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When borderline axillary lymph nodes (bALN) are identified on ultrasound (US) for breast cancer (BC) patients, preoperative management is unclear. We aimed to evaluate if core needle biopsy (CNB) for bALN is clinically helpful or disruptive. Retrospective review of BC patients with bALN from 2014 to 2019 was performed. Clinicopathologic data were compared for those who did and did not have CNB. CNB (n = 34) and no CNB (n = 31) were similar with respect to clinicopathologic factors. Surgical LN-positive rate was the same between cohorts (p = 0.26). CNB was disruptive in 58.8 %; all had CNB for pN0 disease. CNB was helpful in 34.2 %: 14.7 % proceeded directly to axillary dissection; 17.6 % had positive LN localized after neoadjuvant chemotherapy. CNB for bALN is more likely clinically disruptive and did not impact surgical LN positive rate. BC patients with bALN should undergo CNB only if it will change clinical management. [Display omitted] •Management is unclear when borderline axillary lymph nodes are seen on ultrasound•Image-guided biopsy of borderline lymph nodes was more often clinically disruptive•Biopsy of borderline lymph nodes is indicated only if it changes treatment

Background Ultrasound (US) guided transoral biopsy is a novel and safe procedure for obtaining tissue in patients with oral masses. However, this procedure is less commonly used in comparison to US guided transcutaneous biopsy. The aim of this study is to compare the efficacy and safety of US-guided transoral and transcutaneous core needle biopsy (CNB) in patients with oral masses. Methods From November 2019 to March 2021, consecutive patients with oral masses were randomly assigned to undergo US-guided transoral CNB (transoral group) and US-guided transcutaneous CNB from a submental approach (transcutaneous group). During the operation, procedure time, intra‑operative blood loss volume, diagnostic performance, rate of complications and pain level were recorded and compared. Results There were 112 patients (62 in the transoral group and 50 in the transcutaneous group) evaluated in this study. The postprocedural complication rate of the transcutaneous group was significantly higher than the transoral group (24% vs. 0%, P  = 0.000). There was no significant difference in accuracy (95.2% vs. 88%, P  = 0.30), biopsy time (76 ± 12 s vs. 80 ± 13 s, p  = 0.09), blood losses (2.6 ± 0.5 mL vs. 2.7 ± 0.4 mL, p  = 0.17) and visual analogue score ( p  = 0.327 and p  = 0.444 before and after the sampling procedure) between the two groups. Conclusion US-guided transoral CNB results in high rates of technical success and lower rates of postprocedural complications.

ObjectivesTo evaluate different analgesic techniques in MRI-guided in-bore prostate biopsy (IB-GB) regarding the influence on patient procedural experience of pain.MethodsTwo hundred fifty-two consecutive patients who had received an IB-GB either with intrarectal instillation of 2% lidocaine gel (n = 126, group A) or with periprostatic nerve block (PPNB) with 2% mepivacaine (n = 126, group B) were retrospectively included in this study. Pain scores were measured on a visual analog scale, the operating room time (ORT) was recorded for each biopsy and correlations between the parameters were analysed.ResultsPain scores for IB-GB were slightly lower in group B compared with group A (2.0 ± 1.9; 2.4 ± 1.7; p = 0.02). In group A, significantly more targeted biopsy cores were acquired (group B: 5.2 ± 1.1; group A: 5.6 ± 0.8; p < 0.01). ORT was comparable and not significantly different in both groups. There was only a weak correlation between pain scores and ORT in group B (rS = 0.22; p = 0.01), but no correlation between pain scores and the number of biopsy cores or the prostate volume.ConclusionsPain levels are generally low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel. A statistically significant, slightly lower pain score was documented for PPNB and might be preferred when the focus is analgesia. On the other hand, due to the minor difference and easier administration, intrarectal gel instillation seems to be a reasonable practice for standard analgesia for MRI-guided in-bore biopsy.Key Points• Pain levels were low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel as analgesic method.• PPNB prior to IB-GB resulted in a slightly lower pain score but required a higher effort.• Intrarectal gel anaesthesia seems to be a reasonable practice for standard analgesia for IB-GB in an outpatient setting.

