Dunlay, Michael

AbstractIntroduction/PurposePercutaneous core‐needle biopsy of the testicle has been shown to be a safe and effective method of obtaining tissue for histological analysis and can be considered in specific clinical scenarios. While the use of spermatic cord block has been shown to be effective in pain relief in the emergent setting and as an anaesthetic option for inguinal surgery, its use in percutaneous core‐needle biopsy has not been well described. Through this case series, we present our experience and technique of ultrasound‐guided percutaneous core‐needle biopsy using spermatic cord block in the setting of indeterminant testicular masses.MethodsOur departmental biopsy database was reviewed to identify patients who underwent percutaneous core‐needle biopsy of the testicle from March 2010 to July 2022 and who also received spermatic cord block during the procedure.ResultsThree patients were identified who met the search criteria. All three patients presented for the evaluation of indeterminant testicular mass and had a known non‐testicular primary cancer diagnosis at the time of biopsy. All three biopsies were performed using a combination of spermatic cord block, moderate sedation, and local anaesthetic. Biopsies were obtained using an 18‐gauge spring‐loaded device with 4‐5 core samples obtained during each procedure. All biopsies were well tolerated without significant pain or post‐procedure complications.DiscussionUltrasound‐guided percutaneous core‐needle testicular biopsy using spermatic cord block is a safe and effective option in sampling indeterminate testicular masses while maintaining patient comfort.ConclusionThe inclusion of a spermatic cord block in combination with local anaesthetic and moderate sedation has become standard practice in our institution, as we believe this maximises patient comfort and safety resulting in a better patient experience.

AbstractFinding a feeding vessel with diameter greater than 0.9 mm during transarterial chemoembolization (TACE) for hepatocellular cancer (HCC) has been shown to predict tumor necrosis on subsequent pathology. However, whether this translates into a useful clinical predictor for post-chemoembolization response and survival is unknown. This study aimed to determine whether the presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with treatment response and survival after TACE for unresectable HCC. Retrospective medical record search for all chemo-embolizations performed for HCC from 2015 to 2016 yielded 138 patients who underwent 275 TACE sessions spanning 2011 to 2017. Patients consisted of 98 males (71%) with mean age of 62 (range, 37–86). Each patient underwent an average of two TACE sessions (range, 1–11). Endpoints included target tumor response and overall response defined by the mRECIST criteria, as well as patient survival. Preprocedural MRI/CT was reviewed for the presence of arterial feeder. Multivariable logistic regressions and Cox proportional hazard regressions were used to assess the effects of arterial feeder presence on treatment response and survival, respectively, adjusting for other covariates. Overall response was seen in 69% of patients. Arterial feeder was present on preprocedural cross-sectional imaging for 28% of TACE sessions. Median survival was 26.5 months (interquartile range, 13.2–38.1). The presence of arterial feeder led to better target tumor response (OR = 11.9, p < 0.0001), overall response (OR = 9.3, p < 0.0001), and improved survival (HR = 0.55, p = 0.02). The presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with target tumor response, overall response, and survival after TACE.