The introduction of wireless capsule endoscopy has brought a revolutionary change in the diagnostic procedures for gastrointestinal disorders.Biopsy,an essential procedure for disease diagnosis,has been integrated int...The introduction of wireless capsule endoscopy has brought a revolutionary change in the diagnostic procedures for gastrointestinal disorders.Biopsy,an essential procedure for disease diagnosis,has been integrated into robotic capsule endoscopy to augment diagnostic capabilities.In this study,we propose a magnetically driven biopsy robot based on a Kresling origami.Considering the bistable properties of Krelsing origami and the elasticity of the creases,a foldable structure of the robot with constant force characteristics is designed.The folding motion of the structure is used to deploy the needle into the target tissue.The robot is capable of performing rolling motion under the control of an external magnetic drive system,and a fine needle biopsy technique is used to collect deep tissue samples.We also conduct in vitro rolling experiments and sampling experiments on apple tissues and pork tissues,which verify the performance of the robot.展开更多
Wireless capsule endoscopy(WCE)has the potential to fully replace conventional wired counterparts for its low invasiveness.Recent studies have attempted to expand the functions of capsules toward this goal.However,lim...Wireless capsule endoscopy(WCE)has the potential to fully replace conventional wired counterparts for its low invasiveness.Recent studies have attempted to expand the functions of capsules toward this goal.However,limitations in space and energy supply have resulted in the inability to perform multiple diagnostic and treatment tasks using a single capsule.In this study,we developed a dual-functional capsule robot(DFCR)for drug delivery and tissue biopsy based on magnetic torsion spring technology.The delivery module was shown to rotate the push rod with a thrust of 894 mN to release approximately 0.3 mL of semisolid drug.The biopsy module used a built-in blade to cut tissue with a shear stress of 22.87 MPa,producing a sample of approximately 1.8 mm3.Additionally,a five-degree-of-freedom permanent magnet drive system was developed.By adjusting the strength of the unidirectional magnetic field generated by an external magnet,the capsule can be wirelessly controlled to sequentially trigger the two functions.Ex vivo tests on porcine stomachs confirmed the feasibility of the prototype capsule(12 mm in diameter and 45 mm in length)in active movement,medication,and tissue biopsy.The newly developed DFCR further expands the clinical application prospects of WCE robots in minimally invasive surgery.展开更多
BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedura...BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedural image guidance,and various“plugging”techniques,bleeding remains a frequent and potentially highly mor-bid complication,particularly in patients with bleeding risks.Thus,post-biopsy bleeding risk leads to extended patient monitoring,and in significant cases,ad-ditional imaging,intervention,and even surgery.Very rarely,death has resulted.CASE SUMMARY We report a series of five image-guided liver biopsy cases undertaken due to a variety of clinical conditions followed by the use of a new electrocautery hemo-stasis device called SinglePass Kronos.Indications for the CNB included non-alcoholic steatohepatitis,hepatocellular carcinoma and cirrhosis,abnormal liver function tests with positive autoimmune serologies,abnormal imaging findings,and jaundice.All biopsy procedures were successful with no complications th-rough 30 days following CNB.Post-procedure ultrasound confirmed the absence of bleeding in all five cases.CONCLUSION Hemostasis of CNB tracts using SinglePass Kronos was obtained in all cases.Ad-ditional study of this device is warranted.展开更多
The choice of biopsy method is critical in diagnosing prostate cancer(PCa).This retrospective cohort study compared systematic biopsy(SB)or cognitive fusion-targeted biopsy combined with SB(CB)in detecting PCa and cli...The choice of biopsy method is critical in diagnosing prostate cancer(PCa).This retrospective cohort study compared systematic biopsy(SB)or cognitive fusion-targeted biopsy combined with SB(CB)in detecting PCa and clinically significant prostate cancer(csPCa).Data from 2572 men who underwent either SB or CB in Fudan University Shanghai Cancer Center(Shanghai,China)between January 2019 and December 2023 were analyzed.Propensity score matching(PSM)was used to balance baseline characteristics,and detection rates were compared before and after PSM.Subgroup analyses based on prostate-specific antigen(PSA)levels and Prostate Imaging-Reporting and Data System(PI-RADS)scores were performed.Primary and secondary outcomes were the detection rates of PCa and csPCa,respectively.Of 2572 men,1778 were included in the PSM analysis.Before PSM,CB had higher detection rates for both PCa(62.9%vs 52.4%,odds ratio[OR]:1.54,P<0.001)and csPCa(54.9%vs 43.3%,OR:1.60,P<0.001)compared to SB.After PSM,CB remained superior in detecting PCa(63.1%vs 47.9%,OR:1.86,P<0.001)and csPCa(55.0%vs 38.2%,OR:1.98,P<0.001).In patients with PSA 4–12 ng ml−1(>4 ng ml-1 and≤12 ng ml-1,which is also applicable to the following text),CB detected more PCa(59.8%vs 40.7%,OR:2.17,P<0.001)and csPCa(48.1%vs 27.7%,OR:2.42,P<0.001).CB also showed superior csPCa detection in those with PI-RADS 3 lesions(32.1%vs 18.0%,OR:2.15,P=0.038).Overall,CB significantly improves PCa and csPCa detection,especially in patients with PSA 4–12 ng ml−1 or PI-RADS 3 lesions.展开更多
Background:Transrectal(TR)and transperineal(TP)biopsies are commonly used methods for diagnosing prostate cancer.However,their comparative effectiveness in conjunction with machine learning(ML)techniques remains under...Background:Transrectal(TR)and transperineal(TP)biopsies are commonly used methods for diagnosing prostate cancer.However,their comparative effectiveness in conjunction with machine learning(ML)techniques remains underexplored.This study aimed to evaluate the predictive accuracy of ML algorithms in detecting prostate cancer using data derived from TR and TP biopsies.Methods:The clinical records of patients who underwent prostate biopsy at King Saud University Medical City and King Faisal Specialist Hospital and Research Centerin Riyadh,Saudi Arabia,between 2018 and 2025 were analyzed.Data were used to train and testMLmodels,including eXtreme Gradient Boosting(XGBoost),Decision Tree,Random Forest,and Extra Trees.Results:The two datasets are comparable.The models demonstrated exceptional performance,achieving accuracies of up to 96.49%and 95.56%on TP and TR biopsy datasets,respectively.The area under the curve(AUC)values were also high,reaching 0.9988 for TP and 0.9903 for TR biopsy predictions.Conclusion:These findings highlight the potential of MLto enhance the diagnostic accuracy of prostate cancer detection irrespective of the biopsy method.However,TP biopsy data showed marginally higher accuracy,possibly because of the lower risk of contamination.While ML holds great promise for transforming prostate cancer care,further research is needed to address limitations.Collaboration between clinicians,data scientists,and researchers is crucial to ensure the clinical relevance and interpretability of ML models.展开更多
BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biop...BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.展开更多
To the Editor:With the popularity of liver transplantation(LT)and the inspiration for long-time survival,issues related to evaluating the liver allograft have increased in recent years[1-3].Although there has been ren...To the Editor:With the popularity of liver transplantation(LT)and the inspiration for long-time survival,issues related to evaluating the liver allograft have increased in recent years[1-3].Although there has been renewed interest in non-invasive methods to evaluate diffuse liver disease,liver biopsy is still the golden standard in clinical practice,particularly for liver transplant recipients(LTRs).The liver biopsy has always been performed in LTRs as a part of standard procedure in cases whose liver function was normal,named as protocol liver biopsy,or to identify histological abnormalities for abnormal liver function and provide guidance for the adjustment of immunosuppressive regimen[4,5].Percutaneous liver biopsy(PLB)has been frequently conducted in LTRs;however,the clinical implementation of protocol liver biopsy by PLB in LTRs is challenging due to their suboptimal compliance,particularly in China[6].Besides,the PLB procedure has been associated with discomfort and potentially life-threatening complications in the general population,as reported in the literature[7,8].展开更多
Objective:To explore the impact of psychological care on preoperative anxiety and postoperative pain in patients undergoing liver biopsy.Methods:A total of 100 patients undergoing liver biopsy in our hospital from Jan...Objective:To explore the impact of psychological care on preoperative anxiety and postoperative pain in patients undergoing liver biopsy.Methods:A total of 100 patients undergoing liver biopsy in our hospital from January 2024 to October 2024 were selected as the study subjects.They were divided into a control group and a study group using a random number table method,with 50 patients in each group.The control group received routine care,while the study group received psychological care on the basis of the control group’s treatment.The nursing satisfaction,fear scores,anxiety scores,postoperative pain levels,and incidence of complications(local pain at the puncture site,bleeding at the puncture site,skin irritation,tension blisters,infection,severe abdominal pain,pneumothorax)were compared between the two groups.Results:The nursing satisfaction in the study group was higher than that in the control group(P<0.05).After nursing,the fear scores and anxiety scores in both groups were lower than before nursing,and the fear scores and anxiety scores in the study group were lower than those in the control group(P<0.05).The postoperative pain scores in the study group were lower than those in the control group(P<0.05),and the incidence of complications in the study group was lower than that in the control group(P<0.05).Conclusion:The application of psychological care in patients undergoing liver biopsy has a definite effect,which can improve patient satisfaction,reduce preoperative anxiety and fear,alleviate postoperative pain,and reduce the incidence of postoperative complications.It is worthy of clinical promotion and application.展开更多
BACKGROUND Mediastinal lymph nodes(MLNs)can be enlarged due to various benign or malignant causes.Endoscopic ultrasound(EUS)is often employed for the acquisition of tissue specimens of the enlarged MLN(EMLN).AIM To de...BACKGROUND Mediastinal lymph nodes(MLNs)can be enlarged due to various benign or malignant causes.Endoscopic ultrasound(EUS)is often employed for the acquisition of tissue specimens of the enlarged MLN(EMLN).AIM To determine the causes,document the symptoms,and determine factors predicting good yield of EUS-guided EMLN biopsy.METHODS All patients having EMLN(>10 mm)on thoracic imaging and referred for EUSguided biopsy were included in this retrospective observational study.Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation(MOSE)and then sent to a histopathologist for final diagnosis.Analysis for factors predicting good biopsy yield was then performed.RESULTS Of the total 243 patients with EMLN,131(53.9%)were males.The mean age was 47.6(±14.7)and range 14-86 years.Commonest causes of EMLN were tuberculosis 82(33.7%),anthracosis 53(21.8%),neoplastic disease 43(17.7%)and sarcoidosis 14(5.8%).Among the 43 patients with neoplastic diseases:40 had metastatic disease(breast 9,lung 7,pancreatobiliary 6,esophagus 5,kidney 5,hepatocellular 2,neuroendocrine 2,gastrointestinal stromal 1,undetermined 3)and 3 had primary malignancies(lymphoproliferative disorder 2,Kaposi sarcoma 1).Chest related clinical symptoms were absent in more than half the patients with tuberculosis 51/82(62.2%),anthracosis 31/53(58.5%)and neoplastic disease 28/43(65.1%).Factors associated with good biopsy yield were:Subcarinal location of MLN(P=0.026),MLN size>12 mm(P<0.0001),use of fine-needle biopsy(vs fine-needle aspiration)(P=0.049)and satisfactory MOSE(P<0.0001)on univariate analysis;while MLN size>12 mm(P=0.005)and satisfactory MOSE(P<0.0001)on multivariate analysis.CONCLUSION Tuberculosis,anthracosis and metastatic disease were the commonest causes of EMLN.More than half the cases with EMLN had no chest-related symptoms.Large MLN size and satisfactory MOSE observation predicted a good biopsy yield.展开更多
Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of pe...Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations.We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques.Materials and Methods:A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019–2022 was performed.Results:We identified 319 patients—174 transrectal and 145 transperineal.8 patients who had transperineal biopsy(5.5%)received peri-operative antibiotics,compared to 100%with transrectal biopsy.35.86%of transperineal patients received a bowel preparation,compared to 100%in the transrectal group.44.14%and 49.43%of patients received a prior prostate biopsy in the transperineal and transrectal groups,respectively.Patients in the transperineal biopsy group had zero infectious complications,1 ER visit,and zero 30-day readmissions.This is compared to 9 infectious complications(5.17%,p=0.005),8 ER visits(4.60%,p=0.036),and 730-day readmissions(4.02%,p=0.015)in the transrectal group.Conclusions:In a single institution series,patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy.Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group,there were zero infectious complications or 30-day readmissions.With greater infectious complications with transrectal biopsy and growing antibiotic resistance,we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.展开更多
