1
|
Zhu J, Qu Y, Lu M, Ma A, Mo J, Wen Z. CT-based radiomics for prediction of pulmonary haemorrhage after percutaneous CT-guided transthoracic lung biopsy of pulmonary nodules. Clin Radiol 2023; 78:e993-e1000. [PMID: 37726191 DOI: 10.1016/j.crad.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
AIM To evaluate the feasibility of intranodular and perinodular computed tomography (CT) radiomics features for predicting the occurrence of pulmonary haemorrhage after percutaneous CT-guided transthoracic lung biopsy (PCTLB) in pulmonary nodules. MATERIALS AND METHODS The data for 332 patients with pulmonary nodules who underwent PCTLB were reviewed retrospectively. Pulmonary haemorrhage after PCTLB was evaluated using CT (144 cases occurred). Radiomics features based on gross nodular (GNV) and perinodular volumes (PNV) were extracted from pre-biopsy CT images and features selection using least absolute shrinkage and selection operator (LASSO) regression, and three radiomics scores (rad-scores) were built. Rad-scores, clinical, and clinical-radiomic models were developed and evaluated to predict the occurrence of pulmonary haemorrhage. RESULTS Five, five, and six significant features were selected for prediction of pulmonary haemorrhage based on GNV, PNV, and GNV + PNV, respectively. Lesion depth was the only clinical characteristics related to pulmonary haemorrhage. Lesion depth and rad-score based on GNV, PNV, and GNV + PNV for predicting the pulmonary haemorrhage achieved areas under the curves (AUCs) of 0.656, 0.645, 0.651, and 0.635 in the validation group, respectively. Three clinical-radiomic models improved the AUCs to 0.743, 0.723, and 0.748. The performance of rad-score_GNV + PNV combined with lesion depth outperformed the clinical model (p=0.024) and the radiomics signature (p=0.038). In addition, the radiomics signatures were significantly associated with higher-grade pulmonary haemorrhage (p<0.05). CONCLUSIONS Radiomics features from intranodular and perinodular regions of pulmonary nodules have good predictive ability for pulmonary haemorrhage after PCTLB, which may provide additional predictive value for clinical practice.
Collapse
Affiliation(s)
- J Zhu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, 510282, China
| | - Y Qu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, 510282, China
| | - M Lu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, 510282, China
| | - A Ma
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, 510282, China
| | - J Mo
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, 510282, China
| | - Z Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, 510282, China.
| |
Collapse
|
2
|
Yang S, Li J, Wang W, Lou L, Jin X, Wang S, Cai J, Cai C. Development and validation of a predictive model for pulmonary hemorrhage in computed tomography-guided percutaneous lung biopsy. Postgrad Med J 2023; 99:1173-1181. [PMID: 37516454 DOI: 10.1093/postmj/qgad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/13/2023] [Accepted: 07/01/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE This study aimed to identify risk factors for pulmonary hemorrhage (PH) and higher-grade PH that complicate computed tomography (CT)-guided percutaneous lung biopsy (CT-PNLB) and establish predictive models to quantify the risk. METHODS A total of 2653 cases of CT-PNLB were enrolled. Multivariate logistic regression was used to identify independent risk factors to develop a nomogram prediction model. The model was assessed using the area under the curve (AUC) of the receiver operator characteristic (ROC) and calibration curves and validated in the validation group. RESULTS PH occurred in 23.52% (624/2653) of cases, and higher-grade PH occurred in 7.09% (188/2653) of cases. The parameters of lesion size, puncture depth, and contact to pleura were identified as risk factors of PH and higher-grade PH in the logistic regression model, besides the position as a risk factor for PH. The AUC of the PH prediction model was 0.776 [95% confidence interval (CI): 0.752-0.800], whereas that of the validation group was 0.743 (95% CI: 0.706-0.780). The AUC of the higher-grade PH prediction model was 0.782 (95% CI: 0.742-0.832), whereas that of the validation group was 0.769 (95% CI: 0.716-0.822). The calibration curves of the model showed good agreement between the predicted and actual probability in the development and validation groups. CONCLUSION We identified risk factors associated with PH and higher-grade PH after PNLBs. Furthermore, we developed and validated two risk prediction models for PNLB-related PH and higher-grade PH risk prediction and clinical decision support. Key messages What is already known on this topic Pulmonary hemorrhage (PH) and other hemorrhagic complications are the most common complication in CT-guided percutaneous lung biopsy (CT-PNLB), except pneumothorax. However, the risk factors associated with PH remain controversial, and research on models of PH and higher-grade PH is also limited. What this study adds The parameters of lesion size, puncture depth, and contact to pleura were identified as risk factors of PH and higher-grade PH in the logistic regression model, besides the position as a risk factor for PH. In addition, we developed and validated two risk prediction models for PNLB-related PH and higher-grade PH risk prediction and clinical decision support. How this study might affect research, practice, or policy Of all the predictors, the position is the key factor to be considered by the operator. Moreover, two risk prediction models show good discrimination and calibration characteristics to identify patients at high risk of hemorrhage and higher-grade PH after PNLB, so these could assist clinicians in avoiding risk factors in advance.
Collapse
Affiliation(s)
- Song Yang
- Department of Nephrology, Wenzhou Central Hospital, Wenzhou, 325000, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jie Li
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Wangjia Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Lejing Lou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiao Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shijia Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jihao Cai
- Renji College, Wenzhou Medical University, Wenzhou, 325000, China
| | - Chang Cai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| |
Collapse
|
3
|
Philip B, Jain A, Wojtowicz M, Khan I, Voller C, Patel RSK, Elmahdi D, Harky A. Current investigative modalities for detecting and staging lung cancers: a comprehensive summary. Indian J Thorac Cardiovasc Surg 2023; 39:42-52. [PMID: 36590039 PMCID: PMC9794670 DOI: 10.1007/s12055-022-01430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 12/05/2022] Open
Abstract
This narrative review compares the advantages and drawbacks of imaging and other investigation modalities which currently assist with lung cancer diagnosis and staging, as well as those which are not routinely indicated for this. We examine plain film radiography, computed tomography (CT) (alone, as well as in conjunction with positron emission tomography (PET)), magnetic resonance imaging (MRI), ultrasound, and newer techniques such as image-guided bronchoscopy (IGB) and robotic bronchoscopy (RB). While a chest X-ray is the first-line imaging investigation in patients presenting with symptoms suggestive of lung cancer, it has a high positive predictive value (PPV) even after negative X-ray findings, which calls into question its value as part of a potential national screening programme. CT lowers the mortality for high-risk patients when compared to X-ray and certain scoring systems, such as the Brock model can guide the need for further imaging, like PET-CT, which has high sensitivity and specificity for diagnosing solitary pulmonary nodules as malignant, as well as for assessing small cell lung cancer spread. In practice, PET-CT is offered to everyone whose lung cancer is to be treated with a curative intent. In contrast, MRI is only recommended for isolated distant metastases. Similarly, ultrasound imaging is not used for diagnosis of lung cancer but can be useful when there is suspicion of intrathoracic lymph node involvement. Ultrasound imaging in the form of endobronchial ultrasonography (EBUS) is often used to aid tissue sampling, yet the diagnostic value of this technique varies widely between studies. RB is another novel technique that offers an alternative way to biopsy lesions, but further research on it is necessary. Lastly, thoracic surgical biopsies, particularly minimally invasive video-assisted techniques, have been used increasingly to aid in diagnosis and staging.
