Kidney Biopsy Adequacy and Complications in Children – Does Technique Matter?

Background Kidney biopsy is part of the diagnostic workup of many children with renal disease. Traditionally a perpendicular approach to the biopsy has been used but more recently some proceduralists have favoured a tangential approach. It is not clear if one technique is superior with regards to tissue adequacy or complication rates. In our centre interventional radiologists (IR) use general anaesthetic and a tangential approach whereas paediatric nephrologists (PN) use sedation and a perpendicular approach. Methods We examined consecutive kidney biopsies performed between January 2008 and December 2017 for adequacy (sufficient tissue for light and electron microscopy and immunofluorescence) and examined the electronic medical records for data regarding technique and complications. Results IR performed 72 (29.4%) of the 245 native kidney biopsies, obtaining more total glomeruli (median 39 vs 16, p<0.001) and more glomeruli per tissue core (median 13.2 vs 8.0, p<0.001) than PN. No differences in specimen adequacy were observed between the two groups (79.2% IR vs 80.9% PN, p=0.75) and a diagnosis could be made in 98.6% and 93.6% respectively (p=0.1). A statistically lower rate of peri-nephric haematoma (27.8% vs 41.6%, p=0.04) was detected in the IR group, but there were no significant differences in other complications. One patient required a blood transfusion (PN) and another required surgical intervention for a perinephric haematoma (IR). Conclusion IR obtained larger samples and number of glomeruli, but the overall adequacy for native kidney biopsies was good using both perpendicular and tangential techniques, with similar low rates of significant complications.

Migrating and Nerve Fibers-Associated Eosinophilic Granule Cells in the Olfactory Organ of Catfish (Clarias garpienius): Light and Electron Microscopic Evidence

Piscine mast cells or eosinophilic granule cells (EGCs) of fish are equivalent to the mammalian mast cells. Recently, a better understanding of EGCs functions is allowed because of the growing interest in fish models. Herein, we present a trial to furnish data regarding the distribution of the EGCs in the fish olfactory organ, an issue that has not been reported so far. Regarding their distribution, two kinds of EGCs had been identified. An intra-epithelial one was detected in the olfactory epithelium lining of the olfactory lamellae. The stromal one was identified in the connective tissue core of the olfactory lamellae and in the lamina propria underlying the olfactory epithelium. Some were detected in the capillary lumen. The cytoplasm of the EGCs reacted strongly with the MMP-9 antibody. Stimulating a migration perspective for the olfactory EGCs which was confirmed by their location in the blood capillaries. Several EGCs could be verified in close relation, some underneath the epineurium, with the nerve fiber. Mutually, this verifies the existence of intra-epithelial and stromal migrating EGCs in the catfish olfactory organ and their inclusion in the olfactory immune response. Additionally, this provides evidence for an immune–nervous interaction to influence both the immune reactions and the nervous scheme in catfish.

High Density of NRF2 Expression in Malignant Cells Is Associated with Increased Risk of CNS Metastasis in Early-Stage NSCLC

Nuclear factor erythroid 2-related factor 2 (NRF2) protein expression promotes cancer progression in non-small cell lung cancer (NSCLC). However, its role in the clinical setting has not been established. We retrospectively analyzed data from 304 patients with surgically removed NSCLC. Multiplex antibody staining of NRF2 and thioredoxin reductase 1 (TrxR1) was conducted and scored in cytokeratin-positive (CK+) cells within the whole-tissue core as well as the tumor and stromal compartments of each tissue microarray (TMA) core. A high density of NRF2+/CK+ cells in the whole-tissue core compartment was correlated with a higher risk of central nervous system (CNS) relapse OR = 7.36 (95% CI: 1.64–33.06). The multivariate analysis showed an OR = 8.00 (95% CI: 1.70–37.60) for CNS relapse in NRF2+/CK+ high-density cases. The density of TrxR1+/CK+ cells failed to show any statistically significant risk of relapse. The OS analyses for NRF2+/CK+ and TrxR1+/CK+ cell density failed to show any statistical significance. This is the first study to report a correlation between NRF2+/CK+ cell density and the risk of CNS relapse in early-stage NSCLC. The results of our study may impact the follow-up strategy for early-stage NSCLC patients and eventually improve their prognosis.

Histological Study of Suprabranchial Chamber Membranes in Anabantoidei and Clariidae Fishes

Accessory respiratory organs (AROs) are a group of anatomical structures found in fish, which support the gills and skin in the process of oxygen uptake. AROs are found in many fish taxa and differ significantly, but in the suborder Anabantoidei, which has a labyrinth organ (LO), and the family Clariidae, which has a dendritic organ (DO), these structures are found in the suprabranchial cavity (SBC). In this study, the SBC walls, AROs, and gills were studied in anabantoid (Betta splendens, Ctenopoma acutirostre, Helostoma temminckii) and clariid (Clarias angolensis, Clarias batrachus) fishes. The histological structure of the investigated organs was partially similar, especially in relation to their connective tissue core; however, there were noticeable differences in the epithelial layer. There were no significant species-specific differences in the structure of the AROs within the two taxa, but the SBC walls had diversified structures, depending on the observed location. The observed differences between species suggest that the remarkable physiological and morphological plasticity of the five investigated species can be associated with structural variety within their AROs. Furthermore, based on the observed histology of the SBC walls, it is reasonable to conclude that this structure participates in the process of gas exchange, not only in clariid fish but also in anabantoids.

Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat

Diagnosis of thoracic lesions on the basis of history and physical examination is often challenging. Diagnostic imaging is therefore of paramount importance in this field. Radiology has traditionally been considered the diagnostic procedure of choice for these diseases. Nevertheless, it is often not possible to differentiate inflammatory/infectious lesions from neoplastic diseases. A correct cytological and histopathologic diagnosis is therefore needed for an accurate diagnosis and subsequent prognostic and therapeutic approach. In human medicine, Computed Tomography (CT) and CT-guided biopsy are used in the presence of lesions which are not adequately diagnosed with other procedures. In the present study, thoracic lesions from 52 dogs and 10 cats of different sex, breed and size underwent both CT-guided fine-needle aspiration (FNAB) and tissue-core biopsy (TCB). Clinical examination, hematobiochemical analysis and chest radiography were performed on all animals. In this study, 59 of 62 histopathological samples were diagnostic (95.2%). Cytology was diagnostic in 43 of 62 samples (69.4%). General sensitivity, accuracy and PPV for FNAB and TCB were 67.7%, 67.7% and 100% and 96.7%, 95.2% and 98.3%, respectively. Combining the two techniques, the overall mean accuracy for diagnosis was 98.4%. Nineteen of 62 cases showed complications (30.6%). Mild pneumothorax was seen in 16 cases, whereas mild hemorrhage occurred in three cases. No major complications were encountered. CT-guided FNAB cytology can be considered a useful and reliable technique, especially for small lesions or lesions located close to vital organs and therefore dangerous to biopsy in other way.

Metastatic Cholangiocarcinoma in a Bearded Dragon (Pogona vitticeps)

A 6.5-year-old female bearded dragon (Pogona vitticeps) was presented with a swollen right pelvic limb. A tissue core biopsy from the swollen area was performed and a presumptive histopathological diagnosis of adenocarcinoma was made. This diagnosis was confirmed after limb amputation. Two months after amputation a sudden deterioration in the overall health of the patient occurred. Ultrasound examination of the coelomic cavity revealed hypoechoic lesions in the liver. The patient was euthanized and submitted for necropsy which revealed a severely enlarged liver with multiple coalescing yellowish nodules. Cholangiocarcinoma of the liver with metastases to the spleen, left mesovarium and right pelvic limb was diagnosed after histopathological examination.

22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses: a randomized study comparing histologic sample quantity and diagnostic accuracy

Background Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been suggested for obtaining high quality tissue samples from pancreatic tumors. We performed a multicenter randomized crossover trial comparing EUS-FNB with a 20G Procore needle vs. a 22G Acquire needle. The aims were to compare the quantity of targeted tissue (pancreas) and diagnostic accuracy for the two needles. Methods 60 patients admitted for EUS-FNB in three endoscopy units were included. One pass was performed consecutively with each needle, in a randomized order. Histologic material was studied in a blinded manner with respect to the needle. The primary end point was mean cumulative length of tissue core biopsies per needle pass. Results Final diagnosis was adenocarcinoma (n = 46; 77 %), neuroendocrine neoplasm (n = 11; 18 %), autoimmune pancreatitis (n = 2), and mass-forming chronic pancreatitis (n = 1). The mean cumulative length of tissue core biopsies per needle pass was significantly higher with the 22G Acquire needle at 11.4 mm (95 % confidence interval [CI] 9.0 – 13.8] vs. 5.4 mm (95 %CI 3.8 – 7.0) for the 20G Procore needle (P < 0.001), as was the mean surface area (3.5 mm2 [95 %CI 2.7 – 4.3] vs. 1.8 mm2 [95 %CI 1.2 – 2.3]; P < 0.001). Diagnostic adequacy and accuracy were 100 % and 87 % with the 22G Acquire needle, and 82 % and 67 % with the 20G Procore needle (P = 0.001 and P = 0.02, respectively). Conclusions EUS-guided biopsy of pancreatic masses with the 22G Acquire needle provided more tissue for histologic evaluation and better diagnostic accuracy than the 20G Procore needle.

Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely used, safe, and accurate technique for obtaining pathological specimens to be used in the diagnosis of diseases involving lung hilar and mediastinal lymph node (LN) enlargement. However, application of the suction technique during EBUS-TBNA remains controversial. In addition, the effectiveness of the slow-pull capillary technique for the diagnosis of pancreatic masses was recently reported. The aim of this study was to compare the diagnostic accuracy of EBUS-TBNA using these two techniques. Methods: The accuracy, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and availability of tissue cores of the suction and slow-pull capillary techniques were studied retrospectively in patients who underwent EBUS-TBNA for the diagnosis of diseases involving lung hilar and mediastinal LN enlargement. Results: A total of 97 patients with hilar and mediastinal LN enlargement underwent EBUS-TBNA; 30 patients underwent the suction technique, 56 patients underwent the slow-pull capillary technique, 5 patients underwent both techniques, and 6 patients had failed operations. The accuracy, sensitivity, specificity, NPV, PPV, and the number of tissue cores obtained with the suction and slow-pull capillary techniques were 66.67% versus 85.71% ( p = 0.039), 43.75% versus 85.42% ( p < 0.001), 92.86% versus 87.5% ( p > 0.05), 59.09% versus 50% ( p > 0.05), 87.5% versus 97.62% ( p > 0.05), and 19 versus 50 ( p = 0.004), respectively. In both univariate and multivariate analyses, the acquisition of tissue core was significantly associated with the diagnostic accuracy of EBUS-TBNA. Moreover, the slow-pull capillary technique was significantly associated with the acquisition of tissue core in EBUS-TBNA. There were no significant differences between the two groups in the blood contamination of samples. Conclusions: Use of the slow-pull capillary technique in EBUS-TBNA can significantly increase the accuracy related to the diagnosis of diseases involving hilar and mediastinal LN enlargement by improving the acquisition of tissue core. The reviews of this paper are available via the supplemental material section.