Endoscopic ultrasonography(EUS)is a valuable and widely used tool for evaluating pancreatic tumors.Accurate decision-making during EUS procedures,particularly for differentiating between benign and malignant lesions b...Endoscopic ultrasonography(EUS)is a valuable and widely used tool for evaluating pancreatic tumors.Accurate decision-making during EUS procedures,particularly for differentiating between benign and malignant lesions based on imaging characteristics and assessing the need for tissue sampling,is crucial.This review provides a comprehensive overview of pancreatic tumor features observed during EUS and highlights the key criteria for distinguishing between malignant and benign conditions.Additionally,we discuss the indications for fine-needle aspiration or biopsy to obtain histopathological and genetic confirmation.Improving our understanding of these critical aspects can help improve diagnostic accuracy and guide clinicians in determining the most appropriate management strategies for patients with pancreatic tumors.展开更多
BACKGROUND This review evaluated the diagnostic effectiveness of various ultrasound(US)methods compared to liver biopsy.AIM To determine the diagnostic accuracy of US techniques in assessing liver fibrosis and steatos...BACKGROUND This review evaluated the diagnostic effectiveness of various ultrasound(US)methods compared to liver biopsy.AIM To determine the diagnostic accuracy of US techniques in assessing liver fibrosis and steatosis in adults,using the area under the receiver operating characteristic curve(AUROC)as the standard measure.METHODS The review included original retrospective or prospective studies published in the last three years in peer-reviewed medical journals,that reported AUROC values.Studies were identified through PubMed searches on January 3 and April 30,2024.Quality was assessed using the QUADAS-2 tool.Results were tabulated according to the diagnostic method and the type of liver pathology.RESULTS The review included 52 studies.For liver fibrosis detection,2D-shear wave elastography(SWE)AUROCs ranged from 0.54 to 0.994,showing better accuracy for advanced stages.Modifications,including 2D-SWE with propagation map guidance and supersonic imagine achieved AUROCs of 0.84 to nearly 1.0.point SWE and classical SWE had AUROCs of 0.741-0.99,and 0.507-0.995,respectively.Transient elastography(TE),visual TE,vibration-controlled TE(VCTE),and FibroTouch reported AUROCs close to 1.0.For steatosis,VCTE with controlled attenuation parameter showed AUROCs up to 0.89(for≥S1),acoustic radiation force impulse ranged from 0.762 to 0.784,US attenuation parameter from 0.88 to 0.93,and normalized local variance measurement from 0.583 to 0.875.Most studies had a low risk of bias across all or most domains,but evidence was limited by variability in study quality and small sample sizes.Innovative SWE variants were evaluated in a single study.CONCLUSION Modern US techniques can serve as effective noninvasive diagnostic tools for liver fibrosis and steatosis,with the potential to reduce the reliance on biopsies.展开更多
Objective This study aimed to compare the upgrade rate and cancer detection rate between the 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy(TB)and systematic biopsy in selected patients with suspected pro...Objective This study aimed to compare the upgrade rate and cancer detection rate between the 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy(TB)and systematic biopsy in selected patients with suspected prostate cancer(the molecular imaging prostate-specific membrane antigen score of≥2 and multiparametric MRI Prostate Imaging Reporting and Data System score of≥4).Methods Eighty-seven selected biopsy-naive patients were randomized into two groups:TB(n=41)and systematic biopsy(control;n=46).Patients diagnosed with clinically significant prostate cancer proceeded to radical prostatectomy.The primary outcome was the pathological upgrade rate.Secondary outcomes,including the cancer detection rate,incidence of repeat biopsy,positive surgical margin,complications,and prostate-specific antigen level at 6 weeks postoperatively,were compared between the groups using the Pearson or Fisher's exact test,as appropriate.Results In the study,prostate cancer was ultimately detected in all patients.The TB group successfully identified all tumors,whereas five patients in the control group initially missed diagnosis.The pathological upgrade rates for the TB and control groups were 31.7%and 56.5%,respectively.Overall,the detection rate for clinically significant prostate cancer(the International Society of Urological Pathology grade of≥2)was significantly higher in the TB group(92.7%)compared with the control group(76.1%,p=0.035).However,no significant difference was found in the detection rate of all prostate cancer.Complications(Clavien–Dindo grade of≤2)occurred in both the TB group(n=11)and control group(n=13).No statistically significant difference was observed between the groups in terms of the positive surgical margin,complications,or 6-week postoperative prostate-specific antigen level.Conclusion The 18F-DCFPyL PET/MRI-guided ultrasound fusion TB alone was an efficient modality in diagnosing selected patients with prostate cancer.展开更多
We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen(tPSA)>10 ng ml−1 and Prostate Imaging Reporting and Data System(PI-RADS)scores between 1 and 3....We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen(tPSA)>10 ng ml−1 and Prostate Imaging Reporting and Data System(PI-RADS)scores between 1 and 3.Clinical data derived from 517 patients of The First Affiliated Hospital of USTC(Hefei,China)from January 2020 to December 2023 who met the screening criteria for the study were retrospectively collected.Independent predictors were identified via univariate and multivariate logistic regression analysis.The diagnostic capacity of clinical variables was evaluated using the receiver operating characteristic(ROC)curves and area under the curve(AUC).A prostate biopsy strategy was developed via risk stratification.Of the 517 patients,17/348(4.9%)with PI-RADS 1–2 were diagnosed with clinically significant prostate cancer(csPCa),and 27/169(16.0%)patients with PI-RADS 3 were diagnosed with csPCa.The appropriate prostate-specific antigen density(PSAD)cut-off values were 0.45 ng ml−2 for PI-RADS 1–2 patients and 0.3 ng ml−2 for PI-RADS 3 patients.The appropriate prostate volume(PV)cut-off values were 40 ml for PI-RADS 1–2 patients and 50 ml for PI-RADS 3 patients.The prostate biopsy strategy based on PSAD and PV developed in this study can reduce unnecessary prostate biopsies in patients with tPSA>10 ng ml−1 and PI-RADS 1–3.In the study,66.5%(344/517)patients did not need to undergo prostate biopsy,at the expense of missing only 1.7%(6/344)patients with csPCa.展开更多
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxi...BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.展开更多
