1
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Pio L, Brisse HJ, Alaggio R, Zambaiti E, Stenman J, Giuliani S, Montano V, Hinojosa AS, Hoel AT, Pevere A, Abu-Zaid A, Franchi-Abella S, Abdelhafeez AH, Davidoff AM, Losty PD. Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children: A systematic review and meta-analysis from the International Society of Pediatric Surgical Oncology (IPSO). Pediatr Blood Cancer 2024; 71:e30789. [PMID: 38015091 DOI: 10.1002/pbc.30789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Image-guided core-needle biopsy (IGCNB) is a widely used and valuable clinical tool for tissue diagnosis of pediatric neuroblastoma. However, open surgical biopsy remains common practice even if children undergo more invasive and painful procedures. This review aims to determine the diagnostic accuracy and safety of IGCNBs in pediatric patients with neuroblastoma. METHODS We conducted a systematic review of peer-reviewed original articles published between 1980 and 2023, by searching "pediatric oncology," "biopsy," "interventional radiology," and "neuroblastoma." Exclusion criteria were patients older than 18 years, studies concerning non-neurogenic tumors, case reports, and language other than English. Both the systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 533 abstracts articles were analyzed. Of these, eight retrospective studies met inclusion criteria (490 infants, 270 surgical biopsies [SB], 220 image-guided biopsies). Tissue adequacy for primary diagnosis (SB: n = 265, 98%; IGCNB: n = 199, 90%; p = .1) and biological characterization (SB: n = 186, 95%; IGCNB: n = 109, 89%; p = .15) was similar with both biopsy techniques, while intraoperative transfusion rate (SB: n = 51, 22%; IGCNB: n = 12, 6%; p = .0002) and complications (%) (SB: n = 58, 21%; IGCNB: n = 14, 6%; p = .005) were higher with surgical biopsy. Length of stay was similar in both groups; however, no additional data about concurrent diagnostic or treatment procedures were available in the analyzed studies. CONCLUSIONS IGCNB is a safe and effective strategic approach for diagnostic workup of NB and should be considered in preferance to SB wherever possible.
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Affiliation(s)
- Luca Pio
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Rita Alaggio
- Department of Laboratories, Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elisa Zambaiti
- UOC Chirurgia Pediatrica, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Jacob Stenman
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Stefano Giuliani
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Valentina Montano
- UOC Chirurgia Pediatrica, Ospedale Filippo Del Ponte di Varese, ASST Settelaghi, Varese, Italy
| | - Alexander Siles Hinojosa
- Department of Pediatric Surgery, Maternity and Children's Hospital, Regional University Hospital of Malaga, Malaga, Spain
| | - Anders Toel Hoel
- Department of Pediatric Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andrea Pevere
- Department of Pediatric Anesthesiology, Hôpital Armand-Trousseau, AP-HP, UPMC, Paris, France
| | - Ahmed Abu-Zaid
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephanie Franchi-Abella
- Department of Pediatric Imaging, Bicêtre Hospital-Assistance Publique Hôpitaux de Paris-F, Le Kremlin-Bicêtre, France
| | - Abdelhafeez H Abdelhafeez
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paul D Losty
- Institute of Systems, Molecular And Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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2
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Krivonosov AA, Minnullin MM, Akhaladze DG, Grachev NS. [Surgery for abdominal neuroblastoma in children]. Khirurgiia (Mosk) 2024:152-160. [PMID: 38785252 DOI: 10.17116/hirurgia2024051152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This review is devoted to surgical approach for neurogenic tumors in children. The authors discuss epidemiological data, history of surgical approaches, preoperative imaging and risk factors. A special attention is paid to the influence of surgical interventions for various neuroblastomas on overall and event-free survival in pediatric population, as well as the most common surgical complications and modern approaches to their treatment.
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Affiliation(s)
- A A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - M M Minnullin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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3
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Hirvonen M, Sinikumpu JJ, Tervonen O, Sequeiros RB. Magnetic resonance imaging-guided biopsies in children. Acta Radiol Open 2021; 10:20584601211053846. [PMID: 34868661 PMCID: PMC8638078 DOI: 10.1177/20584601211053846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is used far less as an imaging-guided method
for percutaneous biopsies than computed tomography (CT) and ultrasound (US),
despite its imaging benefits, particularly in children. Purpose To evaluate the feasibility, accuracy and safety of MRI-guided biopsies in
paediatric patient population. Material and Methods The retrospective study included 57 consecutive paediatric patients
(<18 years old). A percutaneous core needle biopsy (PCNB) or trephine
biopsy was performed in 53 cases, and an additional fine-needle aspiration
biopsy (FNAB) in 26 cases. In 4 cases, a stand-alone FNAB was taken.
Biopsies were performed with 0.23 T open and 1.5 T closed MRI scanners.
Statistical methods used for confidence intervals and
p-values were Wilson score method and chi-square test. Results The overall diagnostic accuracy of histologic biopsy was 0.94, with
sensitivity 0.82, specificity 1.00, positive predictive value (PPV) 1.00 and
negative predictive value (NPV) 0.92. In histological bone biopsies,
diagnostic accuracy was 0.96, with sensitivity 0.86, specificity 1.00, PPV
1.00 and NPV 0.94. The FNAB sample diagnosis was associated with the
histological diagnosis in 79% of cases. There were no major primary
complications and only a few late complications. After biopsy, 83% of the
children were ambulatory in 6 h. Anti-inflammatory drugs and paracetamol
provided satisfactory pain relief in 96% of the patients after biopsy. Most
outpatients (71%) were discharged from hospital either on the same day or
1 day later. Conclusion MRI is a technically feasible, accurate and safe guidance tool for performing
percutaneous biopsies in children.
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Affiliation(s)
- Mika Hirvonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Paediatric Surgery and Orthopaedics, PEDEGO Research Center, Oulu University Hospital and Oulu University, Oulu, Finland
| | - Osmo Tervonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
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4
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Devin CL, Teeple EA, Linden AF, Gresh RC, Berman L. The morbidity of open tumor biopsy for intraabdominal neoplasms in pediatric patients. Pediatr Surg Int 2021; 37:1349-1354. [PMID: 34148111 DOI: 10.1007/s00383-021-04942-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Tumor biopsy is often essential for diagnosis and management of intraabdominal neoplasms found in children. Open surgical biopsy is the traditional approach used to obtain an adequate tissue sample to guide further therapy, but image-guided percutaneous core-needle biopsy is being used more often due to concerns about the morbidity of open biopsy. We used a national database to evaluate the morbidity associated with open intraabdominal tumor biopsy. METHODS We identified all patients undergoing laparotomy with tumor biopsy in the National Surgical Quality Improvement Project-Pediatric (NSQIP-P) database from 2012 to 2018 and measured the frequency of complications in the 30 days postoperatively. We tested associations between patient characteristics and outcomes to identify risk factors for complications. RESULTS We identified 454 patients undergoing laparotomy for biopsy of an intraabdominal neoplasm. Median postoperative hospital stay was 7 days (IQR 4-12) and operative time was 117 min (IQR 84-172). The overall complication rate was 12.1%, with post-operative infection (6%) and bleeding (4.2%) being the most common complications. Several patient characteristics were associated with bleeding, but the only significant association on multivariable analysis was underlying hematologic disorder. CONCLUSION Open abdominal surgery for pediatric intraabdominal tumor biopsy is accompanied by significant morbidity. Postoperative infection was the most common complication, which can delay initiation of further therapy, especially chemotherapy. These findings support the need to prospectively compare percutaneous image-guided core-needle biopsy to open biopsy as a way to minimize risk and optimize outcomes for this vulnerable population.
