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Published online before print March 27, 2003, 10.1148/radiol.2272011416
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(Radiology 2003;227:414-418.)
© RSNA, 2003

Vascular and Interventional Radiology

Image-guided 25-gauge Needle Biopsy for Thoracic Lesions: Diagnostic Feasibility and Safety1

Eric vanSonnenberg, MD, Brian W. Goodacre, MD, Gerhard R. Wittich, MD, Robert Logrono, MD, Peter T. Kennedy, MD and Joseph B. Zwischenberger, MD

1 From the Department of Radiology, Dana Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, 44 Binney St, Boston, MA 02115 (E.v.S.); Department of Radiology, University of British Columbia, Vancouver, Canada (B.W.G.); Alliance Radiology Consultants, Bayshore Medical, Pasadena, Tex (G.R.W.); Departments of Pathology (R.L.) and Surgery (J.B.Z.), University of Texas Medical Branch, Galveston; and Department of Radiology, Royal Victoria Hospital, Belfast, Northern Ireland (P.T.K.). Received August 22, 2001; revision requested October 17; revision received August 15, 2002; accepted September 30. Address correspondence to E.v.S. (e-mail: evansonnenberg@partners.org).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
PURPOSE: To report our experience regarding the feasibility and safety of 25-gauge needles for biopsy of thoracic lesions.

MATERIALS AND METHODS: Twenty-six patients with thoracic lesions, predominately pulmonary nodules, measuring 0.7–5.2 cm (mean, 1.6 cm) underwent biopsy with computed tomographic (n = 24), ultrasonographic (n = 1), or fluoroscopic (n = 1) guidance. Nineteen patients had severe chronic obstructive pulmonary disease (COPD), one had severe restrictive lung disease, and one had a coagulopathy; the other five patients had nonpulmonary primary tumors. Biopsy with an inner 25-gauge needle traversing an outer extrapleural coaxial cannula was performed in all patients. Cytologic quick staining was performed routinely to determine specimen adequacy and to establish a preliminary diagnosis. Complications, specimen adequacy, and need for larger specimens were evaluated.

RESULTS: Adequate specimens (as determined by cytopathologists) were obtained in 24 (92%) of 26 patients, with a definitive diagnosis achieved in 23 (88%) patients during initial quick staining (17 malignant and six benign diagnoses). Two cases initially considered suspicious for malignancy were reclassified as benign (thymoma and histoplasmosis). At the request of cytopathologists, a larger needle was used to supplement the 25-gauge needle in six patients: In one patient, it provided further diagnostic information; in four, it did not; and in one, it confirmed non-Hodgkin lymphoma. Five patients developed a small pneumothorax (<10%) with use of the 25-gauge needle alone; one other patient, in whom larger needles were placed, received a radiologic chest catheter to evacuate the pneumothorax, thereby allowing the biopsy to continue.

CONCLUSION: Image-guided 25-gauge needle biopsy is both feasible and safe.

© RSNA, 2003

Index terms: Biopsies, complications, 66.739 • Biopsies, technology, 60.126 • Thorax, biopsy, 60.126 • Thorax, neoplasms, 60.314, 60.321


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Percutaneous fine-needle biopsy with imaging guidance is an established primary procedure to diagnose pulmonary nodules. Although fine needles (20–22 gauge) are adequate in most cases (1–5), some authors prefer larger needles for several reasons, such as to extract more tissue to diagnose benign disease, to classify lymphoma, to further characterize malignancies, and to obviate on-site cytopathologists (6–9). In addition, some of these authors suggest that larger needles (18 gauge) convey no higher risk than fine needles for the development of pneumothorax or bleeding.

Conversely, there are few references (6–10) in the literature to the use of 25-gauge needles for lung biopsy, and they are not the specific focus of these articles. Authors of one article (11) focused on pulmonary applications of both 24- and 25-gauge needles and found satisfactory results and relatively few complications. This article preceded the era of computed tomography (CT); it did not specify lesion size or location, and quick stains were not used. Authors of two other articles described satisfactory results obtained with 25-gauge needle biopsy in patients with pneumonia without any radiologic guidance (12,13).