BACKGROUND Hepatobiliary and pancreatic cancers are among the most lethal malignancies due to late-stage diagnosis and limited treatment options.Liquid biopsy has emerged as a minimally invasive tool for early cancer ...BACKGROUND Hepatobiliary and pancreatic cancers are among the most lethal malignancies due to late-stage diagnosis and limited treatment options.Liquid biopsy has emerged as a minimally invasive tool for early cancer detection,prognosis,and therapeutic monitoring.AIM To concise the available data on liquid biopsy and establish its role in hepato-biliary surgeries.METHODS This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines.A comprehensive lite-rature search was performed using PubMed,Scopus,Web of Science,and EMBASE for studies published up to March 2025.Studies assessing the role of circulating tumor DNA,circulating tumor cells,exosomes,and other liquid biopsy markers in hepatobiliary and pancreatic cancers were included.The risk of bias was evaluated using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for clinical trials.RESULTS Liquid biopsy demonstrated significant potential for early cancer detection,perioperative risk stratification,intraoperative surgical decision-making,and postoperative monitoring of minimal residual disease.However,challenges remain regarding standardization,sensitivity,and clinical validation.CONCLUSION Liquid biopsy represents a paradigm shift in hepatobiliary and pancreatic cancer management.Advancements in next-generation sequencing and artificial intelligence may enhance its clinical utility.Further large-scale studies are needed to establish standardized protocols for routine implementation.展开更多
Pediatric cancers are particularly significant due to their uncommon occurrence in children,driven by a variety of underlying factors.Because of their distinct molecular and genetic makeup,which makes early detection ...Pediatric cancers are particularly significant due to their uncommon occurrence in children,driven by a variety of underlying factors.Because of their distinct molecular and genetic makeup,which makes early detection challenging,they are linked to problems.Diagnostic methods like imaging and tissue biopsy are only effective when the tumor has reached a size that can be identified.The liquid biopsy technique,the least intrusive and most convenient diagnostic method,is the subject of this review.It focuses on the significance of single cell analysis in examining uncommon cancer types.The many biomarkers found in bodily fluids and the cancer types they are linked to in children have been assessed,as has the potential route towards early detection and cancer recurrence forecasting.Combining the single cell liquid biopsy with the newest technologies,such as computational and multi-omics approaches,which have improved the efficiency of processing massive and unique genetic data,appears promising.This article discusses on a number of case reports for uncommon pediatric malignancies,such as Neuroblastoma,Medulloblastoma,Wilms Tumor,Rhabdomyosarcoma,Ewing Sarcoma,and Retinoblastoma,as well as their liquid biopsy profiles.Furthermore,the findings raise ethical questions regarding the therapeutic application of the technology as well as possible difficulties related to clinical translation.The likelihood that this single cell liquid biopsy will be clinically validated and eventually used as a routine diagnostic tool for uncommon pediatric cancers will rise with the realistic approach to sensitivity monitoring,specificity upgrading,and optimization.展开更多
The discussion on renal biopsies and biomarkers highlights the essential aspects of nephrology.Although novel diagnostic biomarkers are emerging,renal biopsy remains critical for accurate diagnosis and treatment owing...The discussion on renal biopsies and biomarkers highlights the essential aspects of nephrology.Although novel diagnostic biomarkers are emerging,renal biopsy remains critical for accurate diagnosis and treatment owing to the lack of sufficiently validated biomarkers with high sensitivity and specificity.Puspitasari et al highlighted the significant changes in renal biopsy indications and histological outcomes before and after the coronavirus disease 2019(COVID-19)pandemic,reflecting the complex interactions between clinical workflows,public health issues,and patient demographics.Although biomarkers are increasingly utilized in nephrology,their importance remains balanced with traditional practices.Advancements in precision medicine are exemplified by tests like plasma anti-phospholipase A2 receptor levels.However,the COVID-19 pandemic revealed significant vulnerabilities in nephrology services,emphasizing the necessity for adaptable and robust healthcare strategies to manage chronic conditions during global crises.In conclusion,while biomarkers are poised to assume a more prominent role in nephrology,the significance of renal biopsies and thorough histopathological analysis remains paramount in understanding complex disease processes and guiding personalized patient management.The ongoing integration of traditional diagnostic approaches with innovative biomarker strategies promises to improve patient care and long-term health outcomes.展开更多
BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker...BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker,often varies between primary and metastatic sites;however,routine liver biopsy remains controversial.Although percutaneous computed tomography-guided core needle biopsy(PCT-CNB)is safe and effective for focal lesions,its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored.Conflic-ting survival associations with grade shifts have been reported in previous stu-dies.We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases,correlating with survival outcomes,thereby refining risk stratification and therapeutic strategies.METHODS We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB,76 patient samples from the liver and primary sites,and 16 from the liver and secondary liver sites.Ki-67 immunohistochemistry was performed for tissue sampling,and grading classifications were determined.Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.RESULTS No procedure-related mortality was recorded during or after biopsy.In 37/92 patients(40.2%),the grading classi-fications changed:The grading increased from G1 to G2 in 13 patients,from G1 to G3 in 2,and from G2 to G3 in 14;the grading decreased from G2 to G1 in 5 patients,from G3 to G1 in 1,and from G3 to G2 in 2.Patients with G1 or G2 disease had better progression-free survival and overall survival(OS)outcomes than those with G3 disease did(P=0.001 and P<0.001,respectively).The 5-year and 10-year OS rates for stable G2 patients were 67.5%and 26.0%,respectively,decreasing to 46.4%and 23.2%,respectively,among G2 patients whose grade increased(P=0.016).CONCLUSION The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases.Additionally,when grading increased from G2,the OS rate significantly de-creased.展开更多
Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biop...Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.展开更多
基金supported by the National Natural Science Foundation of China(Grant Nos.51805047 and 52175003)the Outstanding Youth Program of Hunan Education Department(Grant No.23B0335)the Natural Science Foundation of Hunan Province(Grant Nos.2023JJ30021 and 2023JJ50077).
