Assignment 2 - Paper Review

CORE needle biopsy of orbital tumors

Authors :

Andrey A. Yarovoy, Evgeniya S. Bulgakove, Anna V. Shatsikhm Dzhulietta G. Uzunyan, Svetlana S. Kleyankina, Olesya V. Golubeva

The article can be viewed HERE

Background Information

Orbital tumors occur in many different regions of the eye, however, analyzing them histologically has been a challenge in the past. When it comes to giving a patient a diagnosis and appropriate treatment, histological evaluation is often necessary, but thus far has required invasive surgical procedures to provide a sufficient tissue sample. Fine needle Aspiration Biopsy (referred to as FNAB throughout the paper) has also been used but only provides a cytological smear instead of a histological specimen. This paper focuses on core needle biopsy (referred to as CNB throughout the paper), a procedure which is accepted for tumor diagnosis in different locations throughout the body such as in breast tissue or head region. CNB allows for immunohistochemical staining and histological evaluation which shows increased diagnostic accuracy. (1)

Objective

The purpose of this study was to determine how useful Core Needle Biopsy procedures would be in examining orbital lesions and if there would be any complications in this process.

Materials and Methods

Over a 6 year period the researchers examined approximately 250 patients with orbital tumor lesions, with 50 core needle biopsies performed on 46 patients ranging in age from 2-84 years old. These lesions were biopsied using 20 gauge and 18 gauge semi automated needles. After the samples were obtained routine staining and histology (in hematoxylin and eosin stains) examinations were used.

Results

Table 1 in the paper showed that there was an accurate diagnosis given in the majority (94%) of specimens obtained through CNB. Three biopsies showed no diagnosis. Only two of the forty six patients suffered from further complications after undergoing the core needle biopsy, but in both patients there was no decreased visual acuity and no damage was done to the globe or optic nerve. There was also no found motility disorders or any reports of bacterial infection.

The authors of the paper ultimately concluded that core needle biopsy is a safe procedure for a patient with an orbital tumor to undergo and provides tissue that can be examined both through immunohistochemistry and histology.

Personal Critiques

Personally, I liked this paper. The results support the authors claims and the writing was clear and concise.

The results showed that CNB, a less invasive procedure can be used to more accurately to diagnose orbital tumors without any negative side effects to the patient. This development in medical procedure will allow for patients to receive the best medical care possible, and hopefully quicker diagnosis and a better recovery. While all of this is great in theory, I believe a bit more time and a slightly larger sample size would be beneficial. The study did take place over a six year period (starting in 2006) but only examined 46 out of about 250 patients, who reportedly had orbital lesions within this time period. 46 patients is a good start, but may not be an adequate sample size.

The paper could be a bit more thorough on histological details, since I had to research on my own how they determined the pathology of each tumor and how histology and immunohistochemistry are used for diagnosis of cancerous tumors.

The paper only had one table, which adequately showed the results, but it would have been nice to see a figure or a graph. I often find tables hard to look at and find graphs or images easier to examine.

The paper discussed the advantages of core needle biopsies over fine needle aspiration biopsies, but there was no experiment conducted in the comparison of the two techniques. Although indicated in the discussion that FNAB was done at the time of biopsy I think to better this experiment, the authors could have used both procedures on the patients to see which would have obtained the more accurate results.

I also liked that the authors declared no conflict of interest, which proves that there was no bias in the obtained results.

Overall the experiments were well conducted and organized. The researchers did a good job and hopefully we will soon see this procedure being used more often on orbital lesions in our medical system.

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References: 

1. Rautiainen, S., Masarwah, A., Sudah, M., Sutela, A., & Pelkonen, O. (2013). Axillary lymph    node biopsy in newly diagnosed invasive breast cancer: comparative accuracy of fine-needle aspiration biopsy versus core-needle biopsy. Radiology,269(1), 56-60. Retrieved from http://www.ncbi.nlm.nih.gov.qe2a-proxy.mun.ca/pubmed/23771915

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