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Abstract
ABSTRACT Percutaneous computed tomography-guided transthoracic lung biopsy is an effective and minimally invasive procedure to achieve tissue diagnosis. Radiologists are key in appropriate referral for further workup, with percutaneous computed tomography-guided transthoracic lung biopsy performed by both thoracic and general interventionalists. Percutaneous computed tomography-guided transthoracic lung biopsy is increasingly performed for both diagnostic and research purposes, including molecular analysis. Multiple patient, lesion, and technique-related variables influence diagnostic accuracy and complication rates. A comprehensive understanding of these factors aids in procedure planning and may serve to maximize diagnostic yield while minimizing complications, even in the most challenging scenarios.
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Chung C, Kim Y, Park D. Transthoracic Needle Biopsy: How to Maximize Diagnostic Accuracy and Minimize Complications. Tuberc Respir Dis (Seoul) 2020; 83:S17-S24. [PMID: 33272004 PMCID: PMC7837377 DOI: 10.4046/trd.2020.0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022] Open
Abstract
Although transthoracic needle biopsy (TTNB) was introduced for lung biopsy about 40 years ago, it is still mainstay of pathologic diagnosis in lung cancer, because it is relatively inexpensive and can obtain tissue regardless of the tumor-bronchus relationship. With several technological advances, proceduralists can perform TTNB more safely and accurately. Utilizing ultrasound-guided biopsy for peripheral lesions in contact with the pleura and rapid on-site evaluation during the procedure are expected to make up the weakness of TTNB. However, due to the inherent limitations of the percutaneous approach, the incidence of complications such as pneumothorax or bleeding is inevitably higher than that of other lung biopsy techniques. Thorough understating of each biopsy modality and additional technique are fundamental for maximizing diagnostic accuracy and minimizing the complications.
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Affiliation(s)
- Chaeuk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yoonjoo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Dongil Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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Wang S, Dong K, Chen W. Development of a hemoptysis risk prediction model for patients following CT-guided transthoracic lung biopsy. BMC Pulm Med 2020; 20:247. [PMID: 32938417 PMCID: PMC7496204 DOI: 10.1186/s12890-020-01282-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Computed tomography-guided transthoracic needle biopsy (CT-TNB) is a widely used method for diagnosis of lung diseases; however, CT-TNB-induced bleeding is usually unexpected and this complication can be life-threatening. The aim of this study was to develop and validate a predictive model for hemoptysis following CT-TNB. Methods A total of 436 consecutive patients who underwent CT-TNB from June 2016 to December 2017 at a tertiary hospital in China were divided into derivation (n = 307) and validation (n = 129) cohorts. We used LASSO regression to reduce the data dimension, select variables and determine which predictors were entered into the model. Multivariate logistic regression was used to develop the predictive model. The discrimination capacity of the model was evaluated by the area under the receiver operating characteristic curve (AUROC), the calibration curve was used to test the goodness-of-fit of the model, and decision curve analysis was conducted to assess its clinical utility. Results Five predictive factors (diagnosis of the lesion, lesion characteristics, lesion diameter, procedure time, and puncture distance) selected by LASSO regression analysis were applied to construct the predictive model. The AUC was 0.850 (95% confidence interval [CI], 0.808–0.893) in the derivation, and 0.767 (95% CI, 0.684–0.851) in the validation. The model showed good calibration consistency (p > 0.05). Moreover, decision curve analysis indicated its clinical usefulness. Conclusion We established a predictive model that incorporates lesion features and puncture parameters, which may facilitate the individualized preoperative prediction of hemoptysis following CT-TNB.
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Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
| | - Ke Dong
- Department of Nuclear Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
| | - Wei Chen
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang Province, China.
