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Objective: The aim of the present study was to explore the diagnostic value and safety of color Doppler ultrasound (US)-guided transthoracic core needle biopsy (CNB) of peripheral lung, chest wall and mediastinal lesions using automated biopsy guns. Materials and methods: We analyzed clinical and image data, histopathologic and microbiologic details and complications from 121 patients with peripheral lung, chest wall and mediastinal lesions who underwent color Doppler US-guided transthoracic CNB in Ningbo First Hospital between January 2015 and June 2018. Results: Color Doppler US-guided transthoracic CNB performed with a freehand technique using automated biopsy guns had a sensitivity of 93.94%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 78.57%, and a diagnostic accuracy of 95.04%. Lesion size did not affect the diagnostic rate (P=0.40). No serious complications of the procedure were noted. Conclusion: Color Doppler US-guided transthoracic CNB of peripheral lung, chest wall and mediastinal lesions is a safe and inexpensive procedure. The diagnostic accuracy of color Doppler US-guided transthoracic CNB was higher than that of color Doppler US-guided transthoracic fine needle aspiration biopsy (FNAB).

Transthoracic needle biopsy (TNB) is a fast and safe method used to establish definitive diagnosis for most thoracic lesions, whether the lesion is located in the pleura, the lung parenchyma, or the mediastinum. Diffuse disease and solitary lesions are equally approachable.TNB can avoid (when technically possible) more complex diagnostic interventions such asmediastinoscopy, thoracoscopy and exploratory thoracotomy. This article focuses on the advantages of TNB which is a safe, affordable and quick method to obtain histopathological confirmation of intrathoracic tumors. Material and MethodsThe study included a total of 235 cases over a period of 4 and a half years (01.01.2011-30.04.2015). We investigated the demographic and clinical parameters, the guiding methods, the histological results and the complications of the procedure. ResultsThe median age of the patients was 62 years and the predominent sex was male. We could obtain a tissue biopsy in 99% with a histopathological confirmation of 88%. The most frequently used guiding method was the previous CT scan of the patient and the anathomical landmarks (53%). The main histopathological result was squamous cell carcinoma.ConclusionsTNB is generally a safe procedure with limited morbidity and extremely rare mortality. It is an affordable and quick method to obtain histopathological confirmation of intrathoracic tumors.Most TNBs can be performed by using local anesthesia without conscious sedation and virtually any location in the chest can be safely addressed.

Tumor samples are required for pathological examinations, and different instruments are generally used to obtain samples of different types of tumors. Among the many methods available for obtaining tumor tissues, gun biopsy is widely used because it is much simpler than incisional biopsy and can collect many more samples than aspiration biopsy. However, conventional biopsy guns cannot simultaneously perform biopsy aspiration, bleeding prevention, and marker injection. In this study, we developed a biopsy gun that can simultaneously perform biopsy aspiration and sample collection, in addition to injecting a styptic agent and marker to prevent bleeding and contamination in the biopsy track. We then used a prototype to evaluate the feasibility of the developed device. The collectable sample size was also assessed. Performance of the biopsy aspiration feature was also evaluated, including the maximum aspiration viscosity. Finally, we tested the maximum amount of drug that can be injected. We found that the biopsy gun developed here is an alternative tool for biopsy collection with improved procedure safety and diagnostic accuracy.

Minimally invasive core breast biopsy methods are replacing hook-wire-guided surgery wherever ultrasound and stereotactic equipment are available. Cost efficiency is improved, but sampling errors inherent in these techniques cause underestimations of malignancy and the degree of invasiveness in a small but significant number of patients. Diagnostic accuracy improves with increasing specimen weight. The trend is to take many cores. How much tissue is enough to enable a confident diagnosis? Recent research suggests that 1 g of tissue is sufficient. A new coaxial biopsy method presented here can retrieve a contiguous 1-g block of tissue from the center of a mammographic lesion, without stereotactic guidance. This specimen may be superior to multiple small cores obtained by biopsy guns and vacuum devices.