Collapse
Affiliation(s)
- Bejoy Philip
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, L14 3PE UK
| | - Anchal Jain
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Inayat Khan
- Department of Medicine, Royal Sussex County Hospital, Brighton, UK
| | - Calum Voller
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Darbi Elmahdi
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, L14 3PE UK
| |
Collapse
|
4
|
Older Age and Abnormal Pulmonary Ventilation Function Do Not Increase the Risk of Pulmonary Hemorrhage Caused by CT-Guided Percutaneous Core Needle Biopsy. Can Respir J 2022; 2022:5238177. [PMID: 36033344 PMCID: PMC9410978 DOI: 10.1155/2022/5238177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to analyze the differences in risk factors for pulmonary hemorrhage in elderly and young patients with percutaneous computed tomography-guided needle biopsies (PCNBs). The correlations between the incidence of pulmonary hemorrhage and pulmonary function indicators before CT-guided PCNB were also discussed. Methods Between January 2018 and December 2019, 1,100 consecutive patients underwent CT-guided PCNBs at Qilu Hospital. Both univariate and multivariate logistic regression analyses identified risk factors for hemorrhage. Results The occurrence of pulmonary hemorrhage was 22.1% in elderly patients and was 22.6% in young patients. In elderly patients, pulmonary hemorrhage was significantly influenced by needle depth to the lesion and dwell time, while in young patients, pulmonary hemorrhage was independently associated with lesion size, needle depth to the lesion, and dwell time. However, pulmonary function parameters, including FVC (% pred), FEV1 (% pred), FEV1/FVC ratio (%), small airway function parameters (FEF50%, FEF75%, and FEF25–75%), and large airway function parameters (MVV, PEF, and FEF25%), were not risk factors for hemorrhage. Furthermore, the incidence of pulmonary hemorrhage was not associated with different types of pulmonary dysfunctions. The risk of pulmonary hemorrhage did not increase with the severity of pulmonary dysfunctions. Conclusions In this study, age is no longer a risk factor in evaluating pulmonary hemorrhage. Longer needle depth to the lesion and longer dwell time were significantly high risk factors of hemorrhage in both elderly patients and young patients. Patients with severe pulmonary dysfunctions did not show increased risks of pulmonary hemorrhage here.
Collapse
|
5
|
Iguchi T, Matsui Y, Tomita K, Uka M, Umakoshi N, Munetomo K, Hiraki T. CT fluoroscopy-guided biopsy of pulmonary lesions contacting the interlobar fissure: An analysis of 72 biopsies. Diagn Interv Imaging 2022; 103:302-309. [PMID: 35144888 DOI: 10.1016/j.diii.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan; Department of Radiological Technology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan.
| | - Yusuke Matsui
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| |
Collapse
|
6
|
Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Tanaka T, Munetomo K, Gobara H, Kanazawa S. CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes. Diagn Interv Imaging 2021; 102:539-544. [PMID: 34099434 DOI: 10.1016/j.diii.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Takashi Tanaka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| |
Collapse
|
7
|
CT Guided Needle Biopsy of Peripheral Lesions-Lesion Characteristics That May Increase the Diagnostic Yield and Reduce the Complication Rate. J Clin Med 2021; 10:jcm10092031. [PMID: 34065147 PMCID: PMC8126034 DOI: 10.3390/jcm10092031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022] Open
Abstract
Computed tomography-guided needle biopsy (CT-GNB) has a high diagnostic yield for lung cancer but higher complication rates compared to those of other biopsy modalities. We sought to clarify in which thoracic lesions we could achieve a quick pathological diagnosis using CT-GNB, considering the risks and benefits. We retrospectively enrolled 110 patients who underwent CT-GNB and 547 patients who underwent transbronchial biopsy (TBB) for parenchymal lung lesions in clinical practice. The diagnostic rates of CT-GNB and TBB were 87.3% and 75.3%. After failed diagnosis with other biopsy modalities, 92.3% of patients were finally diagnosed using CT-GNB and 65.8% using TBB. In cases with a negative bronchial sign, there was a statistically higher diagnostic rate with CT-GNB than with TBB (p < 0.001: 89.4% vs. 0%). Complication rates were higher with CT-GNB (50.9%) than with TBB (16.3%). However, there were lower rates of complications in cases with inhomogeneous tumors, subpleural lesions, and when more than 15 mm of the punctured needle length was within the target. We conclude that CT-GNB is an effective biopsy modality with a high diagnostic rate that is especially recommended when the bronchus sign is negative. It can be safely performed if risk factors for complications are taken into account.
Collapse
|
8
|
Hu H, Li C, Lv T, Li H, Hu Y, Shen Q, Mino-Kenudson M, Bertolaccini L, Rocco G, Zarogoulidis P, Zhang F, Lin D, Liu H, Song Y. Contrast-enhanced computed tomography prior to percutaneous transthoracic needle biopsy reduces the incidence of hemorrhage. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:288. [PMID: 33708915 PMCID: PMC7944326 DOI: 10.21037/atm-20-4384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Hemorrhage is the second most common complication of percutaneous transthoracic needle biopsy (PTNB), and at present, there is no effective prevention strategy. Contrast-enhanced computed tomography (CECT) has the advantage of clearly visualizing blood supply within the lesion and aiding in the imaging of blood vessels, which can reduce hemorrhage complicating PTNB. As no large-sample studies were evaluating whether CECT could reduce hemorrhage, we conducted the present retrospective study. Methods From November 2011 to February 2016, 1,282 biopsies at Jinling Hospital were retrospectively reviewed; 555 underwent CECT, and 727 underwent non-contrast computed tomography (CT). Factors associated with hemorrhage were defined, and hemorrhage rates were compared between the 2 groups. Results We found that pre-biopsy CECT was associated with a reduced incidence of biopsy-related hemorrhage compared to non-contrast CT (16.4% vs. 23.1%, P=0.003). Propensity score matching (PSM) analysis also showed that the incidence of hemorrhage in the CECT group was lower than that of the non-contrast CT group at a ratio of 1:1 (P=0.039), 1:2 (P=0.028), or 1:3 (P=0.013). In the multivariate analysis, CECT before PTNB was found to be significantly associated with a reduced risk of hemorrhage [odds ratio (OR): 0.671, 95% confidence interval (CI): 0.499–0.902, P=0.008]. Puncture position, lesion size, depth of needle tract, and the number of punctures were also found to be associated with hemorrhage (all P<0.05). Conclusions Compared with non-contrast CT, CECT significantly reduced the risk of post-biopsy pulmonary hemorrhage, which suggests that CECT should be performed before PTNB.
