biopsy

Pulmonary Nodules

Nathan Hinkle — Sat, 12 Sep 2026 05:00:00 +0000

Date Added:

September 12, 2026

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

September 2, 2026

Issue:

Volume:

395

Pages:

894-905

URL:

Pulmonary Nodules

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

DOI: 10.1056/NEJMcp2515063

Keywords

pulmonary nodules

breathing difficulties

adenomatous hyperplasia

MeSH

Bronchoscopy

biopsy

Neoplasms

RPR Commentary: A review of the evaluation and management of pulmonary nodules. James W. Mold, MD, MPH

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Pulmonary nodules are classified as solid or subsolid, with subsolid nodules further classified as part-solid or pure ground-glass. Management strategies differ according to the type of nodule. A comparison of current and previous imaging studies, when available, is essential to assess the risk of the nodule being malignant. Solid nodules that have been stable for 2 years are considered to be benign, whereas subsolid nodules require a longer period of stability to be considered benign. Prediction models to stratify the risk of the nodule being malignant can be used to guide the management of solid nodules. Computed tomographic (CT) surveillance is indicated for low-risk nodules; positron-emission tomography–CT, biopsy, or both for intermediate-risk nodules; and surgical resection for selected high-risk nodules. Subsolid nodules are often slower growing than solid nodules but are associated with a higher risk of being malignant, especially if a solid component develops or progressively enlarges. Biopsy methods include transthoracic needle biopsy and navigational bronchoscopy. Optimal overall management balances timely diagnosis in persons who have cancer with the avoidance of unnecessary invasive procedures in persons who have benign disease.

Author/s:

Matthew E.J. Callister, Gerard Silvestri

What Is Ovarian Cancer?

Megan George — Fri, 05 Dec 2025 17:01:51 +0000

Date Added:

December 5, 2025

Journal/Publication:

JAMA

Publication Date:

December 4, 2025

URL:

What Is Ovarian Cancer?

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jama.2025.18446

Keywords

MeSH

Poly(ADP-ribose) Polymerase Inhibitors

Carcinoma

Ovarian Epithelial

Minimally Invasive Surgical Procedures

Poly(ADP-ribose) Polymerases

Fallopian Tubes

Endometriosis

biopsy

Information for patients about ovarian cancer. James W. Mold, MD, MPH

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Ovarian cancer is a malignancy of the ovary, the female reproductive organ that produces eggs.

How Common Is Ovarian Cancer?
Among women worldwide, ovarian cancer is the eighth most common malignancy and cause of cancer death. In 2022, ovarian cancer was diagnosed in about 325 000 individuals and caused 206 839 deaths worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 will die of it.1

What Are the Risk Factors for Ovarian Cancer?
Risk factors for ovarian cancer include older age (the most common age at diagnosis is 63 years), a family history of breast cancer or ovarian cancer, endometriosis (a chronic inflammatory disease in which uterine lining cells are found outside of the uterus), and never having given birth. About 25% of ovarian cancers are due to inherited genetic variants, primarily in BRCA1 and BRCA2 genes.

What Are the Symptoms of Ovarian Cancer?
At the time of diagnosis, most patients with ovarian cancer have symptoms such as abdominal pain, bloating, urgent or frequent urination, and/or increased abdominal size. Signs and symptoms of advanced ovarian cancer may include a mass in the abdominal area, weight loss, and trouble breathing due to abdominal swelling or from fluid surrounding the lungs.

How Is Ovarian Cancer Diagnosed and Staged?
Ovarian cancer is often diagnosed and staged based on findings from a pelvic ultrasound, abdominal computed tomography (CT) scan, and/or abdominal magnetic resonance imaging (MRI). Total-body positron emission tomography (PET) can detect cancer that has spread to more distant sites in the body. To help with staging, some patients may undergo diagnostic laparoscopy, a minimally invasive surgical procedure, in which clinicians look for a tumor within the abdomen and perform biopsies to assess for ovarian cancer.

Stage I ovarian cancer is limited to the ovary or fallopian tube. Stage II cancer has spread beyond the ovaries and fallopian tubes but is still confined within the pelvis. Stage III cancer involves sites outside the pelvis such as nearby lymph nodes or other areas of the abdomen. Stage IV cancer involves organs or tissues outside the abdominal cavity, such as the liver, spleen, or lungs.

How Is Ovarian Cancer Treated?
All patients diagnosed with ovarian cancer should undergo genetic testing, including for BRCA1/2 variants, to help guide treatment and counseling. First-line treatment for patients with early-stage (I and II) ovarian cancer is surgery, including removal of both ovaries and fallopian tubes, the uterus, lymph nodes, and fatty tissue covering the abdominal organs, followed by chemotherapy. Patients with stage I cancer who are considering having children may undergo more limited surgery with removal of the cancerous ovary and fallopian tube, leaving in place the other ovary and fallopian tube and the uterus.