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Affiliation(s)
- Courtney L Devin
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1015 Walnut Street, Curtis Building, Suite 620, Philadelphia, PA, 19107, USA.
| | - Erin A Teeple
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1015 Walnut Street, Curtis Building, Suite 620, Philadelphia, PA, 19107, USA
- Department of Surgery, Nemours AI duPont Hospital for Children, Wilmington, DE, USA
| | - Allison F Linden
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1015 Walnut Street, Curtis Building, Suite 620, Philadelphia, PA, 19107, USA
- Department of Surgery, Nemours AI duPont Hospital for Children, Wilmington, DE, USA
| | - Renee C Gresh
- Department of Pediatrics, Nemours AI duPont Hospital for Children, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1015 Walnut Street, Curtis Building, Suite 620, Philadelphia, PA, 19107, USA
- Department of Surgery, Nemours AI duPont Hospital for Children, Wilmington, DE, USA
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5
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Bruinsma RS, Nievelstein RAJ, Littooij AS, Vermeulen MA, van de Ven CP, van Noesel MM, Wijnen MHWA, van der Steeg AFW, de Krijger RR. Diagnostic accuracy of image-guided core needle biopsy of non-central nervous system tumors in children. Pediatr Blood Cancer 2021; 68:e29179. [PMID: 34121329 DOI: 10.1002/pbc.29179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS Core needle biopsies (CNB) are less invasive, cause less morbidity, and have lower costs than open biopsies (OB). However, the number of studies reporting CNB accuracy in pediatric tumors is limited and series are small. The aim of this study is to investigate if CNB diagnosis is concordant with the final diagnosis in pediatric solid non-central nervous system (CNS) tumors. METHODS Data from all patients treated in a single center between November 2014 and December 2019 were collected from the national pathology database and from local medical records. Data collection included age, sex, CNB diagnosis, final diagnosis, number of cores obtained, number of cores used for histology, cumulative core length, greatest dimension of the lesion, lesion volume, and complications. RESULTS Out of 361 CNB, 95.6% (345/361) provided a diagnosis. A resection or follow-up biopsy was performed in 201 cases. The final diagnosis was concordant with the CNB in 100% (201/201) of cases. The age, number of cores used for histology, and the greatest dimension of the lesion did not significantly differ between diagnostic and nondiagnostic CNB. The cumulative core length of diagnostic CNB was significantly higher than in the nondiagnostic group (24.72 mm vs. 13.37 mm, p-value .022). Complications occurred in 2.1% (7/337) of CNB procedures. Molecular analysis was successful in 228/233 (98%) of cases in which it was performed. CONCLUSIONS CNB diagnosis is highly concordant with the final diagnosis and the diagnostic rate is high. The complication rate in CNB is low.
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Affiliation(s)
- Rixt S Bruinsma
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rutger A J Nievelstein
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Radiology & Nuclear Medicine, Division Imaging & Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Annemieke S Littooij
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Radiology & Nuclear Medicine, Division Imaging & Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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6
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Serati L, Morosi C, Barretta F, Collini P, Calareso G, Chiaravalli S, Spreafico F, Luksch R, Ferrari A, Massimino M, Marchianò A. Diagnostic yield and accuracy of image-guided percutaneous core needle biopsy of paediatric solid tumours: An experience from Italy. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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7
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Ultrasound-Guided Core Biopsy for Tissue Diagnosis in Pediatric Oncology: 16-Year Experience With 597 Biopsies. AJR Am J Roentgenol 2021; 216:1066-1073. [PMID: 33566633 DOI: 10.2214/ajr.20.23196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE. Percutaneous imaging-guided core needle biopsies (CNBs) for cancer diagnosis in pediatric patients are gaining interest because of their availability, lower rate of complications, and high diagnostic power compared with traditional surgical biopsies. Nevertheless, their precise role in the diagnostic algorithm of pediatric oncology is still unknown. The purpose of this study was to report our accumulated 16-year experience with CNB; discuss the availability, safety, and diagnostic accuracy of the procedure and the adequacy of ancillary testing; and compare our findings with the available literature. MATERIALS AND METHODS. Pediatric ultrasound-guided CNBs performed in our hospital between November 2003 and December 2019 were retrospectively studied. Data collection included demographics, clinical and procedural parameters, complications, and final diagnosis. RESULTS. A total of 597 biopsies were performed in 531 patients (132 performed in known oncologic patients and 465 performed to establish diagnosis). The median time between the biopsy request and the procedure was 1 day. Of 432 biopsies performed in patients with malignancies, 12 (2.8%) had false-negative results. In 165 cases of benign pathologic findings, all had true-negative results. Ancillary testing was adequate in all malignant cases. Overall sensitivity, specificity, and accuracy rates were 97.2%, 100%, and 98.0%, respectively. Five biopsies (0.8%) resulted in complications, including one major bleed and one track seeding. CONCLUSION. Our experience shows that ultrasound-guided CNB for suspected malignancy in pediatric patients has a high safety profile, availability, and accuracy rate compared with surgical biopsy. Our fast-track strategy enables early initiation of designated therapy and has the potential to become the procedure of choice.
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8
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Jiang T, Zhu X, Jiao Y, Li X, Shen Z, Cui Y. Localization Accuracy of Ultrasound-Actuated Needle with Color Doppler Imaging. Diagnostics (Basel) 2020; 10:diagnostics10121020. [PMID: 33260712 PMCID: PMC7761225 DOI: 10.3390/diagnostics10121020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
An ultrasonic needle-actuating device for tissue biopsy and regional anaesthesia offers enhanced needle visibility with color Doppler imaging. However, its specific performance is not yet fully determined. This work investigated the influence on needle visibility of the insertion angle and drive voltage, as well as determined the accuracy and agreement of needle tip localization by comparing color Doppler measurements with paired photographic and B-mode ultrasound measurements. Needle tip accuracy measurements in a gelatin phantom gave a regression trend, where the slope of trend is 0.8808; coefficient of determination (R2) is 0.8877; bias is −0.50 mm; and the 95% limits of agreement are from −1.31 to 0.31 mm when comparing color Doppler with photographic measurements. When comparing the color Doppler with B-mode ultrasound measurements, the slope of the regression trend is 1.0179; R2 is 0.9651; bias is −0.16 mm; and the 95% limits of agreement are from −1.935 to 1.605 mm. The results demonstrate the accuracy of this technique and its potential for application to biopsy and ultrasound guided regional anaesthesia.