Collapse
Affiliation(s)
- Huan Hu
- Department of Respiratory Medicine, Suzhou Hospital Affiliated Nanjing Medical University, Suzhou, China
| | - Chuling Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Huijuan Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yangbo Hu
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Qin Shen
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Pavlos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fang Zhang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Dang Lin
- Department of Respiratory Medicine, Suzhou Hospital Affiliated Nanjing Medical University, Suzhou, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | | |
Collapse
|
9
|
Chen C, Xu L, Sun X, Liu X, Han Z, Li W. Safety and diagnostic accuracy of percutaneous CT-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. ACTA ACUST UNITED AC 2020; 27:94-101. [PMID: 33090094 DOI: 10.5152/dir.2020.20051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the safety and diagnostic accuracy of computed tomography (CT)-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. METHODS This retrospective study examined the safety and diagnostic accuracy of percutaneous CT-guided biopsy for small lung nodules (≤20 mm) located within 10 mm of the pericardium or great vessels. Technical aspects and factors influencing complications were assessed, and diagnostic accuracy was calculated. RESULTS A total of 168 biopsies were performed in 168 patients. The complications were mainly pneumothorax (34.5%; 58 of 168 patients), chest tube insertion (5.3%; 9 of 168 patients), and pulmonary hemorrhage (61.3%; 103 of 168 procedures), with no patient mortality. One patient (0.6%) was admitted because of hemorrhage complications. Significant independent risk factors for pneumothorax were nodules resided in upper or middle lobes and lateral patient position, and for hemorrhage, longer distance from structures and longer needle trajectory through the lung parenchyma. Overall, the sensitivity, accuracy, and specificity were 91.0%, 92.2%, and 100%, respectively. CONCLUSION Percutaneous CT-guided transthoracic biopsy was highly accurate in small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. Complications are common, but most were minor and self-limited.
Collapse
Affiliation(s)
- Chao Chen
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaofei Sun
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoxia Liu
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhi Han
- Department of Spine Surgery, Luoyang Orthopedic Hospital of Henan Province, Luoyang, Henan, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| |
Collapse
|
10
|
Chen C, Xu L, He J, Wang Y, Wang B, Li W, He X. Contralateral Dependent Position During Percutaneous CT-Guided Core Needle Biopsy for Small (≤ 20 mm) Lung Lesions Adjacent to the Pericardium: Effect on Procedures and Complications. Cardiovasc Intervent Radiol 2020; 43:1652-1660. [PMID: 32803284 DOI: 10.1007/s00270-020-02608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the effect of contralateral dependent position on procedures and complications of percutaneous computed tomography (CT)-guided core needle biopsy (PCT-CNB) for small (≤ 20 mm) lung lesions adjacent to the pericardium. MATERIALS AND METHODS Retrospective view was performed to identify patients with small (≤ 20 mm) lung lesions located within 10 mm of the pericardium and who underwent PCT-CNB in the standard supine or prone position (n = 66) or in contralateral dependent position ( n = 35) between March 2010 and January 2020. In 35 patients, CT images in the contralateral dependent position were compared with images in the supine position to assess the mean distance of the lesion from the pericardium and the mean length of interface between these two positions. Complications including rates of pneumothorax, chest tube insertion, and pulmonary hemorrhage were assessed. RESULTS In comparison with axial images in supine position, the pericardium were located farther from the lesion in the contralateral dependent position; the mean distance of lesions from the pericardium became farther (P < 0.001), and the mean length of interface with the pericardium became shorter (P = 0.008). There was no difference in the complication rates between supine or prone position and contralateral dependent position (pneumothorax, P = 0.098; pulmonary hemorrhage, P = 0.791). CONCLUSION Placing patients in contralateral dependent position may confer some advantages, including maximizing distance and minimizing length of interface of the lesion to the pericardium during PCT-CNB for small (≤ 20 mm) lung lesions adjacent to the pericardium.
Collapse
Affiliation(s)
- Chao Chen
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Lichao Xu
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Jia He
- Blood Purification Room, Queshan County People's Hospital, Zhumadian, Henan Province, 463200, China
| | - Ying Wang
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Biao Wang
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Wentao Li
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China.
| | - Xinhong He
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| |
Collapse
|
11
|
Wang D, Li B, Bie Z, Li Y, Li X. Synchronous core-needle biopsy and microwave ablation for highly suspicious malignant pulmonary nodule via a coaxial cannula. J Cancer Res Ther 2020; 15:1484-1489. [PMID: 31939426 DOI: 10.4103/jcrt.jcrt_721_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims This study aimed to evaluate the safety and feasibility of computed tomography (CT)-guided synchronous percutaneous core-needle biopsy and microwave ablation (MWA) for highly suspicious malignant pulmonary nodules. Materials and Methods This retrospective study evaluated medical records of 54 consecutive patients (mean age, 65.5 ± 11.2 years) with 62 highly suspicious malignant pulmonary nodules who synchronously underwent percutaneous core-needle biopsy and MWA via a coaxial cannula (Group A) or sequentially underwent these procedures (Group B) from September 2016 to November 2017. All patients were followed up for at least 6 months after MWA. The safety and feasibility of synchronous core-needle biopsy and MWA were analyzed by comparing clinical data, technical success rate, complication, and curative effect per nodule with those of sequential procedures. Results Technical success rates were 100% in both groups. The pneumothorax rate was 29.6% (8/27) in Group A and 57.1% (20/35) in Group B, which was statistically different (P = 0.031). In Group A, hemoptysis and pleural effusion rates were 22.2% (6/27), and in Group B, the corresponding rates were 28.6% (10/35) and 20.0% (7/35), respectively. No postprocedural pulmonary artery pseudoaneurysm, bronchopleural fistula, or needle-tract tumor seeding developed in both groups. After 6 months' follow-up, the effective rates (complete + partial response) in both groups were 100%. Conclusions Synchronous core-needle biopsy and MWA via a coaxial cannula is technically safe and feasible in the management of highly suspicious malignant pulmonary nodules, and this procedure has lesser complications and similar effects (both 100% effective treatment) compared with sequential procedures.
Collapse
Affiliation(s)
- Dongdong Wang
- Department of Center of Minimally Invasive Therapies for Tumors, Beijing Hospital, National Center of Gerontology, Dongdan, Beijing, China
| | - Bin Li
- Department of Center of Minimally Invasive Therapies for Tumors, Beijing Hospital, National Center of Gerontology, Dongdan, Beijing, China
| | - Zhixin Bie
- Department of Center of Minimally Invasive Therapies for Tumors, Beijing Hospital, National Center of Gerontology, Dongdan, Beijing, China
| | - Yuanming Li
- Department of Center of Minimally Invasive Therapies for Tumors, Beijing Hospital, National Center of Gerontology, Dongdan, Beijing, China
| | - Xiaoguang Li
- Department of Center of Minimally Invasive Therapies for Tumors, Beijing Hospital, National Center of Gerontology, Dongdan, Beijing, China
| |
Collapse
|
12
|
Lee JW, Park CH, Lee SM, Jeong M, Hur J. Planting Seeds into the Lung: Image-Guided Percutaneous Localization to Guide Minimally Invasive Thoracic Surgery. Korean J Radiol 2020; 20:1498-1514. [PMID: 31606955 PMCID: PMC6791818 DOI: 10.3348/kjr.2019.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
Image-guided localization materials are constantly evolving, providing options for the localization of small pulmonary nodules to guide minimally invasive thoracic surgery. Several preoperative methods have been developed to localize small pulmonary lesions prior to video-assisted thoracic surgery. These localization techniques can be categorized into 4 groups according to the materials used: localization with metallic materials (hook-wire, microcoil, or spiral coil), localization with dye (methylene blue or indigo carmine), localization with contrast agents (lipiodol, barium, or iodine contrast agents), and radiotracers (technetium-99m). However, the optimal localization method has not yet been established. In this review article, we discuss the various localization techniques and the advantages and disadvantages of localization techniques as well as the available safety and efficacy data on these techniques.