Treatment for patients with stages III and IV (advanced) ovarian cancer includes both surgery and chemotherapy, often combined with individualized targeted therapies such as bevacizumab and/or poly–ADP ribose polymerase (PARP) inhibitors.

Prognosis After Treatment for Ovarian Cancer
Patients with stages I and II ovarian cancer have a 5-year overall survival rate of 70% to 95%. The 5-year overall rate for stages III and IV ovarian cancer is 10% to 40%. However, 5-year survival is about 70% among patients with advanced-stage ovarian cancer who have BRCA genetic variants and are treated with PARP inhibitors.

Author/s:

Rebecca Voelker

What Is Prostate Cancer?

Megan George — Fri, 25 Jul 2025 13:49:16 +0000

Date Added:

July 25, 2025

Journal/Publication:

JAMA Patient Page

Publication Date:

July 24, 2025

URL:

What Is Prostate Cancer?

Type:

Patient Education Materials

DOI (1):

10.1001/jama.2025.10177

Keywords

Patient Information

jama Patient Information

MeSH

Prostate-Specific Antigen

Digital Rectal Examination

early detection of cancer

Early Detection of Cancer* / methods

Information for patients about prostate cancer. James W. Mold, MD, MPH

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Prostate cancer is a common malignancy in older men. Prostate cancer typically affects older men (average age at diagnosis is 67 years) and is more common among Black men than White men.1 More than half of prostate cancer risk is due to genetic factors. Prostate cancer is the second most common cause of cancer in men worldwide, with about 1.5 million cases diagnosed in 2021. In the US, 3.4 million men were living with prostate cancer in 2021.

Author/s:

Rebecca Voelker, MSJ

A “no-biopsy” approach to diagnosing celiac disease

Aubrey Delammermore — Tue, 25 Oct 2022 05:00:00 +0000

Date Added:

October 25, 2022

Journal/Publication:

Journal of Family Practice

Publisher:

Frontline Medical Communications

Publication Date:

October 1, 2022

Issue:

Volume:

Pages:

359-361

URL:

A “no-biopsy” approach to diagnosing celiac disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.12788/jfp.0485

Keywords

celiac disease

Gastroenterology

diagnosis

Predictive Value of Tests

MeSH

World Health Organization

This antibody test is almost as good as a biopsy for diagnosing celiac disease. James W. Mold, MD, MPH

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PRACTICE CHANGER
CONSIDER A “NO-BIOPSY” APPROACH BY EVALUATING SERUM IMMUNOGLOBULIN (IG) A ANTI-TISSUE TRANSGLUTAMINASE (TTG-IGA) ANTIBODY TITERS IN ADULT PATIENTS WHO PRESENT WITH SYMPTOMS CONCERNING FOR CELIAC DISEASE (CD). AN INCREASE OF ≥ 10 TIMES THE UPPER LIMIT OF NORMAL (ULN) FOR TTG-IGA HAS A POSITIVE PREDICTIVE VALUE (PPV) OF ≥ 95% FOR DIAGNOSING CD WHEN COMPARED WITH ESOPHAGOGASTRODUODENOSCOPY (EGD) WITH DUODENAL BIOPSY—THE CURRENT GOLD STANDARD.

Author/s:

Mott, T., Gray, C., Storey, J.

Itchy vesicles

Bethie Seay — Sun, 17 Oct 2021 05:00:00 +0000

Date Added:

October 17, 2021

Journal/Publication:

MDedge

Publication Date:

October 14, 2021

Type:

Meta-analyses, Reviews, and Guidelines

A concise summary of the appearance, cause, and treatment of dermatitis herpetiformis.

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A 58-year-old man presented to the family medicine skin clinic with a 4-month history of intensely pruritic vesicles on his forehead, back, elbows, dorsum of his hands, and knees. The patient also reported lesions inside his mouth; however, they were not visible at the time of the office visit. He had a history of psoriasis and Graves disease and had recently been given a biopsy-confirmed diagnosis of celiac disease.

What’s your diagnosis?

Author/s:

Colom, M., Stulberg, D.

Vulvar lichen sclerosus

Bethie Seay — Thu, 14 Oct 2021 05:00:00 +0000

Date Added:

October 14, 2021

Journal/Publication:

CMAJ

Publication Date:

October 12, 2021

Issue:

Volume:

193

Pages:

E1572

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.210448

MeSH

Betamethasone Valerate

Ointments

Perineum

Glycogen Storage Disease Type VI

A quick review and picture of vulvar lichen sclerosis.

