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Touch Preparation of Core Biopsy Specimens On Site Improves Accuracy of Diagnosing Cancer

September 22, 2009
Written by: , Filed in: Breast Imaging
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CT-guided biopsy is a popular first method of determining the diagnosis of cancer via 2 basic methodologies, fine-needle aspiration (FNA) and core biopsy.

A recent study published in the Journal of Vascular and Interventional Radiology has show that touch preparation of core biopsy specimens can improve the accuracy of diagnosing cancer, for better patient outcomes, with equal risk to patients as a result of undergoing the procedure.

While this study did not specifically focus on breast cancer diagnosis, it is of interest because it would seem to indicate that touch preparation of core biopsy specimens on site might also improves accuracy of diagnosis with regard to breast cancer. Increased accuracy would reduce the need for repeat procedures due to a lack of sufficient tissue being retrieved, which would in turn also reduce risk involved in undergoing the procedure, and also reduce psychological distress in patients.

The Study

The study’s main objective was to quantify the improved accuracy in diagnosing cancer caused by the on-site cytopathologic evaluation.

430 patients underwent core biopsy in their institution over 1.5 years, using 20-gauge cutting needle biopsies in all locations other than bone. In bone, an 11-gauge biopsy was performed. Guiding needles were used in all cases.

If the result of the touch prep was negative, the guiding needle was moved and another session started unless a benign neoplasm, inflammatory process, or infectious process was identified, or it was not safe for the patient to proceed. More sessions were performed as needed.

Of 430 patients, 413 had final diagnoses; 432 biopsies were performed on 427 lesions.

Of these biopsies, 49% were in lung and 21% in bone and soft tissue.

For the first session, touch prep accuracy rate was 80%, and the first session biopsy accuracy rate was 88%.

With the second session, the touch prep cumulative accuracy rate rose to 86%, and the biopsy cumulative accuracy rate increased to 94%.

The touch prep cumulative accuracy rate after the third session rose to 86.3%, and the biopsy cumulative accuracy rate increased to 95%.

Only a few lesions underwent more sessions. Cytohistologic evaluation increased the accuracy of lesions <1.1 cm to 95.5%, but smaller lesions required more sessions to achieve a positive result.

The major complication rate was 4.8%. The minor complication rate was 23%. There was no increase in complications rate with an increase in sessions. Lesions <4.3 cm were more likely to cause pulmonary complications.

Reviewer’s Comments

Core biopsy has been shown to increase accuracy over FNA without significantly increasing complication rates. This study shows that the accuracy rate of core biopsy can be increased by on-site cytopathologic evaluation by up to 4.0% in lung and up to 9.5% in non-pulmonary lesions when compared to single biopsy sessions.

In this study, >2 biopsies in the lung did not increase accuracy.

Touch prep was useful not only in determining if adequate amount of tissue was retrieved, but also in cultures in cases of infection, and in obtaining cells for lymphoma.

Touch prep is also useful identifying a single successful pass, thus decreasing patients’ theoretical exposure to risk.

The authors recommend that on-site cytopathologic evaluation with touch prep of core biopsies be performed, especially in lesions <2 cm and in non-pulmonary sites.

This is a useful study in relation to the diagnosis of breast cancer as well, demonstrating as it does increased accuracy of diagnosis with no increased risk to the patient as a result of undergoing the procedure.

Author: Sharon Gonzales, MD

Reference: Tsou M-H, Tsai S-F, et al. CT-Guided Needle Biopsy: Value of On-Site Cytopathologic Evaluation of Core Specimen Touch Preparations. J Vasc Interv Radiol; 2009;20 (January): 71-76

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