Needle biopsies are common for the diagnosis and staging of disease. One type of biopsy is Endoscopic UltraSound Fine Needle Aspiration (EUS FNA), which involves the insertion of a needle under ultrasound guidance so that the physician may visualize the position of the needle in relation to target tissue and surrounding structures. EUS FNA procedures are used to ensure that the correct tissue is sampled and to minimize risk to the patient. Although EUS FNA is a highly sensitive and specific procedure, it is still difficult to acquire a sample in certain clinical situations. For example, different tip geometries may be suited for different situations due to tissue density and fibrosis. In addition, samples are most typically cytological, which may be difficult to handle.
The present invention is directed to a biopsy device, comprising a needle extending longitudinally from a proximal end to a distal end and including a channel extending therethrough and a stylet extending through the channel of the needle and including a coil at a distal end thereof such that rotation of the stylet relative to the needle moves the coil from a closed configuration in the channel to a tissue collecting configuration in which the coil extends distally past the distal end of the needle to be inserted into a target tissue.
The present invention is further directed to a biopsy stylet sized and shaped for slidable insertion through a channel of a biopsy needle, the stylet including a coil at a distal end thereof such that rotation of the stylet relative to the needle moves the coil from a closed configuration in the channel to a tissue collecting configuration in which the coil extends distally past a distal end of the needle to be inserted into a target tissue
The present invention may be further understood with reference to the following description and the appended drawings, wherein like elements are referred to with the same reference numerals. The present invention relates to devices for needle biopsies and, in particular, relates to a biopsy device including improved distal tip features for tissue acquisition. Exemplary embodiments of the present invention describe distal tip geometries of stylets used in conjunction with an endoscopic needle device. It should be noted that the terms “proximal” and “distal,” as used herein, are intended to refer to a direct toward (proximal) and away from (distal) a user of the device.
As shown in
The stylet 102, as shown in
The stylet 102 is slidably received in the channel 108 of the needle 104 and is movable between a closed configuration for inserting the device 100 into the body and withdrawing the device 100 therefrom and a tissue sampling configuration for sampling tissue. In the closed configuration, the coil 114 is withdrawn into the channel 108 with the coil distal end 118 located within the opening in the distal end 106 of the needle 104 to prevent non-targeted tissue from entering the channel 108 as the needle is advanced to the target area through non-targeted tissue. Once the distal end 106 of the needle 104 has reached the target area, the stylet 102 is advanced distally to move the coil 114 into the target tissue. For example, the shaft 110 may be screwed into the target tissue by rotating the shaft 110. That is, the stylet 102 may be rotated relative to the needle 104 about a longitudinal axis thereof as the stylet 102 is moved distally relative to the needle 104 to facilitate penetration of the target tissue via the coil 114. The stylet 102 may be advanced and/or rotated to penetrate the target tissue.
Once the coil 114 has penetrated the target tissue, the stylet 102 may be retracted proximally into the closed configuration via a proximal motion of the shaft 110 drawing target tissue grasped by the coil 114 into the channel 108. Once target tissue has been grasped by the coil 114, the stylet 102 may be moved proximally manually or via an actuating mechanism 120. As the coil 114 is drawn into the needle 104, a cutting edge on the distal end 106 of the needle 104 severs the tissue grasped by the coil from the surrounding tissue such that the cut portion of tissue is housed within the needle 104 until the device 100 is removed from the body. In another embodiment, the needle 104 may be moved distally relative to the stylet 102, moving the needle 104 over the coil 114 and the tissue grasped thereby to capture a tissue sample within the needle 104 and sever the captured tissue from surrounding tissue.
The actuating mechanism 120 may be an add-on feature or a separate device coupled to a proximal end of the device 100 to draw the stylet 102 proximally relative to the needle 104, reverting the device 100 to the closed configuration. For example, as shown in
The actuating mechanism 120 further includes a female luer connection 138 coupling to a male luer 138′ of the needle device. The stylet 102 passes through a lumen 140 of the male luer 138′ into the channel 128. For example, the female luer connection 138 may include a threaded inner surface 144 engaging an outer surface 142 of the male luer 138′. It will be understood by those of skill in the art, however, that the luer 138 may engage the housing 122 in any number of ways. A spring (not shown) may be housed within the channel 128, between a proximal end 146 of the male luer 138′ and the distal end 132 of the piston 130, biasing the piston 130, and thus the stylet 102, toward the closed configuration. The spring may be, for example, a helical, coil spring biasing the piston 130. In an alternative embodiment, the spring may include a gas that may be captured in, for example, a gas piston. It will be understood by those of skill in the art that the spring may be any biasing element that biases the piston 130, and thereby the stylet 102, toward the closed configuration.
