Percutaneous CT-guided lung biopsy for the diagnosis of persistent pulmonary consolidation

Imaging and serum antigen levels that influence the treatment and prognosis of cryptococcosis in immunocompetent and immuno-compromised patients: A 10-year retrospective study

This article was to summarize the treatment course and prognosis of immunocompetent and immunocompromised patients with pulmonary cryptococcal infections and to analyse the relevant factors. The chisquared test was used to test for differences in categorical variables, and the independent samples t test was used to compare continuous variables. Multivariable analyses using the Cox proportional hazards model were used to estimate the effect of prognostic factors on treatment time and improvement time. A total of 243 patients were included in the analysis. Immunocompetent patients with diffuse imaging infiltrates had an extension of the treatment course within six months (P = 0.048) and an extension of the improvement days within four weeks (P = 0.008). In immunocompromised patients, an antigen assay ≥ 40 (P = 0.013) is an unfavourable factor leading to an extension of treatment by nine months. The serum antigen assay in 26/98 (26.53%) immunocompetent patients who did not turn negative when the treatment had finished was significantly lower than that in 14/29 (48.28%) immunocompromised patients (P = 0.027). All patients who underwent surgical resection had a good prognosis. Diffuse imaging infiltrates suggest longer treatment days and a longer improvement time in immunocompetent patients. Higher serum antigen levels in immunocompromised patients indicate longer treatment. Serum antigen assays in immunocompromised patients are difficult to negative.

Diagnostic yield and complication rates of percutaneous transthoracic CT-guided coaxial needle biopsy in persistent pulmonary consolidation

OBJECTIVES

To investigate the diagnostic performance and complication rates of percutaneous transthoracic CT-guided coaxial core needle biopsy (PTCNB) in persistent consolidations and evaluate its safety in routine clinical practice.

METHODS

A total of 685 patients (404 males, 281 females) underwent PTCNB with coaxial core technique for persisted consolidation were reviewed in this study. According to histopathological and microbiological analysis, the results of biopsy specimens were categorized as follows: malignant, specific benign, non-specific benign and non-diagnostic. The final diagnosis was established through surgical resection or clinicoradiological follow-up for at least 12 months following biopsy. Diagnostic yield of PTCNB was defined as the percentage of the true diagnosis from biopsy as malignant and specific benign lesions.

RESULTS

With respect to the final diagnosis, 54 (54/685; 7.88%) cases were obtained by surgery and the remaining were by follow-up. The total accuracy, sensitivity, specificity of PTCNB for malignancy diagnosis was 94.45%, 84.87%, 100%, respectively. Diagnostic yield of PTCNB was 66.28%. Compared to lesions smaller than 3 cm, higher diagnostic yield (70.89%), lower complication incidence (38.22%) and shorter procedure time (8.78 min) were observed in lesions ≥ 3 cm group.

CONCLUSION

PTCNB in persistent consolidation is a safe and effective procedure, which provide relatively high diagnostic yield and acceptable complication, especially in size over 3 cm lesions.

CRITICAL RELEVANCE STATEMENT

CT-guided coaxial needle biopsy for pulmonary consolidation is a safe and effective procedure. The coaxial needle biopsy yielded high diagnostic rates and low complication rates (including pneumothorax and intrapulmonary hemorrhage), especially in larger lesions.

Diagnostic value of the Xpert MTB/RIF assay combined with endobronchial ultrasonography with a guide sheath for peripheral nodular pulmonary tuberculosis

BACKGROUND

The diagnosis of peripheral isolated nodular lesions that are suspected as pulmonary tuberculosis (PTB) is challenging, which are not easily accessible via conventional bronchoscopy. This study evaluated the combined use of Xpert MTB/RIF assay and endobronchial ultrasonography with a guide sheath (EBUS-GS) for detecting MTB infection in peripheral lung bands, for early detection of PTB.

METHODS

The clinical data of 232 patients with suspected peripheral nodular PTB who underwent EBUS-GS between June 2020 and October 2023 were retrospectively reviewed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of acid-fast bacilli smear, culture, Xpert MTB/RIF assay, and pathological examination were calculated. To assess diagnostic accuracy, the results of the four methods were directly compared with the final clinical diagnosis.

