Niels Juul

Ultrasonically Guided Fine Needle Aspiration Biopsy of Renal Masses

A consecutive series of 301 ultrasonically guided fine needle aspiration biopsies of renal masses was reviewed. The retrieval rate was 95 per cent and a correct cytological diagnosis was established in 82 per cent of the cases. There were 14 false positive aspirates, for a predictive value of a malignant aspirate of only 93 per cent. All false positive results were misinterpreted as relatively well differentiated adenocarcinoma. We conclude that renal fine needle aspiration biopsy may add information but the risk of a false positive finding must always be considered.

US-guided fine needle aspiration versus coarse needle biopsy of thyroid nodules.

OBJECTIVE The aim of this study was retrospectively to evaluate ultrasound (US) guided fine-needle aspiration (FNA), in combination with US-guided coarse-needle biopsies, (CNB) from solitary or dominant thyroid nodules routinely performed during a 2 year period. METHODS Seventy seven patients were biopsied using US-guided FNA and CNB. FNA was performed using a 21-Gauge needle and CNB using a 18-Gauge single action spring-activated needle biopsy system. The biopsies were performed with local anaesthesia. The Department of Pathology routinely examined the biopsy specimens. The retrieval rate in obtaining material for diagnostic evaluation was FNA (97%), CNB (88%), FNA and CNB (100%). RESULTS In all, 41 of the 77 patients underwent neck-surgery. The surgical specimens were used to determine the results of diagnosing neoplasia. The accuracy, sensitivity and specificity for FNA were 80, 83, and 77%. For CNB 86, 78, and 94%. For both FNA and CNB 80, 89 and 73%. The diagnostic value of the two methods showed no significant difference (P < 0.05). CNB revealed contrary to FNA, however, one additional cancer. Also a higher number of false positive findings was noticed using FNA. No serious complications were registered. Adequate biopsies were obtained in all the patients using the combination of US-guided FNA and CNB. No patient underwent rebiopsy. CONCLUSIONS The study demonstrated that neither US-guided CNB nor the combination of US-guided FNA and CNB were superior to US-guided FNA. US-guided CNB is only recommended in few selected patients.

Histological sampling with a 23 gauge modified Menghini needle

A 23 gauge modified Menghini (Surecut) needle biopsy technique for obtaining tissue core biopsies was compared with the conventional fine needle aspiration biopsy technique in the diagnosis of ultrasonically detected abdominal mass lesions. In 30 consecutive cases (19 malignant and 11 benign), adequate material for histological examination was obtained in 87% and for cytological examination in 97%. The diagnostic accuracy with respect to malignancy was 84% for histology and 89% for cytology. The predictive value of malignancy was 100% in both. The histological material provided additional information in four cases of malignancy, concerning the type and origin of the tumours, and in nine cases of benign lesions, indicating the type of lesion that appeared as a tumourlike mass in the ultrasound study. The Surecut needle biopsy has been found valuable in obtaining histological material from abdominal mass lesions and may supplement or even replace the fine needle aspiration biopsy in such lesions.

Ultrasonically guided fine needle aspiration biopsy of retroperitoneal mass lesions

Ultrasonically-guided fine needle aspiration biopsy of retroperitoneal mass lesions was performed in 96 consecutive patients. The puncture was done transperitoneally, guided by a dynamic scanner. The procedure is rapid with a high diagnostic sensitivity and specificity. A correct cytological diagnosis was established in 88% of the punctured masses with no false positives. Guided fine needle aspiration biopsy is recommended as an integral part of the ultrasound study of retroperitoneal tumour diagnosis. There were no complications to any of the biopsies and the risk is regarded as minimal.

Optimal set-up for ultrasound guided punctures using new scanner applications: an in-vitro study.