Collapse
Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miri Jeong
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
13
|
Zhu J, Qu Y, Wang X, Jiang C, Mo J, Xi J, Wen Z. Risk factors associated with pulmonary hemorrhage and hemoptysis following percutaneous CT-guided transthoracic lung core needle biopsy: a retrospective study of 1,090 cases. Quant Imaging Med Surg 2020; 10:1008-1020. [PMID: 32489925 DOI: 10.21037/qims-19-1024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Pulmonary hemorrhage and hemoptysis are the second-most common and potentially life-threatening complications after pneumothorax following percutaneous computed tomography-guided transthoracic lung biopsy (PCTLB). Preventing hemorrhagic complications after PCTLB requires an accurate estimation of risk factors. This study investigated the risk factors associated with pulmonary hemorrhage and hemoptysis following PCTLB, and whether the ratio of main pulmonary artery diameter (mPAD) to ascending aorta diameter (mPAD/AAD ratio) is a risk factor. Methods We retrospectively analyzed 1,090 cases of PCTLB obtained from 1,050 patients using a core needle. The risk factors for overall pulmonary hemorrhage, higher-grade pulmonary hemorrhage, and hemoptysis were evaluated by multivariate analysis of patient characteristics, computed tomography (CT) imaging data including pulmonary artery diameter (mPAD) to ascending aorta diameter (mPAD/AAD) ratio, technical variables related to the biopsy, and pathologic findings. Results Pulmonary hemorrhage occurred in 31.38% (342/1,090) of PCTLB cases, including lower-grade (24.4%, 266/1,090) and higher-grade hemorrhage (6.97%, 76/1,090). The incidence of hemoptysis was 3.03% (33/1,090). Multivariate analysis revealed significant associations between overall pulmonary hemorrhage and lesion location in the lower lobe, subsolid and smaller lesions, greater lesion depth, and lung metastases. For higher-grade pulmonary hemorrhage, an mPAD/AAD ratio >1, smaller lesions, greater lesion depth, emphysema, and lung metastases were risk factors. Risk factors for hemoptysis were history of hypertension and lower- and higher-grade pulmonary hemorrhage. Conclusions Pulmonary artery enlargement detected by CT (mPAD/AAD ratio >1) is independently associated with higher-grade pulmonary hemorrhage following PCTLB.
Collapse
Affiliation(s)
- Jianbin Zhu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yaoming Qu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Xianlong Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Chunxiu Jiang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Jianhua Mo
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Jiandong Xi
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| |
Collapse
|
14
|
Cardiac motion non-influential in percutaneous computed tomography-guided biopsies of small (≤ 20 mm) lung nodules near pericardium. Jpn J Radiol 2020; 38:890-898. [PMID: 32297063 DOI: 10.1007/s11604-020-00970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the impact of cardiac motion during percutaneous computed tomography (CT)-guided core needle biopsy (PCT-CNB) of small lung lesions near pericardium, focusing on safety and diagnostic accuracy. MATERIALS AND METHODS Seventy-eight PCT-CNBs were performed between March 2010 and June 2018 in 78 patients with small (≤ 20 mm) lung nodules, each within 10 mm of pericardium. Shifts in distance and length of interface separating lesions from pericardium were calculated and compared by cardiac chambers (left atrium, left ventricle, right atrium, or right ventricle). Risk factors for complications were subjected to univariate analysis, and diagnostic accuracy was assessed. RESULTS The respective mean values were 0.8 ± 1.1 mm (range 0-5.1 mm) for shifts in distance and 1.5 ± 2.1 mm (range 0-10.8 mm) for length of interface. Neither parameter shifted significantly with respect to cardiac chambers (p > 0.05, both). Pneumothorax ensued in 28 patients (35.9%), and pulmonary hemorrhage occurred in 41 (52.6%). The overall sensitivity, specificity, and accuracy of PCT-CNB were 91.2%, 100%, and 93.2%, respectively. CONCLUSION Our data indicate that cardiac motion has no impact on either the incidence of complications or the diagnostic accuracy of PCT-CNB in patients with small (≤ 20 mm) lung lesions near pericardium.
Collapse
|
15
|
Padovani B, Boutros J, Marquette CH, Hofman V, Ducreux D, Mouroux J, Diascorn Y, Leroy S. CT-guided percutaneous biopsies of mediastinal and paramediastinal masses in the lateral decubitus position. Eur Radiol 2020; 30:3146-3151. [PMID: 32065281 DOI: 10.1007/s00330-020-06659-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/11/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous parasternal puncture is a common procedure that allows sampling of mediastinal lesions. The trans-pulmonary route is sometimes mandatory in the dorsal position and is associated with complications such as pneumothorax. METHODS Our study explored the efficacy of the lateral decubitus position in avoiding the trans-pulmonary route. Sixteen patients were included between 2005 and 2019. In three patients, the procedure was intended to place fiducial markers. RESULTS No pneumothorax or hematoma occurred. Access to the lesion was not possible in 1 patient. A histological diagnosis was made for all patients undergoing sampling. This technique seems to be safe and efficient. KEY POINTS • Parasternal access to mediastinal and paramediastinal lesions whenever a trans-pulmonary crossing is mandatory in the dorsal position is safe, simple, and efficient in the lateral decubitus position.
Collapse
Affiliation(s)
- Bernard Padovani
- Department of Radiology, Université Côte d'Azur, CHU de Nice, Nice, France.
| | - Jacques Boutros
- Department of Pulmonary Medicine, Université Côte d'Azur, CHU de Nice, Nice, France
| | - Charles-Hugo Marquette
- Department of Pulmonary Medicine, Université Côte d'Azur, CHU de Nice, Nice, France.,FHU OncoAge, CNRS UMR7284, Inserm U1081, Institute of Research on Cancer and Ageing (IRCAN), Université Côte d'Azur, Nice, France
| | - Véronique Hofman
- FHU OncoAge, CNRS UMR7284, Inserm U1081, Institute of Research on Cancer and Ageing (IRCAN), Université Côte d'Azur, Nice, France.,FHU OncoAge, Centre Hospitalier Universitaire de Nice, Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, Nice, France
| | - Dorothée Ducreux
- Department of Radiology, Université Côte d'Azur, CHU de Nice, Nice, France
| | - Jérome Mouroux
- Department of Thoracic Surgery, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Yann Diascorn
- Department of Radiology, Université Côte d'Azur, CHU de Nice, Nice, France
| | - Sylvie Leroy
- Department of Pulmonary Medicine, Université Côte d'Azur, CHU de Nice, Nice, France.,CNRS UMR 7275, Institut de Pharmacologie Moléculaire et Cellulaire, Université Côte d'Azur, Sophia Antipolis, France
| |
Collapse
|
16
|
Dautruche A, Filion E, Mathieu D, Bahig H, Roberge D, Lambert L, Vu T, Campeau MP. To Biopsy or Not to Biopsy?: A Matched Cohort Analysis of Early-Stage Lung Cancer Treated with Stereotactic Radiation with or Without Histologic Confirmation. Int J Radiat Oncol Biol Phys 2020; 107:88-97. [PMID: 32004581 DOI: 10.1016/j.ijrobp.2020.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/11/2020] [Accepted: 01/21/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE For nonoperable stage I non-small cell lung cancer, stereotactic body radiation therapy (SBRT) has emerged as a standard treatment option. We aimed to compare the clinical outcomes of lung SBRT between patients with versus without pathologic cancer diagnosis. METHODS AND MATERIALS We included patients treated by SBRT for a single pulmonary lesion between July 2009 and July 2017. Patients in the clinical diagnosis group had a positron emission tomography/computed tomography scan showing hypermetabolism, growth of the mass on sequential computed tomography, and were not eligible for biopsy, refused biopsy, or had an inconclusive biopsy. For each of those patients, a matched pair in the pathologic diagnosis group was identified by matching for patient, treatment, and tumoral characteristics. We performed a power calculation to estimate the sample size required to detect a difference arising from a 5% or 15% rate of benign processes in the group without pathology. RESULTS A total of 924 lung SBRT treatments were performed among 878 patients from 2009 to 2017. Within this population, 131 patients were treated based on clinical findings. They were matched with 131 patients with a pathologic diagnosis who received treatment. At 3 years, no significant differences were observed in overall survival (hazard ratio [HR], 1.2; 95% confidence interval [CI], 0.7-2.1), local control (HR, 0.9; 95% CI, 0.4-2), or regional (HR, 0.5; 95% CI, 0.2-1.4) or distant recurrence (HR, 0.6; 95% CI, 0.3-1.1). CONCLUSIONS In our population, we found no clinically significant difference in patterns of recurrence or survival after lung SBRT for patients who had received clinical versus pathological diagnoses. There was, however, a trend toward more distant recurrences in the pathologic diagnosis group. Our power calculation suggests that data from multiple institutions would be required to rule out a difference in outcomes due to 5% to 15% of clinically diagnosed cases being treated for benign processes.