RESULTS

In total, 146 and 86 patients were clinically diagnosed with peripheral nodular PTB and non-PTB, respectively. The sensitivity, specificity, PPV, NPV, and AUC values of combined Xpert MTB/RIF assay and EBUS-GS were 47.26%, 100.0%, 100.0%, 52.76%, and 0.74; those of acid-fast bacilli smear were 8.22%, 97.67%, 85.71%, 38.53%, and 0.53; those of culture were 31.51%, 100.0%, 100.0%, 46.24%, and 0.66; and those of pathological examination were 23.97%, 97.67%, 94.59%, 43.08%, and 0.61, respectively.

CONCLUSION

The diagnostic accuracy of the combined Xpert MTB/RIF assay and EBUS-GS was significantly better than that of other conventional tests. Hence, this novel technique can be routinely applied for diagnosing and managing peripheral nodular PTB.

Discrimination of Lung Cancer and Benign Lung Diseases Using BALF Exosome DNA Methylation Profile

Benign lung diseases are common and often do not require specific treatment, but they pose challenges in the distinguishing of them from lung cancer during low-dose computed tomography (LDCT). This study presents a comprehensive methylation analysis using real-time PCR for minimally invasive diagnoses of lung cancer via employing BALF exosome DNA. A panel of seven epigenetic biomarkers was identified, exhibiting specific methylation patterns in lung cancer BALF exosome DNA. This panel achieved an area under the curve (AUC) of 0.97, with sensitivity and specificity rates of 88.24% and 97.14%, respectively. Each biomarker showed significantly higher mean methylation levels (MMLs) in both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) compared to non-cancer groups, with fold changes from 1.7 to 13.36. The MMLs of the biomarkers were found to be moderately elevated with increasing patient age and smoking history, regardless of sex. A strong correlation was found between the MMLs and NSCLC stage progression, with detection sensitivities of 79% for early stages and 92% for advanced stages. In the validation cohort, the model demonstrated an AUC of 0.95, with 94% sensitivity and specificity. Sensitivity for early-stage NSCLC detection improved from 88.00% to 92.00% when smoking history was included as an additional risk factor.

Evaluation of robotic-assisted navigation system for CT-guided thoracic and abdominal lesion puncture: A prospective clinical study

INTRODUCTION

The study aims to compare the accuracy and safety of robotic-assisted navigation puncture to freehand puncture during computed tomography (CT)-guided percutaneous needle insertion in the chest and abdomen.

METHODS

A total of 60 patients required percutaneous puncture procedures, with 40 involving the chest and 20 involving the abdomen. Eligible patients were randomly assigned to two groups. The test group punctured using a robotic-assisted navigation system, whereas the control group punctured manually. The primary outcome assessment standards are single puncture success rates, with the number of needle modifications and CT scan timings during the procedure serving as supplementary outcome evaluation standards. The Wilcoxon rank sum test is used for the comparison.

RESULTS

The puncture procedure's success rates after just one puncture: The test group punctures accurately without adjusting the puncture needle, while the control group uses an average number of 1.73 ± 1.20 pins. The once-puncture success rate of robot navigation puncture is considerably higher than that of bare-handed puncture (P < 0.001). The times of CT scan are necessitated when the puncture is in place: the average times in the test group is 3.03 ± 0.18 times, while the control group is 4.70 ± 1.24 times.

CONCLUSION

In conclusion, the robotic-assisted navigation system improves puncture accuracy while reducing the need for needle corrections during percutaneous puncture procedures. It also shortens CT scans and reduces radiation exposure from X-rays.

CT-guided needle biopsy is not associated with increased ipsilateral pleural metastasis

INTRODUCTION

Histological confirmation of a lung tumor is the prerequisite for treatment planning. It has been suspected that CT-guided needle biopsy (CTGNB) exposes the patient to a higher risk of pleural recurrence. However, the distance between tumor and pleura has largely been neglected as a possible confounder when comparing CTGNB to bronchoscopy.

METHODS

All patients with lung cancer histologically confirmed by bronchoscopy or CTGNB between 2010 and 2020 were enrolled and studied. Patients' medical histories, radiologic and pathologic findings and surgical records were reviewed. Pleural recurrence was diagnosed by pleural biopsy, fluid cytology, or by CT chest imaging showing progressive pleural nodules.

