Surveillance biopsy

To ease the differential diagnosis when rejection is suspected, most institutions perform routine surveillance biopsies. A representative surveillance biopsy schedule is 3 weeks 3, 6, 9, 12 months and annually thereafter (Trulock 1997). 

If performed when based on clinical indications, transbronchial biopsy has been reported to reach a sensitivity for the detection of acute rejection of up to 94% (Trulock 1997). The rationale for surveillance biopsy protocols is based upon retrospective evidence that up to one-third of surveillance biopsies demonstrate evidence of allograft rejection (Chakinala et al. 2004) whereas only 40% of histologically confirmed grades II-IV acute rejections are associated with clinical signs or symptoms (Baz et al. 1996). There are reports in the literature however that suggest a much lower yield after 24 months, and some centers do not routinely perform biopsies after this point (Dransfield et al. 2004). In the study of Tamm et al. (1997) the benefit of surveillance biopsies was questioned. In this study, 51 heart-lung transplant recipients who underwent surveillance transbronchial biopsies were compared with 75 pa-... 

Biomonitoring for human health hazard surveillance typically involves collection of hair, expired air, bodily fluids (blood, urine, saliva, breast milk, semen), feces, epithelial scrapings, exfoliated cells, or, less frequently, tissue biopsies from people known or suspected of being exposed to potential chemical, physical, or biological hazards. These samples are analyzed for toxic chemicals, their metabolites, or biomarker responses. The most commonly used biomarkers in humans are those relating to DNA and chromosomal damage, because these effects contribute to cancer risk. Besides biomarkers of chemical exposure and effects, there are also human biomarkers of tumor formation and susceptibility to toxic... 

Lynch et al. ° described an FAP patient who developed rectal carcinoma 15 months after beginning chemoprophylaxis with sulindac. There was metastatic adenocarcinoma in 6 of 20 perirectal lymph nodes. In addition to the carcinoma, her rectal mucosa contained two adenomas and multiple foci of adenomatous changes in flat mucosa. It was concluded that, while sulindac may alter the pathogenesis of FAP, those patients undergoing sulindac chemoprevention must be monitored closely by endoscopic examination. This surveillance should include an aggressive biopsy approach, since the absence of polyps does not prove the absence of malignant neoplastic changes. 

Sheth D, Wesn CA, Schroder D, Boccaccio JE, Lloyd LR (1999) The advanced breast biopsy instrumentation (ABBI) experience at a community hospital. Am Surg 65 726-730 Shumak RS, Ramsay E, Warner E, Bishop J, Diprospero L, Plewes DB (2000) MRI surveillance of women at high risk for hereditary breast cancer preliminary results (abstract). Radiology 217 (P) 269... 

Evidence suggests surveillance can be delayed at least three years, subject to individual patient circumstance Communicate to referring physician as per accepted guidelines for communication, such as ACR Practice Guideline for Communication Diagnostic Radiology. Subject to local practice, endoscopic biopsy may be indicated... 

A particular consideration in the management of a perforated gastric ulcer is the need to reliably confirm the absence of neoplasia. Even if the biopsies at the repair of the acute perforation are negative, endoscopic surveillance should be undertaken at 8 weeks with four-quadrant biopsy to confirm absence of neoplasia and eradication of H. pylori. 

Marshall DT, Savage SJ, Garrett-Mayer E, Keane TE, Hollis BW, Horst RL, et al. Vitamin D3 supplementation at 4000 international units per day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer imder active surveillance. J Clin Endocrinol Metab July 2012 97(7) 2315-24. 

No large-scale surveillance reports are yet available for omeprazole or other PPIs. However, neither gastric carcinoids nor carcinomas have been observed in several prospective long-term studies for up to 10 years with omeprazole, nor has dysplasia of the gastric endocrine cells or the mucosa been found in multiple biopsies. Also, no increase in intestinal metaplasia occurred [14, 31, 35]. 

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