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Purpose: To explore imaging biomarkers predictive of intratumoral haemorrhage for lesions intended for elective stereotactic biopsy. Method: This study included a retrospective cohort of 143 patients with 175 intracranial lesions intended for stereotactic biopsy. All the lesions were randomly split into a training dataset (n=121) and a test dataset (n=54) at a ratio of 7:3. Thirty-four lesions were defined as "hemorrhage-prone tumors" as haemorrhage occurred between initial diagnostic MRI acquisition and the scheduled biopsy procedure. Radiomics features were extracted from the contrast-enhanced T1 Weighted Imaging and T2 Weighted Imaging images. Features informative of haemorrhage were then selected by the LASSO algorithm, and an Support Vector Machine model was built with selected features. The Support Vector Machine model was further simplified by discarding features with low importance and calculating them using a "permutation importance" method. The model's performance was evaluated with confusion matrix-derived metrics and area under curve (AUC) values on the independent test dataset. Results: Nine radiomics features were selected as haemorrhage-related features of intracranial tumours by the LASSO algorithm. The simplified model's sensitivity, specificity, accuracy, and AUC reached 0.909, 0.930, 0.926, and 0.949 (95% CI: 0.865-1.000) on the test dataset in the discrimination of "hemorrhage-prone tumors". The permutation method rated feature "T2_gradient_firstorder_10Percentile" as the most important, the absence of which decreased the model's accuracy by 10.9%. Conclusion: Radiomics features extracted on contrast-enhanced T1 Weighted Imaging and T2 Weighted Imaging sequences were predictive of future haemorrhage of intracranial tumours with favourable accuracy. This model may assist in the arrangement of biopsy procedures and the selection of target lesions in patients with multiple lesions. [ABSTRACT FROM AUTHOR]

• Our data suggests a potential benefit of cytoreductive surgery for selected patients with PCNSL. • Although not statistically significant, there was a trend towards improved OS, reduced TTR, greater RIC, and reduced WBRT requirement. Cytoreductive surgery for Primary Central Nervous System Lymphoma (PCNSL) is controversial and is not routinely practiced. Cumulative literature in recent years, however, suggests a potential survival benefit associated with a greater extent of resection. A retrospective single institution cohort analysis of 58 consecutive patients with PCNSL was conducted between January 2011 and December 2020. Demographic, clinical, and radiographic characteristics were compared between patients with and without cytoreductive surgery following diagnosis of PCNSL. The primary outcome measures were progression-free survival (PFS) and overall survival (OS). Secondary outcome measures included time to remission (TTR), time to chemotherapy (TTC) and response to initial chemotherapy (RIC). Forty-six patients (79.3 %) received stereotactic biopsy and 12 (20.6 %) underwent cytoreductive surgery. There was a trend towards longer OS (29.8 vs 22.3 months, p = 0.672), shorter TTR (4.0 vs 4.7 months, p = 0.362), and greater complete or near-complete radiographic RIC (81.8 % vs 67.6 %, p = 0.367) for patients undergoing cytoreductive surgery. This correlated with a lesser need for whole brain radiotherapy (WBRT) (8.3 % vs 19.6 %, p = 0.359). Our data suggests a potential benefit of cytoreductive surgery for selected patients diagnosed with PCNSL. Although not statistically significant, there was a trend towards improved OS, reduced TTR, greater RIC, and reduced WBRT requirement. Further studies with better randomization and statistical power are needed to validate this correlation. [ABSTRACT FROM AUTHOR]