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Affiliation(s)
- Tingyi Jiang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- Correspondence: (T.J.); (Y.C.)
| | - Xinle Zhu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
| | - Yang Jiao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xinze Li
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
| | - Zhitian Shen
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei 230031, China
| | - Yaoyao Cui
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- Correspondence: (T.J.); (Y.C.)
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9
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de la Monneraye Y, Michon J, Pacquement H, Aerts I, Orbach D, Doz F, Bourdeaut F, Sarnacki S, Philippe-Chomette P, Audry G, Coulomb A, Fréneaux P, Klijanienko J, Berrebi D, Zucker JM, Schleiermacher G, Brisse HJ. Indications and results of diagnostic biopsy in pediatric renal tumors: A retrospective analysis of 317 patients with critical review of SIOP guidelines. Pediatr Blood Cancer 2019; 66:e27641. [PMID: 30746839 DOI: 10.1002/pbc.27641] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES According to the Renal Tumor Study Group (RTSG) of the International Society of Paediatric Oncology (SIOP), diagnostic biopsy of renal tumors prior to neoadjuvant chemotherapy is not mandatory unless the presentation is atypical for a Wilms tumor (WT). This study addresses the relevance of this strategy as well as the accuracy and safety of image-guided needle biopsy. METHODS Clinical, radiological, and pathological data from 317 children (141 males/176 females, mean age: 4 years, range, 0-17.6) consecutively treated in one SIOP-affiliated institution were retrospectively analyzed. RESULTS Presumptive chemotherapy for WT was decided for 182 patients (57% of the cohort), 24 (8%) were operated upfront, and 111 (35%) were biopsied at diagnosis. A non-WT was confirmed after surgery in 5/182 (3%), 11/24 (46%), and 28/111 (25%), respectively. Age at diagnosis was the most commonly (46%) used criterion to go for biopsy but a nine-year threshold should be retrospectively considered more relevant. Tumor volumes of clear cell sarcoma of the kidney and WT were significantly higher than those of other tumors (P = 0.002). The agreement between core-needle biopsy (CNB) and final histology was 99%. No significant morbidity was associated with CNB. CONCLUSION The use of SIOP criteria to identify patients eligible for presumptive WT neoadjuvant chemotherapy or upfront surgery avoided biopsy in 65% of children and led to a 97% rate of appropriate preoperative chemotherapy. Image-guided CNB is a safe and accurate diagnostic procedure. The relevance of SIOP biopsy criteria might be improved by using an older age threshold (9 years instead of 6 years) and by adding initial tumor volume.
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Affiliation(s)
- Yvan de la Monneraye
- Department of Pediatrics, APHP, University Hospital Ambroise Paré, Boulogne-Billancourt, Paris, France.,Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - J Michon
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - H Pacquement
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - I Aerts
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - Daniel Orbach
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - F Doz
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France.,University Paris Descartes, Paris, France
| | - F Bourdeaut
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - S Sarnacki
- Department of Surgery, APHP, University Hospital Necker-Enfants-Malades, Paris, France
| | - P Philippe-Chomette
- Department of Surgery, APHP, University Hospital Robert Debré, Paris, France
| | - G Audry
- Department of Surgery, APHP, University Hospital Armand-Trousseau, Paris, France
| | - A Coulomb
- Department of Pathology, APHP, University Hospital Armand-Trousseau, Paris, France
| | - P Fréneaux
- Department of Biopathology, Institut Curie, Paris, France
| | - J Klijanienko
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - D Berrebi
- Department of Pathology, APHP, University Hospital Robert Debré, Paris, France.,University Paris Diderot, Paris, France
| | - J-M Zucker
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - G Schleiermacher
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France.,INSERM U830 Transfer Department, RTOP (Translational Research in Pediatric Oncology), Institut Curie, Paris, France
| | - H J Brisse
- Imaging Department, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
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10
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Campagna G, Rosenfeld E, Foster J, Vasudevan S, Nuchtern J, Kim E, Commander S, Naik-Mathuria B. Evolving biopsy techniques for the diagnosis of neuroblastoma in children. J Pediatr Surg 2018; 53:2235-2239. [PMID: 29753525 DOI: 10.1016/j.jpedsurg.2018.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/09/2018] [Accepted: 04/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/PURPOSE To compare the adequacy and safety of percutaneous core needle biopsy and surgical wedge biopsy of neuroblastoma in children. METHODS A retrospective review of patients who underwent biopsy for intermediate- or high-risk neuroblastoma at our institution between 2011 and 2015 was performed (recent cohort). Procedure details and outcomes were collected and analyzed using descriptive statistics and Wilcoxon rank tests; P < 0.05 was considered significant. Published data from 2002 to 2010 were compared (historic cohort). RESULTS Since 2011, percutaneous, ultrasound-guided, core needle biopsy has been more commonly utilized (47% (16/34) recent vs. 25% (7/28) historic; P = 0.07), and the number of core needle samples increased from median 7 (historic) to 25 (recent). Complications decreased (21% (7/34) recent vs. 64% (18/28) historic; P < 0.01). Biopsy adequacy in the recent cohort was similar (94% percutaneous vs. 89% surgical; P = 1.00), which is improved from the historic cohort (71% percutaneous vs. 100% surgical; P = 0.06). Larger tumors were more likely to have a percutaneous biopsy (82 ± 37 cm percutaneous vs. 47 ± 29 cm surgical; P = 0.04). CONCLUSIONS When multiple cores are obtained, percutaneous core needle biopsy is adequate for complete tissue diagnosis of neuroblastoma and can be safely performed. This can be considered as an alternative to open surgical biopsy. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Eric Rosenfeld
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Foster
- Department of Pediatric Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sanjeev Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jed Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Eugene Kim
- Department of Pediatric Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Sarah Commander
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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11
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Avanzini S, Faticato MG, Crocoli A, Virgone C, Viglio C, Severi E, Fagnani AM, Cecchetto G, Riccipetitoni G, Noccioli B, Leva E, Sementa AR, Mattioli G, Inserra A. Comparative retrospective study on the modalities of biopsying peripheral neuroblastic tumors: a report from the Italian Pediatric Surgical Oncology Group (GICOP). Pediatr Blood Cancer 2017; 64. [PMID: 27762097 DOI: 10.1002/pbc.26284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Peripheral neuroblastic tumors are the most common extracranial solid neoplasms in children. Early and adequate tissue sampling may speed up the diagnostic process and ensure a prompt start of optimal treatment whenever needed. Different biopsy techniques have been described. The purpose of this multi-center study is to evaluate the accuracy and safety of the various examined techniques and to determine whether a preferential procedure exists. METHODS All children who underwent a biopsy, from January 2010 to December 2014, as a result of being diagnosed with a peripheral neuroblastic tumor, were retrospectively reviewed. Data collected included patients' demographics, clinical presentation, intraoperative technical details, postoperative parameters, complications, and histology reports. The Mann-Whitney U and Fisher's exact tests were used for statistical analysis. RESULTS The cohort included 100 patients, 32 of whom underwent an incisional biopsy (performed through open or minimally invasive access) (Group A), and the remaining 68 underwent multiple needle-core biopsies (either imaging-guided or laparoscopy/thoracoscopy-assisted) (Group B). Comparing the two groups revealed that Group A patients had a higher rate of complications, a greater need for postoperative analgesia, and required red blood cell transfusion more often. Overall adequacy rate was 94%, without significant differences between the two groups (100% vs. 91.2% for Group A and Group B, respectively, P = 0.0933). CONCLUSIONS Both incision and needle-core biopsying methods provided sub-optimal to optimal sampling adequacy rates in children affected by peripheral neuroblastic tumors. However, the former method was associated with a higher risk of both intraoperative and postoperative complications compared with the latter.
