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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.

ObjectiveTo evaluate the performance of core-needle biopsy (CNB) in thyroid using a cohort of patients in which it was used as first choice.MethodsOur 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.ResultsThe 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%).ConclusionsCNB 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.

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.

Background This study aimed to retrospectively explore the safety and feasibility of computed tomography (CT)‐guided synchronous microwave ablation (MWA) followed by core‐needle biopsy (CNB) via a coaxial cannula for highly suspected malignant lung ground‐glass opacities (GGOs). Methods The clinical data of 66 patients (66 GGOs) treated with CT‐guided synchronous MWA followed by CNB via a coaxial cannula from January 2019 to January 2021 were included in this study. The technical success rate, curative effect, and complications were evaluated. Results Technical success rates were 100%. The pneumothorax rate was 36.4% (24/66). 72.7% (48/66) patients had the bronchopulmonary hemorrhage, 81.3% of hemorrhage was attributable to CNB. 24.2% (16/66) patients had varying degrees of pleural effusion. The pathological results were adenocarcinomas (n = 44), atypical adenomatous hyperplasia (n = 2), chronic inflammation (n = 3) and indeterminate pathological diagnosis (n = 17) with a 69.7% (46/66) positive diagnosis rate. The therapeutic response rate was 100.0% (66/66). Conclusions Synchronous MWA followed by CNB via a coaxial cannula has a satisfactory ablation effectiveness and an acceptable biopsy positive rate, which is an alternative treatment for highly suspected malignant GGOs. Synchronous microwave ablation followed by core‐needle biopsy can reduce the influence of biopsy‐induced pneumothorax and pulmonary hemorrhage on microwave ablation, which has a satisfactory therapeutic effect and an acceptable diagnostic positivity rate.

Axillary assessment in breast cancer is key to determining an upfront surgery or neoadjuvant chemotherapy (NAC) approach. We investigated the false-negative rate (FNR) of axillary-node ultrasound-guided core-needle biopsy (US-CNBx) and the surgical management of pN ​+ ​patients. This single-institution study from 2010 to 2020 included patients with benign findings on US-CNBx and upfront surgery. Statistical analyses were performed via t-tests and chi-squared tests. 95 axillae met inclusion, 23 were pN+, resulting in a US-CNBx FNR of 24.2 ​%. pN ​+ ​patients more frequently had cT2-T3 tumors vs pN0 patients (43.5 ​% vs 27.8 ​%, p ​= ​0.03). Of the 23 ​pN ​+ ​patients, 9 underwent breast-conserving surgery (BCS) and 14 underwent mastectomy. In those with BCS, 7 had 1–2 positive nodes, 2 had ≥3 nodes; 3 received an ALND. In those with mastectomies, 12 had 1–2 positive nodes, 2 had ≥3 positive nodes; 6 received an ALND. In this cohort, US-CNBx had a FNR of 24.2 ​%. pN ​+ ​patients had a greater frequency of cT2–cT3 tumors, therefore clinicians should be cognizant of potential occult nodal disease despite negative CNBx when deciding management. •US-CNBx had a false negative rate of 24.2% in women with invasive breast cancer who underwent upfront surgery.•Patients with pN ​+ ​disease had larger tumors compared to patients with pN- disease following negative US-CNBx.•Three pN+ ​patients had HER2+ tumors or TNBC and were eligible for NAC, however, they had upfront surgery.•Clinicians may suspect occult axillary disease in larger tumors when weighing upfront surgery vs NAC in HER2+ and TNBC.

Purpose: To evaluate technical outcome, diagnostic yield and safety of computed tomographic fluoroscopy-guided percutaneous core needle biopsies in patients with mediastinal masses. Methods: Overall, 155 CT fluoroscopy-guided mediastinal core needle biopsies, performed from March 2010 to June 2020 were included. Size of lesion, size of needle, access path, number of success, number of biopsies per session, diagnostic yield, patient’s position, effective dose, rate of complications, tumor localization, size of tumor and histopathological diagnosis were considered. Post-interventional CT was performed, and patients observed for any complications. Complications were classified per the Society of Interventional Radiology (SIR). Results: 148 patients (age, 54.7 ± 18.2) underwent 155 CT-fluoroscopy-guided percutaneous biopsies with tumors in the anterior (114; 73.5%), middle (17; 11%) and posterior (24; 15.5%) mediastinum, of which 152 (98%) were technically successful. For placement of the biopsy needle, in 82 (52.9%) procedures a parasternal trajectory was chosen, in 36 (23.3%) a paravertebral access, in 20 (12.9%) through the lateral intercostal space and in 17 (11%) the thoracic anterior midline, respectively. A total of 136 (89.5%) of the biopsies were considered adequate for a specific histopathologic analysis. Total DLP (dose-length product) was 575.7 ± 488.8 mGy*cm. Mean lesion size was 6.0 ± 3.3 cm. Neoplastic pathology was diagnosed in 115 (75.7%) biopsies and 35 (23%) biopsy samples showed no evidence of malignancy. Minor complications were observed in 18 (11.6%) procedures and major pneumothorax requiring drainage insertion in 3 interventions (1.9%). Conclusion: CT fluoroscopy-guided percutaneous core needle biopsy of mediastinal masses is an effective and safe procedure for the initial assessment of patients with mediastinal tumors.

Purpose To propose a simplified histological classification for core-needle biopsy (CNB) of thyroid nodules with four diagnostic categories (DC) and provide the risk of malignancy (ROM) and the expected incidence for each DC. There is no uniform scheme for categorizing CNB specimens, except for a Korean diagnostic classification similar to the Bethesda system for FNAC. Methods Data from a single institution using CNB as a routine diagnostic tool for thyroid nodules. Biopsies were classified as non-diagnostic, benign, follicular tumour (FT) or malignant. The frequency of each DC and the correlation with surgical pathology of nodules undergoing surgery after CNB were evaluated. Results Of 6284 CNBs on 5782 nodules [195 (3.1%) non-diagnostic, 5043 (80.3%) benign, 435 (6.9%) FT and 611 (9.7%) malignant], 1914 nodules (33.1%) underwent surgery after 2016 CNBs: 48 non-diagnostic, 1035 benign, 355 FT and 578 malignant. Malignancy was diagnosed after surgery in 11 non-diagnostic (ROM: 22.9%), 23 benign (ROM: 2.2%), 44 FT (ROM: 12.4%, 11.5% excluding low-grade malignancy) and 568 malignant CNBs (ROM: 98.3%, 93.8% excluding low-grade malignancy). Sensitivity and positive predictive value for malignancy of FT or malignant CNB were 94.7% and 65.6%, and for thyroid neoplasm (adenoma or carcinoma) were 93.2% and 92.6%. Conclusions Our diagnostic classification for CNB of thyroid nodules has a high diagnostic accuracy with a low rate of indeterminate categories. This classification, applied in a Western practice, shows a low ROM for nodules classified as follicular tumours, which could be improved with immunohistochemical studies.