PurposeTo compare the pain control efficacies of the pelvic plexus block (PPB), periprostatic nerve block (PNB), and controls during a 14-core basal and apical core prostate biopsy.MethodsThis randomized controlled study, performed between January 2015 and January 2016, included patients with an abnormal serum prostate-specific antigen (PSA > 3 ng/mL) level or a palpable nodule on digital rectal examination. The enrolled patients were randomized into three groups: Group 1, intrarectal local anesthesia (IRLA, 10 mL of 2% lidocaine jelly) and PPB with 3.0 mL of 2% lidocaine injected at the bilateral pelvic plexus; Group 2, IRLA and PNB with 3.0 mL of 2% lidocaine injected at both periprostatic nerves; and Group 3, only IRLA. Patients answered the visual analog scale (VAS) questionnaire at 6 time points.ResultsThis study consisted of 163 patients (Group 1 = 55, Group 2 = 55, and Group 3 = 53). Pain at the apical biopsy location was less in Groups 1 and 2 than in Group 3 (p < 0.001, p < 0.001) and between the two local anesthetic groups (PNB + IRLA vs PPB + IRLA). Group 2 patients reported less pain than Group 1 patients (p = 0.022). Pain during the basal core biopsy was significantly less in Groups 1 and 2 than in Group 3 (p = 0.002, p < 0.001), but there were no significant differences in pain control between the two methods (PNB + IRLA vs PPB + IRLA, p = 0.054) during basal core biopsy.ConclusionsPNB + IRLA is an effective local anesthetic method for reducing pain when performing apical biopsies compared with PPB + IRLA or IRLA alone.

Purpose To compare the procedural time and complication rate of coaxial technique with those of noncoaxial technique in transperineal prostate biopsy. Materials and Methods Transperineal prostate biopsy with coaxial (first group, n  = 120) and noncoaxial (second group, n  = 120) methods was performed randomly in 240 patients. The procedural time was recorded. The level of pain experienced during the procedure was assessed on a visual analogue scale (VAS), and the rate of complications was evaluated in comparison of the two methods. Results The procedural time was significantly shorter in the first group ( p  < 0.001). In the first group, pain occurred less frequently ( p  = 0.002), with a significantly lower VAS score being experienced ( p  < 0.002). No patient had post procedural fever. Haematuria ( p  = 0.029) and haemorrhage from the site of biopsy ( p  < 0.001) were seen less frequently in the first group. There was no significant difference in the rate of urethral haemorrhage between the two groups ( p  = 0.059). Urinary retention occurred less commonly in the first group ( p  = 0.029). No significant difference was seen in the rate of dysuria between the two groups ( p  = 0.078). Conclusions Transperineal prostate biopsy using a coaxial needle is a faster and less painful method with a lower rate of complications compared with conventional noncoaxial technique.

To evaluate targeted magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion prostate biopsy versus systematic prostate biopsy and the two approaches combined for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in our center. From September 2018 to June 2020, a total of 161 patients with PI-RADS ≥3 were enrolled in this study. They were randomly to undergo either systematic prostate biopsy (systematic group) or targeted MRI/TRUS fusion prostate biopsy + systematic prostate biopsy (combined group). The clinical data and pathological results of biopsies were analyzed. The detection rate of PCa by targeted MRI/TRUS fusion prostate biopsy was higher than systematic prostate biopsy (38/81 vs. 33/81) in combinated group, but there was no significantly difference. The PCa detection rate in combinated group was significantly higher than systematic group (47/81 vs. 34/80, P = 0.049). There were 40 patients in combinated group and 22 patients in systematic group diagnosed as csPCa, respectively. The ratio of detected csPCa was much higher in combinated group (P = 0.032). In Gleason score no more than 6, the detected ratio of targeted MRI/TRUS fusion prostate biopsy was significantly lower than systematic biopsies in combinated group (P = 0.044). While, in Gleason score higher than 6, the detected ratios of targeted MRI/TRUS fusion prostate biopsy were all higher than systematic biopsies. Among patients with PI-RADS ≥ 3, targeted MRI/TRUS fusion prostate biopsy is superior to systematic prostate biopsy in the detection rate of PCa and csPCa, but it still misses some PCa patients, including csPCa. Combining targeted MRI/TRUS fusion prostate biopsy and systematic prostate biopsy can led to more detection of all PCas, especially csPCa.