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Affiliation(s)
| | - Maria Grazia Faticato
- Department of Pediatric Surgery, IRCCS G. Gaslini, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophtalmology, Gynecology, and Maternal-Infantile sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Alessandro Crocoli
- Department of General and Thoracic Surgery, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
| | - Calogero Virgone
- Department of Pediatric Surgery, Padova University Hospital, Padova, Italy
| | - Camilla Viglio
- Department of Pediatric Surgery, Buzzi Hospital, Milan, Italy
| | - Elisa Severi
- Department of Pediatric Surgery, Meyer Children Hospital, Florence, Italy
| | - Anna Maria Fagnani
- Department of Pediatric Surgery, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Cecchetto
- Department of Pediatric Surgery, Padova University Hospital, Padova, Italy
| | | | - Bruno Noccioli
- Department of Pediatric Surgery, Meyer Children Hospital, Florence, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Girolamo Mattioli
- Department of Pediatric Surgery, IRCCS G. Gaslini, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophtalmology, Gynecology, and Maternal-Infantile sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Alessandro Inserra
- Department of General and Thoracic Surgery, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
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12
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Huang MW, Zhang JG, Zheng L, Liu SM, Yu GY. Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy. JOURNAL OF RADIATION RESEARCH 2016; 57:662-667. [PMID: 27422928 PMCID: PMC5137284 DOI: 10.1093/jrr/rrw033] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/30/2015] [Accepted: 02/11/2016] [Indexed: 06/06/2023]
Abstract
To transfer the preplan for the head and neck brachytherapy to the clinical implantation procedure, a preplan-based 3D-printed individual template for needle insertion guidance had previously been designed and used. The accuracy of needle insertion using this kind template was assessed in vivo In the study, 25 patients with head and neck tumors were implanted with 125I radioactive seeds under the guidance of the 3D-printed individual template. Patients were divided into four groups based on the site of needle insertion: the parotid and masseter region group (nine patients); the maxillary and paranasal region group (eight patients); the submandibular and upper neck area group (five patients); and the retromandibular region group (six patients). The distance and angular deviations between the preplanned and placed needles were compared, and the complications and time required for needle insertion were assessed. The mean entrance point distance deviation for all 619 needles was 1.18 ± 0.81 mm, varying from 0.857 ± 0.545 to 1.930 ± 0.843 mm at different sites. The mean angular deviation was 2.08 ± 1.07 degrees, varying from 1.85 ± 0.93 to 2.73 ± 1.18 degrees at different sites. All needles were manually inserted to their preplanned positions in a single attempt, and the mean time to insert one needle was 7.5 s. No anatomical complications related to inaccurately placed implants were observed. Using the 3D-printed individual template for the implantation of 125I radioactive seeds in the head and neck region can accurately transfer a CT-based preplan to the brachytherapy needle insertion procedure. Moreover, the addition of individual template guidance can reduce the time required for implantation and minimize the damage to normal tissues.
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Affiliation(s)
- Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
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13
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Metz T, Heider A, Vellody R, Jarboe MD, Gemmete JJ, Grove JJ, Smith EA, Mody R, Newman EA, Dillman JR. Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population. Pediatr Radiol 2016; 46:1173-8. [PMID: 26914937 DOI: 10.1007/s00247-016-3571-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/14/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND A paucity of literature describes the use of imaged-guided percutaneous core needle biopsy for the diagnosis and characterization of pediatric soft-tissue masses and lesions. OBJECTIVE To retrospectively determine whether image-guided percutaneous core needle biopsy is adequate for diagnosing and characterizing benign and malignant pediatric soft-tissue masses and lesions. MATERIALS AND METHODS We identified children (≤18 years old) who underwent US- or CT-guided percutaneous core needle biopsy of a soft-tissue mass or other lesion between January 2012 and March 2014. Using medical records, we documented the following data: age and gender, site of the mass or lesion, size and number of biopsy specimens, whether the biopsy procedure was diagnostic, whether sufficient tissue was obtained for necessary ancillary testing (e.g., cytogenetic evaluation), and whether there was a procedural complication within 1 week. RESULTS One hundred eight soft-tissue masses or lesions were biopsied under imaging guidance in 84 children; 39 (46%) were girls. Mean age ± standard deviation (SD) was 12.1 ± 5.1 years (range 6 months to 18 years). Of these procedures, 105/108 (97%) were diagnostic; 82/108 (76%) were US-guided; 87/108 (81%) were performed using a 17-gauge introducer needle/18-gauge biopsy instrument. The mean number ± SD of core needle biopsy specimens obtained was 8.9 ± 5.0. For newly diagnosed malignancies, adequate tissue was obtained for ancillary testing in 28/30 (93%) masses. One minor complication was documented. CONCLUSION Image-guided percutaneous core needle biopsy of pediatric soft-tissue masses is safe, has a high diagnostic rate, and provides sufficient tissue for ancillary testing.
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Affiliation(s)
- Terrence Metz
- Department of Radiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Amer Heider
- Department of Pathology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ranjith Vellody
- Department of Radiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Marcus D Jarboe
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Joseph J Gemmete
- Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jason J Grove
- Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ethan A Smith
- Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rajen Mody
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Erika A Newman
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan R Dillman
- Department of Radiology,Cincinnati Children's Hospital Medical Center,, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229-3039, USA.