OBJECTIVE To investigate if US-visualisation of the needle tip echo during US-guided punctures could be improved by use of new technological applications. METHOD an US-guided 18 G Trocar needle was inserted into targets of a puncture phantom. The punctures were performed in series of 10 using different settings of the US-scanner (GE Logic 700 Expert). At 7-cm of puncture depth the quality of the echo was tested using four different settings; normal (N), N + automatic tissue optimising (ATO), coded harmonic imaging (CHI), CHI + ATO and at 13-cm of puncture depths six different settings; N, N + ATO, coded excitation (CE), CE+ATO, CHI, CHI+ATO. In total 100 (40 + 60) images were randomly numbered and read independently by three radiologists with regard to scoring of the quality of the echoes from the needle tip, needle shaft and the target. RESULTS US visualisation of the needle tip was significantly (P < 0.005) improved as compared to normal settings (N) when the settings of ATO and CE were used. CHI resulted in the lowest score. A high agreement between observers was registered. Similar results were registered with regard to scorings from the needle shaft and target. CONCLUSION Not only changes of needle designs and puncture techniques can enhance echoes from the needle but also changes in the settings of the US-scanner with the use of new technological applications can improve visualisation of the needle echo.

Percutaneous balloon catheter nephrostomy guided by ultrasound. Results of a new technique.

A new method for percutaneous nephrostomy is described. The renal pelvis is punctured guided by ultrasound and after dilatation of the tract a 10F silicone balloon catheter is inserted. The procedure was successful in 51 of 52 attempts (98%). The catheters were maintained from two to 150 days. Eight catheters slipped out unintended (16%) 27 to 86 days after the insertion. No serious complications were seen.

Puncture of renal mass lesions

The ultrasonic accuracy in differentiating simple renal cysts from other masses is high and ultrasound has therefore become one of the primary diagnostic procedures in cases of renal mass lesions.

Ultrasonically-guided biopsy of lytic bone lesions suspected for metastases

Abstract Ultrasonically guided biopsy was performed in 11 patients with lytic bone lesions suspected for metastases and primary detected by conventional X-ray and CT. The lesions were localized in the ribs, scapula and sacrum. The material obtained by fine needle aspiration biopsies and cutting biopsies confirmed malignancy in all patients. We conclude that US-guided biopsy from osteolytic bone lesions is a rapid and useful procedure to obtain the diagnosis. The only limitation in the applicability of US-guided biopsy was the clear visualization of the lesion by the ultrasound examination which depend on the localization of the lesion.

Electron microscopy of ultrasound-guided fine-needle biopsy specimens

A prospective 3-year study was undertaken in order to assess the value of electron microscopy (EM) as a supplement to routine light microscopy (LM) in ultrasound-guided fine-needle biopsy of suspected abdominal and retroperitoneal tumours. Eight-six of the 899 ultrasound-guided fine-needle biopsies performed during this period were supplemented with EM using the following indications: metastatic lesions with unknown primary tumour, primary retroperitoneal tumours, tumours with atypical clinical histories and where the primary LM evaluation was unable to determine tumour cell type. Two methods of obtaining material for EM were tested, namely, fine-needle aspiration and fine-needle histological biopsy (Surecut). Both methods yielded suitable material for EM evaluation in approximately 80% of the 76 cases where tumour cells were identified by LM. However, it was technically easier to process material for EM when obtained by fine-needle histological biopsy. The results of the 62 cases where suitable material for EM was obtained were grouped according to the histopathological and clinical value of the diagnosis. In 23 cases (37%) EM was without additional diagnostic value. In 12 cases (19%), EM supplied a more precise histopathological diagnosis, but the diagnostic gain was without clinical significance. In 27 cases (44%) EM was of significant clinical value, as the diagnosis by itself was enough to change the investigative procedure and/or the treatment of the patient.

Fine needle histological sampling

The caliber of a biopsy needle should be large enough to yield a satisfactory amount of tissue for the pathologist and small enough to be virtually without risk to the patient. In daily practice fine needle aspiration biopsy has proven satisfactory in the diagnosis of malignancy. The needles used are 22 or 23 gauge and a high sensitivity and specificity can be obtained with very few complications. The technique demands the cooperation of an expert cytologist, however, and has not gained acceptance in all centers. Attempts to obtain material for histological examination with fine needles have therefore been made.