RESULTS

In this retrospective unicenter analysis, 844 patients underwent curative resection for early-stage lung cancer between 2010 and 2020. Median follow-up was 47.5 months (3-137). 27 patients (3.2 %) with ipsilateral pleural recurrence (IPR) were identified. The distance of the tumor to the pleura was significantly smaller in patients who underwent CTGNB. A tendency of increased risk of IPR was observed in tumors located in the lower lobe (HR: 2.18 [±0.43], p = 0.068), but only microscopic pleural invasion was a significant independent predictive factor for increased risk of IPR (HR: 5.33 [± 0.51], p = 0.001) by multivariate cox analysis. Biopsy by CTGNB did not affect IPR (HR: 1.298 [± 0.39], p = 0.504).

CONCLUSION

CTGNB is safe and not associated with an increased incidence of IPR in our cohort of patients. This observation remains to be validated in a larger multicenter patient cohort.

Development of a machine learning model for predicting pneumothorax risk in coaxial core needle biopsy (≤3 cm)

PURPOSE

The aim is to devise a machine learning algorithm exploiting preoperative clinical data to forecast the hazard of pneumothorax post-coaxial needle lung biopsy (CCNB), thereby informing clinical decision-making and enhancing perioperative care.

METHOD

This retrospective analysis aggregated clinical and imaging data from patients with lung nodules (≤3 cm) biopsies. Variable selection was done using univariate analysis and LASSO regression, with the dataset subsequently divided into training (80 %) and validation (20 %) subsets. Various machine learning (ML) classifiers were employed in a consolidated approach to ascertain the paramount model, which was followed by individualized risk profiling showcased through Shapley Additive eXplanations (SHAP).

RESULTS

Out of the 325 patients included in the study, 19.6% (64/325) experienced postoperative pneumothorax. High-risk factors determined were Cancer, Lesion_type, GOLD, Size, and Depth. The Gaussian Naive Bayes (GNB) classifier demonstrated superior prediction with an Area Under the Curve (AUC) of 0.82 (95% CI 0.71-0.94), complemented by an accuracy rate of 0.8, sensitivity of 0.71, specificity of 0.84, and an F1 score of 0.61 in the test cohort.

CONCLUSION

The formulated prognostic algorithm exhibited commendable efficacy in preoperatively prognosticating CCNB-induced pneumothorax, harboring the potential to refine personalized risk appraisals, steer clinical judgment, and ameliorate perioperative patient stewardship.

Lung Needle Biopsy and Lung Ablation: Indications, Patient Management, and Postprocedure Imaging Findings

The clinical role and use of percutaneous transthoracic needle biopsy (TTNB) and ablation of lung tumors are evolving. Here we discuss important considerations for referring providers, including current and emerging indications supported by guidelines, critical aspects of pre and postprocedure patient management, and expected postprocedure imaging findings.

Routine radiology-pathology concordance evaluation of CT-guided percutaneous lung biopsies increases the number of cancers identified

BACKGROUND

Routine concordance evaluation between pathology and imaging findings was introduced for CT-guided biopsies.

PURPOSE

To analyze malignancy rate in concordant, discordant, and indeterminate non-malignant results of CT-guided lung biopsies.

METHODS

Concordance between pathology results and imaging findings of consecutive patients undergoing CT-guided lung biopsy between 7/1/2016 and 9/30/2021 was assessed during routine meetings by procedural radiologists. Concordant was defined as pathology consistent with imaging findings; discordant was used when pathology could not explain imaging findings; indeterminate when pathology could explain imaging findings but there was concern for malignancy. Recommendations for discordant and indeterminate were provided. All the malignant results were concordant. Pathology of repeated biopsy, surgical sample, or follow-up was considered reference standard.

RESULTS

Consecutive 828 CT-guided lung biopsies were performed on 795 patients (median age 70 years, IQR 61-77), 423/828 (51%) women. On pathology, 224/828 (27%) were non-malignant. Among the non-malignant, radiology-pathology concordance determined 138/224 (62%) to be concordant with imaging findings, 54/224 (24%) discordant, and 32/224 (14%) indeterminate. When compared to the reference standard, 33/54 (61%) discordant results, 6/30 (20%) indeterminate, and 3/133 (2%) concordant were malignant. The prevalence of malignancy in the three groups was significantly different (p < 0.001). Time to diagnosis was significantly different between patients who reached the diagnosis with imaging follow-up (median 114 days, IQR 69-206) compared to repeat biopsy (33 days, IQR 18-133) (p = 0.01).