Abstract Objective The purpose of this study was to evaluate the analgesic effect of a prilocaine + bupivacaine combination in patients undergoing periprostatic nerve block (PNB) by comparing its effects with those of prilocaine alone. Design Single center, single-blind, prospective descriptive study. Subjects Four hundred patients with transrectal prostate biopsy pain. Methods The patients in this prospective, randomized controlled study were divided into two groups. The first group received prilocaine during PNB (Group 1), whereas the second received a prilocaine + bupivacaine combination (Group 2). Results The mean visual analog scale (VAS) scores immediately after biopsy were 2.52 ± 0.7 and 2.53 ± 0.9, respectively (P = 0.35). VAS values were significantly lower in Group 2 at one and six hours following the procedure. The most painful part of the biopsy according to many patients was the probe insertion. Conclusions The prilocaine + bupivacaine combination is an effective analgesic method during prostate biopsies and for one and six hours after prostate biopsy.

Core needle biopsies (CNBs) are among the most common biopsy procedures, yielding long, thin deformation-prone cores. Core deformation results in both distorted histologic features and tortuosity (ie, deviation from the ideal straight path) along the length of the core. Tortuosity creates challenges in slide preparation and downstream pathologist assessment (eg, absent diagnostically relevant tissue after sectioning), indicating a clinical need for its minimization. Despite this need, there is no standard protocol for reporting CNB tortuosity. To (1) establish an actionable protocol for scoring CNB tortuosity, (2) build BiopTort, a software tool assigning CNB images interpretable, tiered scores consistent with the protocol, and (3) investigate our protocol and BiopTort's impact on interpathologist concordance and scoring time. Using a held-out CNB data set (N = 167), 3 pathologists assessed tortuosity in 3 sequential stages: (1) Baseline: a 3-tier scale based on prior experience, (2) Protocol: rescored with our 4-tier Tortuosity Scoring Protocol, (3) BiopTort-Aided: rescored with the protocol alongside BiopTort. Interrater concordance for each stage, using the Fleiss κ, was recorded. Fleiss κ was 0.19, 0.40, and 0.63, and average time per slide was 8.0, 24.2, and 13.3 seconds for stages 1 to 3, respectively. BiopTort was statistically noninferior to human interrater pairwise concordance. These results suggest our protocol lessens interpathologist variability, with BiopTort further reducing variability and scoring protocol employment time cost. When deployed in CNB quality control workflows, our computer-aided protocol appears well situated to facilitate standardized, efficient, and actionable reporting of CNB tortuosity. BiopTort is open-source (http://bioptort.com).

Background The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30 years, this has evolved from the use of fine-needle aspiration biopsy (FNAB) to the current methodology of vacuum assisted biopsy (VAB). Methods This article provides an historical review of the application of needle interventions of the breast in the diagnosis and management of breast conditions, and discusses current indications for the use of vacuum assisted biopsies and vacuum assisted excisions. Results Whilst FNAB continues to have a limited role in breast disease diagnosis, the necessity of achieving an histological diagnosis has preferentially seen the development and wider application of automated core needle biopsies (CNB) and VAB in the assessment and management of breast lesions. The advantages of CNB and VAB include the ability to distinguish in situ and invasive disease pre-operatively, and the ability to achieve prior knowledge of immunohistochemical tumour markers particularly in the setting of neoadjuvant drug treatments. Conclusion Due to its ability to obtain larger tissue samples, VAB does have diagnostic advantages over CNB and indications for the utilization of VAB are discussed. VAB additionally has an expanding role as a tool for breast lesion excision.

Core needle biopsy (CNB) has been suggested as a complementary diagnostic method to fine-needle aspiration in patients with thyroid nodules. Many recent CNB studies have suggested a more advanced role for CNB, but there are still no guidelines on its use. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology has developed the present consensus statement and recommendations for the role of CNB in the diagnosis of thyroid nodules. These recommendations are based on evidence from the current literature and expert consensus.