Circumstances such as severe chronic obstructive pulmonary disease (COPD) or an uncorrectable coagulopathy present additional hazards and challenges to the usual lung biopsy procedure. Numerous (14–16), but not all (3), authors have found an increased risk of pneumothorax with lung biopsy in patients with COPD. Bronchoscopy with washings is a less invasive alternative but frequently is nondiagnostic with peripheral nodules. Bronchoscopic biopsy incurs risks of bleeding and pneumothorax.

Recently, several patients with COPD and/or a coagulopathy prompted us to attempt 25-gauge needle biopsy of thoracic lesions. The purpose of this study was to report our subsequent experience regarding the feasibility and safety of 25-gauge needles for biopsy of thoracic lesions.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Patients
In the initial three of 26 patients, there were specific reasons for the use of 25-gauge needles: two patients were at high risk for pneumothorax because of severe COPD and large bullae, and the third patient had an uncorrectable coagulopathy (20,000 platelets); all needed tissue diagnosis of a pulmonary nodule. In the subsequent consecutive 23 patients, attempts with 25-gauge needle biopsy were undertaken to further assess the feasibility and safety of the 25-gauge needle.

The patients (14 men and 12 women) ranged in age from 44 to 78 years. The thoracic lesions ranged in size from 0.7 to 5.2 cm (Table 1). Five nodules abutted the pleura. Two lesions were mediastinal. The patients’ underlying diseases included COPD, documented with pulmonary function tests (n = 19), coagulopathy (n = 1), restrictive lung disease (n = 1), and nonpulmonary primary tumor (n = 6); one patient had both COPD and coagulopathy.


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  		TABLE 1. Sizes of Lesions Subjected to 25-gauge Needle Biopsy

 
Procedure
Two 25-gauge needles were used: the Baxter needle (Baxter, Valencia, Calif) and the Zavala needle (Cook, Bloomington, Ind). The specifications were 9- or 12-cm length and a thin-wall 25-gauge diameter. A 24-gauge variety of the Zavala needle was available but was not used. When extra biopsy passes with larger needles were requested by pathologists, 20- and 18-gauge automated systems were used.

Twenty-four procedures were performed with CT guidance without CT fluoroscopy; one, with sonography; and one, with conventional fluoroscopy. An outer guiding cannula was used in all patients to prevent the flexible 25-gauge needles from deviating into the superficial soft tissues. The guiding cannulas were 18 and 20 gauge. These latter needles were placed in the superficial soft tissues; none entered the pleura or lung parenchyma (Fig 1). A transsternal coaxial method was used for mediastinal biopsy (Fig 2); the second mediastinal biopsy was accessed with direct puncture without traversing the sternum.



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  		Figure 1. Transverse CT scan obtained with the patient in the prone position during a CT-guided biopsy with 25-gauge needle and outer soft-tissue 20-gauge needle introducer. The inner needle is well seated in the spiculated lesion (arrow), despite deflection of the needle medially. The patient had severe COPD but no complication from the biopsy. The diagnosis was small cell carcinoma.

 


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  		Figure 2a. CT scans obtained with the patient in the supine position during transsternal mediastinal biopsy with outer coaxial 20-gauge and inner 25-gauge needles with CT guidance. (a) The 20-gauge needle has traversed the sternum (arrow). (b) The 25-gauge needle is noted in the aortopulmonary window lymph node (arrow). The diagnosis was metastatic carcinoma.

 


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  		Figure 2b. CT scans obtained with the patient in the supine position during transsternal mediastinal biopsy with outer coaxial 20-gauge and inner 25-gauge needles with CT guidance. (a) The 20-gauge needle has traversed the sternum (arrow). (b) The 25-gauge needle is noted in the aortopulmonary window lymph node (arrow). The diagnosis was metastatic carcinoma.

 
Biopsies were performed by fellows in training and experienced faculty members trained in image-guided interventional radiology. Review of charts, databases, and images was performed by two faculty radiologists (E.v.S., B.W.G.) and a fellow (P.T.K.). Slide review was performed by a faculty pathologist (R.L.).