• Robotic assisted biopsy lives up to its promises of increased safety, accuracy and reliability. • Robotic assisted biopsy allows a high diagnostic rate up to 97,4%. • Robotic biopsy has a very low hemorrhagic complication rate (3,5 %) with no permanent deficit. • Robotic assisted biopsy has very low mortality rate (0,3%). • Learning curve for Robotic biopsy is relatively short with a cut off of 10 procedures to get acquainted. A 12-year long, prospective, single center study was conducted, comparing two frameless systems for brain biopsies: ROSA robotic-assisted stereotaxy and BrainLab Varioguide image-guided stereotaxy (Image Guided Surgery, IGS). All consecutive adult and pediatric patients undergoing frameless brain biopsies were included. Successfully achieving diagnosis was the primary endpoint, analysis of all periprocedural complications was the secondary endpoint, and the tertiary endpoint was the length of the procedure, with the aim of assessing of the learning curve for each operator over time. The results for the ROSA robot and the Varioguide system were compared and benchmarked to data from the literature. We performed 526 on 516 patients, 314 with the ROSA robot (Group A) and 212 with the IGS Varioguide (Group B). Histological diagnosis was achieved in 97.4% of cases in Group A, versus 93.3% in Group B (p < 0.05). No statistically significant difference was found for secondary and tertiary endpoints. The complication rate appeared similar between the 2 frameless systems, with a hemorrhagic complications rate of 3.5% in Group A and 4.7% in Group B. Permanent neurological deterioration was only recorded in 0.8% of cases from Group B. Mortality was recorded in 0.3% in Group A and 0.4% in Group B. This study provides evidence to confirm that robotic surgery lives up to its promises of increased safety, accuracy, and reliability. [ABSTRACT FROM AUTHOR]

• DIPG. • Stereotactic biopsy. • Convection enhanced delivery. • Targeted therapies. Diffuse intrinsic pontine gliomas (DIPG) are high grade gliomas of the brainstem with fatal outcomes. Radiation is known to be partially effective to control the immediate flare but relapse is frequent. There has been ongoing research to study the role of molecular subgroups and identification of specific targets but this is not possible with histopathological diagnosis alone. The authors' objective is to highlight the need for and discuss ongoing molecular research. There is an inherent need for the availability of tumor tissue to be able to conduct research studies. The authors advocate the use of neuronavigation assisted stereotactic technique for tumor biopsy. The technique is feasible with a predefined surgical trajectory. After obtaining tissue diagnosis further work can be performed to isolate and identify histone protein genetic mutations and methylation changes responsible for DIPG molecular subgrouping. Moreover, convection enhanced delivery of therapeutic agents is being developed for better instillation of future drug agents. Despite identification of genetic/epigenetic mutations, growth factors, receptors, and tissue biomarkers, the oncogenesis of DIPG remains elusive. The authors' effort to provide a comprehensive review on DIPG to better understand the disease, need for tissue diagnosis, described surgical technique, and need for pre-clinical and clinical future research is novel. [ABSTRACT FROM AUTHOR]

Abnormal tissue in stereotactic brain biopsies (SBB) is traditionally identified intraoperatively via pathological frozen section (FS), a time-consuming and error-prone process. The objective of this study was to assess the efficacy of 5-aminolevulinic acid (5-ALA) administration on SBB operation time, diagnostic yield, and the associated complication rate. We retrospectively evaluated all consecutive patients undergoing SBB with preoperative 5-ALA administration and intraoperative assessment of fluorescence (5-ALA group) between 2010 and 2017 in a single center. They were compared to all consecutive patients who underwent traditional brain biopsy with FS (control group). Demographics, clinical data, diagnostic yield of biopsies, and complication rates were documented. In all, 376 patients underwent SBB for suspected oncological pathology during the study period. All 34 of the 5-ALA-assisted SBB were diagnostic compared to 96.8% of the control group. The mean operative time was the same for both groups, but it was significantly shorter for the 5-ALA patients with florescent samples compared to patients with negative fluorescence (61 ± 25 min vs. 136 ± 54 min, P = 0.003) and compared to the control group (74 ± 34 min vs. 61 ± 25 min, P = 0.03). Symptomatic bleed was absent in the 5-ALA group and present in 5.4% of the controls. No adverse events were associated with preoperative 5-ALA administration. Preoperative administration of 5-ALA may improve the diagnostic yield of SBB and shortens operation time in cases of fluorescent pathological tissue. In addition, it may reduce the risk for associated postoperative symptomatic bleed. 5-ALA-assisted SBB is a viable alternative to traditional biopsies with FS. [ABSTRACT FROM AUTHOR]

