Cutting needles

Improves crockfastness on sanded or flocked goods. Improves sewability, reduces needle cutting, needle heat and prevents build-up on needles. 

Both classical and modified types of biopsy needles are available suction needles (e. g. Menghini, Klatskin, and Jamshidi) and cutting needles (e. g. Vim-Silverman and Tru-cut) as well as spring-loaded needles. (12, 26, 86, 123, 129, 158, 162)... 

One of the first major compilations of statistics was produced by H. Thaler in 1964 in 23,382 biopsies, the lethality rate was 0.017% and the complication rate 0.10%. (158) In evaluating 79,381 liver biopsies, H. Lindner (1967) calculated a lethality rate of 0.015% and a morbidity rate of 0.34%. (85) In 19,563 liver biopsies, E. WiLDHiRT registered no fatal cases with a morbidity rate of 0.089%. (176) In a multicentre study carried out by F. PiccioNiNo et af, 68,276 liver biopsies were recorded during the period 1973-1983 with a lethality rate of 0.009% and a morbidity rate of 0.21%. In this study, the Vim-Silverman and Tru-cut needle types proved to have the highest risk rate (0.31% to 0.34%). (121) Severe complications were found in 0.57% of cases by J.F. Cadranel et al. (15) Among 4,124 of our own biopsies (Menghini needle), we registered no cases of death whatsoever from 1961 to 1987 the complication rate was 0.15% (s. tab. 7.7). 

In cirrhosis and fibrosis, the biopsy needle used will either be the Vim-Silverman needle or the Tru-Cut needle. Adequate tissue can thereby be obtained for assessment. Because of the increased bleeding tendency connected with these needle types, the diameter should not exceed 1.6 mm (which is generally not required anyway). The liver is punctured tangentially, mainly in the lateral area of the right lobe. Subsequent to the puncture, the stylet is removed, the outer cannula advanced, the inner needle sheath pushed forwards in a rotating movement out of the outer cannula before both are finally withdrawn together. 

Due to their cutting action (which differs from the Menghini technique), Vim-Silverman and Tru-cut needles produce a sufficiently large and almost intact cirrhosis tissue sample. As a consequence, the false-positive results can be brought down to below 10%. Nevertheless, the risk of subsequent bleeding is clearly higher. For this reason, the diameter of the needle should not exceed 1.6 mm. 

Fig. 24.7. Ultrasound-guided fine-needle biopsy with a cutting needle in a case of endoscopically negative biopsies. The needle tip is clearly visible in hypoechoic gastric wall (arrow). Final diagnosis gastric adenocarcinoma...

Akan H, Ozen N, Incesu L et al (1998) Are percutaneous trans-gastric biopsies using 14, 16 and 18 G Tru-Cut needles safe An experimental study in the rabbit. Australas Radiol 42 99-101... 

Nicholson ML, Wheatley TJ, Doughman TM, White SA, Morgan JD, Veitch PS, Furness PN. A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. Kidney Int. 2000, 58(l) 390-5. 

Fig. 2. The steps taken to isolate epiblast fragments from sites adjacent to the distal cap region on the posterior side of a 6.5-d embryo. A Position of the pinning needle (pn) and the line of cut that will be made by the cutting needle (cn) just proximal to the required tissues (shaded area). B Second cut made to isolate the tissue fragment. Similar cutting actions are employed to isolate tissue fragments from other regions of the embryo. Curved arrows indicate the direction of slicing made by the cutting needle. Abbreviation ps, primitive streak.

Fig. 4.3. Tru-Cut needles consist of an inner needle with a sampling chamber at its distal end and an outer circular knife...

Automated biopsy guns use 14- to 18-gauge cutting needles. The automated core-biopsy procedure imposes the firing of the needle into the lesion for tissue acquisition and the removal of the needle from the breasttorecoverthe biopsy specimen (Fig. 4.5b-d). 

Minkowitz S, Moskowitz R, Khalif RA, Alderete MN (1986) Tru-Cut needle biopsy of the breast. An analysis of its specificity and sensitivity. Cancer 57 320 323... 

In comparison to aspiration biopsy, the punch biopsy (synonymous with core biopsy) technique is performed either with spring-activated cutting needles (Tru-Cut) in combination with a biopsy gun or with manually activated cutting needles. This technique allows for obtaining cores of tissue with an intact histological structure that facilitates a precise histological diagnosis or immunohistochemical analysis. 

Klein J8 et al. (1996) Transthoracic needle biopsy with a coaxially placed 20-G automated cutting needle results in 122 patients. Radiology 198 715-720 Laurent F et al. (2000) CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm results with an automated 20-G coaxial cutting needle. Clin Radiol 55 281-287... 

Fig. 19.8. Sonographically guided renal biopsy using the needle guide attached to the transducer the dotted lines show the path of the needle and help to guide the biopsy needle (18 gauge core cut needle, performed with a biopsy gun) for safe puncture as well as retrieval of sufficient specimen material. The image is retrospectively taken from the cine-loop analysis of the needle movement during biopsy (usefiil for documentation and analysis of the procedure) The callipers mark the length of the intraparenchymal needle track (1.7 cm)...

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