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An otherwise healthy 71-year-old woman presented to our clinic with a history of pruritus and burning of the vulva. On examination, we observed an atrophic, white, shiny plaque involving the vulva, perineum and perianal areas. The clitoral hood and labia minora were completely scarred and the introitus was narrow (Figure 1). We diagnosed vulvar lichen sclerosus, a chronic inflammatory disease affecting the anogenital area that can present in any age group, though it is most common before puberty and after menopause. We noted no areas of concern for malignant disease, so we did not take a biopsy. We treated the patient with high-potency steroids (clobetasol ointment twice daily for 6 wk, then weekly). She responded well to treatment, and once her disease settled, we switched her to mid-potency steroids (betamethasone valerate 0.1% ointment daily).

Author/s:

Cleminson, K., Baxter, M. L.

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis: A Systematic Review and Meta-analysis

Brian Desmarais — Thu, 20 Aug 2020 15:06:27 +0000

Date Added:

August 20, 2020

Journal/Publication:

JAMA Internal Medicine

Publication Date:

August 17, 2020

URL:

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2020.3050.

MeSH

Information Storage and Retrieval

This meta-analysis involving 68 studies calculated the likelihood ratios of various signs and symptoms of temporal arteritis (giant cell arteritis), which could be helpful when deciding when to refer patients for temporal artery biopsy.. James W. Mold, MD, MPH

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Abstract

Importance: Current clinical guidelines recommend selecting diagnostic tests for giant cell arteritis (GCA) based on pretest probability that the disease is present, but how pretest probability should be estimated remains unclear.

Objective: To evaluate the diagnostic accuracy of symptoms, physical signs, and laboratory tests for suspected GCA.

Data sources: PubMed, EMBASE, and the Cochrane Database of Systematic Reviews were searched from November 1940 through April 5, 2020.

Study selection: Trials and observational studies describing patients with suspected GCA, using an appropriate reference standard for GCA (temporal artery biopsy, imaging test, or clinical diagnosis), and with available data for at least 1 symptom, physical sign, or laboratory test.

Data extraction and synthesis: Screening, full text review, quality assessment, and data extraction by 2 investigators. Diagnostic test meta-analysis used a bivariate model.

Main outcome(s) and measures: Diagnostic accuracy parameters, including positive and negative likelihood ratios (LRs).

Results: In 68 unique studies (14 037 unique patients with suspected GCA; of 7798 patients with sex reported, 5193 were women [66.6%]), findings associated with a diagnosis of GCA included limb claudication (positive LR, 6.01; 95% CI, 1.38-26.16), jaw claudication (positive LR, 4.90; 95% CI, 3.74-6.41), temporal artery thickening (positive LR, 4.70; 95% CI, 2.65-8.33), temporal artery loss of pulse (positive LR, 3.25; 95% CI, 2.49-4.23), platelet count of greater than 400 × 103/μL (positive LR, 3.75; 95% CI, 2.12-6.64), temporal tenderness (positive LR, 3.14; 95% CI, 1.14-8.65), and erythrocyte sedimentation rate greater than 100 mm/h (positive LR, 3.11; 95% CI, 1.43-6.78). Findings that were associated with absence of GCA included the absence of erythrocyte sedimentation rate of greater than 40 mm/h (negative LR, 0.18; 95% CI, 0.08-0.44), absence of C-reactive protein level of 2.5 mg/dL or more (negative LR, 0.38; 95% CI, 0.25-0.59), and absence of age over 70 years (negative LR, 0.48; 95% CI, 0.27-0.86).

Conclusions and relevance: This study identifies the clinical and laboratory features that are most informative for a diagnosis of GCA, although no single feature was strong enough to confirm or refute the diagnosis if taken alone. Combinations of these symptoms might help direct further investigation, such as vascular imaging, temporal artery biopsy, or seeking evaluation for alternative diagnoses.

Author/s:

van der Geest, Kornelis S. M., Sandovici , S., Brouwer, Elisabeth, Mackie, S.L.

Impact of Biopsy Technique on Clinically Important Outcomes for Cutaneous Melanoma: A Systematic Review and Meta-analysis

Brian Desmarais — Tue, 21 Jul 2020 16:25:55 +0000

Date Added:

July 21, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Clinic

Publication Date:

July 15, 2020

URL:

Impact of Biopsy Technique on Clinically Important Outcomes for Cutaneous Melanoma: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocpiqo.2020.04.005

MeSH

Melanoma, Cutaneous Malignant

Melanoma

Skin Neoplasms

biopsy

This meta-analysis confirmed the recommendation that a full thickness excisional biopsy is the preferred method for determining whether a skin lesion is a malignant melanoma. Punch biopsy is associated with a small but statistically significant increase in mortality. James W. Mold, MD, MPH