The aspirated material was handed immediately to a cytology technician who placed it onto glass slides. From each needle pass, smears were prepared in sets that included air-dried, stained (Quik-Dip; Mercedes Medical, Sarasota, Fla), and 95% ethanol-fixed smears for further Papanicolaou staining. The needles were rinsed in Hank balanced solution (Gibco, Grand Island, NY) for additional concentration procedures and cell recovery.

The air-dried and stained smears were utilized for immediate on-site assessment of specimen adequacy, for preliminary diagnosis, and for deciding if 25-gauge needles were adequate or if larger needles might be requested. The latter cytologic assessment of the specimen was performed within a few minutes after aspiration. Aspiration was repeated when samples were judged to be insufficient for diagnosis by the cytopathologist in attendance or in cases requiring microbiologic cultures. Core biopsies were requested if the preceding aspirates were deemed to be nondiagnostic or probably inadequate. Tumor lesions suspicious for lymphoma were subjected to additional needle passes for flow-cytometry analysis. A final cytologic diagnosis was rendered within 24 hours (up to 72 hours in cases having additional studies).

Our institutional review board did not require its approval or patient informed consent for this study. However, informed consent was obtained from each patient for the interventional procedure. Chart, pathology report, specimen, and image reviews were performed by radiologist (E.v.S., B.W.G., G.R.W., P.T.K.), pathologist (R.L.), and surgical (J.B.Z.) authors. Indications, patient data, results of biopsies, complications, and outcomes were recorded.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 
A 25-gauge needle was inserted successfully into the lesion in each patient. One pass was made in 12 patients; two passes, in three patients; three passes, in seven patients; and more than three passes, in four patients. Needles larger than 25 gauge (22 and 18 gauge) were used after initial 25-gauge biopsy in six patients: Additional diagnosis of malignancy was made in one patient, confirmation (but no added data) of primary non-Hodgkin lymphoma at the quick-stain 25-gauge needle biopsy was made in one patient, and no additional information was obtained in the other four patients.

Specimens obtained with a 25-gauge needle were considered "adequate" for cellularity with quick staining in 24 (92%) of 26 patients (Fig 3). A diagnosis was achieved in 23 (88.5%) of the 26 patients with the 25-gauge needle. The diagnoses were large cell carcinoma (n = 6); metastatic tumor (n = 4); small cell carcinoma (n = 2); squamous cell carcinoma (n = 2), one pneumoconiosis complicated by carcinoma; primary adenocarcinoma (n = 2); benign granulomatous inflammation (n = 2) (Fig 4); and one each of thymoma, hamartoma (Fig 5), lymphoma, a resolving infarct (Fig 6), and histoplasmosis (Table 2).



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  		Figure 3. Transverse CT scan obtained in a woman with Sjögren syndrome in the prone position during CT-guided biopsy with 25-gauge needle (arrow). The biopsy demonstrated adequate tissue that revealed no malignancy. Multiple small pulmonary nodules were present.

 


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  		Figure 4. CT scan obtained in a 59-year-old woman with a history of both breast and cervical carcinomas; 25-gauge needle biopsies revealed sarcoidlike granulomas. CT-guided biopsy of the lesion (arrow) was performed in the slightly right posterior oblique position.

 


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  		Figure 5. CT scan obtained with the patient in the prone position. CT-guided biopsy was complicated by a small asymptomatic pneumothorax (black arrow). Blood (white arrows) is noted around the small nodule (arrowhead). Note the needle tip within the lesion that established the diagnosis of pulmonary hamartoma.

 


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  		Figure 6. CT scan obtained in a 46-year-old woman in the prone position. A diagnosis of resolving pulmonary infarct (arrow) was made with the 25-gauge needle biopsy with CT guidance. Excellent tissue with abundant histiocytes was noted histopathologically.

 

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  		TABLE 2. Diagnoses of Thoracic Lesions in Patients Undergoing 25-gauge Needle Biopsy

 
Complications with the 25-gauge needle included a small (less than 10%) pneumothorax in five patients, one pneumothorax in a patient with COPD for which the patient received a 7-F catheter to continue the biopsy (Fig 7), and one small mediastinal hematoma. In the patient with the pneumothorax induced by the 25-gauge needle, the pleural catheter was placed to continue the biopsy by allowing the lesion to return to its original location. Table 3 provides an overall summary of the results.