Collapse
Affiliation(s)
| | - Edith Filion
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | | | - Houda Bahig
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - David Roberge
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Louise Lambert
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Toni Vu
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | | |
Collapse
|
17
|
Accuracy and complications of CT-guided pulmonary core biopsy in small nodules: a single-center experience. Cancer Imaging 2019; 19:51. [PMID: 31337425 PMCID: PMC6651998 DOI: 10.1186/s40644-019-0240-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/16/2019] [Indexed: 01/05/2023] Open
Abstract
Background Computed tomography (CT)-guided pulmonary core biopsies of small pulmonary nodules less than 15 millimeters (mm) are challenging for radiologists, and their diagnostic accuracy has been shown to be variable in previous studies. Common complications after the procedure include pneumothorax and pulmonary hemorrhage. The present study compared the diagnostic accuracy of small and large lesions using CT-guided core biopsies and identified the risk factors associated with post-procedure complications. Methods Between January 1, 2016, and December 31, 2017, 198 CT-guided core biopsies performed on 195 patients at our institution were retrospectively enrolled. The lesions were separated into group A (< or = 15 mm) and group B (> 15 mm) according to the longest diameter of the target lesions on CT. Seventeen-gauge introducer needles and 18-gauge automated biopsy instruments were coaxially used for the biopsy procedures. The accuracy and complications, including pneumothorax and pulmonary hemorrhage, of the procedures of each group were recorded. The risk factors for pneumothorax and pulmonary hemorrhage were determined using univariate analysis of variables. Results The diagnostic accuracies of group A (n = 43) and group B (n = 155) were 83.7 % and 96.8 %, respectively (p = 0.005). The risk factors associated with post-biopsy pneumothorax were longer needle path length from the pleura to the lesion (p = 0.020), lesion location in lower lobes (p = 0.002), and patients with obstructive lung function tests (p = 0.034). The risk factors associated with post-biopsy pulmonary hemorrhage were longer needle path length from the pleura to the lesion (p < 0.001), smaller lesions (p < 0.001), non-pleural contact lesions (p < 0.001), patients without restrictive lung function tests (p = 0.034), and patients in supine positions (p < 0.003). Conclusion CT-guided biopsies of small nodules equal to or less than 15 mm using 17-gauge guiding needles and 18-gauge biopsy guns were accurate and safe. The biopsy results of small lesions were less accurate than those of large lesions, but the results were a reliable reference for clinical decision-making. Understanding the risk factors associated with the complications of CT-guided biopsies is necessary for pre-procedural planning and communication.
Collapse
|
18
|
Influencing factors of pneumothorax and parenchymal haemorrhage after CT-guided transthoracic needle biopsy: single-institution experience. Pol J Radiol 2019; 83:e379-e388. [PMID: 30655914 PMCID: PMC6334090 DOI: 10.5114/pjr.2018.79202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/10/2018] [Indexed: 01/05/2023] Open
Abstract
Purpose To evaluate the incidences and influencing factors of pneumothorax and parenchymal haemorrhage after computed tomography (CT)-guided transthoracic needle biopsy (TTNB). Material and methods A retrospective analysis of 216 patients who underwent CT-guided TTNB was performed. The frequencies and risk factors of pneumothorax and parenchymal haemorrhage were determined. P values less than 0.05 were considered statistically significant. Results The incidences of pneumothorax and parenchymal haemorrhage were 23.1% and 45.4%, respectively. Twenty-two per cent of patients with pneumothorax needed percutaneous drainage, but all patients with parenchymal haemorrhage had clinical improvement after conservative treatment. No procedure-related mortality was detected. Univariate analysis showed that underlying pulmonary infection, lesion size of less than 1 cm, and lesion depth of more than 2 cm were significant influencing factors of pneumothorax. A significant relationship between the underlying chronic obstructive pulmonary disease (COPD) and the need for drainage catheter insertion was found. Pulmonary haemorrhage was more likely to occur in patients with underlying malignancy, solid pulmonary nodule, lesion size of 3 cm or less, and lesion depth of more than 3 cm. Consolidation was the protective factor for pulmonary haemorrhage. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV), and accuracy of CT-guided core needle biopsy (CNB) for the diagnosis of malignancy were 95.7%, 100%, 100%, 93.3%, and 97.3%, respectively. The rate of diagnostic failure was 10.2%. Conclusions Pulmonary hemorrhage is the most common complication after CT-guided TTNB. Influencing factors for pneumothorax are underlying pulmonary infection, lesion size < 1 cm, and lesion depth > 2 cm. Underlying malignancy, solid pulmonary nodule, lesion size ≤ 3 cm, and lesion depth > 3 cm are associated with pulmonary haemorrhage.
Collapse
|
19
|
Bingham BA, Huang SY, Chien PL, Ensor JE, Gupta S. Pulmonary Hemorrhage Following Percutaneous Computed Tomography-Guided Lung Biopsy: Retrospective Review of Risk Factors, Including Aspirin Usage. Curr Probl Diagn Radiol 2018; 49:12-16. [PMID: 30470549 DOI: 10.1067/j.cpradiol.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND To evaluate the significance of aspirin, as well as, other potential confounding risk factors, on the incidence and volume of pulmonary hemorrhage in patients undergoing percutaneous computed tomography-guided lung biopsy. METHODS This retrospective study was approved by the institutional review board. Between September 2013 and December 2014, 252 patients taking aspirin underwent transthoracic computed tomography-guided lung biopsy. Patient, technical, and lesion-related risk factors were evaluated. Univariate analysis was performed with a Student's t test, chi-square test, or Fisher's exact test, as appropriate followed by multivariate logistic regression. RESULTS Of 252 patients, 49 (19.4%) continued or stopped aspirin ≤4 days prior to biopsy and 203 (80.6%) patients stopped aspirin ≥5 days prior to biopsy. Pulmonary hemorrhage occurred in 174 cases (69.0%). The median volume of hemorrhage was 3.74 cm3 (range, 0-163.5 cm3). Multivariate analysis revealed that lesion size (P < 0.0001) and lesion depth (P < 0.0001) were independent risk factors for the incidence of pulmonary hemorrhage, while lesion size (P = 0.0035), transgression of intraparenchymal vessels (P < 0.0001), and lesion depth (P = 0.0047) were independent risk factors for severity of hemorrhage. Aspirin stopped ≤4 days from a percutaneous lung biopsy was not associated with pulmonary hemorrhage. CONCLUSION Aspirin taken concurrently or stopped within 4 days of transthoracic lung biopsy is not an independent risk factor for pulmonary hemorrhage. The incidence of hemorrhage following lung biopsy is associated with lesion size and depth, while the severity of hemorrhage is associated with lesion size, depth, as well as traversal of intraparenchymal vessels.