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We performed a systematic review and meta-analysis to examine the relationship between the type of biopsy technique employed in the diagnosis of cutaneous melanoma and 4 clinically important outcomes: melanoma-specific mortality, all-cause mortality, Breslow tumor depth, or melanoma recurrence. Our database was obtained by searching PubMed, Ovid MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Library from inception until December 6, 2019. Studies were identified that compared biopsy techniques used to diagnose cutaneous melanoma with any of our study outcomes. We included 7 observational studies for our meta-analysis after screening 3231 titles and abstracts. Pooled data identified a significantly higher all-cause mortality in the punch biopsy group (risk ratio [RR], 1.520; P=.02). A higher, but nonsignificant, rate of melanoma-specific mortality (RR, 1.96; P=.22) and melanoma recurrence (RR, 1.20; P=.186) was also found for the punch biopsy group. Breslow tumor thickness was not significantly lower for punch incision (standardized mean difference, −0.42; P=.27). We found limited evidence for differences in clinically important outcomes across the spectrum of the most common methods employed in clinical practice for the initial diagnosis of cutaneous melanoma. A small, but significant, increase (P=.02) in all-cause mortality with punch biopsies was not seen for the other outcomes and was most likely due to small sample sizes and demographic differences in the included studies and unlikely represents a clinically important outcome. Our findings support the use of existing clinical practice guidelines for evaluating pigmented lesions suspicious for cutaneous melanoma.

Author/s:

Shellenberger, R.A., Fayyaz, F., Sako, Z., Tawagi, K., Scheidel, C., Nabhan, M.

Final Update Summary: Breast Cancer: Medication Use to Reduce Risk

John Bayhi — Wed, 04 Sep 2019 17:50:29 +0000

Date Added:

September 4, 2019

Journal/Publication:

US Preventative Services Task Force / JAMA

Publisher:

American Medical Association

Publication Date:

September 3, 2019

Issue:

322

Volume:

Pages:

857-867

URL:

Final Update Summary: Breast Cancer: Medication Use to Reduce Risk

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.11885

Keywords

PMID (1):

31479144

MeSH

breast neoplasms

risk reduction behavior

biopsy

risk assessment

tamoxifen

Raloxifene Hydrochloride

aromatase inhibitors

It looks like all women need to be assessed for risk of breast cancer so that high-risk women can be offered medications to reduce risk. James W. Mold, MD, MPH

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IMPORTANCE:

Breast cancer is the most common nonskin cancer among women in the United States and the second leading cause of cancer death. The median age at diagnosis is 62 years, and an estimated 1 in 8 women will develop breast cancer at some point in their lifetime. African American women are more likely to die of breast cancer compared with women of other races.

OBJECTIVE:

To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on medications for risk reduction of primary breast cancer.

EVIDENCE REVIEW:

The USPSTF reviewed evidence on the accuracy of risk assessment methods to identify women who could benefit from risk-reducing medications for breast cancer, as well as evidence on the effectiveness, adverse effects, and subgroup variations of these medications. The USPSTF reviewed evidence from randomized trials, observational studies, and diagnostic accuracy studies of risk stratification models in women without preexisting breast cancer or ductal carcinoma in situ.

FINDINGS:

The USPSTF found convincing evidence that risk assessment tools can predict the number of cases of breast cancer expected to develop in a population. However, these risk assessment tools perform modestly at best in discriminating between individual women who will or will not develop breast cancer. The USPSTF found convincing evidence that risk-reducing medications (tamoxifen, raloxifene, or aromatase inhibitors) provide at least a moderate benefit in reducing risk for invasive estrogen receptor-positive breast cancer in postmenopausal women at increased risk for breast cancer. The USPSTF found that the benefits of taking tamoxifen, raloxifene, and aromatase inhibitors to reduce risk for breast cancer are no greater than small in women not at increased risk for the disease. The USPSTF found convincing evidence that tamoxifen and raloxifene and adequate evidence that aromatase inhibitors are associated with small to moderate harms. Overall, the USPSTF determined that the net benefit of taking medications to reduce risk of breast cancer is larger in women who have a greater risk for developing breast cancer.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects. (B recommendation) The USPSTF recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer. (D recommendation) This recommendation applies to asymptomatic women 35 years and older, including women with previous benign breast lesions on biopsy (such as atypical ductal or lobular hyperplasia and lobular carcinoma in situ). This recommendation does not apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ.

Author/s:

US Preventive Services Task Force, Owens, Douglas K., Davidson, Karina W., Krist, Alex H., Barry, Michael J., Cabana, M, Caughey, AB, Doubeni, Chyke A., Epling, John W. Jr., Kubik, M, Landefeld, CS, Mangione, Carol M., Pbert, L, Silverstein, Michael, Tseng, Chien-Wen, Wong, JB