Purpose To compare 18-gauge-needle automated biopsy guns to 14-gauge systems for diagnostic efficacy and safety in percutaneous renal biopsy. Materials and Methods One hundred sixty-one computed tomographic (CT) guided biopsies for diffuse renal disease were retrospectively reviewed. An automated biopsy gun with an 18-gauge needle was used in 74 procedures, and a 14-gauge needle was used in 87 cases. Results Adequate tissue for histologic diagnosis was obtained in 96% (71 of 74) of cases with use of the 18-gauge needle, compared with 99% (86 of 87) in the 14-gauge group. The mean glomeruli per specimen were 10.7 and 13.7, respectively. Major hemorrhagic complications occurred in two cases (2.7%) of the 18-gauge group and in three cases (3.4%) of the 14-gauge group. Conclusion The use of a biopsy gun with an 18-gauge needle provides high tissue recovery rate, comparable to that with the 14-gauge system. The complication rate was acceptably low, with no statistically significant difference from the 14-gauge needles ( P = .80).

Over the last few years spring-driven mechanical biopsy guns have been introduced for performing renal biopsies. There has been little research done comparing these guns with traditional hand-driven needles in performing biopsies of native kidneys. We wished to compare our experience with the two needle types. We studied retrospectively the results and complication rates of 155 native kidney biopsies. Sixty-nine were performed with hand-driven 14-gauge needles and eighty-six with 18-gauge, spring-driven biopsy guns. Sufficient tissue for diagnosis was obtained in 96% of cases in the hand-driven group compared with 99% in the biopsy gun group (P = NS). Complications occurred in six cases in the hand-driven group compared with one case in the biopsy gun group (P = 0.02). As expected, the reported number of glomeruli per core in the 14-gauge cores was greater than in the 18-gauge cores (16.5 v 6.2, P0.01). This was partially offset by the greater number of passes made with the smaller needle. We conclude that similar results can be expected from both biopsy methods, with a possible slight decrease in complications using biopsy guns with smaller needle diameters.

To evaluate 20 different automated biopsy devices with respect to the quality of tissue obtained for histopathologic analysis, a total of 1,470 18-gauge biopsy specimens were obtained from 10 fresh autopsy cases, including 30 liver, 20 kidney, 10 pancreas, and 10 psoas muscle biopsy specimens per device and per biopsy depth. There was no statistical difference in the performance of the long-throw Biopty, ASAP 18, 1.9-cm UltraCut, long-throw Monopty, and 2.5-cm ABS biopsy guns. All obtained a large amount of tissue with minimal fragmentation or crush artifact. Most of the short-throw biopsy guns (depth of biopsy < or = 1.1 cm) did not perform as well. Although the other guns performed adequately, less than optimal results were obtained with the Temno, Bio-Gun, Roth, Klear Kut, ABC, and Urocut biopsy guns. Most 18-gauge automated biopsy devices with a biopsy excursion of at least 2.0 cm provide a high-quality, diagnostically adequate specimen for histopathologic analysis.

Advancement of radiologic technologies allows the detection of vertebral lesions at an earlier stage, thereby increasing the proportion of vertebral lesions that are surrounded by intact bone when they are detected. While biopsy guns are effective in obtaining good-quality tissue samples of osteolytic bone lesions, lesions that are covered by intact bone are not accessible with a biopsy gun. For percutaneous biopsy of osteolytic vertebral lesions, an intact-bone transgressing technique is described in which a simple, inexpensive and small-calibre (18-gauge) instrument is used to allow multiple passage of 20-gauge biopsy guns for effective tissue sampling. In this series consisting of metastatic and myeloproliferative lesions, the effectiveness and safety of this well-tolerated technique are demonstrated in thoracic and lumbar vertebrae.