文摘The introduction of wireless capsule endoscopy has brought a revolutionary change in the diagnostic procedures for gastrointestinal disorders.Biopsy,an essential procedure for disease diagnosis,has been integrated into robotic capsule endoscopy to augment diagnostic capabilities.In this study,we propose a magnetically driven biopsy robot based on a Kresling origami.Considering the bistable properties of Krelsing origami and the elasticity of the creases,a foldable structure of the robot with constant force characteristics is designed.The folding motion of the structure is used to deploy the needle into the target tissue.The robot is capable of performing rolling motion under the control of an external magnetic drive system,and a fine needle biopsy technique is used to collect deep tissue samples.We also conduct in vitro rolling experiments and sampling experiments on apple tissues and pork tissues,which verify the performance of the robot.
基金supported by the National Natural Science Foundation of China(No.52105072)Zhejiang Provincial Natural Science Foundation of China(No.LZ24E050004)+2 种基金Jiangsu Provincial Outstanding Youth Program(No.BK20230072)a grant from Suzhou Industrial Foresight and Key Core Technology Project(No.SYC2022044)grants from Jiangsu Qinglan Project and Jiangsu 333 High-level Talents.
文摘Wireless capsule endoscopy(WCE)has the potential to fully replace conventional wired counterparts for its low invasiveness.Recent studies have attempted to expand the functions of capsules toward this goal.However,limitations in space and energy supply have resulted in the inability to perform multiple diagnostic and treatment tasks using a single capsule.In this study,we developed a dual-functional capsule robot(DFCR)for drug delivery and tissue biopsy based on magnetic torsion spring technology.The delivery module was shown to rotate the push rod with a thrust of 894 mN to release approximately 0.3 mL of semisolid drug.The biopsy module used a built-in blade to cut tissue with a shear stress of 22.87 MPa,producing a sample of approximately 1.8 mm3.Additionally,a five-degree-of-freedom permanent magnet drive system was developed.By adjusting the strength of the unidirectional magnetic field generated by an external magnet,the capsule can be wirelessly controlled to sequentially trigger the two functions.Ex vivo tests on porcine stomachs confirmed the feasibility of the prototype capsule(12 mm in diameter and 45 mm in length)in active movement,medication,and tissue biopsy.The newly developed DFCR further expands the clinical application prospects of WCE robots in minimally invasive surgery.
文摘BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedural image guidance,and various“plugging”techniques,bleeding remains a frequent and potentially highly mor-bid complication,particularly in patients with bleeding risks.Thus,post-biopsy bleeding risk leads to extended patient monitoring,and in significant cases,ad-ditional imaging,intervention,and even surgery.Very rarely,death has resulted.CASE SUMMARY We report a series of five image-guided liver biopsy cases undertaken due to a variety of clinical conditions followed by the use of a new electrocautery hemo-stasis device called SinglePass Kronos.Indications for the CNB included non-alcoholic steatohepatitis,hepatocellular carcinoma and cirrhosis,abnormal liver function tests with positive autoimmune serologies,abnormal imaging findings,and jaundice.All biopsy procedures were successful with no complications th-rough 30 days following CNB.Post-procedure ultrasound confirmed the absence of bleeding in all five cases.CONCLUSION Hemostasis of CNB tracts using SinglePass Kronos was obtained in all cases.Ad-ditional study of this device is warranted.
基金supported financially by the National Nature Science Foundation of China(No.82373355,No.82172703,No.82303856,and No.82473505)the Discipline Leader Project of Shanghai Municipal Health Commission(No.2022XD013)the AoXiang Project of Shanghai Anti-Cancer Association(No.SACA-AX202302).
文摘The choice of biopsy method is critical in diagnosing prostate cancer(PCa).This retrospective cohort study compared systematic biopsy(SB)or cognitive fusion-targeted biopsy combined with SB(CB)in detecting PCa and clinically significant prostate cancer(csPCa).Data from 2572 men who underwent either SB or CB in Fudan University Shanghai Cancer Center(Shanghai,China)between January 2019 and December 2023 were analyzed.Propensity score matching(PSM)was used to balance baseline characteristics,and detection rates were compared before and after PSM.Subgroup analyses based on prostate-specific antigen(PSA)levels and Prostate Imaging-Reporting and Data System(PI-RADS)scores were performed.Primary and secondary outcomes were the detection rates of PCa and csPCa,respectively.Of 2572 men,1778 were included in the PSM analysis.Before PSM,CB had higher detection rates for both PCa(62.9%vs 52.4%,odds ratio[OR]:1.54,P<0.001)and csPCa(54.9%vs 43.3%,OR:1.60,P<0.001)compared to SB.After PSM,CB remained superior in detecting PCa(63.1%vs 47.9%,OR:1.86,P<0.001)and csPCa(55.0%vs 38.2%,OR:1.98,P<0.001).In patients with PSA 4–12 ng ml−1(>4 ng ml-1 and≤12 ng ml-1,which is also applicable to the following text),CB detected more PCa(59.8%vs 40.7%,OR:2.17,P<0.001)and csPCa(48.1%vs 27.7%,OR:2.42,P<0.001).CB also showed superior csPCa detection in those with PI-RADS 3 lesions(32.1%vs 18.0%,OR:2.15,P=0.038).Overall,CB significantly improves PCa and csPCa detection,especially in patients with PSA 4–12 ng ml−1 or PI-RADS 3 lesions.
