Acecut

All patients fasted for 6 h. They took oral antibiotics from one day before the biopsy to 6 days post-biopsy. All patients were laid in a left decubitus and knee-chest position. An end-fire endo-cavity transducer (5–9 MHz or 4–10 MHz) was placed in contact with the perineum by the same radiologist who had interpreted the pre-biopsy MR images (Table 1) and had 11 years of experience with prostate biopsies prior to the first case 2009. First, the prostate urethra was searched as a landmark in the sagittal planes by pushing a transducer to the perineum (Fig. 1D). Then, the radiologist scanned the entire prostate to localize the index tumor detected on MRI (Fig. 1E). After tumor localization, the perineum was sterilized with alcohol and anesthetized with a total of 5–10 mL of 2% lidocaine, which was repeatedly injected along the biopsy path until the patient no longer complained of pain. An 18-gage automated co-axial needle (ACECUT; TSK Laboratory, Tochigi-shi, Japan) was introduced into a guider placed on the transducer (Fig. 1F). The needle tip was placed as close to the index tumor as possible. All biopsy cores were multi-focally sampled within the tumor except for two cases in which one core was obtained. The biopsy tracts were easily detected because they were mostly hyperechoic in the TPUS images (Fig. 1G).

US-guided PNB was performed using two US systems (EPIQ Elite; Philips Healthcare, Bothell, WA, USA, and iU22; Philips Healthcare, Bothell, WA, USA). Low-frequency (1–5 MHz) or high-frequency (10–12 MHz) transducers were selected according to the patient’s body habitus to ensure ample visualization of the lesion. All samples were acquired using an 18-gauge automated core biopsy needle (Acecut; TSK Laboratory, Tochigi, Japan) without a coaxial approach.

All needle biopsies were performed using imaging guidance by one of the eight radiologists with 1–26 years of breast imaging experience. US-guided CNB was performed using a 14-or 18-gauge (G) Tru-cut needle with a 22 mm throw (ACECUT, TSK Laboratory, Tokyo, Japan), with a minimum of four cores obtained from each lesion. VABs were performed for small or non-mass lesions or lesions containing calcifications. VABs were also indicated when precise targeting was difficult by the core needle or the in cases in which the results might vary depending on the amount of tissue sample. US-guided VAB was performed using an 8–18-G vacuum-assisted probe (Mammotome, Devicor Endo-Surgery, Cincinnati, OH; Suros, Hologic Inc. Bedford, MA). The needle gauge was determined by lesion size or characteristics and each radiologist’s preference. Stereotactic VAB was performed for microcalcifications that were not visible on US, using an 11-G vacuum-assisted probe (Mammotome, Devicor Endo-Surgery, Cincinnati, OH) and the stereotactic unit of a prone table (Lorad, Hologic Inc., Danbury, CT).

Transrectal US-guided biopsy was performed by the same uroradiologist who had conducted the image fusion. Local anesthesia with 10 mL of lidocaine was applied before each biopsy. An automated biopsy gun with an 18-gauge, 20 cm cutting needle (ACECUT, TSK Laboratory, Tochigi, Japan) was used. Initially, rigid registration of US and MRI were performed (Figure 2A). After registration, the cross-mark on the index lesion on the MRI was transferred to the corresponding US point. Then, nonrigid image registration was performed (Figure 2B). Slight change of markers position was noted after nonrigid registration. Under the guidance of the nonrigid registered US and MRI, two-core TB per each index lesion was performed (Figure 2C), followed by 12-core SB. For each biopsy core, Gleason score and length of PCa, if any, were recorded by an experienced uropathologist blinded from the clinical results.

Ultrasound-guided renal biopsy was performed as previously described [18 (link)]. In brief, renal tissue was obtained using a 16-gauge biopsy gun (Acecut; TSK Laboratory, Tochigi, Japan). The specimen was fixed in 10% formalin and embedded in paraffin. Sections (4 µm thickness) were stained with periodic acid-Schiff (PAS). Pathological changes in glomeruli were defined as global sclerosis, cellular crescent, fibrocellular crescent, fibrous crescent, and others. Pathological analyses were performed by an experienced nephrologist (S.F.), who was independent of the acquisition and analysis of the clinical information.