Abstract Background There is currently no clear consensus recommendation for the use of short-interval follow-up mammography after a benign-concordant breast biopsy (BCBB), and practice patterns vary widely. The objectives of this study were to evaluate whether a short-interval follow-up mammogram provided clinical utility after stereotactic BCBB and to examine the costs associated with this surveillance strategy. Methods A retrospective review of women who underwent a stereotactic breast biopsy yielding benign-concordant results between January 2005 and October 2014 was performed to evaluate findings on subsequent imaging, to calculate compliance with recommended short-interval imaging, and to examine whether subsequent imaging revealed an abnormality at the site of the initial stereotactic BCBB. A cost analysis was performed utilizing Medicare reimbursement rates to calculate projected and actual costs of short-interval follow-up imaging after stereotactic BCBB. Results Of the 470 stereotactic BCBB performed, a short-interval mammogram was completed in 207 (44.0%), 9 (4.3%) of which had suspicious mammographic findings at the initial biopsy site, and 6 subsequently underwent biopsy, with none resulting in malignant or high-risk pathology. The cost of short-interval mammographic follow-up (n = 207) was calculated at $28,541.16. Conclusions This study provides evidence that 6-month follow-up mammography has low clinical utility and unnecessarily increases costs after stereotactic BCBB. A safe and more cost-effective strategy may be resumption of routine mammography at 12 months post-biopsy. Highlights • Only 44% underwent planned mammogram six months after benign breast biopsy. • Short-interval mammogram follow-up identified a new lesion at the biopsy site in 4%. • Biopsy of new findings did not yield any malignant or high-risk lesions. • The significant cost of performing 6-month post-biopsy mammography was unnecessary. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether false-positive stereotactic vacuum-assisted breast biopsy (SVAB) affects subsequent mammographic screening adherence.Materials and Methods: This Institutional Review Board-approved, HIPAA-compliant retrospective review of women with SVAB was performed between 2012 and 2014. Patient age, clinical history, biopsy pathology, and first postbiopsy screening mammogram were reviewed. Statistical analyses were performed using Fisher's exact, Mann-Whitney, and χ2 tests.Results: There were 913 SVABs performed in 2012 to 2014 for imaging detected lesions; of these, malignant or high-risk lesions or biopsies resulting in a recommendation of surgical excision were excluded, leaving 395 SVABs yielding benign pathology in 395 women. Findings were matched with a control population consisting of 45,126 women who had a BI-RADS 1 or 2 screening mammogram and did not undergo breast biopsy. In all, 191 of 395 (48.4%) women with a biopsy with benign results and 22,668 of 45,126 (50.2%) women without biopsy returned for annual follow-up >9 months and ≤18 months after the index examination (P = .479). In addition, 57 of 395 (14.4%) women with a biopsy with benign results and 3,336 of 45,126 (7.4%) women without biopsy returned for annual follow-up >18 months after the index examination (P < .001). Older women, women with personal history of breast cancer, and women with postbiopsy complication after benign SVAB were more likely to return for screening (P = .026, P = .028, and P = .026, respectively).Conclusion: The findings in our study suggest that SVABs with benign results do not negatively impact screening mammography adherence. The previously described "harms" of false-positive mammography and biopsy may be exaggerated. [ABSTRACT FROM AUTHOR]

Breast cancer is the leading cause of death amongst women in Singapore. Stereotactic Vacuum-assisted breast biopsy (VABB) is an established alternative to surgical biopsy for histological diagnosis of microcalcification and nonpalpable lesions. Stereotactic VABB utilizes Digital breast tomosynthesis (DBT) or Prone stereotactic (PS) systems for tissue sampling. However, clinical performance and patient complication outcomes between both systems are indeterminate. As such, we aim to examine indices affecting clinical performance in both systems and identify one that would contribute to higher technical success rates for VABB procedure. Patient complication and relative radiation exposure will also be reviewed. Using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) methodology, we performed a systematic literature search from databases: PubMed-MEDLINE, Cochrane Library, CINAHL and ScienceDirect. Applied search strategies resulted in 102 articles, of which 7 were included and critically evaluated. A total of 2285 VABB procedures were enrolled from 7 eligible studies. 1094 and 1191 VABB were performed using PS and upright DBT systems respectively. Significantly reduced mean procedural, targeting, and sampling time were observed in upright DBT systems. Technical success rates were higher in DBT upright (97-100%) than in PS systems (93-95.1%). Whilst increased exposures were required in PS systems (p <0.001), equipment malfunction and architectural distortions were less prevalent. Higher occurrences of vasovagal reaction and hematoma incidence are reported in upright DBT systems albeit with non-statistical significance (p >0.05). Upright DBT systems are associated with higher clinical performance, technical success rates and reduced exposures. However, visibility of sharp biopsy devices in upright systems may induce anxiety and emotional stress, thus contributing to increased vasovagal reactions. PS systems are useful in patients with spinal conditions or the aged with a compromised vasovagal tolerance. Newer unconventional alternatives such as lateral decubitus position in upright DBT should warrant more studies to evaluate clinical utility. [ABSTRACT FROM AUTHOR]