Collapse
Affiliation(s)
- Brigid A Bingham
- The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology, Houston, TX
| | - Steven Y Huang
- The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology, Houston, TX.
| | - Pamela L Chien
- The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology, Houston, TX
| | - Joe E Ensor
- Houston Methodist Research Institute, Houston Methodist Cancer Center, Houston, TX
| | - Sanjay Gupta
- The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology, Houston, TX
| |
Collapse
|
20
|
Chassagnon G, Gregory J, Al Ahmar M, Magdeleinat P, Legmann P, Coste J, Revel MP. Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures. Diagn Interv Radiol 2018; 23:347-353. [PMID: 28762333 DOI: 10.5152/dir.2017.160338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy. METHODS All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable. RESULTS A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16-0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049). CONCLUSION The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy.
Collapse
Affiliation(s)
- Guillaume Chassagnon
- Department of Radiology, Paris Descartes University, Sorbonne Paris Cité Groupe Hospitalier Cochin-Hotel Dieu, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
21
|
Chen CH, Huang WM, Liang SH, Jhou ZY, Chen CW, Chien YC, Lin HC, Wang CH, Huang CC, Liao WN, Huang CY. Does biopsy needle traversing through central portion of lesion increase the risk of hemoptysis during percutaneous transthoracic needle biopsy? Jpn J Radiol 2018; 36:231-237. [PMID: 29352406 DOI: 10.1007/s11604-018-0719-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/03/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate whether traversal through the central part of a pulmonary lesion by a biopsy needle, and other factors, increases the risk of hemoptysis in patients undergoing CT-guided percutaneous transthoracic needle biopsy (PTNB). MATERIALS AND METHODS From July 2012 to November 2016, 227 patients undergoing 233 procedures were recruited as our study population. Patients were classified according to the occurrence of hemoptysis. Radiological assessments were performed by reviewing multiplanar reconstructed CT images. Other factors complicating PTNB-related hemoptysis were classified into (1) patient-related variables: age, gender, presence of emphysema; (2) lesion-related variables: size, location, distance to pleura, characteristics, presence of and degree of enhancement, histopathology of biopsy results; and (3) procedure-related variables: lesion depth, patient's body position. RESULTS Twenty-two cases (9.4%) experienced hemoptysis. Univariate analysis revealed that subsolid lesions (p = 0.031) and lesion depth > 1 cm (p = 0.049) were risk factors. Traversal through the central part of the lesion by the biopsy needle was not a risk factor. CONCLUSION Traversal through the central part of the lesion by the biopsy needle is not a risk factor of PTNB-related hemoptysis, but subsolid lesions and lesion depth > 1 cm increase the risk of hemoptysis.
Collapse
Affiliation(s)
- Chia-Hung Chen
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Wei-Ming Huang
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Shih-Hsuan Liang
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Zong-Yi Jhou
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chien-Wen Chen
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Yu-Chan Chien
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Hui-Chen Lin
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chih-Hsin Wang
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chun-Chao Huang
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Wei-Ni Liao
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan. .,Department of Medicine, Mackay Medical College, Taipei, Taiwan. .,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Chung-Yao Huang
- Department of Radiology, Mackay Memorial Hospital, Taipei Branch, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan. .,Department of Medicine, Mackay Medical College, Taipei, Taiwan. .,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| |
Collapse
|
22
|
CT-guided hook-wire localisation prior to video-assisted thoracoscopic surgery of pulmonary lesions. Clin Radiol 2017; 72:898.e7-898.e11. [DOI: 10.1016/j.crad.2017.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022]
|
23
|
Abstract
PURPOSE This study aimed to assess the current practice patterns of radiologists performing percutaneous lung biopsies. MATERIALS AND METHODS This cross-sectional study used a web-based survey sent to the Society of Thoracic Radiology membership from August to October 2015. Responses were collected anonymously, and results were tallied. RESULTS A total of 244 Society of Thoracic Radiology members responded to the survey. One hundred thirty-seven radiologists regularly perform percutaneous lung biopsies, of whom 102 (74%) practice at an academic teaching hospital. Computed tomography (CT) and CT fluoroscopy were the modalities of choice for image guidance, preferred by 82 (60%) and 48 (35%) respondents, respectively. Twenty (15%) respondents preferred fine-needle aspiration (FNA) alone, 57 (42%) preferred core needle biopsy (CNB) alone, and 59 (43%) preferred both FNA and CNB in the same setting. On-site cytology was routinely requested by 70 (71%) respondents with access to such services. In cases of suspected lung cancer, 79 (60%) respondents estimated sending tissue for molecular analysis >25% of the time. Forty-three (32%) respondents reported using intraprocedural preventive measures to minimize risk of pneumothorax. CONCLUSIONS Among surveyed radiologists who perform percutaneous lung biopsies, most utilize CT guidance with either CNB alone or in conjunction with FNA. A small minority routinely performs FNA alone, which may negatively impact diagnostic accuracy and provide insufficient tissue for molecular profiling. Education of all radiologists regarding the importance of routinely acquiring and sending greater amounts of tissue for molecular/genomic assessment of suspected lung cancer is needed.
Collapse
|
24
|
Zhao G, Shi X, Sun W, Liang H, Mao X, Wen F, Shan M, Wang X, Lu Z. Factors affecting the accuracy and safety of computed tomography-guided biopsy of intrapulmonary solitary nodules ≤30 mm in a retrospective study of 155 patients. Exp Ther Med 2017; 13:1986-1992. [PMID: 28565797 DOI: 10.3892/etm.2017.4179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/09/2016] [Indexed: 11/06/2022] Open
Abstract
Computed tomography (CT)-guided percutaneous fine needle biopsy is a common method for lung biopsy. The objective of this study was to investigate factors affecting the accuracy and safety of CT-guided percutaneous lung biopsy of nodules ≤30 mm in diameter. Between January 2013 and March 2014, 155 patients underwent a CT-guided percutaneous biopsy procedure on an intrapulmonary solitary nodule measuring ≤30 mm in diameter. Prospectively collected data were retrospectively reviewed and examined for the influence of clinical and pathological characteristics (age, gender, smoking status, adhesion of nodule to the pleura, puncture depth, nodule size and time of biopsy) on the accuracy of biopsy and incidence of pneumothorax and hemorrhage. The accuracy of CT-guided biopsy was 90.3% (140/155). Biopsies predominantly contained lung adenocarcinoma (114/140; 81.4%) or squamous cell carcinoma of the lung (10/140; 7.1%). Accuracy was significantly dependent on nodule size, ranging in accuracy from 85 to 97% for patients with nodule diameters of ≤20 or 21-30 mm, respectively (P<0.05). Pleural adherence of the nodule significantly increased the accuracy of the biopsy (P<0.05). Patients with a nodule of 11-20 mm in diameter had a significantly higher incidence of pneumothorax compared with patients with a smaller nodule (P=0.013). In conclusion, the nodule size and adhesion to the pleura influenced the accuracy of CT-guided biopsy of intrapulmonary nodules that were ≤30 mm in diameter. Nodule size may also affect the incidence of severe complications. CT-guided percutaneous lung biopsy has a high accuracy and is easy and safe to conduct for intrapulmonary solitary nodules of ≤30 mm in diameter.