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Fior D, Vacirca F, Leni D, Pagni F, Ippolito D, Riva L, Sironi S, Corso R. Virtual Guidance of Percutaneous Transthoracic Needle Biopsy with C-Arm Cone-Beam CT: Diagnostic Accuracy, Risk Factors and Effective Radiation Dose. Cardiovasc Intervent Radiol 2019; 42:712-719. [PMID: 30652222 DOI: 10.1007/s00270-019-02163-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE C-arm cone-beam computed tomography-guided transthoracic lung core needle biopsy (CBCT-CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. The purpose of our study was to evaluate the diagnostic performance, complication rates and effective radiation dose of CBCT-CNB with virtual guidance. MATERIALS AND METHODS We retrospectively collected data regarding 375 CBCT-CNBs performed with virtual guidance (XperGuide-Philips Healthcare, Best, The Netherlands) from January 2010 to June 2015 on 355 patients (mean age, 68.1 years ± 11.8; age range, 31-88 years). Patients were divided into groups and compared based on the diagnostic failure and lesion size (15 mm cutoff). Diagnostic performance, complication rate and effective radiation dose were investigated. Variables influencing diagnostic performance and complications were assessed using Student's T test and Pearson's χ2 test. RESULTS The sensitivity, specificity, positive and negative predictive value and accuracy for patients subjected to CNBs were 96.8%, 100%, 100%, 100% and 97.2%, respectively. Considering risk factors for pneumothorax, no significant differences were found regarding patient and lesion characteristics. Perilesional hemorrhage occurred more frequently in older patients (p = 0.046) and in smaller lesions (p = 0.001). Hemoptysis was significantly more frequent in patients with perilesional hemorrhage (p = 0.01). Mean effective radiation dose in CBCT-CNB was 7.12 ± 8.78 mSv. CONCLUSIONS CBCT-CNB combined with virtual guidance is a reliable and accurate technique that allows exact localization of pulmonary lesions, effective preprocedural planning and real-time fluoroscopy altogether.
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Affiliation(s)
- Davide Fior
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Francesco Vacirca
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Davide Leni
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Fabio Pagni
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Pathology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Davide Ippolito
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Luca Riva
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, BG, Italy
| | - Rocco Corso
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
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Wang S, Tu J, Dong K. Nomogram to predict postoperative PR in patients undergoing CT-guided transthoracic lung biopsy. J Thorac Dis 2019; 11:1705-1713. [PMID: 31179117 DOI: 10.21037/jtd.2019.01.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Pleural reaction (PR) frequently occurs following computed tomography-guided transthoracic needle biopsy (CT-TNB). The purpose of this study was to establish a predictive model for PR following CT-TNB. Methods In this study, a total of 436 patients who underwent CT-TNB between June 2016 and December 2017 at a tertiary hospital were consecutively included. Patient demographics, lesion features, laboratory tests, and biopsy parameters were collected. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were performed to establish a prediction model for post-CT-TNB PR, presented by a nomogram. Discrimination and calibration were assessed. For internal validation, a bootstrap resampling method was applied, and decision curve analysis (DCA) was used to evaluate its clinical utility. Results PR occurred in 7.8% (34/436) of patients. Four non-zero coefficient variables (gender, age, lesion location, and puncture position) were filtered by LASSO regression analysis and were used to establish a predictive model. The area under the curve in the derivation and validation was 0.840 (95% CI, 0.767-0.913) and 0.841 (95% CI, 0.769-0.912), respectively. The model was well-calibrated (P>0.05), and DCA indicated clinical efficacy. Conclusions In this study, we established a nomogram, including as parameters gender, age, lesion location, and puncture position, which may have great significance for individualized prediction of post-CT-TNB PR.