CONCLUSION

Routine radiology-pathology concordance evaluation of CT-guided lung biopsy correctly identifies patients at high risk for missed diagnosis of malignancy. Repeat biopsy is the fastest method to reach diagnosis.

CLINICAL RELEVANCE STATEMENT

A routine radiology-pathology concordance assessment identifies patients with non-malignant CT-guided lung biopsy result who are at greater risk of missed diagnosis of malignancy.

KEY POINTS

• A routine radiology-pathology concordance evaluation of CT-guided lung biopsies classified 224 non-malignant results as concordant, discordant, or indeterminate. • The percentage of malignancy on follow-up was significantly different in concordant (2%), discordant (61%), and indeterminate (20%) (p < 0.001). • Time to definitive diagnosis was significantly shorter with repeat biopsy (33 days), compared to imaging follow-up (114 days), p = 0.01.

Diagnostic yield using electromagnetic navigation bronchoscopy for peripheral pulmonary nodules <2 cm

BACKGROUND

Although electromagnetic navigation bronchoscopy (ENB) is highly sensitive in the diagnosis of peripheral pulmonary nodules (PPNs), its diagnostic yield for subgroups of smaller PPNs is under evaluation.

OBJECTIVES

Diagnostic yield evaluation of biopsy using ENB for PPNs <2 cm.

DESIGN

The diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value of the ENB-mediated biopsy for PPNs were evaluated.

METHODS

Patients who had PPNs with diameters <2 cm and underwent ENB-mediated biopsy between May 2015 and February 2020 were consecutively enrolled. The final diagnosis was made via pathological examination after surgery.

RESULTS

A total of 82 lesions from 65 patients were analyzed. The median tumor size was 11 mm. All lesions were subjected to ENB-mediated biopsy, of which 29 and 53 were classified as malignant and benign, respectively. Subsequent segmentectomy, lobectomy, or wedge resection, following pathological examinations were performed on 64 nodules from 57 patients. The overall sensitivity, specificity, positive predictive value, and negative predictive value for nodules <2 cm were 53.3%, 91.7%, 92.3%, and 51.2%, respectively. The receiver operating curve showed an area under the curve of 0.721 (p < 0.001). Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value were 62.5%, 100%, 100%, and 42.9%, respectively, for nodules with diameters equal to or larger than 1 cm; and 30.8%, 86.7%, 66.7%, and 59.1%, respectively, for nodules less than 1 cm. In the subgroup analysis, neither the lobar location nor the distance of the PPNs to the pleura affected the accuracy of the ENB diagnosis. However, the spiculated sign had a negative impact on the accuracy of the ENB biopsy (p = 0.010).

CONCLUSION

ENB has good specificity and positive predictive value for diagnosing PPNs <2 cm; however, the spiculated sign may negatively affect ENB diagnostic accuracy. In addition, the diagnostic reliability may only be limited to PPNs equal to or larger than 1 cm.

Comparison between percutaneous transthoracic co-axial needle CT-guided biopsy and transbronchial lung biopsy for the diagnosis of persistent pulmonary consolidation

BACKGROUND

Diagnosing persistent pulmonary consolidation still faces challenges. The purpose of this study is to compare the diagnostic yield and the complication rate between percutaneous transthoracic CT-guided coaxial needle biopsy (PTCNB) and transbronchial lung biopsy (TBLB) of persistent pulmonary consolidation.

MATERIALS

From January 1, 2016, to December 31, 2020, we have retrospectively enrolled a total of 155 consecutive patients (95 males, 60 females) with persistent pulmonary consolidation who underwent both TBLB and PTCNB. According to the standard reference, the diagnostic yield, accuracy, sensitivity and specificity of PTCNB and TBLB were assessed and compared.