文摘Background:Transrectal(TR)and transperineal(TP)biopsies are commonly used methods for diagnosing prostate cancer.However,their comparative effectiveness in conjunction with machine learning(ML)techniques remains underexplored.This study aimed to evaluate the predictive accuracy of ML algorithms in detecting prostate cancer using data derived from TR and TP biopsies.Methods:The clinical records of patients who underwent prostate biopsy at King Saud University Medical City and King Faisal Specialist Hospital and Research Centerin Riyadh,Saudi Arabia,between 2018 and 2025 were analyzed.Data were used to train and testMLmodels,including eXtreme Gradient Boosting(XGBoost),Decision Tree,Random Forest,and Extra Trees.Results:The two datasets are comparable.The models demonstrated exceptional performance,achieving accuracies of up to 96.49%and 95.56%on TP and TR biopsy datasets,respectively.The area under the curve(AUC)values were also high,reaching 0.9988 for TP and 0.9903 for TR biopsy predictions.Conclusion:These findings highlight the potential of MLto enhance the diagnostic accuracy of prostate cancer detection irrespective of the biopsy method.However,TP biopsy data showed marginally higher accuracy,possibly because of the lower risk of contamination.While ML holds great promise for transforming prostate cancer care,further research is needed to address limitations.Collaboration between clinicians,data scientists,and researchers is crucial to ensure the clinical relevance and interpretability of ML models.
基金Supported by the National Natural Science Foundation of China,No.82170103Natural Science Foundation of Fujian Province,No.2024J011325+1 种基金Young People Training Project from Fujian Province Health Bureau,No.2020GGB057 and No.2023QNB008Xiamen Medical and Health Guidance Project,No.3502Z20224ZD1060,No.3502Z20214ZD1043,and No.3502Z20224ZD1058.
文摘BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.
基金supported by a grant from 2021 Shandong Provincial Social Science Popularization and Application Research Project (2021-SKZC-18)。
文摘To the Editor:With the popularity of liver transplantation(LT)and the inspiration for long-time survival,issues related to evaluating the liver allograft have increased in recent years[1-3].Although there has been renewed interest in non-invasive methods to evaluate diffuse liver disease,liver biopsy is still the golden standard in clinical practice,particularly for liver transplant recipients(LTRs).The liver biopsy has always been performed in LTRs as a part of standard procedure in cases whose liver function was normal,named as protocol liver biopsy,or to identify histological abnormalities for abnormal liver function and provide guidance for the adjustment of immunosuppressive regimen[4,5].Percutaneous liver biopsy(PLB)has been frequently conducted in LTRs;however,the clinical implementation of protocol liver biopsy by PLB in LTRs is challenging due to their suboptimal compliance,particularly in China[6].Besides,the PLB procedure has been associated with discomfort and potentially life-threatening complications in the general population,as reported in the literature[7,8].
文摘Objective:To explore the impact of psychological care on preoperative anxiety and postoperative pain in patients undergoing liver biopsy.Methods:A total of 100 patients undergoing liver biopsy in our hospital from January 2024 to October 2024 were selected as the study subjects.They were divided into a control group and a study group using a random number table method,with 50 patients in each group.The control group received routine care,while the study group received psychological care on the basis of the control group’s treatment.The nursing satisfaction,fear scores,anxiety scores,postoperative pain levels,and incidence of complications(local pain at the puncture site,bleeding at the puncture site,skin irritation,tension blisters,infection,severe abdominal pain,pneumothorax)were compared between the two groups.Results:The nursing satisfaction in the study group was higher than that in the control group(P<0.05).After nursing,the fear scores and anxiety scores in both groups were lower than before nursing,and the fear scores and anxiety scores in the study group were lower than those in the control group(P<0.05).The postoperative pain scores in the study group were lower than those in the control group(P<0.05),and the incidence of complications in the study group was lower than that in the control group(P<0.05).Conclusion:The application of psychological care in patients undergoing liver biopsy has a definite effect,which can improve patient satisfaction,reduce preoperative anxiety and fear,alleviate postoperative pain,and reduce the incidence of postoperative complications.It is worthy of clinical promotion and application.
文摘BACKGROUND Mediastinal lymph nodes(MLNs)can be enlarged due to various benign or malignant causes.Endoscopic ultrasound(EUS)is often employed for the acquisition of tissue specimens of the enlarged MLN(EMLN).AIM To determine the causes,document the symptoms,and determine factors predicting good yield of EUS-guided EMLN biopsy.METHODS All patients having EMLN(>10 mm)on thoracic imaging and referred for EUSguided biopsy were included in this retrospective observational study.Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation(MOSE)and then sent to a histopathologist for final diagnosis.Analysis for factors predicting good biopsy yield was then performed.RESULTS Of the total 243 patients with EMLN,131(53.9%)were males.The mean age was 47.6(±14.7)and range 14-86 years.Commonest causes of EMLN were tuberculosis 82(33.7%),anthracosis 53(21.8%),neoplastic disease 43(17.7%)and sarcoidosis 14(5.8%).Among the 43 patients with neoplastic diseases:40 had metastatic disease(breast 9,lung 7,pancreatobiliary 6,esophagus 5,kidney 5,hepatocellular 2,neuroendocrine 2,gastrointestinal stromal 1,undetermined 3)and 3 had primary malignancies(lymphoproliferative disorder 2,Kaposi sarcoma 1).Chest related clinical symptoms were absent in more than half the patients with tuberculosis 51/82(62.2%),anthracosis 31/53(58.5%)and neoplastic disease 28/43(65.1%).Factors associated with good biopsy yield were:Subcarinal location of MLN(P=0.026),MLN size>12 mm(P<0.0001),use of fine-needle biopsy(vs fine-needle aspiration)(P=0.049)and satisfactory MOSE(P<0.0001)on univariate analysis;while MLN size>12 mm(P=0.005)and satisfactory MOSE(P<0.0001)on multivariate analysis.CONCLUSION Tuberculosis,anthracosis and metastatic disease were the commonest causes of EMLN.More than half the cases with EMLN had no chest-related symptoms.Large MLN size and satisfactory MOSE observation predicted a good biopsy yield.