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  		Figure 7. Transverse CT scans obtained with the patient in the supine position. One pass with a 22-gauge needle caused a pneumothorax that resulted in the lesion moving from the original CT location. (a) A 7-F catheter was inserted to evacuate the pneumothorax (arrow). (b) The lung reexpanded, with a small pneumothorax remaining (arrow), and one more 25-gauge needle pass permitted the diagnosis of metastatic head and neck carcinoma in this small cavitated nodule.

 

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  		TABLE 3. Results of 25-gauge Needle Biopsy for Thoracic Lesions in 26 Patients

 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
REFERENCES
 
The literature is sparse regarding 25-gauge needle biopsy, particularly for thoracic lesions. Aside from the aforementioned pulmonary references (6,10), authors of the article about 24- and 25-gauge needles (11) describe an 87% accuracy in diagnosis of pulmonary lesions, with a pneumothorax rate of 4%. Authors of another report (17) describe both 22- and 25-gauge biopsy for mediastinal tuberculosis. In other articles (18–20) about 25-gauge needles, ophthalmologic uses predominate for a variety of indications (such as to minimize fluid leak) and sites, including the posterior orbit and anterior chamber. Superficial soft-tissue lesions have proven to be easily amenable to 25-gauge needle biopsy (21,22), as have thyroid abnormalities (23). A 25-gauge needle injection with lidocaine for anesthesia has been shown to displace tumor cells that might lead to seeding (24). Authors of a more recent article (25) suggest that 25-gauge needles may be used to obtain samples in suspected lymphoma for flow cytometry and immunohistochemistry studies. In our study, in one patient with non-Hodgkin lymphoma, no additional information was provided with use of larger needles over the 25-gauge needle specimen. In our series, encouraging results with 25-gauge needle biopsy are underscored by benign biopsy diagnoses of lesions, such as hamartoma and histoplasmosis.

The potential advantages of 25-gauge needle biopsy seem intuitive but would require larger numbers of patients and a prospective randomized study for further evaluation. However, as a technique in high-risk COPD patients, it might be considered to help avoid symptomatic pneumothorax and a chest tube (26,27). The possibility of a 25-gauge needle helping to reduce the risk of bleeding in any patient, and especially in those with coagulopathy, is also attractive, albeit unproven. Accidental traversing of the internal mammary, mediastinal, or phrenic arteries during thoracic biopsy can have catastrophic results with larger needles (28).

Another possible advantage of the 25-gauge needle might be a reduction in bloodiness of the histopathologic specimen. Excess blood in the slide preparations causes hemodilution of the diagnostic cells; this bloodiness impairs cytologic evaluation and sometimes necessitates the need for additional needle passes and larger needles. Our diagnostic yield of 92% with 25-gauge needles from specimens judged as "adequate" compares favorably with that of other studies (5,6,9,26,27). The 3.8% pneumothorax rate requiring a chest tube is low, albeit the total number is small.

A drawback to the use of the 25-gauge needle most obviously would be needle deviation. To secure the inner coaxial 25-gauge needle, the outer guiding cannula (18–20 gauge) is useful. We used this method routinely, even in the transsternal 25-gauge needle biopsy. We are exploring the use of a firmer 25-gauge needle as well.

A second potential drawback might be lack of substantial tissue for histologic examination in patients with lymphoma and certain benign lesions (6,7). However, flow cytometry and immunochemistry studies for lymphoma (25) improve diagnostic sensitivity (11); the 25-gauge needle specimen probably is adequate in most cases, as these tests can be performed with a small-needle specimen.

Although 25-gauge needle biopsy is not preferable in all situations, it is feasible for lung biopsy and may be preferred in select situations. It may be most valuable in patients with severe COPD and in those with uncorrectable or severe coagulopathy who are highly likely to have a nonlymphomatous malignancy. Adequate, and not too bloody, specimens appear to be obtained routinely. Overall, our indications for use of 25-gauge needle biopsy with thoracic lesions currently include the following: a patient with severe COPD; a patient with an uncorrectable or temporary coagulopathy who requires an urgent biopsy; a suspected neoplasm that is vascular; thin patients, as there is less chance for needle deviation; diminishment of unwanted blood in necrotic specimens; the need to traverse a bulla en route to a pulmonary lesion; firm rubbery lesions in the lung (like thyroid nodules [23]) that may be more easily pierced with a 25-gauge needle than with larger needles; and globally, any lesion suspected of being bronchogenic carcinoma or metastatic disease to the lung or mediastinum.