RESULTS

According to the standard reference, the final biopsy diagnoses of 11 cases were confirmed true malignant based on the surgical resections, the remaining were confirmed by clinical and imaging follow-up for at least 12 months. The overall diagnostic accuracy, sensitivity and specificity of PTCNB for malignant diagnosis were 91.61%, 72.34% and 100%, whereas of TBLB were 87.74%, 59.57% and 100%. The diagnostic yield of PTCNB and TBLB were 50.32% and 25.16%, respectively. For the TBLB-based negative cases, PTCNB provided a definite diagnostic yield of 37.93%. There were 45 (29.03%), 22 (14.19%) and 13 (8.39%) patients who experienced pneumothorax, intrapulmonary hemorrhage and hemoptysis, respectively, in PTCNB, while there were only 5 (3.22%) cases of mild intraprocedural bleeding occurring in TBLB.

CONCLUSIONS

CT-guided co-axial needle biopsy is an effective and safe modality, associated with higher diagnostic yield and better diagnostic accuracy compared to transbronchial lung biopsy for malignancy presenting as persistent consolidation, especially as the complementary method for TBLB-based negative lung lesions.

KEY POINTS

Both PTCNB and TBLB showed high diagnostic accuracy for malignancy. PTCNB had a higher diagnostic yield than TBLB for persistent pulmonary consolidation. PTCNB could provide a complementary diagnosis for TBLB-based negative lung consolidation.

Computed tomography-guided lung biopsy with rapid on-site evaluation for diagnosis of lung lesions: a meta-analysis

BACKGROUND

Lung biopsy (LB) procedures performed with computed tomography (CT guidance can enable the reliable diagnosis of lung lesions. These diagnostic efforts can be further expedited through a rapid on-site evaluation (ROSE) approach, allowing for the rapid assessment of collected tissue samples to gauge the adequacy of these samples, their features, and associated cytomorphological characteristics. The present analysis was developed to examine the safety and efficacy of CT-guided LB with ROSE as a means of diagnosing lung lesions.

METHODS

Studies published as of July 31, 2022 in the PubMed, Embase, and Wanfang databases were identified for this meta-analysis. Diagnostic accuracy was the primary endpoint, while secondary endpoints included the operative duration, the number of punctures, and rates of lung hemorrhage, pneumothorax, and secondary LB.

RESULTS

This meta-analysis included 6 total studies. Relative to CT alone, CT with ROSE was associated with a significant increase in diagnostic accuracy (P < 0.00001). In contrast, there were no significant differences between these two groups with respect to the operative duration (P = 0.86), the number of punctures (P = 0.60), or the rates of pneumothorax (P = 0.82) or lung hemorrhage (P = 0.81). Pooled secondary LB rates were significantly lower for patients that underwent CT with ROSE relative to patients in the CT only group (P = 0.0008). Significant heterogeneity was detected for the operative duration (I² = 94%) and number of punctures (I² = 98%) endpoints, while no publication bias was detected for any study endpoints.

CONCLUSIONS

These results suggest that ROSE may contribute to significant improvements in the diagnostic accuracy of CT-guided LB without contributing to higher rates of complications.

Improving CT-guided transthoracic biopsy diagnostic yield of lung masses using intraprocedural CT and prior PET/CT fusion imaging

Objective

The purpose of this study was to evaluate the usefulness of intraprocedural CT and prior PET/CT fusion imaging in improving the diagnostic yield of CT-guided transthoracic core-needle biopsy (CNB) in lung masses.

Methods

In total, 145 subjects with lung masses suspicious for malignancy underwent image-guided transthoracic CNB. According to imaging modality the subjects were divided into two groups. PET/CT images obtained no more than 14 days before the biopsy were integrated with intraprocedural CT images. The integrated or fused images were then used to plan the puncture sites. The clinical characteristics, diagnostic yield of CNB, diagnostic accuracy rate, procedure-related complications and procedure duration were recorded and compared between the two groups. Final clinical diagnosis was determined by surgical pathology or at least 6-months follow-up. The diagnostic accuracy of CNB was obtained by comparing with final clinical diagnosis.

Results

145 subjects underwent CNB with adequate samples, including 76 in fusion imaging group and 69 in routine group. The overall diagnostic yield and diagnostic accuracy rate were 80.3% (53/66), 82.9% (63/76) for fusion imaging group, 70.7% (41/58), 75.4% (52/69) for routine group, respectively. In addition, the diagnostic yield for malignancy in fusion imaging group (98.1%, 52/53) was higher than that in routine group (81.3%, 39/48). No serious procedure-related complications occurred in both two groups.