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Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Junwei Tu
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ke Dong
- Department of Nuclear Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
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Risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle biopsy of lung lesions: a single-centre experience with 822 biopsies. Pol J Radiol 2018; 83:e407-e414. [PMID: 30655918 PMCID: PMC6334126 DOI: 10.5114/pjr.2018.79205] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/24/2018] [Indexed: 01/05/2023] Open
Abstract
Purpose To determine the risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle lung biopsy (CT-CNB). Material and methods Variables that could increase the risk of pneumothorax and chest tube placement were retrospectively analysed in 822 CT-CNBs conducted with 18-gauge non-coaxial CT-CNB in 813 patients (646 men and 167 women; range: 18-90 years; mean: 59.8 years). Predictor variables were age, gender, patient position, severity of pulmonary emphysema, lesion size and localisation, contour characteristics, presence of atelectasis, pleural tag and fissure in the needle-tract, length of the aerated lung parenchyma crossed by the needle, needle entry angle, number of pleural punctures, experience of the operator, and procedure duration. All variables were investigated by ×2 test and logistic regression analysis. Results The overall incidence of pneumothorax was 15.4% (127/822). Chest tube placement was required for 22.8% (29/127) of pneumothoraxes. The significant independent variables for pneumothorax were lesions smaller than 3 cm (p = 0.009), supine and lateral decubitus position during the procedure (p < 0.001), greater lesion depth (p = 0.001), severity of pulmonary emphysema (p < 0.001), needle path crossing the fissure (p < 0.001), and a path that skips the atelectasis (p < 0.001) or pleural tag (p < 0.001); those for chest tube placement were prone position (p < 0.001), less experienced operator (p = 0.001), severity of pulmonary emphysema (p < 0.001), and greater lesion depth (p = 0.008). Conclusions The supine and lateral decubitus position, a needle path that crosses the fissure, and a path that skips the atelectasis or a pleural tag are novel predictors for the development of pneumothorax.
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Zhou Q, Dong J, He J, Liu D, Tian DH, Gao S, Li S, Liu L, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Tan L, Li D, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Casal RF, Pompeo E, Carretta A, Riquet M, Rena O, Falcoz PE, Saji H, Khan AZ, Danguilan JL, Gonzalez-Rivas D, Guibert N, Zhu C, Shen J. The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer. J Thorac Dis 2018; 10:5538-5544. [PMID: 30416804 DOI: 10.21037/jtd.2018.09.28] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingsi Dong
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming 650100, China
| | - Shidong Xu
- Department of Thoracic surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450000, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marc Riquet
- Georges Pompidou European Hospital, General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Ottavio Rena
- Thoracic Surgery Unit, University of Eastern Piedmont, AOU Maggiore della Carità, Vercelli, Italy
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ali Zamir Khan
- Department of Minimally Invasive Thoracic Surgery, Medanta The Medicity, Gurgaon, India
| | - Jose Luis Danguilan
- Lung Center of the Philippines, Quezon City, Philippines, USA.,University of the Philippines College of Medicine, Manila, Philippines, USA
| | | | - Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Chengchu Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
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Lim HJ, Park CM, Yoon SH, Bae JS, Goo JM. Cone-Beam CT Virtual Navigation-Guided Percutaneous Needle Biopsy of Suspicious Pleural Metastasis: A Pilot Study. Korean J Radiol 2018; 19:872-879. [PMID: 30174476 PMCID: PMC6082769 DOI: 10.3348/kjr.2018.19.5.872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/06/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the diagnostic performance of cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous pleural biopsy for suspected malignant pleural disease. Materials and Methods This study enrolled 59 patients (31 males and 28 females; mean age, 63.4 years) with suspected malignant pleural disease diagnosed with CBCT from December 2010 to December 2016. Sixty-three CBCT-guided biopsies were performed using a coaxial system with 18- or 20-gauge cutting needles. Procedural details, diagnostic performance, radiation exposure, and complication rates were investigated. Results The mean diameter perpendicular to the pleura of 51 focal and 12 diffuse pleural lesions was 1.53 ± 0.76 cm. The mean distance from the skin to the target was 3.40 ± 1.51 cm. Mean numbers of CT acquisitions and biopsies were 3.21 ± 0.57 and 3.05 ± 1.54. Total procedure time and coaxial introducer indwelling time were 11.87 ± 5.59 min and 8.78 ± 4.95 min, respectively. The mean dose area product was 12013.61 ± 7969.59 mGym2. There were 48 malignant, 10 benign, and 5 indeterminate lesions. Sensitivity, specificity, and diagnostic accuracy were 93.8% (45/48), 100% (10/10), and 94.8% (55/58), respectively. Positive and negative predictive values for malignancy were 100% (45/45) and 76.9% (10/13), respectively. Four patients (6.8%) with benign pathology during initial biopsy but still showing a high suspicion of malignancy underwent repeat biopsy and three of them were finally diagnosed with malignant pleural disease. There were three cases of minimal pneumothorax and no grave procedure-related complications. Conclusion Cone-beam computed tomography-guided biopsy is an accurate and safe diagnostic technique for suspected malignant pleural lesion with reasonable radiation exposure and procedure time.