Objective Stereotactic procedures are performed in many neurosurgical departments in order to obtain tumor tissue from brain lesions for histopathological evaluation. Biopsies can be performed frame-guided and frame less. Some departments use a biopsy needle (cylinder probe), others a forceps for repetitive smaller tissue samples. Although the applied techniques are somehow different, it is still unclear how many tissue samples have to be taken to establish reliably a final diagnosis based on histopathological and genetic examinations. Only precise histopathological diagnosis results in adequate therapy. Methods We included 43 consecutive patients who underwent stereotactic biopsy of a suspected glioblastoma between 02/2013 and 07/2015. All patients showed contrast enhancing tumors in the MRI. The patients underwent stereotactic biopsy with the Leksell frame attached to their head. All stereotactic procedures were performed in the presence of a neuropathologist. Target and Entry Points were calculated with BrainLab iplan software (BrainLab iplan 1.0, Munich, Germany). First the two samples 5mm before the Target (pre-target) and the “Targetpoint” itself were analyzed (group 1), then a histopathological evaluation of all samples was performed (group 2). Results Mean number of extracted samples was 14. Using classical hematoxylin-eosin stainings, in group 1 histopathological diagnosis was correct in only 30 cases accounting for 73%. Contrariwise a final diagnosis was made in 100% in group 2. Conclusion If only two tissue samples were evaluated in this group of patients with suspected glioblastoma, a correct diagnosis was possible in only 73% of the cases. We conclude that two samples are not enough to establish a final diagnosis even in a subgroup of suspected glioblastoma. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Little is known about the localized inflammation that patients experience after gamma knife stereotactic radiosurgery (GKSR) or a stereotactic biopsy (SB) procedure. This study was conducted to gather and compare baseline data of local pin-site inflammation in patients with GKSR and SB in the early postprocedural period. This was a prospective, nonrandomized observational study of current practice. Eligible patients were consented and surveyed in-person or via phone, 24 hr and 7 days after procedure, regarding inflammation at pin sites. This study included a total of 59 subjects aged 26-77 years. Inflammation of at least one pin site was seen in 37 subjects. One subject developed a superficial infection requiring oral antibiotics. There was no statistical difference in inflammation between SB and GKSR subjects. There was a higher rate of inflammation at 1 week for frontal pin sites. Localized inflammation was more common than hypothesized after GKSR and SB. Patients should be educated about pin-site inflammation after GKSR. Early post-treatment follow-up should be performed and include assessment for pin-site inflammation. Pin-site inflammation that persists after 7 days should be visually assessed for possible localized infection. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Core needle biopsy results of segmental calcifications on mammography can have direct impact on surgical management. Although dependent on breast size, cancer spanning greater than 5 cm is usually treated with mastectomy, and cancer less than 5 cm is managed with lumpectomy. Approach to stereotactic biopsy of morphologically similar segmental calcifications that span more than 5 cm on mammography varies geographically and is currently largely based on preference of the surgical or medical oncology colleagues. Some clinicians prefer biopsy of the anterior and posterior aspects of the abnormality, whereas others believe a single biopsy within the abnormality is adequate. There is insufficient data to support whether a single biopsy of calcifications is adequate to establish the need for mastectomy, or if pathology-proven cancer in the anterior and posterior components to define the extent of disease is required. This study aims to evaluate concordance rates of paired biopsies of suspicious segmental mammographic calcifications.Materials and Methods: From a 5-year review of our imaging database, 32 subjects were identified with breast imaging reporting and data system (BI-RADS) 4 or 5 segmental calcifications on mammography who underwent anterior and posterior stereotactic biopsies. The paired biopsy results were independently analyzed for concordance on benign, high-risk, or malignant pathology.Results: Of the 32 cases, there was perfect agreement (32/32 cases = 100% concordance, 95% confidence interval = 89.3-100%) in anterior and posterior pairs in benign, high-risk, or malignant findings (kappa = 1, P < 0.001).Conclusions: The absence of data on pathological concordance in anterior and posterior aspects of suspicious, morphologically similar, segmental calcifications spanning 5 cm or more has led to a varied clinical approach to stereotactic biopsy. The 100% rate of pathological concordance in our study suggests that a single biopsy is adequate for diagnosis and representative of the whole mammographic abnormality. Implementation of this approach will potentially reduce unnecessary biopsies and surgeries, minimize healthcare costs, and decrease patient morbidity. [ABSTRACT FROM AUTHOR]