Our data support more the effectiveness of 25-gauge needles to help establish a diagnosis than to prevent complications such as pneumothorax or vessel injury. While the latter may seem intuitive, it is not borne out by our data. Further experience and research are necessary in this regard.

A variety of percutaneous techniques and instruments are used for specific situations in thoracic biopsy. Included are saline injection to widen soft-tissue planes (8), iatrogenic pneumothorax (4), transsternal approach (29,30), angled CT gantry, and a transtracheal route. A 25-gauge needle biopsy may well be included in this armamentarium for select situations.


   ACKNOWLEDGMENTS
 
Our appreciation to Alexandra Friedman, Vicki McDowell, and Faith McDaniel for assistance with the manuscript.


   FOOTNOTES
 
Abbreviation: COPD = chronic obstructive pulmonary disease

Author contributions: Guarantor of integrity of entire study, E.v.S.; study concepts, E.v.S., B.W.G., G.R.W., J.B.Z.; study design, E.v.S., B.W.G., R.L.; literature research, E.v.S., B.W.G., R.L.; clinical studies, E.v.S., B.W.G., G.R.W., P.T.K.; data acquisition, E.v.S., B.W.G., P.T.K.; data analysis/interpretation, E.v.S., B.W.G., R.L.; statistical analysis, E.v.S., B.W.G.; manuscript preparation and revision/review, all authors; manuscript definition of intellectual content, E.v.S., B.W.G., G.R.W., R.L., J.B.Z.; manuscript editing, E.v.S., B.W.G., G.R.W., J.B.Z.; manuscript final version approval, E.v.S., B.W.G., J.B.Z.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 