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Affiliation(s)
- Hyun-Ju Lim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
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Rebonato A, Maiettini D, Andolfi M, Fischer MJ, Vannucci J, Metro G, Basile A, Rossi M, Duranti M. CT-Guided Percutaneous Trans-scapular Lung Biopsy in the Diagnosis of Peripheral Pulmonary Lesion Nodules of the Superior Lobes Using Large Needles. Cardiovasc Intervent Radiol 2017; 41:284-290. [DOI: 10.1007/s00270-017-1768-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022]
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Anzidei M, Porfiri A, Andrani F, Di Martino M, Saba L, Catalano C, Bezzi M. Imaging-guided chest biopsies: techniques and clinical results. Insights Imaging 2017. [PMID: 28639114 PMCID: PMC5519500 DOI: 10.1007/s13244-017-0561-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. Methods Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive. Results Although a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy. Conclusion Percutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications. Teaching points • Imaging-guided biopsy is one of the main methods to obtain lung nodule specimens. • CT has the highest accuracy for diagnosis as an imaging guide. • Compared to FNAB, CNB has a higher accuracy for diagnosis. • Pneumothorax and parenchymal pulmonary haemorrhage care the most frequent complications. • Several clinical and technical variables can affect diagnostic accuracy and patient safety.
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Affiliation(s)
- Michele Anzidei
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Andrea Porfiri
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Fabrizio Andrani
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Michele Di Martino
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Bezzi
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
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C-Arm Cone-Beam CT Virtual Navigation-Guided Percutaneous Mediastinal Mass Biopsy: Diagnostic Accuracy and Complications. Eur Radiol 2015; 25:3508-17. [PMID: 25916390 DOI: 10.1007/s00330-015-3762-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/07/2015] [Accepted: 04/01/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the usefulness of C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous mediastinal mass biopsy in terms of diagnostic accuracy and complication rates. METHODS Seventy-eight CBCT virtual navigation-guided percutaneous mediastinal mass biopsies were performed in 75 patients (M:F, 38:37; mean age, 48.55 ± 18.76 years). The procedural details, diagnostic sensitivity, specificity, accuracy and complication rate were investigated. RESULTS Mean lesion size was 6.80 ± 3.08 cm, skin-to-target distance was 3.67 ± 1.80 cm, core needle biopsy rate was 96.2 % (75/78), needle indwelling time was 9.29 ± 4.34 min, total procedure time was 13.26 ± 5.29 min, number of biopsy specimens obtained was 3.13 ± 1.02, number of CBCTs performed was 3.03 ± 0.68, rate of lesion border discrimination from abutting mediastinal structures on CBCT was 26.9 % (21/78), technical success rate was 100 % (78/78), estimated effective dose was 5.33 ± 4.99 mSv, and the dose area product was 12,723.68 ± 10,665.74 mGy⋅cm(2). Among the 78 biopsies, 69 were malignant, 7 were benign and 2 were indeterminate. Diagnostic sensitivity, specificity and accuracy for the diagnosis of malignancies were 97.1 % (67/69), 100 % (7/7) and 97.4 % (74/76), respectively, with a complication rate of 3.85 % (3/78), all of which were small pneumothoraces. CONCLUSIONS CBCT virtual navigation-guided biopsy is a highly accurate and safe procedure for the evaluation of mediastinal lesions. KEY POINTS • CBCT virtual navigation-guided percutaneous mediastinal biopsy is highly accurate • CBCT virtual navigation-guided percutaneous mediastinal biopsy is a safe procedure • Mediastinal vascular injury can be avoided under CBCT virtual navigation guidance.
