Indeterminate findings on imaging-guided biopsy: should additional intervention be pursued?
Author(s): Dameron RD, deLong DM, Fisher AJ, DeLong DM, Dodd LG, Nelson RC
Publication: AJR Am J Roentgenol, 1999, Vol. 173, Page 461-4
PubMed ID: 10430154 PubMed Review Paper? No
Purpose of Paper
This paper investigated how biopsy needle-gauge, guidance method, number of passes and pathology findings may influence the rate of a follow-up malignancy diagnosis in indeterminate abdominal biopsies.
Conclusion of Paper
During follow-up, indeterminate lesions biopsied with Computed Tomography (CT)-guidance were more likely to be subsequently diagnosed as malignant than those biopsied under sonography guidance (49% versus 27.5%). Similarly, a follow-up malignant diagnosis was more likely than a benign diagnosis when the indeterminate biopsy contained atypical cells (71% versus 29%, p=0.008). The incidence of malignant diagnosis during follow-up was not significantly affected by the number of needle passes, needle gauge (G), tissue biopsied, lesion diameter or depth, or the presence of reactive cells in the initial biopsy.
Studies
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Study Purpose
This study investigated how biopsy needle-gauge, guidance method, number of passes and pathology findings may influence the rate of a follow-up malignancy in abdominal biopsies originally classified as indeterminate. The sample set comprised biopsies, originally classified as indeterminate (atypical or reactive cells without definite evidence of malignancy), that were obtained from 91 abdominal lesions (35 liver, 28 pancreas, 6 adrenal, 4 kidney and 18 lymph nodes or spleen) by CT guidance (51 lesions) or sonography guidance (40 lesions). Diagnosis was based on biopsy (58 cases), radiology (28 cases) or clinical follow-up in the 6-36 months following initial biopsy (28 cases). For cases where the follow-up diagnosis was malignant (36 cases including adenocarcinoma, mesothelioma, lymphoma, sarcoma and hemangioendothelioma) the biopsy was considered to be a false negatives, and a follow-up diagnosis of benign (55 cases) constituted a true negative. Initial indeterminate biopsies were performed with a 20 or 22-G self-aspirating needle (56 lesions) or an 18-G automated spring-loaded cutting needle (35 cases) and included 1-5 passes. Details of specimen processing were not specified and assumed to include formalin fixation and H&E staining.
Summary of Findings:
False negatives occurred more frequently in biopsies obtained by CT guidance than by sonography-guidance (49% versus 27.5%, p=0.037). Atypical cells occurred more frequently in biopsies that were classified as false-negative than those classified as a true negative (71% versus 29%, p=0.008), but reactive cells were present in comparable proportions. False negative rate was not significantly affected by the number of needle passes, needle gauge, tissue biopsied, lesion diameter or lesion depth.
Biospecimens
- Tissue - Adrenal Gland
- Tissue - Kidney
- Tissue - Liver
- Tissue - Lymph Node
- Tissue - Pancreas
- Tissue - Spleen
Preservative Types
- Formalin
Diagnoses:
- Neoplastic - Benign
- Neoplastic - Carcinoma
- Neoplastic - Other
- Neoplastic - Lymphoma
- Neoplastic - Sarcoma
Platform:
Analyte Technology Platform Morphology H-and-E microscopy Morphology Light microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition CT-guided biopsy
Sonography-guided
Biospecimen Acquisition Needle gauge 20 or 22-G self-aspirating needle
18-G automated spring-loaded cutting needle
Biospecimen Acquisition Biospecimen location Liver
Kidney
Adrenal
Pancreas
Spleen or lymph
Biospecimen Aliquots and Components Biospecimen heterogeneity Intratumoral sampling (exact positions not specified)
Biospecimen Aliquots and Components Aliquot size/volume 1-5 passes