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14
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El Ochi MR, Bellarbi S, Rouas L, Lamalmi N, Malihy A, Alhamany Z, Cherradi N. [Contribution of radio-guided biopsy in the histopathological diagnosis of childhood tumors of: experience of Rabat Child Hospital]. Pan Afr Med J 2015; 21:318. [PMID: 26587165 PMCID: PMC4633739 DOI: 10.11604/pamj.2015.21.318.5657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 08/19/2015] [Indexed: 11/30/2022] Open
Abstract
La biopsie radioguidée constitue une alternative à la biopsie chirurgicale invasive et à la cytologie pour le diagnostic des tumeurs pédiatriques. L'intérêt de notre étude est d’évaluer la valeur diagnostique des biopsies radioguidées examinées au laboratoire d'anatomopathologie de l'hôpital d'Enfants de Rabat (HER). L’étude a porté sur 78 biopsies radioguidées recueillies dans notre laboratoire entre janvier 2008 et décembre 2011. l’âge moyen des patients était de 5 ans et 10 mois avec une prédominance masculine (65,4%). La tumeur était abdominale dans 80% des cas, thoracique dans 15% cas, thoracique et abdominale dans 2,5% et sacrée dans 1,2%. Les biopsies étaient écho-guidées dans 90% des cas et scannoguidées dans 10% des cas. Le diagnostic histopathologique était posé dans 89% des cas. L'immuno-histochimie a été indiquée dans 35% des cas. Les diagnostics les plus fréquents étaient: tumeurs neuroblastiques (42 cas), lymphomes non hodgkiniens (10 cas), rhabdomyosarcomes (6 cas), autres (sarcome d'Ewing, néphroblastomes, tumeur myofibroblastique inflammatoire, maladies de Hodgkin, leucémie aiguë, hépatoblastome et ostéosarcome). Dans notre série, la biopsie radioguidée a permis un diagnostic histopathologique certain dans 89% des cas. Elle nécessite une étroite collaboration entre clinicien, radiologue et anatomopathologiste pour discuter son indication, afin de diminuer le nombre de biopsies peu ou non représentatives.
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Affiliation(s)
- Mohamed Réda El Ochi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Salma Bellarbi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Lamiae Rouas
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Najat Lamalmi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Abderrahmane Malihy
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Zaitouna Alhamany
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Nadia Cherradi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
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15
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Predictors of diagnostic success in image-guided pediatric soft-tissue biopsies. Pediatr Radiol 2015; 45:1529-34. [PMID: 25958250 DOI: 10.1007/s00247-015-3364-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/20/2015] [Accepted: 04/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Image-guided percutaneous core needle biopsy (PCNB) of soft-tissue lesions is a minimally invasive technique that can provide a definitive diagnosis for treatment. Anatomical and age considerations in children require judicious use of safe percutaneous biopsy techniques. There are, however, limited data on the determinants of diagnostic yield in soft-tissue lesions in this population. OBJECTIVES To assess lesion-related and technical factors that affect diagnostic yield and safety in PCNB of pediatric soft-tissue lesions. MATERIALS AND METHODS This was a retrospective cohort study of 205 PCNB performed from January 2000 to July 2014. Diagnostic yield and its associations with technical and lesion-related factors were evaluated using bivariate analysis. RESULTS The mean patient age was 11.1 ± 6.9 years (interquartile range [IQR]: 4.3-16 years). Ultrasound guidance alone was used in 91% of cases. The mean number of passes was 7.5 ± 3.2 (IQR: 5-9 passes) per case. The overall diagnostic yield was 75% and the overall accuracy was 88%. Performing fewer than four passes was associated with a nondiagnostic biopsy (P = 0.001). There were no lesion or other technical factors that predicted a diagnostic biopsy. There were two complications (1%) over 14 years. CONCLUSION Image-guided PCNB is a safe and effective means for the diagnosis of pediatric soft-tissue abnormalities. Aside from performing at least four passes, our data show no technical or lesion-related factors that increase diagnostic yield in pediatric PCNB of soft-tissue lesions.
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16
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Aria D, Vatsky S, Towbin R, Schaefer CM, Kaye R. Interventional radiology in the neonate and young infant. Semin Ultrasound CT MR 2014; 35:588-607. [PMID: 25454054 DOI: 10.1053/j.sult.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Aria
- Phoenix Children׳s Hospital, Phoenix, AZ
| | | | | | | | - Robin Kaye
- Phoenix Children׳s Hospital, Phoenix, AZ.
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17
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Lungren MP, Patel MN, Racadio JM, Johnson ND. Ultrasound-guided interventions in children. Eur J Radiol 2014; 83:1582-91. [DOI: 10.1016/j.ejrad.2014.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/21/2014] [Indexed: 12/28/2022]
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18
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Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm in pediatric patients. Pediatr Surg Int 2014; 30:31-7. [PMID: 24190521 DOI: 10.1007/s00383-013-3427-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ultrasound-guided core needle biopsy of abdominal and pelvic masses in adults has gained tremendous popularity. However, the application of the same treatment in children is not as popular because of apprehensions regarding inadequate tissues for the biopsy and accidental puncture of vital organs. METHODS Data of the application of ultrasound-guided core needle biopsy in 105 pediatric patients with clinically or ultrasound-diagnosed abdominopelvic masses were reviewed. Diagnostic procedures were conducted in our institution from May 2011 to May 2013. RESULTS The biopsies were conducted on 86 malignant lesions and 19 benign lesions. 86 malignant tumors comprised neuroblastomas (30 cases), hepatoblastomas (15 cases), nephroblastomas (11 cases), and primitive neuroectodermal tumors/malignant small round cells (6 cases). Among malignant tumor cases, only a pelvic primitive neuroectodermal tumor did not receive a pathological diagnosis. Therefore, the biopsy accuracy was 98.8 % in malignant tumor. However, the biopsies for one neuroblastomas and one malignant small round cell tumor were inadequate for cytogenetic analysis. Therefore, 96.5 % of the malignant tumor patients received complete diagnosis via biopsy. 19 benign tumors comprised mature teratoma (10 cases), hemangioendothelioma (3 cases), paraganglioma (2 cases), and infection (2 cases). The diagnostic accuracy for benign neoplasm was 100 %. Five patients experienced postoperative complications, including pain (2 patients), bleeding from the biopsy site (2 patients), and wound infection (1 patient). CONCLUSION Ultrasound-guided core needle biopsy is an efficient, minimally invasive, accurate, and safe diagnostic method that can be applied in the management of abdominal or pelvic mass of pediatric patients.