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Yin ZY, Lin ZY, Wang Y, Li PC, Shen N, Wang Q, Ye T, Zou ZW, Wu B, Yang KY, Wu G. Risk factors of complications after CT-guided percutaneous needle biopsy of lumps near pulmonary hilum. ACTA ACUST UNITED AC 2015; 35:278-282. [DOI: 10.1007/s11596-015-1424-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 02/26/2015] [Indexed: 11/30/2022]
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Boskovic T, Stojanovic M, Stanic J, Pena Karan S, Vujasinovic G, Dragisic D, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Papaiwannou A, Madesis A, Diplaris K, Karaiskos T, Zaric B, Branislav P, Zarogoulidis P. Pneumothorax after transbronchial needle biopsy. J Thorac Dis 2014; 6:S427-34. [PMID: 25337399 DOI: 10.3978/j.issn.2072-1439.2014.08.37] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 12/18/2022]
Abstract
Currently there several diagnostic techniques that re used by radiologists and pulmonary physicians for lung cancer diagnostics. In several cases pneumothorax (PNTX) is induced and immediate action is needed. Both radiologists and pulmonary physicians can insert a chest tube for symptom relief. However; only pulmonary physicians and thoracic surgeons can provide a permanent solution for the patient. The final solution would be for a patient to undergo surgery for a final solution. In our current work we will provide all those diagnostic cases where PNTX is induced and treatment from the point of view of expert radiologists and pulmonary physicians.
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Affiliation(s)
- Tatjana Boskovic
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Milos Stojanovic
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Jelena Stanic
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Slobodanka Pena Karan
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Gordana Vujasinovic
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Dragan Dragisic
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Konstantinos Zarogoulidis
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ioanna Kougioumtzi
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Georgios Dryllis
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ioannis Kioumis
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Georgia Pitsiou
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Machairiotis
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Katsikogiannis
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Antonis Papaiwannou
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Athanasios Madesis
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Konstantinos Diplaris
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Theodoros Karaiskos
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Bojan Zaric
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Perin Branislav
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Paul Zarogoulidis
- 1 Institute for Pulmonary Diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 2 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia; 3 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 5 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 6 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 7 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Boskovic T, Stanic J, Pena-Karan S, Zarogoulidis P, Drevelegas K, Katsikogiannis N, Machairiotis N, Mpakas A, Tsakiridis K, Kesisis G, Tsiouda T, Kougioumtzi I, Arikas S, Zarogoulidis K. Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J Thorac Dis 2014; 6 Suppl 1:S99-S107. [PMID: 24672704 DOI: 10.3978/j.issn.2072-1439.2013.12.08] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022]
Abstract
Transthoracic needle biopsy (TTNB) is done with imaging guidance and most frequently by a radiologist, for the aim is to diagnose a defined mass. It is integral in the diagnosis and treatment of many thoracic diseases, and is an important alternative to more invasive surgical procedures. FNAC is a method of aspiration cytopathology, which with transthoracic biopsy ("core biopsy") is a group of percutaneous minimally invasive diagnostic procedures for exploration of lung lesions. Needle choice depends mostly upon lesion characteristics and location. A recent innovation in biopsy needles has been the introduction of automatic core biopsy needle devices that yield large specimens and improve the diagnostic accuracy of needle biopsy. Both computed tomography and ultrasound may be used as imaging guidance for TTNB, with CT being more commonly utilized. Common complications of TTNB include pneumothorax and hemoptysis. The incidence of pneumothorax in patients undergoing TTNB has been reported to be from 9-54%, according to reports published in the past ten years, with an average of around 20%. Which factors statistically correlate with the frequency of pneumothorax remain controversial, but most reports have suggested that lesion size, depth and the presence of emphysema are the main factors influencing the incidence of pneumothorax after CT-guided needle biopsy. On the contrary, gender, age, and the number of pleural passes have not been shown to correlate with the incidence of pneumothorax. The problem most responsible for complicating outpatient management, after needle biopsy was performed, is not the presence of the pneumothorax per se, but an increase in the size of the pneumothorax that requires chest tube placement and patient hospitalization. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.