Conclusion

CNB with prior PET/CT fusion imaging is particularly helpful in improving diagnostic yield and accurate rate of biopsy in lung masses, especially in heterogeneous ones, thus providing greater potential benefit for patients.

CT fluoroscopy-guided biopsy of pulmonary lesions contacting the interlobar fissure: An analysis of 72 biopsies

PURPOSE

The purpose of this study was to evaluate retrospectively the safety and diagnostic yield of computed tomography (CT) fluoroscopy-guided biopsy for pulmonary lesions with interlobar fissure contact.

MATERIALS AND METHODS

Seventy-two lesions showing interlobar fissure contact (mean size, 15.2 ± 5.3 [SD] mm [range: 5.3-27.0 mm]; mean length of interlobar fissure contact, 8.9 ± 3.6 [SD] mm [range: 2.6-17.5 mm] in 72 patients (33 men, 39 women; mean age, 69.7 ± 10.3 [SD] years; age range: 37-91 years) were evaluated. Multiple variables were assessed to determine the risk factors for diagnostic failure and pneumothorax. Additionally, these variables were compared between these 72 lesions and randomly selected controls (i.e., non-contact lesions).

RESULTS

All biopsies were technically successful using the transfissural (n = 14) or conventional routes (the route into the lung lobe with the target) with (n = 35) or without (n = 23) possible risk of needle insertion into the interlobar fissure after penetrating the target lesion. Sixty-eight (94.4%) procedures succeeded diagnostically and four (5.6%) failed. There were 27 grade I pneumothorax (37.5%), one (1.4%) grade II bleeding, and five (6.9%) grade IIIa pneumothorax requiring chest tube placement. Groups with and without pneumothorax did not differ significantly in patient-, lesion-, or procedure-related variables. Diagnostic yields and pneumothorax occurrence showed no significant differences between lesions with interlobar fissure contact and controls.

CONCLUSION

CT fluoroscopy-guided biopsy of pulmonary lesions with interlobar fissure contact is a safe procedure with a high diagnostic yield. Furthermore, because of potential complications, the transfissural route should be used only when a safer route is not possible.

CT-Guided Percutaneous Core Needle Biopsy in Typing and Subtyping Lung Cancer: A Comparison to Surgery

Background: Lung cancer histologic types and subtypes are closely associated with treatment selection and prognosis prediction. In this study, we aim to evaluate the suitability of computed tomography-guided percutaneous core needle biopsy (CT-guided PCNB) in typing and subtyping lung cancer. Methods: From August 2007 to December 2015, the patients who underwent CT-guided PCNB and lung lesion resection were retrospectively collected and analyzed. All pathological sections were reassessed in consensus by 2 junior pathologists (group A) and 2 senior pathologists (group B), respectively. All cases were diagnosed on 3 levels: first, malignant and benign diagnosis; second, histologic types diagnosis; and third, histologic subtypes diagnosis and compared with surgery results. Pearson chi-square test was used to compare the differences of diagnostic accuracy between pathologists in group A and group B. Results: A cohort of 160 patients was included in this study. On the first level, the diagnostic accuracy was 90.63% (group A) and 94.38% (group B), (P = .20). On the second level, the diagnostic accuracy for malignant lesions, adenocarcinoma (ADC), and squamous cell carcinoma (SQC) were, respectively, 72.66%, 84.72%, and 69.05% (group A) and 76.98%, 90.28%, and 71.43% (group B) (P > .05). On the third level, the diagnostic accuracy for ADC subtypes were 26.39% (group A) and 55.56% (group B) (P < 0.01); for SQC subtypes were 28.57% (group A) and 38.10% (group B) (P = 0.36). Conclusion: Small specimens obtained by CT-guided PCNB were suitable for the diagnosis of lung cancer histologic types, which may contribute to the selection of a suitable treatment strategy for the unresectable lung cancers. While for the diagnosis of subtypes, discussion with experienced pathologists was recommended.

Differentiating between active and latent tuberculosis with chest computed tomography

PURPOSE

The purpose of this study was to evaluate the capabilities of chest computed tomography (CT) in distinguishing between active and latent tuberculosis in patients positive for interferon-gamma release assay (IGRA) testing, and to compare the performance of CT with that of quantitative IGRA testing in a low incidence setting.