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19
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Hassan SF, Mathur S, Magliaro TJ, Larimer EL, Ferrell LB, Vasudevan SA, Patterson DM, Louis CU, Russell HV, Nuchtern JG, Kim ES. Needle core vs open biopsy for diagnosis of intermediate- and high-risk neuroblastoma in children. J Pediatr Surg 2012; 47:1261-6. [PMID: 22703803 DOI: 10.1016/j.jpedsurg.2012.03.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 03/06/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Open biopsy has been the mainstay for definitive diagnosis of neuroblastoma in pediatric patients. However, needle core biopsy may represent a faster, less invasive, and safer alternative to open biopsy in children. The purpose of this study was to compare safety and efficacy between needle core and open biopsy in the diagnosis of patients with intermediate- and high-risk neuroblastoma at our institution. METHODS We retrospectively reviewed the medical records of children with intermediate- and high-risk neuroblastoma who underwent open or needle core biopsies from 2002 to 2010. Data collected included patient demographics, tumor size, sample adequacy for diagnosis and risk stratification (histology and cytogenetics), length of hospital stay, time to initiate chemotherapy after biopsy, need for repeat biopsy, and both intraoperative and postoperative complications. Mann-Whitney U and Fisher's exact tests were used for statistical analysis. RESULTS During the study period, 7 patients underwent needle core primary biopsies (5 intermediate-risk primary tumors and 2 high-risk primary tumors), and 4 patients underwent needle core biopsy for metastatic tumors, whereas 21 patients had open biopsies (10, intermediate risk; 11, high risk). Median age at biopsy and median tumor size were similar in both groups. There was no significant difference in adequacy of biopsy, need for repeat biopsy, time to initiate chemotherapy, length of stay, or minor complications. The rate of major complications differed significantly between the 2 groups with 0% after needle core biopsy vs 48% after open biopsy (P = .027). CONCLUSIONS In children, needle core biopsy is comparable in efficacy with open biopsy in the diagnosis of intermediate- and high-risk neuroblastoma with significantly lower rates of major postoperative complications. These findings warrant a larger scale evaluation of diagnostic needle core biopsies in pediatric patients with solid tumor.
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Affiliation(s)
- Saif F Hassan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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20
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Pediatric malignancies: neuroblastoma, Wilm's tumor, hepatoblastoma, rhabdomyosarcoma, and sacroccygeal teratoma. Surg Clin North Am 2012; 92:745-67, x. [PMID: 22595719 DOI: 10.1016/j.suc.2012.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Common pediatric malignancies are reviewed: neuroblastoma, Wilms tumor, hepatoblastoma, rhabdomyosarcoma, and sacrococcygeal teratoma. Elements of presentation, diagnosis, staging, treatment, and longterm prognosis are discussed, with particular attention to surgical management.
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21
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UyBico SJ, Motamedi K, Omura MC, Nelson SD, Eilber FC, Eckardt J, Seeger LL. Relevance of Compartmental Anatomic Guidelines for Biopsy of Musculoskeletal Tumors: Retrospective Review of 363 Biopsies over a 6-Year Period. J Vasc Interv Radiol 2012; 23:511-18, 518.e1-2. [DOI: 10.1016/j.jvir.2012.01.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 01/07/2012] [Accepted: 01/10/2012] [Indexed: 12/11/2022] Open
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de Larrinoa AF, del Cura J, Zabala R, Fuertes E, Bilbao F, Lopez JI. Value of ultrasound-guided core biopsy in the diagnosis of malignant lymphoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:295-301. [PMID: 17486566 DOI: 10.1002/jcu.20383] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Ultrasound-guided core needle biopsy for the diagnosis and management of malignant lymphomas is controversial and has not been accepted as an alternative to surgical biopsy. We investigate the clinical usefulness of this procedure in a large series of patients. METHODS Over a 5-year period (2000-2004), ultrasound-guided core needle biopsies were performed in 102 malignant lymphomas. Five diagnostic categories were considered: large B-cell lymphomas (LBCL), small B-cell lymphomas (SBCL), Hodgkin's disease (HD), T cell lymphomas, and miscellaneous. Surgical excisional biopsy of the node was performed in 47 cases (46.1%) for diagnostic confirmation. RESULTS The overall diagnostic accuracy of ultrasound-guided core needle biopsy was 88.2% (90/102). SBCL (39), LBCL (36), HD (15), T cell lymphomas (5), and miscellaneous (7) [including T cell-rich B cell (2), natural killer cell (1), Burkitt's lymphoma (1), and non-Hodgkin's lymphoma of the B cell type, NOS (3)] were correctly diagnosed. Three HDs, 1 natural killer cell lymphoma, 1 follicular lymphoma, and 1 LBCL were not correctly diagnosed. The core needle biopsy did not yield tumor tissue in 6 cases. CONCLUSIONS Ultrasound-guided core needle biopsy is effective in the diagnosis of malignant lymphomas and can be used as the first diagnostic approach in selected clinical situations.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy/methods
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/pathology
- Female
- Hodgkin Disease/diagnosis
- Humans
- Killer Cells, Natural/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Lymph Nodes/pathology
- Lymphoma/diagnosis
- Lymphoma/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, Follicular/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, T-Cell/diagnosis
- Male
- Middle Aged
- Prospective Studies
- Ultrasonography, Interventional
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Shin HJ, Amaral JG, Armstrong D, Chait PG, Temple MJ, John P, Smith CR, Taylor G, Connolly BL. Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol 2007; 37:362-9. [PMID: 17340168 DOI: 10.1007/s00247-007-0421-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 12/27/2006] [Accepted: 01/18/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous core needle biopsy (PCNB) of musculoskeletal lesions can provide early and definitive diagnosis and guide decisions on management. The technique is less invasive than open biopsy and has a low complication rate. OBJECTIVES The purpose of this study was to assess the diagnostic accuracy and safety of image-guided PCNB of musculoskeletal lesions in children. MATERIALS AND METHODS Retrospective review of the medical records of patients referred for PCNB of musculoskeletal lesions was performed. Data collected included tumor type and complication rates. Lesion "hit" or "missed", and core adequacy and ability to reach a definitive pathological diagnosis were reviewed and used to determine whether the biopsy was overall successful or unsuccessful. RESULTS A total of 127 biopsies were performed in 111 patients. Of the 127 PCNB procedures, 114 "hit" the lesion and 13 "missed," and 120 of the cores provided for analysis were deemed adequate for pathological interpretation and 7 were deemed inadequate. A definitive pathological diagnosis was possible in 97 of the 127 PCNB preocedures and not possible in 30. Overall 76% of the PCNB procedures were successful. The diagnostic success of biopsy in primary malignant tumors was significantly higher (92%) than in primary benign tumors (65%; P=0.008). Six minor complications resulted from PCNB. CONCLUSION This study showed that PCNB is accurate and safe for the diagnosis of musculoskeletal lesions in pediatric patients, and its results are comparable to those in adult studies.