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Affiliation(s)
- Tatjana Boskovic
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Jelena Stanic
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Slobodanka Pena-Karan
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Kostas Drevelegas
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Andreas Mpakas
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Georgios Kesisis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Stamatis Arikas
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
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Sayyouh M, Vummidi DR, Kazerooni EA. Evaluation and management of pulmonary nodules: state-of-the-art and future perspectives. ACTA ACUST UNITED AC 2014; 7:629-44. [PMID: 24175679 DOI: 10.1517/17530059.2013.858117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The imaging evaluation of pulmonary nodules, often incidentally detected on imaging examinations performed for other clinical reasons, is a frequently encountered clinical circumstance. With advances in imaging modalities, both the detection and characterization of pulmonary nodules continue to evolve and improve. AREAS COVERED This article will review the imaging modalities used to detect and diagnose benign and malignant pulmonary nodules, with a focus on computed tomography (CT), which continues to be the mainstay for evaluation. The authors discuss recent advances in the lung nodule management, and an algorithm for the management of indeterminate pulmonary nodules. EXPERT OPINION There are set of criteria that define a benign nodule, the most important of which are the lack of temporal change for 2 years or more, and certain benign imaging criteria, including specific patterns of calcification or the presence of fat. Although some indeterminate pulmonary nodules are immediately actionable, generally those approaching 1 cm or larger in diameter, at which size the diagnostic accuracy of tools such as positron emission tomography (PET)/CT, single photon emission CT (SPECT) and biopsy techniques are sufficient to warrant their use. The majority of indeterminate pulmonary nodules are under 1 cm, for which serial CT examinations through at least 2 years for solid nodules and 3 years for ground-glass nodules, are used to demonstrate either benign biologic behavior or otherwise. The management of incidental pulmonary nodules involves a multidisciplinary approach in which radiology plays a pivotal role. Newer imaging and postprocessing techniques have made this a more accurate technique eliminating ambiguity and unnecessary follow-up.
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Affiliation(s)
- Mohamed Sayyouh
- University of Michigan Health System, Division of Cardiothoracic Radiology, Department of Radiology , Ann Arbor, MI , USA
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16
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Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 2013; 271:291-300. [PMID: 24475839 DOI: 10.1148/radiol.13131265] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate the diagnostic performance and complications of C-arm cone-beam computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) in 1108 patients. MATERIALS AND METHODS This retrospective study was approved by the institutional review board with waiver of patient informed consent. From January 2009 to December 2011, 1108 patients (633 male, 475 female; mean age, 62.4 years ± 12.3 [standard deviation]) with 1116 pulmonary lesions (mean size, 2.7 cm ± 1.7) underwent 1153 cone-beam CT-guided PTNBs. A coaxial system with 18-gauge cutting needles was used. Diagnostic performance, complication rate, influencing factors, and patient radiation exposure were investigated. Variables influencing diagnostic performance and complications were assessed by using uni- and multivariate logistic regression analyses. RESULTS Among 1153 PTNBs, pathologic analysis showed 1148 (99.6%) were technically successful (766 malignant [66.4%], 323 benign [28.0%], and 59 [5.1%] indeterminate). Sensitivity, specificity, and accuracy for diagnosis of malignancy were 95.7% (733 of 766), 100% (323 of 323), and 97.0% (1056 of 1089), respectively. In regard to diagnostic failures (five technical failures, 33 false-negative findings), lesions 1 cm in diameter or smaller and lesions in the lower lobe were significant risk factors (P = .028 and P = .034, respectively). As for complications, pneumothorax and hemoptysis occurred in 196 (17.0%) and 80 (6.9%) procedures, respectively. Multivariate analysis revealed two or more pleural passages and emphysema along the needle pathway were the two most significant risk factors for pneumothorax, and ground-glass nodules were the most significant risk factor for hemoptysis (P < .001 for all). Virtual guidance was a significant protective factor for both pneumothorax and hemoptysis (P < .001 for both). Mean estimated effective radiation dose through cone-beam CT-guided PTNBs was 7.3 mSv ± 4.1. CONCLUSION Cone-beam CT-guided PTNB is a highly accurate and safe technique with which to diagnose pulmonary lesions with reasonable radiation exposure.