MATERIALS AND METHODS

Patients with latent or active tuberculosis define by an IGRA positive test were retrospectively recruited. Sensitivity, specificity and accuracy were determined for CT variables and quantitative IGRA results. Final diagnosis of active tuberculosis was based on clinical data and microbiological culture. Univariable and multivariable analyses were performed using logistic regression model to identify CT variables associated with the diagnosis of active tuberculosis.

RESULTS

A total of 92 patients with positive IGRA results who underwent CT examination were included. There were 54 men and 38 women with a mean age of 53.5±18 (SD) years (range: 40-68 years). Of them, 22 patients (24%) had positive Mycobacterium tuberculosis culture and 70 (76%) had latent tuberculosis. Among CT variables, consolidation had the greatest sensitivity (77%; 95%CI: 60-95%) and "tree-in-bud" the greatest specificity (97%; 95% CI: 93-100%) for the diagnosis of active tuberculosis. At univariable analysis "tree-in-bud", splenic calcification and non-calcified lung nodules were the significant variables independently associated with active tuberculosis. At multivariable analysis, the adjusted odds ratio of "tree-in-bud" was 42.91 (95% CI: 5.62-327.42). Using an optimal threshold of 51 spots, quantitative IGRA yielded 64% sensitivity (95% CI: 44-84%) and 61% specificity (95% CI: 50-73%) for the diagnosis of active tuberculosis.

CONCLUSIONS

In a low incidence setting, chest CT, especially when "tree-in-bud" pattern is present, is superior to quantitative IGRA testing to identify patients with active tuberculosis among those with positive IGRA testing.

CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes

PURPOSE

The purpose of this study was to retrospectively compare two puncture routes (transpleural vs. transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact.

PATIENTS AND METHODS

A total of 102 patients (72 men; mean age, 71.1±9.5 [SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7±5.9 [SD] mm; range, 6.0-29.4mm; mean length of pleural contact, 10.1±4.2 [SD] mm; range, 2.8-19.6mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes.

RESULTS

Biopsy was performed via the direct transpleural route (n=59; 57.8%) and transpulmonary route (n=43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7±9.4 [SD] mm (range: 4.1-47.6mm; P<0.001) and the introducer needle trajectory angle of<45° was significantly observed (8.5% [5/59] vs. 60.5% [26/43]; P<0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43]; P=0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43]; P<0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43]; P=0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43]; P=0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43]; P=0.004) were significantly lower in the direct transpleural group.

CONCLUSION

Direct transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route.

CT features of lung metastases from pancreatic adenocarcinoma: Correlation with histopathologic findings

PURPOSE

The purpose of this study was to evaluate the prevalence of an atypical, alveolar presentation of pulmonary metastases from pancreatic adenocarcinoma (PDAC) on computed tomography (CT) and to correlate CT features with those obtained at histopathologic analysis.

MATERIAL AND METHODS

A total of 76 patients with lung metastases from PDAC over a 10-year period (2009-2019) in a French university hospital were retrospectively included. There were 34 men and 42 women with a mean age of 67.6±11.3 (SD) years (range: 38-89 years). CT features of PDAC were classified according to their presentations as usual metastatic pattern or atypical alveolar pattern; the atypical alveolar pattern corresponding to either ground glass nodules or opacities, solid nodules with a halo sign, "air-space" nodules with air bronchogram, or parenchymal consolidation. Imaging-histopathologic correlation was performed when tissue samples were available.

RESULTS

Pulmonary metastases were synchronous in 36 patients (36/76; 47%) and metachronous in 40 patients (40/76; 53%). A predominant alveolar presentation on CT was observed in 17 patients (17/76, 22%). Nodules with halo sign were the predominant alveolar pattern in 7 patients (7/17; 41%), air-space nodules were predominant in 4 patients (4/17; 24%) whereas pure ground glass nodules and consolidations were observed as predominant features in 3 patients (3/17; 18%) each. For 5 patients who had histopathological confirmation, alveolar metastases of PDAC were characterized by columnar tumor cells lining the alveolar wall, which was not seen in other radiological presentations, whereas there were no differences regarding mucin secretion between pulmonary metastases with alveolar presentation and those with typical pattern.

CONCLUSIONS

Lung metastases from PDAC may present with a so-called "alveolar" pattern on CT. This misleading CT features is found in 22% of patients with lung metastases from PDAC and is due to lepidic growth of the metastatic cells.