Debate over which biopsy needle is the best has intensified recently with the introduction of automated biopsy guns including the 18-gauge long-throw and short-throw Biopty, the 18-gauge Cook, and the 14- and 18-gauge Klear Kut. To evaluate the efficacy of these mechanized biopsy guns versus that of conventional manual biopsy needles in the acquisition of adequate tissue for histopathologic evaluation, open hepatic and renal biopsies were performed in 15 pygmy pigs. The specimens were evaluated separately in a double-blind fashion by two histopathologists using graded criteria. Overall, the best results were obtained with the manual 14-gauge Tru-Cut needle, the long-throw 18-gauge Biopty gun, and the 18-gauge Cook biopsy gun. By comparison, the aspiration-type needles did not perform as well when considered as a group. Several other needles scored well in the biopsy of either the liver or kidney, but not in both. Disappointing results were obtained with the Klear Kut guns (both 14- and 18-gauge) and the V...

The purpose of this study was to compare several of the commonly used manual biopsy needles with several of the new automated biopsy devices (biopsy guns) for biopsy of medical renal disease.Ten different biopsy needles or automated devices were each used to do two biopsies of 10 cadaveric kidneys. The specimens were reviewed in a blinded fashion by a pathologist using a previously published histopathologic scale.Of the four conventional biopsy needles tested (16-gauge Jamshidi, 18-gauge Sure-Cut, 14-gauge Tru-Cut, and 14-gauge Vim Silverman), the Jamshidi needle obtained the greatest average number of glomeruli (5.64). Results similar to those obtained with the conventional needles were obtained with the 16- and 18-gauge Biopty and Ultra-Cut biopsy guns. The 18-gauge Autovac gun with either a 2- or 4-cm depth of biopsy suffered from a significant number of biopsies from which no tissue was obtained. The 14-gauge Biopty gun was clearly superior, leading in all graded categories including the average number of glomeruli (8.11) per biopsy.The automated biopsy device, or biopsy gun, can provide more diagnostic specimens than can manual or conventional needles in biopsy for medical renal disease.

To compare commercially available 14-guage core biopsy guns and 11- and 14-gauge, directional, vaccum-assisted biopsy probes for tissue yield and fragmentation.One hundred passes were made through fresh turkey breasts by using each of 11 14-gauge, automated biopsy gun-needle combinations and a directional, stereotactic, vacuum-assisted biopsy system equipped with 11- or 14-gauge probes. Specimens were measured for total weight, individual length, diameter, and number of fragments.Among the handheld devices, the Pro-Mag 2.2 gun (Manan Medical Products, Northbrook, Ill) and 14-gauge Biopsy-Cut needle (Bard, Covington, Ga) had the greatest yield (17.7 mg per core specimen); this combination also produced the greatest percentage of nonfragmented cores (83%). Directional, vacuum-assisted biopsy specimens were significantly larger (P.001): 36.8 mg per core specimen for the 14-gauge probe and 94.4 mg per core specimen for the 11-gauge probe. Specimens obtained with directional, vacuum-assisted biopsy were more fragmented than those obtained with spring-actuated, two-stage, long-throw, automated biopsy systems.Statistically significant differences with various biopsy devices are seen in the breast tissue yield and in fragmentation.

To compare seven large-core, long-throw, 14-gauge biopsy guns for yield and quality of breast tissue obtained.A two-phase, randomized and blinded study was performed. In the first phase, four fully automated 14-gauge biopsy guns (BIP, Manan, Biopsy, and ASAP) and one semiautomated device (Temno) were used to obtain breast cores from a cadaver. Samples were assessed for volume, number of fragments, and crush artifact. In the second phase, seven biopsy guns (previously mentioned guns plus Monopty and Ultra-Cut guns) were used to obtain cores from a breast parenchyma model. These cores were then evaluated for weight, volume, and number of fragments.The mean specimen volume of cadaveric breast tissue obtained was 17.9 mm3 for the BIP gun, 17.8 for the Manan gun, 14.9 for the Biopsy gun, 14.1 for the ASAP gun, and 9.9 for the Temno gun. The Temno gun obtained statistically significantly smaller volumes than all other guns. For the breast parenchyma model, mean obtained volumes were 24.5, 24.1, 16.2, 21.7, 17.5, 20.0, and 15.2 mm3, respectively. The BIP and Manan guns yielded statistically significantly larger cores than all other guns except the ASAP.Yields of breast tissue provided by each biopsy device differed statistically significantly. BIP and Manan biopsy guns yielded the greatest volume of core tissue, which may facilitate histopathologic diagnosis from breast biopsies performed with imaging guidance.