Among percutaneous biopsy techniques, the vacuum assisted breast biopsy (VAB) obtains large tissue samples to alleviate some of the limitations associated with conventional percutaneous biopsy techniques. We aimed to determine the efficacy of VAB in previous equivocal biopsies using the mammotome device. Materials and Methods: A prospective non-randomized efficacy study was planned and executed on 43 patients (42 women, 1 man) whose previous FNAC and/or CNB of breast masses yielded inconclusive results or were suspicious for cancer. Results: VAB revealed malignancy in 31 (72%) of the 43 patients. Among them, 23 were diagnosed as infiltrative ductal carcinoma (IDC) on VAB, 20 underwent surgery and the final histopathological diagnosis was the same in 19 of them. One patient showed ductal carcinoma-in-situ (DCIS) only in the surgical specimen. Other malignancies included infiltrating lobular carcinoma (ILC) in 5 patients and one each of DCIS, non- Hodgkin lymphoma (NHL) and metastasis from lung cancer. Benign lesions were detected in 12 (28%) patients. These included 8 fibroadenomas, 2 fibrocystic disease and 1 each of mastitis and breast abscess. Four patients with fibroadenoma underwent surgical excision. [ABSTRACT FROM AUTHOR]

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Tuberculosis is among the oldest and most devastating infectious diseases worldwide. Nearly one third of the world’s population has active or latent disease, resulting in 1.5million deaths annually. Central nervous system involvement, while rare, is the most severe form of tuberculosis. Manifestations include tuberculoma and tuberculous meningitis, with the majority of cases occurring in children and immunocompromised patients. Despite advancements in imaging and laboratory diagnostics, tuberculomas of the central nervous system remain a diagnostic challenge due to their insidious nature and nonspecific findings. On imaging studies tuberculous meningitis is characterized by diffuse basal enhancement, but tuberculomas may be indistinguishable from neoplasms. Early diagnosis is imperative, since clinical outcomes are largely dependent on timely treatment. Stereotactic biopsy with histopathological analysis can provide a definitive diagnosis, but is only recommended when non-invasive methods are inconclusive. Standard medical treatment includes rifampicin, isoniazid, pyrazinamide, and streptomycin or ethambutol. In cases of drug resistance, revision of the treatment regimen with second-line agents is recommended over the addition of a single drug to the first-line regimen. Advances in genomics have identified virulent strains of tuberculosis and are improving our understanding of host susceptibility. Neurosurgical referral is advised for patients with elevated intracranial pressure, seizures, or brain or spinal cord compression. This review synthesizes pertinent findings in the literature surrounding central nervous system tuberculoma in an effort to highlight recent advances in pathophysiology, diagnosis, and treatment. [Copyright &y& Elsevier]

