A worrying lump
Tim French, Terry Wardle in The Problem-Based Learning Workbook, 2022
Triple assessment of a breast lesion consists of physical examination, imaging (mammography and/or ultrasonography), and sampling of the lump for cytological and/or histological assessment (fine needle aspiration cytology (FNAC) or core biopsies). This form of assessment establishes a diagnosis in 95% of patients with suspected breast cancer. clinical examination is used to provide an index of suspicion based on the findings (see (a))imaging: this consists of a mammogram and/or ultrasound. Mammography and ultrasonography are used for women over 35 years old. Those under 35 years old should be investigated using ultrasonography, as the denser breast tissue in this age group makes mammography unreliablecytology: fine needle aspiration (FNA) has many benefits. If the lump is due to a cyst, aspiration can provide relief from both pain, and the anxiety surrounding the prospect of cancer. In contrast, if the lump is solid, cells can be obtained for cytological examination. Sometimes a core biopsy may also be performed whereby small samples of tissue are obtained.
Rhabdomyosarcoma
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Imaging for staging should precede biopsy in order to determine the best anatomical approach to the tumor, suggest which area is best representative of the underlying disease, and avoid radiological artifact at the biopsy site that may affect the interpretation of the images. Enough tissue for pathological, biological, cytogenetic, and treatment protocol studies should be procured. Incisional, excisional, and core-needle biopsies are acceptable depending on the circumstances. Fine-needle aspiration biopsy should not be used as the samples are inadequate for the evaluation of tissue architecture. Open, laparoscopic, or thoracoscopic techniques can be used for intra-abdominal or intrathoracic primary or metastatic disease. Core-needle biopsy is less invasive and is being successfully used in most anatomic locations, though it has a slightly higher rate of diagnostic failure. Multiple cores are required for diagnosis. Unplanned incisional or needle biopsies may complicate surgical excision and compromise the preservation of cosmesis and function (Table 61.4: Procedure 1).
History-taking model
Kaji Sritharan, Vivian A Elwell, Sachi Sivananthan in Essential OSCE Topics for Medical and Surgical Finals, 2007
ClosureThe results of the investigation should be available at your next appointment, and will also be sent to your GP. Biopsy results typically take around 1 week to be processed.Ask the patient whether they have any questions.Thank the patient.Give them your bleep number and name in case they have any further questions.Give them an information leaflet from the hospital which explains the procedure in more detail.
Transthoracic ultrasound-guided biopsy in the hands of chest physicians – a stepwise approach
Published in European Clinical Respiratory Journal, 2019
Ida Skovgaard Christiansen, Paul Frost Clementsen, Uffe Bodtger, Therese Maria Henriette Naur, Pia Iben Pietersen, Christian B Laursen
The biopsy site is scanned using the sterile transducer. Once the optimal biopsy path has been identified a local anesthetic can be injected using ultrasound guidance. When injecting the local anesthetic one should note whether the needle path is still optimal for the subsequent biopsy procedure. The largest amount of the local anesthetic should be applied to the skin and parietal pleura. Once the local anesthetic has had some time to induce analgesia the biopsy procedure can be performed. If a core biopsy is performed, a small skin incision is made to facilitate the needles penetration of the skin. The optimal biopsy site is once again identified using the transducer. Great care should be made in order to ensure that no vessels, nerves, aerated lung or other vital structures are located in the needle path. Whenever possible, a needle path just above a rib should be chosen in order to minimize the risk of making a lesion of an intercostal artery.
A comprehensive review of endoscopic ultrasound core biopsy needles
Published in Expert Review of Medical Devices, 2018
Theodore W. James, Todd H. Baron
A study conducted by Bang et al. evaluated the performance of the Acquire core biopsy needle in 30 patients over a 3-month period [43]. Utilizing on-site cytopathology, the Acquire needle was able to provide a definitive diagnosis in 96.6% of cases. This was an initial validation study without a comparator. A follow-up randomized trial of 46 patients with pancreatic masses demonstrated significantly higher total tissue and tumor areas with the Acquire 22-gauge needle than FNA and had the added benefit of retained desmoplastic fibrosis, which is required for molecular profiling [44]. A separate study by Mukai et al. sought to compare the volume of tissue acquired through EUS-FNB with the Acquire 22-gauge needle, the ProCore 20-gauge needle and 41 different 22-gauge FNA needles [45]. The sample weight was quantified using an electronic scale. The Acquire and ProCore needles performed similarly with respect to tissue volume acquired and level of specimen blood contamination; both needles outperformed conventional 22-gauge FNA needles.
Percutaneous renal mass biopsy: historical perspective, current status, and future considerations
Published in Expert Review of Anticancer Therapy, 2019
Brittney H. Cotta, Margaret F. Meagher, Aaron Bradshaw, Stephen T. Ryan, Gerant Rivera-Sanfeliz, Ithaar H. Derweesh
PRMB is most commonly performed in the outpatient setting under local anesthesia and sedation. Image guidance can be performed with computed tomography (CT) or ultrasound, and tissue sampling may be carried out by fine needle aspiration (FNA) or by core needle biopsy [22]. While FNA may allow multiple passes with more extensive tumor sampling, with smaller needle access (21 gauge or less), an experienced cytopathologist is required during the procedure to confirm adequate cell sampling. Core needle biopsy allows for a more limited number of solid tissue samples which permit analysis of tissue ultrastructure but may be affected by sampling errors [23,24]. Core needle biopsy has superior diagnostic yield and accuracy to FNA. FNA is associated with a wide range of diagnostic accuracy, with sensitivities ranging from 64% to 89% [25], and a diagnostic rate of 72% compared to 92% with a core biopsy [26]. There are data which suggest that the combination of FNA and CB can improve diagnostic rate but in most cases, a core biopsy is sufficient and preferred [26,27].
Related Knowledge Centers
- Interventional Cardiology
- Microscope
- Tissue
- Pathology
- Medical Test
- Surgeon
- Interventional Radiology
- Sampling
- Cell
- Fine-Needle Aspiration