Collapse
Affiliation(s)
- Gang Zhao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xiaobao Shi
- Department of Radiology, The Fourth Hospital of China Medical University, Shenyang, Liaoning 110032, P.R. China
| | - Wei Sun
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Hongyuan Liang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xiaonan Mao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Feng Wen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Ming Shan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xihai Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zaiming Lu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| |
Collapse
|
25
|
Zhou Z, Zhan P, Jin J, Liu Y, Li Q, Ma C, Miao Y, Zhu Q, Tian P, Lv T, Song Y. The imaging of small pulmonary nodules. Transl Lung Cancer Res 2017; 6:62-67. [PMID: 28331825 DOI: 10.21037/tlcr.2017.02.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lung cancer is the leading cause of cancer death worldwide. The major goal in lung cancer research is the improvement of long-term survival. Pulmonary nodules have high clinical importance, they may not only prove to be an early manifestation of lung cancer, but decide to choose the right therapy. This review will introduce the development and current situation of several imaging examination methods: computed tomography (CT), positron emission tomography/computed tomography (PET/CT), endobronchial ultrasound (EBUS).
Collapse
Affiliation(s)
- Zejun Zhou
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ping Zhan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jiajia Jin
- Department of Respiratory Medicine, Jinling Hospital, Southeast University School of Medicine, Nanjing 210002, China
| | - Yafang Liu
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Chenhui Ma
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yingying Miao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qingqing Zhu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Panwen Tian
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southeast University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southeast University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China
| |
Collapse
|
26
|
Wang Y, Jiang F, Tan X, Tian P. CT-guided percutaneous transthoracic needle biopsy for paramediastinal and nonparamediastinal lung lesions: Diagnostic yield and complications in 1484 patients. Medicine (Baltimore) 2016; 95:e4460. [PMID: 27495081 PMCID: PMC4979835 DOI: 10.1097/md.0000000000004460] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) is used for identifying paramediastinal lung lesions that cannot be diagnosed by bronchoscopy, but the diagnostic performance and complication rate are unreported.This retrospective study was approved by the institutional review board committee. A total of 1484 patients who underwent PTNB between April 2012 and April 2015 were enrolled. The cohort was divided into a paramediastinal (n = 195) and a nonparamediastinal group (n = 1289) based on lesion location. Diagnostic yield for malignancy and complication rates were analyzed in both groups. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for hemoptysis complication in the paramediastinal group.Percutaneous transthoracic needle biopsy showed 95.6% (109/114) sensitivity and 100% (77/77) specificity for the diagnosis of lesions in the paramediastinal group, with similar accuracy (95.4%, 186/195) to that in the nonparamediastinal group (94.7%, 1221/1289; P = 0.699). Compared with PTNB for nonparamediastinal lesions, PTNB for paramediastinal lesions demonstrated a comparable pneumothorax rate (8.21% vs 8.69%; P = 0.823) and hemothorax rate (2.56% vs 1.47%; P = 0.261), and a higher hemoptysis rate (28.2% vs 19.4%; P = 0.005). Among 6 defined paramediastinal regions, the overall complication rate was the highest in the posterior region (42.4%) and the lowest in the paraventricular region (13.6%). Multivariate analysis revealed that lesion size of 2 to 3 cm (odds ratio [OR] 3.22), intrapulmonary length of needle path >2 cm (OR 8.85), and proximal to pulmonary artery (OR 10.33) were independent risk factors for hemoptysis in the paramediastinal group.Computed tomography-guided PTNB can diagnose paramediastinal lesions with high yield and acceptable complication rates. Given higher rate of hemoptysis in PTNB for paramediastinal lesions, more attention should be paid in cases with high risks.
Collapse
Affiliation(s)
- Ye Wang
- Department of Respiratory and Critical Care Medicine
- Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Faming Jiang
- Department of Respiratory and Critical Care Medicine
| | - Xiaobo Tan
- Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Panwen Tian
- Department of Respiratory and Critical Care Medicine
- Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Correspondence: Panwen Tian, Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, #37 GuoXue Xiang, Chengdu, Sichuan Province 610041, China (e-mail: )
| |
Collapse
|
27
|
Chiappetta M, Rosella F, Dall'armi V, Pomes LM, Petracca Ciavarella L, Nachira D, Pirronti T, Margaritora S, Granone P. CT-guided fine-needle ago-biopsy of pulmonary nodules: predictive factors for diagnosis and pneumothorax occurrence. Radiol Med 2016; 121:635-43. [PMID: 27132130 DOI: 10.1007/s11547-016-0639-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate variables that could predict diagnosis during CT-guided fine-needle aspiration. METHODS Data from 249 patients who underwent FNAB from January 2010 to December 2012 were analyzed in a retrospective observational study. RESULTS Mean age was 66.7 ± 11.5 years, male/female ratio 158/91 (63 vs. 37 %). The nodules were in right lung in 123 patients (49 %), in left lung in 126 patients (51 %), the upper, lower and middle lobe localizations were, respectively in 122 (49 %), 100 (40 %) and 17 (6 %) patients. Mean nodule-chest wall distance was 63.89 ± 21.38 mm. The tumor location, the needle diameter, the presence of necrosis or cavitation, the node-chest wall distance and the number of passages were not related to the diagnostic outcome (p = NS). The nodule diameter was predictive of diagnosis. Odds ratio for a 10-30 mm tumor was 2.51 (95 % OR: 1.24-5.08, p value = 0.011), the odds ratio for a 30-50 mm tumor was 2.39 (95 % OR: 1.22-4.69, p value = 0.011), and the odds ratio for a tumor larger than 50 mm was 4.44 (95 % OR: 1.89-10.44, p value = 0.001). Post-procedure pneumothorax occurred in 62 cases (25 %). The determinant factors for pneumothorax occurrence were emphysema, odds ratio 6.87 (95 % CI 1.07-44.10, p value = 0.04), and the number of pleural passages, odds ratio of 5.47 (95 % OR: 1.92-15.58), 7.44 (95 % OR: 2.58-21.5), 6.13 (95 % OR: 2.07-18.11) p value = 0.001 for one, two, three or more of three passages, respectively. CONCLUSIONS In our experience, nodule size is the most important diagnostic factor during fine-needle aspiration, while the number of passages and the presence of emphysema constitute risk factors for pneumothorax occurrence.
Collapse
Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy.
| | - Francesco Rosella
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital-Catholic University, Rome, Italy
| | - Valentina Dall'armi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Leda Marina Pomes
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
| | | | - Dania Nachira
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
| | - Tommaso Pirronti
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital-Catholic University, Rome, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
| | - Pierluigi Granone
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
| |
Collapse
|
28
|
Abstract
PET can be used to guide percutaneous needle biopsy to the most metabolic lesion, improving diagnostic yield. PET biopsy guidance can be performed using visual or software coregistration, electromagnetic needle tracking, cone-beam computed tomography (CT), and intraprocedural PET/CT guidance. PET/CT-guided biopsies allow the sampling of lesions that may not be clearly visible on anatomic imaging, or of lesions that are morphologically normal. PET can identify suspicious locations within complex tumors that are most likely to contain important diagnostic and prognostic information.
