful in identifying 80 to 90% of cases with P. carinii pneumonitis. While this is a simple procedure that does not require a general anesthetic, it does not provide a view of the histological pattern and extent of disease, and some degree of pneumothorax may be expected in up to one third of the cases.
Biopsy strategies for intermediate and high suspicion thyroid nodules with macrocalcifications
Published in Current Medical Research and Opinion, 2023
Sungmok Kim, Jae Ho Shin, Yon Kwon Ihn
Our study has limitations. First, selection bias may have been introduced due to retrospective study design. Second, unpaired comparisons were made between FNAB and CNB, and the sample sizes were relatively small, especially for the rim type and the entirely calcified type macrocalcifications due to rarity, which may have caused underestimation of malignancy potentials11. Nevertheless, statistical significances in analyzing the mode of biopsy (FNAB vs. CNB) and factors affecting the poor FNAB performance were achieved. We speculate that further studies are necessary to strengthen the superior performance of CNB for thyroid nodules with macrocalcification. Third, variability among FNAB operators and pathologists may have affected the unsatisfactory rates of FNAB and CNB; nonetheless, our results reflect a routine daily practice. Lastly, generalizability of our results may be limited due to different types of core needle biopsy calibers and mode of CNB (automatic vs. semi-automatic mechanism).
Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment
Published in Journal of Investigative Surgery, 2022
Yulong Yin, Xianghua Liu, Qingjie Meng, Xiaogang Han, Haomeng Zhang, Yonggang Lv
Ultimately and critically important, the diagnosis of IGM depends on histopathologic examination. Open biopsy has been used for diagnosis in some studies [61], including lesion resection and even mastectomy. Percutaneous needle biopsy has been widely applied and increasingly adopted in suspected cases. Fine-needle aspiration cytology (FNAC) is a simple, fast and is minimally invasive, but its diagnostic sensitivity is low [62]. Several studies have demonstrated that only 21% of IGM cases have been diagnosed using FNAC alone, even patients suffered FNAC often need further open biopsies to make a definite diagnosis [35, 63, 64]. Although granulomas cannot be found via needle biopsy in up to 15% of cases, they are virtually always present in biopsy specimens [44]. Therefore, open biopsy may be necessary for difficult diagnostic cases, or when core-needle biopsy is insufficient.
Application of multimodal MRI and radiologic features for stereotactic brain biopsy: insights from a series of 208 patients
Published in British Journal of Neurosurgery, 2021
Peng Chen, Jiaming Mei, Wei Cheng, Xiaofeng Jiang, Shiying Lin, Xiangpin Wei, Ruobing Qian, Chaoshi Niu
STB guided by MRS and PWI images was technically successful in all patients. Definite pathological diagnosis was made from needle biopsy specimens in all cases. Twenty-seven biopsy specimens were obtained from 17 glioma patients (WHO grade I–II: 7; WHO grade III–IV: 10), six biopsies with diffuse large B cell lymphoma and four biopsies with inflammation. In glioma patients, we first performed PWI (DSC) to identify high-perfusion areas and then performed 1H-MRS in these areas to identify the voxel with the highest CNI (Figures 1 and 2). Biopsies from such areas all got pathological diagnoses. In five lymphoma patients, biopsy combined MRS and PWI (DSC) was successfully. However, the tumors displayed low perfusion in one lymphoma patients, so we chose a relatively high-perfusion region and MRS data to select the target (Figure 3). In inflammation patients, we also used PWI (DSC) to identify relative high-perfusion areas and then performed 1H-MRS in these areas to identify the voxel with the highest CNI (Figure 4).