基金the Cancer Institute of New Jersey is supported by a grant from the National Cancer Institute:P30CA072720Arnav Srivastava is supported by a training grant from the National Cancer Institute:T32CA180984.
文摘Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations.We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques.Materials and Methods:A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019–2022 was performed.Results:We identified 319 patients—174 transrectal and 145 transperineal.8 patients who had transperineal biopsy(5.5%)received peri-operative antibiotics,compared to 100%with transrectal biopsy.35.86%of transperineal patients received a bowel preparation,compared to 100%in the transrectal group.44.14%and 49.43%of patients received a prior prostate biopsy in the transperineal and transrectal groups,respectively.Patients in the transperineal biopsy group had zero infectious complications,1 ER visit,and zero 30-day readmissions.This is compared to 9 infectious complications(5.17%,p=0.005),8 ER visits(4.60%,p=0.036),and 730-day readmissions(4.02%,p=0.015)in the transrectal group.Conclusions:In a single institution series,patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy.Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group,there were zero infectious complications or 30-day readmissions.With greater infectious complications with transrectal biopsy and growing antibiotic resistance,we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.
文摘Endoscopic ultrasonography(EUS)is a valuable and widely used tool for evaluating pancreatic tumors.Accurate decision-making during EUS procedures,particularly for differentiating between benign and malignant lesions based on imaging characteristics and assessing the need for tissue sampling,is crucial.This review provides a comprehensive overview of pancreatic tumor features observed during EUS and highlights the key criteria for distinguishing between malignant and benign conditions.Additionally,we discuss the indications for fine-needle aspiration or biopsy to obtain histopathological and genetic confirmation.Improving our understanding of these critical aspects can help improve diagnostic accuracy and guide clinicians in determining the most appropriate management strategies for patients with pancreatic tumors.
基金Supported by Wroclaw Medical University’s Grant,No.SUBZ.C270.24.078.
文摘BACKGROUND This review evaluated the diagnostic effectiveness of various ultrasound(US)methods compared to liver biopsy.AIM To determine the diagnostic accuracy of US techniques in assessing liver fibrosis and steatosis in adults,using the area under the receiver operating characteristic curve(AUROC)as the standard measure.METHODS The review included original retrospective or prospective studies published in the last three years in peer-reviewed medical journals,that reported AUROC values.Studies were identified through PubMed searches on January 3 and April 30,2024.Quality was assessed using the QUADAS-2 tool.Results were tabulated according to the diagnostic method and the type of liver pathology.RESULTS The review included 52 studies.For liver fibrosis detection,2D-shear wave elastography(SWE)AUROCs ranged from 0.54 to 0.994,showing better accuracy for advanced stages.Modifications,including 2D-SWE with propagation map guidance and supersonic imagine achieved AUROCs of 0.84 to nearly 1.0.point SWE and classical SWE had AUROCs of 0.741-0.99,and 0.507-0.995,respectively.Transient elastography(TE),visual TE,vibration-controlled TE(VCTE),and FibroTouch reported AUROCs close to 1.0.For steatosis,VCTE with controlled attenuation parameter showed AUROCs up to 0.89(for≥S1),acoustic radiation force impulse ranged from 0.762 to 0.784,US attenuation parameter from 0.88 to 0.93,and normalized local variance measurement from 0.583 to 0.875.Most studies had a low risk of bias across all or most domains,but evidence was limited by variability in study quality and small sample sizes.Innovative SWE variants were evaluated in a single study.CONCLUSION Modern US techniques can serve as effective noninvasive diagnostic tools for liver fibrosis and steatosis,with the potential to reduce the reliance on biopsies.
基金supported by the Youth support Program of Chinese General Hospital (Grand Number: 22QNFC044 to Niu S).
文摘Objective This study aimed to compare the upgrade rate and cancer detection rate between the 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy(TB)and systematic biopsy in selected patients with suspected prostate cancer(the molecular imaging prostate-specific membrane antigen score of≥2 and multiparametric MRI Prostate Imaging Reporting and Data System score of≥4).Methods Eighty-seven selected biopsy-naive patients were randomized into two groups:TB(n=41)and systematic biopsy(control;n=46).Patients diagnosed with clinically significant prostate cancer proceeded to radical prostatectomy.The primary outcome was the pathological upgrade rate.Secondary outcomes,including the cancer detection rate,incidence of repeat biopsy,positive surgical margin,complications,and prostate-specific antigen level at 6 weeks postoperatively,were compared between the groups using the Pearson or Fisher's exact test,as appropriate.Results In the study,prostate cancer was ultimately detected in all patients.The TB group successfully identified all tumors,whereas five patients in the control group initially missed diagnosis.The pathological upgrade rates for the TB and control groups were 31.7%and 56.5%,respectively.Overall,the detection rate for clinically significant prostate cancer(the International Society of Urological Pathology grade of≥2)was significantly higher in the TB group(92.7%)compared with the control group(76.1%,p=0.035).However,no significant difference was found in the detection rate of all prostate cancer.Complications(Clavien–Dindo grade of≤2)occurred in both the TB group(n=11)and control group(n=13).No statistically significant difference was observed between the groups in terms of the positive surgical margin,complications,or 6-week postoperative prostate-specific antigen level.Conclusion The 18F-DCFPyL PET/MRI-guided ultrasound fusion TB alone was an efficient modality in diagnosing selected patients with prostate cancer.
基金supported by the National Natural Science Foundation of China(No.82072807)the Scientific Research Project of Universities of the Department of Education of Anhui Province(No.2022AH040182)the Anhui Province Key Clinical Specialties Construction Project(2023).