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Affiliation(s)
- Hyun-Joon Shin
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Gupta A, Kumar A, Walters S, Chait P, Irwin MS, Gerstle JT. Analysis of needle versus open biopsy for the diagnosis of advanced stage pediatric neuroblastoma. Pediatr Blood Cancer 2006; 47:875-9. [PMID: 16276526 DOI: 10.1002/pbc.20666] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adequate tissue biopsy is necessary for the appropriate diagnosis and risk stratification of pediatric neuroblastoma (NB). We compared the quality and adequacy of biopsy tissue and complication rates in children with NB who underwent open (OBX) and image-guided needle biopsy (NBX) at our center. METHODS We retrospectively reviewed all patients diagnosed with stage III and IV NB from September 2001 to August 2004. The 24 patients were divided into two groups: those in whom the diagnosis was initiated using NBX, and those diagnosed using OBX. In addition to demographic data, we collected data pertaining to sufficiency of biopsy tissue for biology studies including: Shimada Classification, MYC-N amplification, and DNA index analysis and complications associated with the procedure. Chi-Square and Student's t-test were used to analyze the categorical and continuous variables, respectively. RESULTS Of 24 patients, 11 underwent NBX, and 13 patients underwent OBX. Eighteen patients had stage IV disease, 5 patients had stage III disease, and 1 stage IVS. Ten major complications occurred in four NBX patients and six OBX patients. There was no difference in days of narcotic use, time to DAT, or hospital stay between the two groups. Ten patients (seven NBX and three OBX, P = 0.045) had tissue that was insufficient for biology studies. Three of the seven NBX patients underwent a second biopsy for clarification of risk group. CONCLUSIONS This study demonstrated that more than half of patients undergoing NBX for NB had insufficient tissue for complete histological and molecular classification and that the incidence of procedural complications between NBX and OBX are similar.
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Affiliation(s)
- Abha Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Coley BD, Hogan MJ. Image-guided interventions in neonates. Eur J Radiol 2006; 60:208-20. [PMID: 16962732 DOI: 10.1016/j.ejrad.2006.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 07/10/2006] [Accepted: 07/12/2006] [Indexed: 01/28/2023]
Abstract
Minimally invasive interventional radiological procedures can be invaluable in the care of neonates and infants. These procedures have proven to be useful in a wide variety of clinical situations, improving patient care, comfort and safety. Most techniques in adult interventional radiology have been adapted for use in pediatric patients, covering the spectrum of diagnostic and therapeutic intervention. Procedural techniques are similar, but require considerations of patient size, sedation, and support personnel in order to render optimal care. Proper physician training is imperative to provide the necessary confidence and expertise, and post-procedural follow-up is required to maximize positive outcomes. This paper discusses many of the procedures that may be performed in neonates, and offers suggestions and techniques for successful outcomes.
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Affiliation(s)
- Brian D Coley
- Department of Radiology, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Abolhassani N, Patel R, Moallem M. Needle insertion into soft tissue: a survey. Med Eng Phys 2006; 29:413-31. [PMID: 16938481 DOI: 10.1016/j.medengphy.2006.07.003] [Citation(s) in RCA: 310] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 06/26/2006] [Accepted: 07/04/2006] [Indexed: 11/18/2022]
Abstract
Needle insertion in soft tissue has attracted considerable attention in recent years due to its application in minimally invasive percutaneous procedures such as biopsies and brachytherapy. This paper presents a survey of the current state of research on needle insertion in soft tissue. It examines the topic from several aspects, e.g. modeling needle insertion forces, modeling tissue deformation and needle deflection during insertion, robot-assisted needle insertion, and the effect of different trajectories on tissue deformation. All studies show that the axial force of a needle during insertion in soft tissue is the summation of different forces distributed along the needle shaft such as stiffness force, frictional force and cutting force. Some studies have modeled these forces. The force data in some procedures is used for identifying tissue layers as the needle is inserted or for path planning. Needle deflection and tissue deformation are major problems for accurate needle insertion and attempts have been made to model them. Using current models several insertion techniques have been developed which are briefly reviewed in this paper.
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Affiliation(s)
- Niki Abolhassani
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London, Ontario, Canada.
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Sebire NJ, Roebuck DJ. Pathological diagnosis of paediatric tumours from image-guided needle core biopsies: a systematic review. Pediatr Radiol 2006; 36:426-31. [PMID: 16532346 DOI: 10.1007/s00247-006-0123-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2005] [Accepted: 01/13/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Image-guided core needle biopsy is widely used in paediatric oncology, but many protocols continue to discourage this practice. No published randomized studies compare image-guided needle biopsy with surgical techniques. OBJECTIVE To perform a systematic review of the literature on image-guided core needle biopsy in paediatric oncology. MATERIALS AND METHODS Several computerized databases were searched using the terms [(needle OR core) AND (biops*[ti]) AND (paediatric OR pediatric OR child OR children OR childhood OR boy OR girl)[ti]] to identify series of more than five cases of needle core biopsy for tumour diagnosis in children. Data from included studies were combined to calculate pooled estimates of adequacy, accuracy and complication rates. RESULTS Thirteen studies fulfilled the inclusion criteria. Overall biopsy adequacy rate (defined as sufficient to make a diagnosis) was 94% (95% CI 92-96%). The diagnostic accuracy rate in cases with adequate material (defined as achieving the correct specific diagnosis) was 94% (95% CI 92-96%). Complications requiring treatment occurred in 1%. CONCLUSIONS Available pooled data suggest that about 95% of image-guided needle core biopsies provide an adequate sample for diagnosis of malignant disease in childhood. In such cases, the pathological diagnosis is correct in about 95%. Complications are rare.
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Affiliation(s)
- Neil J Sebire
- Department of Paediatric Histopathology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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Abstract
OBJECTIVES To present the more frequent solid tumors, that require a general anaesthesia and to describe the particularities of the anaesthetic management. DATA SOURCES AND EXTRACTION The PUBMED database was searched for articles (1990 - 2005) combined with references analysis of major articles on the topics. DATA SYNTHESIS Neoplasma is the first cause of paediatric death. In children less than 5 years of age, neuroblastoma and nephroblastoma are the more frequent of the tumour. The incidence of each pathology is low. However a general anaesthesia is required in numerous situations: bone marrow aspiration and biopsy, central venous catheter insertion, various biopsies under computed tomography, ultrasound, thoracoscopy or laparoscopy, MRI scan, surgery and body radiation. The key points of successful anaesthetic management include complete preoperative evaluation together with the oncology paediatric team. Particularly, cardiotoxicity may result from chemotherapy and hypertension is frequently associated with neuroblastoma and nephroblastoma. Mediastinal location of lymphomas induced a significant risk of cardiopulmonary complications during induction of general anaesthesia. A peak expiratory flow rate or a tracheal cross-section area less than 50% of predicted values are contraindication to general anaesthesia. Cephalic rhabdomyosarcoma may be responsible of difficult airway management. Specific guidelines are available for platelet and red cell transfusion in paediatric oncology patients. Surgical antibioprophylaxis are adapted in immunodepressed children to a potential increased risk of postoperative infectious complications, according personal previous history, microbiological ecology and body bacterial flora. Dosage of anaesthetic agents takes into account denutrition, hydroelectrolytic disturbances and hypovolemia.