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Appropriate treatment of brainstem lesions is possible only when an accurate histopathologic diagnosis is made. Stereotactic biopsy has been used extensively to aid the diagnosis and management of intracranial lesions. This study presents the authors’ 18-year experience with diagnostic stereotactic biopsy of brainstem lesions.Hospital records for all patients with brainstem lesions who underwent stereotactic biopsy at our hospital between 1989 and 2007 were retrospectively reviewed.A stereotactic biopsy for brainstem tumors was performed on 200 patients (61% male) with a mean age of 23.9±16.97 years at the time of diagnosis. Glioma was the most common histopathologic diagnosis in 95.0% of the patients (n=190). Diagnoses in 10 patients included lymphoma (5), abscess (3), adenocarcinoma (1), and multiple sclerosis (1). The mortality was 0.5% and the morbidity was 4.0%: intraparenchymal hemorrhage, 5 cases; perilesional edema, 1 case; hydrocephalus, 1 case; and aspirative pneumonia, 1 case.Although the diverse pathology of brainstem lesions in adults requires an accurate diagnosis for the appropriate treatment strategy, the high incidence of brainstem glioma in children has led to some debate on the usefulness of the stereotactic biopsy in these patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Stereotactic biopsy for brainstem lesion offers high diagnostic yield with low morbidity. We compared two modalities of biopsy procedure, frame-based and frameless stereotaxy, either transfrontal or transcerebellar route. The benefits and operation considerations are discussed. Methods: Ten patients with intrinsic brainstem lesion diagnosed with stereotactic biopsy from August 2006 to March 2010 were retrospectively reviewed. All procedures were performed under general anesthesia. Six of 10 patients were approached with transfrontal route, whereas the other four patients with transcerebellar route. Frame-based stereotaxy or frameless navigation system was applied. Results: All lesions of the 10 patients were successfully diagnosed with stereotactic biopsy procedure. There was no major morbidity after the procedure. Conclusion: A number of approaches are available for stereotactic brainstem biopsy. Surgical approach should be tailored, according to the location neurological function, with special concern for the patients’ safety. In selected condition, frameless stereotaxy biopsy also provides competed diagnostic yield. [Copyright &y& Elsevier]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Stereotactic biopsy is a minimally invasive method of reaching a pathological diagnosis. However, it is not always possible with this method to obtain the tissue samples required for an exact pathological diagnosis. The factors that can make histological diagnoses uncertain are the heterogeneity of tumors and/or brain shifts in the case of small tumors. In this study, we investigated the usefulness of fluorescence in determining the existence of tumor components in obtained tissues. Six patients underwent stereotactic biopsy. 5-Aminolevulinic acid (5-ALA) was administered orally prior to operation. Frameless stereotactic biopsies were performed. The obtained samples were irradiated with 405nm light and all samples showed red light excitation. Intraoperative rapid pathological diagnosis was made in each case by microscopic examination of frozen section samples. The final pathological diagnoses were of three glioblastomas, one astrocytoma grade 3, and two malignant lymphomas. One case was initially thought to be gliosis on rapid pathological diagnosis, but the final pathological diagnosis reached by examination of a permanent HE stained section was astrocytoma grade 3. Another case, finally diagnosed as malignant lymphoma, was initially diagnosed as infiltration of lymphocytes. The discrepancies between rapid and permanent pathological diagnoses might be caused by the destruction of cells. 5-ALA photodynamic diagnosis is not influenced by the destruction of tissues, simply because it does not depend on the structure of tissues. Stereotactic fluorescence biopsy is very useful in that it enables rapid and exact biopsy and obviates the necessity of waiting for an intraoperative report from a pathologist. [Copyright &y& Elsevier]

Although radiographic and clinical appearance may suggest the pathological diagnosis of a mass lesion located within vital areas of the brainstem, surgeons frequently have elected to treat patient without the benefit of a tissue diagnosis. Such an emperic approach often leads to inappropriate therapy. We present five patients with intrinsic brainstem lesions who underwent CT guided stereotactic biopsy using CRW stereotactic frame. Positive diagnosis was achieved in all cases. There was no operative morbidity, however, one patient died of postoperative intratumoural haematoma. [ABSTRACT FROM AUTHOR]

Abstract: This case study describes a qualitative investigation of the experiences of 14 experienced mammography radiographers who successfully undertook a formal programme of education and training in stereotactic needle core biopsy (SNCB) of the breast. They now routinely perform SNCB within symptomatic and screening breast services in a variety of NHS hospitals across the country. All 14 radiographers completed a semi-structured postal questionnaire approximately six months after the end of the course. A tentative theory derived from the data suggests that the professional challenge associated with radiographer-performed SNCB builds personal confidence and effects positive change. Three main categories emerging from the data – challenge, confidence and change are underpinned by two main themes – educational, professional and service drivers that promote the realisation of goals and vision; and personal, peer and external motivation sustained by respect, recognition and reward. SNCB role extension as explored in this study is having a positive and transformational impact on patient users of breast diagnostic clinical services and on the professional health carers providing them. The key drivers for this as identified in the study are a formal educational experience, professional role extension opportunities and the NHS modernisation process. The participants experienced positive change as individuals and as professional breast cancer multidisciplinary team members. Academic and financial rewards, respect and recognition from colleagues across professional disciplines and from patients, were key motivators that sustained the process. This study indicates that radiographer-performed SNCB can help deliver the NHS Plan and the NHS Cancer Plan and in doing so has the potential to improve the working lives of health care professionals and ultimately to improve the quality of care for patients. [Copyright &y& Elsevier]