文摘We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen(tPSA)>10 ng ml−1 and Prostate Imaging Reporting and Data System(PI-RADS)scores between 1 and 3.Clinical data derived from 517 patients of The First Affiliated Hospital of USTC(Hefei,China)from January 2020 to December 2023 who met the screening criteria for the study were retrospectively collected.Independent predictors were identified via univariate and multivariate logistic regression analysis.The diagnostic capacity of clinical variables was evaluated using the receiver operating characteristic(ROC)curves and area under the curve(AUC).A prostate biopsy strategy was developed via risk stratification.Of the 517 patients,17/348(4.9%)with PI-RADS 1–2 were diagnosed with clinically significant prostate cancer(csPCa),and 27/169(16.0%)patients with PI-RADS 3 were diagnosed with csPCa.The appropriate prostate-specific antigen density(PSAD)cut-off values were 0.45 ng ml−2 for PI-RADS 1–2 patients and 0.3 ng ml−2 for PI-RADS 3 patients.The appropriate prostate volume(PV)cut-off values were 40 ml for PI-RADS 1–2 patients and 50 ml for PI-RADS 3 patients.The prostate biopsy strategy based on PSAD and PV developed in this study can reduce unnecessary prostate biopsies in patients with tPSA>10 ng ml−1 and PI-RADS 1–3.In the study,66.5%(344/517)patients did not need to undergo prostate biopsy,at the expense of missing only 1.7%(6/344)patients with csPCa.
文摘BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.
文摘BACKGROUND Hepatobiliary and pancreatic cancers are among the most lethal malignancies due to late-stage diagnosis and limited treatment options.Liquid biopsy has emerged as a minimally invasive tool for early cancer detection,prognosis,and therapeutic monitoring.AIM To concise the available data on liquid biopsy and establish its role in hepato-biliary surgeries.METHODS This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines.A comprehensive lite-rature search was performed using PubMed,Scopus,Web of Science,and EMBASE for studies published up to March 2025.Studies assessing the role of circulating tumor DNA,circulating tumor cells,exosomes,and other liquid biopsy markers in hepatobiliary and pancreatic cancers were included.The risk of bias was evaluated using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for clinical trials.RESULTS Liquid biopsy demonstrated significant potential for early cancer detection,perioperative risk stratification,intraoperative surgical decision-making,and postoperative monitoring of minimal residual disease.However,challenges remain regarding standardization,sensitivity,and clinical validation.CONCLUSION Liquid biopsy represents a paradigm shift in hepatobiliary and pancreatic cancer management.Advancements in next-generation sequencing and artificial intelligence may enhance its clinical utility.Further large-scale studies are needed to establish standardized protocols for routine implementation.
文摘Pediatric cancers are particularly significant due to their uncommon occurrence in children,driven by a variety of underlying factors.Because of their distinct molecular and genetic makeup,which makes early detection challenging,they are linked to problems.Diagnostic methods like imaging and tissue biopsy are only effective when the tumor has reached a size that can be identified.The liquid biopsy technique,the least intrusive and most convenient diagnostic method,is the subject of this review.It focuses on the significance of single cell analysis in examining uncommon cancer types.The many biomarkers found in bodily fluids and the cancer types they are linked to in children have been assessed,as has the potential route towards early detection and cancer recurrence forecasting.Combining the single cell liquid biopsy with the newest technologies,such as computational and multi-omics approaches,which have improved the efficiency of processing massive and unique genetic data,appears promising.This article discusses on a number of case reports for uncommon pediatric malignancies,such as Neuroblastoma,Medulloblastoma,Wilms Tumor,Rhabdomyosarcoma,Ewing Sarcoma,and Retinoblastoma,as well as their liquid biopsy profiles.Furthermore,the findings raise ethical questions regarding the therapeutic application of the technology as well as possible difficulties related to clinical translation.The likelihood that this single cell liquid biopsy will be clinically validated and eventually used as a routine diagnostic tool for uncommon pediatric cancers will rise with the realistic approach to sensitivity monitoring,specificity upgrading,and optimization.
文摘The discussion on renal biopsies and biomarkers highlights the essential aspects of nephrology.Although novel diagnostic biomarkers are emerging,renal biopsy remains critical for accurate diagnosis and treatment owing to the lack of sufficiently validated biomarkers with high sensitivity and specificity.Puspitasari et al highlighted the significant changes in renal biopsy indications and histological outcomes before and after the coronavirus disease 2019(COVID-19)pandemic,reflecting the complex interactions between clinical workflows,public health issues,and patient demographics.Although biomarkers are increasingly utilized in nephrology,their importance remains balanced with traditional practices.Advancements in precision medicine are exemplified by tests like plasma anti-phospholipase A2 receptor levels.However,the COVID-19 pandemic revealed significant vulnerabilities in nephrology services,emphasizing the necessity for adaptable and robust healthcare strategies to manage chronic conditions during global crises.In conclusion,while biomarkers are poised to assume a more prominent role in nephrology,the significance of renal biopsies and thorough histopathological analysis remains paramount in understanding complex disease processes and guiding personalized patient management.The ongoing integration of traditional diagnostic approaches with innovative biomarker strategies promises to improve patient care and long-term health outcomes.
基金Supported by the National Natural Science Foundation of China,No.82072034.
文摘BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker,often varies between primary and metastatic sites;however,routine liver biopsy remains controversial.Although percutaneous computed tomography-guided core needle biopsy(PCT-CNB)is safe and effective for focal lesions,its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored.Conflic-ting survival associations with grade shifts have been reported in previous stu-dies.We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases,correlating with survival outcomes,thereby refining risk stratification and therapeutic strategies.METHODS We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB,76 patient samples from the liver and primary sites,and 16 from the liver and secondary liver sites.Ki-67 immunohistochemistry was performed for tissue sampling,and grading classifications were determined.Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.RESULTS No procedure-related mortality was recorded during or after biopsy.In 37/92 patients(40.2%),the grading classi-fications changed:The grading increased from G1 to G2 in 13 patients,from G1 to G3 in 2,and from G2 to G3 in 14;the grading decreased from G2 to G1 in 5 patients,from G3 to G1 in 1,and from G3 to G2 in 2.Patients with G1 or G2 disease had better progression-free survival and overall survival(OS)outcomes than those with G3 disease did(P=0.001 and P<0.001,respectively).The 5-year and 10-year OS rates for stable G2 patients were 67.5%and 26.0%,respectively,decreasing to 46.4%and 23.2%,respectively,among G2 patients whose grade increased(P=0.016).CONCLUSION The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases.Additionally,when grading increased from G2,the OS rate significantly de-creased.
文摘Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.