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Affiliation(s)
- C Lejus
- Service anesthésie-réanimation chirurgicale, Hôtel-Dieu-hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes cedex, France.
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Schulz T, Tröbs RB, Schneider JP, Hirsch W, Schmidt F, Kahn T. MR Imaging-guided percutaneous procedures in children. Acad Radiol 2005; 12:1128-34. [PMID: 16112513 DOI: 10.1016/j.acra.2005.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 05/30/2005] [Accepted: 01/30/2005] [Indexed: 10/25/2022]
Abstract
Magnetic resonance imaging (MRI)-guided therapeutic interventions in children are very rare. In comparison to other imaging techniques, it is very unusual for MRI to be used for diagnostic percutaneous interventions despite its imaging benefits. We provide a brief description of available MRI systems and instruments and use clinical examples to present and discuss typical indications for percutaneous procedures while showing possibilities for percutaneous therapeutic interventions.
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Affiliation(s)
- Thomas Schulz
- Department of Diagnostic Diagnostic Radiology, Leipzig University Hospital, Liebigstr 20, 04103, Leipzig, Germany.
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Zangos S, Eichler K, Wetter A, Lehnert T, Hammerstingl R, Diebold T, Reichel P, Herzog C, Hansmann ML, Mack MG, Vogl TJ. MR-guided biopsies of lesions in the retroperitoneal space: technique and results. Eur Radiol 2005; 16:307-12. [PMID: 16059677 DOI: 10.1007/s00330-005-2870-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 06/06/2005] [Accepted: 07/04/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to evaluate the safety and precision of MRI-guided biopsies of retroperitoneal space-occupying tumors in an open low-field system. In 30 patients with indistinct retroperitoneal tumors [paraaortic lesion (n=20), kidney (n=2), suprarenal gland (n=3) and pancreas (n=5)] MR-guided biopsies were performed using a low-field system (0.2 T, Magnetom Concerto, Siemens, Germany). For the monitoring of the biopsies T1-weighted FLASH sequences (TR/TE=160/5 ms; 90 degrees ) were used in all patients and modified FLASH sequences (TR/TE=160/13 ms; 90 degrees ) in ten patients. After positioning of the needle in the tumors 114 biopsy specimens were acquired in coaxial technique with 16-gauge cutting needles (Somatex, Germany). The biopsies were successfully performed in all patients without vascular or organ injuries. The visualization of the aortic blood flow with MRI facilitated the biopsy procedures of paraaortic lesions. The size of the lesions ranged from 1.6 to 7.5 cm. The median distance of the biopsy access path was 10.4 cm. Adequate specimens were obtained in 28 cases (93.3%) resulting in a correct histological classification of 27 lesions (90%). In conclusion, MR-guided biopsies of retroperitoneal lesions using an open low-field system can be performed safely and accurately and is an alternative to CT-guided biopsies.
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Affiliation(s)
- S Zangos
- Institute for Diagnostic and Interventional Radiology, J.W. Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Schulz T, Tröbs RB, Schneider JP, Hirsch W, Puccini S, Schmidt F, Kahn T. Pediatric MR-guided interventions. Eur J Radiol 2005; 53:57-66. [PMID: 15607853 DOI: 10.1016/j.ejrad.2004.07.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 07/20/2004] [Accepted: 07/26/2004] [Indexed: 11/16/2022]
Abstract
MRI guided interventions are a relatively new but steadily growing field within surgery in pediatric age. Besides the advantages of MRI, such as multiplanar capability and excellent soft tissue contrast and spatial resolution, particularly relevant for the pediatric population is the lack of ionizing radiation. There is meanwhile a group of well defined diagnostic or therapeutic indications for applying MR imaging during pediatric interventions. Aim of this review is to give an overview about indications of MR-guided procedures in children as well as the advantages and disadvantages of MR-guided interventions. We also briefly discuss interventional MR-systems and MR-compatible devices. It is our opinion that MR-guidance for pediatric interventions is a promising technique at the beginning of its development.
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Affiliation(s)
- T Schulz
- University of Leipzig, Department of Diagnostic Radiology, Liebigstrasse 20, 04103 Leipzig, Germany.
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Abstract
Many of the soft tissue sarcomas that occur in children are of the same histology as those in adults; however, the relative prevalence of these sarcomas is different between children and adults. In some cases, the biologic behavior of pediatric sarcomas is more benign than that in adults. Treatment for sarcomas in children is also different. Pediatric sarcomas are more commonly responsive to chemotherapy. Furthermore, in children who are still growing, surgery and radiation are associated with higher morbidity than in adults. This article discusses the diagnosis and treatment of rhabdomyosarcoma and undifferentiated sarcomas, with an emphasis on surgical considerations, and the diagnosis and treatment of nonrhabdomyosarcomatous soft tissue sarcomas in children.
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Affiliation(s)
- Cynthia E Herzog
- Division of Pediatrics, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 87, Houston, TX 77030, USA.
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Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology 2002; 224:548-54. [PMID: 12147855 DOI: 10.1148/radiol.2242011528] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine if a subset of atypical ductal hyperplasia (ADH) lesions diagnosed at 11-gauge, directional, vacuum-assisted, prone, stereotactic biopsy fit the "probably benign" definition of a less than 2% chance of being carcinoma at subsequent surgical excision. MATERIALS AND METHODS Clinical, mammographic, and stereotactic biopsy features in 104 consecutive nonpalpable ADH lesions were correlated with the presence of carcinoma at lumpectomy. The results were analyzed with chi(2) statistic, with P <.05 indicative of significant difference. RESULTS Surgical excision revealed carcinoma in 22 (21%) of 104 ADH lesions. The lowest incidences of carcinoma (each P <.02) were 16% (15 of 92) in patients with no personal history of breast carcinoma, 13% (nine of 67) when maximum lesion diameter was less than 10 mm, and 8% (three of 36) when 100% of the mammographic lesion was removed at stereotactic biopsy. CONCLUSION No clinical, mammographic, or biopsy features alone or in combination could be used to define a substantial subset of probably benign lesions with a less than 2% chance of carcinoma at lumpectomy.
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Affiliation(s)
- Roger J Jackman
- Department of Radiology, Palo Alto Medical Clinic, 795 El Camino Real, Palo Alto, CA 94301, USA.
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