The lever 150 is pivotably attached to a side of the housing 122 and extends through an opening 152 in a side of the housing 122. The lever 150 includes a biasing element 154 contacting an outer surface 156 of the housing 122 to bias the lever 150 toward a position angled relative to a longitudinal axis of the housing 122 so that an engaging element 158 of the lever extends through the opening 152 and engages a side of the piston 130. When the actuating mechanism 120 is in the closed configuration, the piston 130 is moved proximally through the channel 128 with the engaging element 158 of the lever 150 engaging the radially protruding distal end 132 of the piston. In this position, the lever 150 is rotated to a position substantially parallel to the longitudinal axis of the housing 122 (i.e., substantially parallel to the needle 102 extending therethrough). To move the device to the tissue sampling configuration, a user pushes the cap 136 distally toward the proximal end 124 of the housing 122 moving piston 130 distally through the housing 122 until the engaging element 158 of the lever 150 moves out of contact with the radially protruding end 132 of the piston 130. At this point, the biasing element 154 rotates the lever 150 (counterclockwise as seen in
As described above, in the tissue sampling configuration, the distal end 118 of the coil 114 extends distally past the distal end 106 of the needle 104 to penetrate the target tissue. Once the target tissue is penetrated by the coil 114 and thereby grasped by the coil 114, a user may press a button 158 on the lever 150 to release the engaging element 156 from the shoulder 148 and allow the piston 130 to move proximally into the closed configuration. This draws the stylet 102 along with the grasped target tissue proximally into the channel 108 of the needle 104. If additional tissue samples are desired, it will be understood by those of skill in the art that the stylet 102 may be removed from the body while the needle 104 remains therein. Thus, the needle 104 maintains the path to the target area within the body such that the stylet 102 may be repeatedly inserted therethrough to collect tissue samples.
As shown in
Although the device 100 has been described as used with the actuating mechanism 120, it will be understood by those of skill in the art that the device 100 may be moved between the closed and tissue sampling configurations using any actuating mechanism capable of drawing the stylet 102 into the channel 108 of the needle 104.
As shown in
The distal portion 214 extends from proximal end 216 to a distal tip 218 and includes a lumen 222 extending therethrough. The distal portion 214 may be formed as, for example, a hypotube, with a sharpened tissue penetrating distal tip 218. The distal tip 218 may be tapered and formed as a fish-mouth to facilitate insertion into a target tissue. The fish-mouth may be formed via an oscillating bevel as would be understood by those skilled in the art. For example, the distal tip 128 may include two opposing U-shaped slots 224 extending along a portion of a length thereof such that the distal tip 218 appears as a convex parabola in a first longitudinal side view, as shown in
The coupling mechanism 220 may be, for example, a latch mechanism including an opening 230 extending laterally through the proximal end 216 of the distal portion 214 sized and shaped to receive a tab 232 extending laterally outward from the distal end 212 of the proximal portion 210 to engage the opening 230. Thus, to couple the distal portion 214 to the proximal portion 210, the distal end 212 of the proximal portion 210 may be inserted into the proximal end 216 of the distal portion 214 until the tab 232 is engaged with the opening 230. To release the coupling mechanism 220, a user may press the tab 232 inward so that the tab 232 is disengaged from the opening 230 and the distal portion 214 is released from the proximal portion 210. It will be understood by those of skill in the art, however, that the coupling mechanism 220 any mechanism that facilitates releasable coupling between the distal portion 214 and the proximal portion 210. For example, in another embodiment, the coupling mechanism 220 may provide an annular snap fit or a threaded engagement. The distal portion 214 may be disengaged from proximal portion 210 aid in removal of the tissue sample from within the lumen 222 once the device 200 has been removed from the body. Upon disengagement from the proximal portion 210, the user is able to access the tissue collected within the lumen 222 from both the proximal and distal ends 216, 218 thereof.
Similarly to the device 100, in the closed configuration, the distal portion 214 of the tube 202 is housed substantially within the channel 108 of the needle 104 with the distal tip 218 residing in an opening in the distal end 106 of the needle 104. It will also be understood by those of skill in the art that the device 200 may be initially inserted into the body with a stylet including for example, a ball or conical tip, received within the lumen 222 thereof to prevent any tissue from entering the lumen 222 as the device 200 is being inserted to the target area. Once the device 200 has been positioned in the body, as desired, the device 200 is moved to the tissue sampling configuration by moving the tube 202 distally relative to the needle 104 so that the distal portion 214 extends into and penetrates the target tissue. As the distal portion 214 penetrates the target tissue, the target tissue is received within the lumen 222 and is retained therewithin via the protrusion 226. The tube 202 may also be rotated about a longitudinal axis thereof to aid in tissue removal. Once tissue has been collected within the distal portion 214, the tube 202 may be moved proximally relative to the needle 104 to revert back to the closed configuration. As the device 200 is moved back to the closed configuration, a cutting edge on the distal end 106 may sever the tissue received within the lumen 222 from the surrounding tissue. As discussed with respect to the device 100, the tube 202 may be moved proximally via a manual motion of the tube 202 or an actuating mechanism 120, 120′. Alternatively, the needle 104 may be moved distally over the tube 202 to cover the distal portion 214.