Forty-eight biopsy devices (needles, stylets, guide wires, biopsy guns, etc) were evaluated for ferromagnetism (n = 48) and artifacts (n = 43) in a 1.5-T magnetic resonance (MR) system, with previously described techniques. Forty-five of the 48 devices were found to be ferromagnetic. Artifacts varied, depending on the type and size of the component material(s) of the device. Most of the commercially available biopsy devices are not useful for MR imaging-guided biopsy procedures because of the presence of ferromagnetism and associated artifacts.

The purpose of this study was to compare the efficacies of four different types of end-cut biopsy guns with the side-notch Tru-cut biopsy gun.A total of 25 liver, 15 kidney, 10 pancreas, and 15 breast biopsies were performed in the tissue from five autopsies with each of 12 different biopsy devices/biopsy depths. The tissue obtained was evaluated by an experienced cytopathologist who, not knowing which gun was used to obtain each specimen, used a predetermined grading scheme.When tissue was obtained, the end-cut biopsy guns performed equivalently to the side-notch biopsy gun in all four tissues. However, the end-cut guns had a significant number of "zero" biopsies (biopsy attempts during which no tissue was obtained). The proportion of zero biopsies with the end-cut guns ranged from up to 28% in the liver to 60% and 73% in the breast and kidney, respectively.The end-cut biopsy guns are easy to use and potentially can obtain high-quality specimens. However, the rate of zero biopsies during which no tissue is obtained is a serious deficiency. As a result, the use of the end-cut biopsy gun should be encouraged only for use with an introducer, with which multiple biopsy specimens can easily be obtained without additional needle punctures.

Open hepatic and renal biopsies were performed in 15 healthy pygmy pigs by each of 15 different commonly used needles/automated biopsy devices (guns). These biopsies were performed by three radiologists, each with widely varying prior experience in the use of each device. These 15 biopsy needles/biopsy guns were divided into six categories and compared in a multivariate model to assess differences in radiologist performance based upon their prior experience. The performance of individual radiologists varied the most with the group of aspiration needles. Even an experienced radiologist who had previously performed 55 such biopsies performed statistically worse than another radiologist who had performed in excess of 200. The biopsy guns, as a group, also demonstrated significant variability between radiologists and their experience level. However, when considered alone, experience appeared less a factor with the Bard 18-gauge (1.20 mm) long-throw biopsy gun. Considerable experience-related variability was also encountered in the liver with the Vim Silverman needle and in the kidney with the vacuum needles. The 14 gauge (2.00 mm) Tru-Cut needle provided a high-quality specimen seemingly independent of operator experience. Regardless of the needle or device used, prior experience in their use appears most important in biopsies of softer, less fibrous, and more vascular tissue.

Percutaneous bone biopsy with use of traditional trephine needles may be unsuccessful in osteolytic lesions. The authors used an 18-gauge biopsy gun in 25 consecutive lytic lesions. This procedure was safe, effective, and not technically difficult. Use of biopsy guns with detachable handles made positioning with computed tomography (CT) guidance less difficult. The only technical difficulty arose in biopsy of small lesions, in which the gun may misfire when contacting solid bone. A biopsy gun is an effective tool in the biopsy of osteolytic lesions.