  1. Yankelevitz DF, Davis SD, Henschke CI. Aspiration of a large pneumothorax resulting from transthoracic needle biopsy. Radiology 1996; 200:675-697.
  2. Stewart CJ, Stewart IS. Immediate assessment of fine needle aspiration cytology of lung. J Clin Pathol 1996; 49:839-843.[Abstract/Free Full Text]
  3. Anderson CL, Crespo JC, Lie TH. Risk of pneumothorax not increased by obstructive lung disease in percutaneous needle biopsy. Chest 1994; 105:1705-1708.[Abstract/Free Full Text]
  4. Bressler EL, Kirkham JA. Mediastinal masses: alternative approaches to CT-guided needle biopsy. Radiology 1994; 191:391-396.[Abstract/Free Full Text]
  5. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol 1996; 167:105-109.[Abstract/Free Full Text]
  6. Staroselsky AN, Schwarz Y, Man A, Marmur S, Greif J. Additional information from percutaneous cutting needle biopsy following fine-needle aspiration in the diagnosis of chest lesions. Chest 1998; 113:1522-1525.[Abstract/Free Full Text]
  7. Lucidarme O, Howarth N, Finet JF, Grenier PA. Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle. Radiology 1998; 207:759-765.[Abstract/Free Full Text]
  8. Goodacre BW, Savage C, Zwischenberger JB, Wittich GR, vanSonnenberg E. Salinoma window technique for mediastinal lymph node biopsy. Ann Thorac Surg 2002; 74:276-277.[Abstract/Free Full Text]
  9. Milman N. Percutaneous lung biopsy with a fine bore cutting needle (Vacu-Cut): improved results using drill technique. Thorax 1995; 50:560-562.[Abstract]
  10. Garcia-Rio F, Pino JM, Casadevall J, et al. Use of spirometry to predict risk of pneumothorax in CT-guided needle biopsy of the lung. J Comput Assist Tomogr 1996; 20:20-23.[CrossRef][Medline]
  11. Zavala DC, Schoell JE. Ultrathin needle aspiration of the lung in infectious and malignant disease. Am Rev Respir Dis 1981; 123:125-131.[Medline]
  12. Dorca J, Manresa F, Esteban L, et al. Efficacy, safety, and therapeutic relevance of transthoracic aspiration with ultrathin needle in nonventilated nosocomial pneumonia. Am J Respir Crit Care Med 1995; 151:1491-1496.[Abstract]
  13. Zalacain R, Llorente J, Gaztelurrutia L, Pijoan J, Sobradillo V. Influence of three factors on the diagnostic effectiveness of transthoracic needle aspiration in pneumonia. Chest 1995; 107:96-100.[Abstract/Free Full Text]
  14. Fish GD, Stanley JH, Miller KS, Schabel SI, Sutherland SE. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests. AJR Am J Roentgenol 1988; 150:71-74.[Abstract/Free Full Text]
  15. Poe RH, Kallay MC, Wicks CM, Odoroff CL. Predicting risk of pneumothorax in needle biopsy of the lung. Chest 1984; 85:232-235.[Abstract/Free Full Text]
  16. Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol Diagn (Stockh) 1976; 17:813-828.
  17. Khan J, Akhtar M, von Sinner WN, Bouchama A, Bazarbashi M. CT-guided fine needle aspiration biopsy in the diagnosis of mediastinal tuberculosis. Chest 1994; 106:1329-1332.[Abstract/Free Full Text]
  18. Sisley K, Nichols C, Parsons MA, Farr R, Rees RC, Rennie IG. Clinical applications of chromosome analysis, from fine needle aspiration biopsies, of posterior uveal melanomas. Eye 1998; 12:203-207.
  19. Espana-Gregori E, Hernandez M, Menezo-Rozalen JL, Diaz-Llopis M. Metastatic anterior chamber non-Hodgkin lymphoma in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 1997; 124:243-245.[Medline]
  20. Zajdela A, Vielh P, Schlienger P, Haye C. Fine-needle cytology of 292 palpable orbital and eyelid tumors. Am J Clin Pathol 1990; 93:100-104.[Medline]
  21. Alexander AA, Nazarian LN, Feld RI. Superficial soft-tissue masses suggestive of recurrent malignancy: sonographic localization and biopsy. AJR Am J Roentgenol 1997; 169:1449-1451.[Abstract/Free Full Text]
  22. Nicol KK, Ward WG, Pike EJ, Geisinger KR, Cappellari JO, Kilpatrick SE. Fine-needle aspiration biopsy of gouty tophi: lessons in cost-effective patient management. Diagn Cytopathol 1997; 17:30-35.[CrossRef][Medline]
  23. Green I, Ali SZ, Allen EA, Zakowski MF. A spectrum of cytomorphologic variations in medullary thyroid carcinoma: fine-needle aspiration findings in 19 cases. Cancer 1997; 81:40-44.[CrossRef][Medline]
  24. Youngson BJ, Liberman L, Rosen PP. Displacement of carcinomatous epithelium in surgical breast specimens following stereotaxic core biopsy. Am J Clin Pathol 1995; 103:598-602.[Medline]
  25. Simsir A, Fetsch P, Stetler-Stevenson M, Abati A. Immunophenotypic analysis of non-Hodgkin’s lymphomas in cytologic specimens: a correlative study of immunocytochemical and flow cytometric techniques. Diagn Cytopathol 1999; 20:278-284.[CrossRef][Medline]
  26. Westcott JL. Percutaneous transthoracic needle biopsy. Radiology 1988; 169:593-601.[Free Full Text]
  27. vanSonnenberg E, Casola G, Ho M, et al. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology 1988; 167:457-461.[Abstract/Free Full Text]
  28. Padhani AR, Scott WW, Jr. Case report: phrenic artery injury—a rare complication of percutaneous needle lung biopsy. Br J Radiol 1996; 69:356-358.[Abstract]
  29. Swanson D, Wittich G. CT-guided transsternal biopsy of a mediastinal mass. J Interv Radiol 1990; 5:163-164.
  30. D’Agostino HB, Sanchez RB, Laoide RM, et al. Anterior mediastinal lesions: transsternal biopsy with CT guidance—work in progress. Radiology 1993; 189:703-705.[Abstract/Free Full Text]



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