As shown in
Slightly proximally of the distal tip 318, along a distal portion 314 thereof, the tube 302 includes a side opening 324 extending through a wall 326 thereof for receiving tissue into the lumen 322. The side opening 324 may include a cutting edge 328 for severing from surrounding tissue the tissue received through the side cut 324. In one exemplary embodiment, the side opening 324 may be substantially rounded, in the shape of, for example, a cylinder intersecting the wall 326 substantially perpendicular to a longitudinal axis of the tube 302 so that the cutting edge 328 of the side opening 324 extends about an entire perimeter thereof. Thus, a tissue sample may be cut via a variety of motions such as, for example, a forward and/or backward motion along with a rotational motion. However, it will be understood by those of skill in the art that the side opening 324 may be any of a variety of shapes so long as tissue may be received therethrough. In a preferred embodiment, the tube 302 includes two side openings 324, a second side opening 324 positioned along the tube 302 in a position substantially diametrically opposing the first side opening 324. It will be understood by those of skill in the art, however, that the tube 302 may include any number of side openings 324 in any of a variety of positions along the stylet.
In an alternate embodiment, the distal portion 314 of the tube 302 may be releasably coupled to a remaining portion of the tube 302, similarly to the tube 202. A releasable coupling aids in tissue removal from the lumen 322 after tissue collection. The tube 302 may be utilized in a manner substantially similar to the device 200. Similarly to the device 200, the device 300 is movable from a closed configuration to a tissue sampling configuration in which the distal tip 318 extends distally past the distal end 106 of the needle 104 to be inserted into a target tissue. The tube 302 may be moved distally and/or rotated relative to the needle 104 to collect tissue within the lumen 322 via the distal tip 318 and/or the side opening 324. Upon collection of the target tissue, the device 300 may be moved to the closed configuration and removed from the body, as described with respect to the device 100 above.
As shown in
The distal end 418 of the tube 402 may be tapered and includes a plurality of tips 430 formed via at least one longitudinal slot 432 extending therethrough. For example, the longitudinal slot 432 may cut the distal end 418 in half, forming two tips 430 which are biased in a position in which the tips 430 that are separated, but set close to one another. Each of the tips 430 may have a leading edge 434 along an inner surface 436 thereof such that insertion of the distal end 418 into a target tissue causes the tips 430 to move away from one another into an open configuration to receive tissue therebetween. Removal of the tube 402 from the target tissue by, for example, moving the device 400 into the closed configuration in which the distal end 418 of the tube 402 is received within the needle 104, will move the tips 430 back to the biased configuration, gripping tissue therebetween. Thus, the tube 402 may collect tissue via both the tips 430 and the side opening 424.
The tube 402 may be used with the needle 104 in a manner substantially similar to the devices 200 and 300, as described above. Specifically, the tube 402 may be moved distally out of the needle 104 to be inserted into the target tissue. The insertion and/or rotation of the tube 402 facilitates collection of tissue within the lumen 422 via the side opening 424 and the tips 430. Once tissue has been collected, as desired, the device 400 may be moved to the closed configuration, as described above with respect to the device 100, while also severing the collected tissue from the surrounding tissue.
As shown in
Each of the ribs 524 extends about a periphery of the stylet 502 and may be formed of a plurality of planar surfaces 526 for improved visibility. In a preferred embodiment, the ribs 524 may be four-sided facets such that each of the ribs 524 includes four planar surfaces 524. The ribs 524 may be back-cut such that the distal end 514 is easily inserted into tissue when moved distally into the tissue sampling configuration while cutting and retaining tissue when moved proximally into the needle 104, into the closed configuration. As the stylet 502 is moved proximally, the tissue is collected between each of the ribs 524.
The device 500 may be utilized in a manner substantially similar to the device 100. In particular, the device 500 is inserted into the body int the closed configuration, until a distal end thereof is adjacent a target area. The device 500 may then be moved to the tissue sampling configuration such that the distal end 514 of the stylet pierces tissue and is inserted therein. The stylet 502 may be reverted to the closed configuration using any of the methods, as described above in regard to the device 100. Moving the device 500 into the closed configuration captures the tissue sample within the needle 104.
It will be understood by those of skill in the art that individual features of the embodiments described above may be omitted and or combined to form alternate embodiments. For example, an alternate embodiment may include a device comprising hypotube including a plurality of tips at a distal end thereof, as described in regard to the tube 402, and which is releasably couplable to a proximal portion thereof, as described in regard to the tube 202. It will be understood by those of skill in the art that there exists a variety of possible combinations of features.
It will be understood by those skilled in the art that various modification can be made in the structure and the methodology of the present invention, without departing from the spirit or scope of the invention. Thus, it is intended that the present invention cover the modifications and variations of this invention provided that they come within the scope of the appended claims and their equivalents.
The present application claims the priority to the U.S. Provisional Application Ser. No. 61/437,997, entitled “Distal Tip Configurations For Biopsy With EUS FNA” filed Jan. 31, 2011. The specification of the above-identified application is incorporated herewith by reference.
Number | Date | Country | |
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61437997 | Jan 2011 | US |