Collapse
Affiliation(s)
- Ghassan El-Haddad
- Division of Interventional Radiology, Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612-9416, USA.
| |
Collapse
|
29
|
Tai R, Dunne RM, Trotman-Dickenson B, Jacobson FL, Madan R, Kumamaru KK, Hunsaker AR. Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases. Radiology 2016; 279:287-96. [DOI: 10.1148/radiol.2015150381] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Potretzke TA, Gunderson TM, Aamodt D, Weisbrod AJ, Hesley GK, Welch TJ, Atwell TD. Incidence of bleeding complications after percutaneous core needle biopsy in hypertensive patients and comparison to normotensive patients. Abdom Radiol (NY) 2016; 41:637-42. [PMID: 26826087 DOI: 10.1007/s00261-016-0653-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To retrospectively determine the rate of major bleeding complications after solid organ or lung biopsy in patients with hypertension and compare to the rates of bleeding in normotensive patients. MATERIALS AND METHODS Following IRB approval, retrospective review of all solid organ and lung biopsies performed at our institution between June 1st, 2013 and October 31st, 2015 was performed. Hypertension was defined as a maximum observed systolic blood pressure of 160 mmHg or greater and/or diastolic blood pressure of 90 mmHg or greater at the time of the biopsy procedure. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 4.0) established by the National Cancer Institute. RESULTS 4756 total biopsies in 3876 unique patients (median age 60, 57% male) were included. 1488 (31.3%) of these biopsies were performed in hypertensive patients. Fifteen major hemorrhages (CTCAE grade 3 or higher) occurred (0.32%). There were no deaths. There was no significant association between hypertension and major bleeding. The incidence of bleeding in hypertensive patients was 0.40% (6/1488), which was not statistically different than the incidence in normotensive patients (9/3268, 0.28%, p = 0.496). For the subgroup of native renal parenchymal biopsies, the rate of bleeding was slightly higher in hypertensive patients (3/213, 1.4% vs. 1/355, 0.28% in normotensive patients) but remained low, and the difference was not statistically significant (p = 0.188). CONCLUSION The overall incidence of major bleeding after percutaneous biopsy is very low. Hypertension does not appear to significantly increase the risk of major bleeding complications.
Collapse
Affiliation(s)
- Theodora A Potretzke
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA.
| | - Tina M Gunderson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 55905, USA
| | - David Aamodt
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Adam J Weisbrod
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Gina K Hesley
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Timothy J Welch
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| |
Collapse
|
31
|
Diagnostic Accuracy and Safety of CT-Guided Percutaneous Transthoracic Needle Biopsies: 14-Gauge versus 22-Gauge Needles. J Vasc Interv Radiol 2016; 27:674-81. [PMID: 27017121 DOI: 10.1016/j.jvir.2016.01.134] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the diagnostic accuracy and safety of a 14-gauge core needle versus a 22-gauge fine needle in the evaluation of thoracic lesions by CT-guided percutaneous transthoracic needle biopsy (TTNB). MATERIALS AND METHODS Medical charts of all patients who underwent CT-guided percutaneous transthoracic core-needle biopsies (CNBs) with a 14-gauge Spirotome device (99 patients, 102 procedures) and fine-needle biopsies (FNBs) with a 22-gauge Rotex needle (92 patients, 102 procedures) between 2007 and 2013 at a single academic institution were retrospectively reviewed. Variables that could influence diagnostic accuracy and safety were collected. RESULTS The overall and cancer-specific diagnostic accuracy rates were 90% and 94%, respectively, with CNB, versus 82% and 89% with FNB. Precise cancer type/subtype was provided by 97% of CNBs versus 65% of FNBs (P < .001). In patients with lung cancer considered for targeted therapy, biomarker analyses were feasible in 80% of CNBs versus 0% of FNBs (P < .001). The rate of pneumothorax was significantly higher with CNB versus FNB (31% vs 19%; P = .004), but chest tube insertion rates were similar (10% vs 11%, respectively). Major bleeding complications occurred in 1% of CNBs versus 2% of FNBs and were associated with one death in the CNB group. CONCLUSIONS Percutaneous transthoracic CNB with a 14-gauge Spirotome needle provided better characterization of cancer lesions and allowed biomarker analyses without a significant increase in major procedural complications.
Collapse
|
32
|
XU LIYING, DING XUN, LIAO MEIYAN. Non-traumatic acute paraplegia associated with a CT-guided needle biopsy in a silicotic nodule: A case report. Mol Clin Oncol 2016; 4:453-455. [DOI: 10.3892/mco.2015.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/07/2015] [Indexed: 11/05/2022] Open
|
33
|
Wei YH, Zhou FX, Li Y, Zhou YF, Anish K, Xu LY, Liao MY. Extrapleural locating method in computed tomography-guided needle biopsies of 1,106 lung lesions. Exp Ther Med 2015; 10:1707-1719. [PMID: 26640541 PMCID: PMC4665221 DOI: 10.3892/etm.2015.2735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/24/2015] [Indexed: 11/17/2022] Open
Abstract
Transthoracic needle biopsy is considered to be safe and effective for the diagnosis of focal lung lesions. The aim of the present study was to evaluate factors affecting the accuracy and safety of automated cutting needle lung biopsy (ACNB) using a new extrapleural locating (EPL) method. Computed tomography (CT)-guided needle biopsies were performed on 1,065 patients between March 2005 and May 2012 using the EPL method. The locating needle remained in the chest following extrapleural positioning, while the radiologist confirmed the puncture angle and distance between the locating needle and lesion. The biopsy instrument was advanced into the lung, and the core needle was subsequently fired into the lesion based on the direction indicated by the locating needle. Univariate and multivariate regression analyses were used to evaluate the diagnostic accuracy and safety of the procedure. The sensitivity, specificity, positive predictive value and negative predictive value of the extrapleural method were 91.9, 100, 100 and 82.9%, respectively, and the overall diagnostic accuracy was 94.2%. Significant risk factors affecting accuracy were younger age, atelectasis, hemoptysis and lesion depth (P<0.03). Multivariate logistic regression analysis revealed that the risk of malignant lesions receiving a false-negative diagnosis decreased for each additional year of subject age [odds ratio (OR), 0.97; P=0.027] and increased with each millimeter increase in lesion depth (OR, 1.03; P=0.008). Among the 1,106 lesions biopsied, 207 were associated with pneumothorax, 251 with hemorrhage and 58 with hemoptysis. Multivariate analysis revealed that lesion size and emphysema affected pneumothorax incidence, while age, lesion location and depth and emphysema significantly affected hemorrhage incidence (P<0.05). In conclusion, low-dose, CT-guided ACNB with the EPL method provides a safe and accurate diagnosis.
Collapse
Affiliation(s)
- Yue-Hua Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Fu-Xiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yan Li
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yun-Feng Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Krishna Anish
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Li-Ying Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Mei-Yan Liao
- Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China ; Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| |
Collapse
|
34
|
Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients. Cardiovasc Intervent Radiol 2015; 39:261-70. [DOI: 10.1007/s00270-015-1167-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
|
35
|
The Effect of Needle Gauge on the Risk of Pneumothorax and Chest Tube Placement After Percutaneous Computed Tomographic (CT)-Guided Lung Biopsy. Cardiovasc Intervent Radiol 2015; 38:1595-602. [DOI: 10.1007/s00270-015-1097-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
|