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Affiliation(s)
- Sang Min Lee
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (S.M.L., C.M.P., K.H.L., Y.E.B., J.M.G.), Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (S.M.L., C.M.P., K.H.L., Y.E.B., J.M.G.); Cancer Research Institute, Seoul National University, Seoul, Korea (C.M.P., J.M.G.); and Department of Radiology, Kyung Hee University Hospital, Seoul, Korea (J.I.K.)
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17
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C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules: diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol 2012; 199:W322-30. [PMID: 22915422 DOI: 10.2214/ajr.11.7576] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study is to retrospectively evaluate the diagnostic accuracy and complications of C-arm cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for small (≤ 20 mm) lung nodules and their possible influencing factors. MATERIALS AND METHODS From March 2009 to July 2010, 161 consecutive patients (77 men and 84 women; mean [± SD] age, 61 ± 11.8 years; range, 29-85 years) with 173 small (≤ 20 mm) lung nodules underwent CBCT-guided PTNB performed by an experienced chest radiologist in a tertiary referral hospital. The diagnostic accuracy, sensitivity, specificity, and complication rates were statistically evaluated, and influencing factors were assessed using univariate and subsequent multivariate analysis. RESULTS Of 173 nodules (mean size, 15 ± 3.7 mm), 94 (54.3%) were diagnosed as malignant, 69 (39.9%) as benign, and 10 (5.8%) as indeterminate. On PTNB, 160 nodules were correctly diagnosed and three were false-negatives. Diagnostic accuracy, sensitivity, and specificity were 98.2%, 96.8%, and 100%, respectively. No factors significantly decreased diagnostic accuracy. As for complications, pneumothorax, hemoptysis, and chest pain occurred in 55 (31.8%), 25 (14.5%), and two (1.2%) patients, respectively. Multivariate analysis revealed that the presence of emphysema along the needle pathway was a significant risk factor (odds ratio [OR], 10.11), and the occurrence of hemoptysis was a significant protective factor (OR, 0.28) against pneumothorax. Ground-glass nodules were found to be a significant independent risk factor for hemoptysis (OR, 5.10). CONCLUSION C-arm CBCT-guided PTNB is highly accurate for small lung nodules, and the diagnostic accuracy does not significantly decrease even in technically challenging conditions.
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Wallace AB, Suh RD. Percutaneous transthoracic needle biopsy: special considerations and techniques used in lung transplant recipients. Semin Intervent Radiol 2011; 21:247-58. [PMID: 21331136 DOI: 10.1055/s-2004-861559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lung transplant recipients are among the patients most likely eventually to undergo diagnostic lung biopsy. Unfortunately, these patients are at particularly high risk for experiencing intra- and periprocedural complications. Percutaneous transthoracic needle biopsy (TNB) has over time emerged as an increasingly safe and reliable method of obtaining lung tissue for diagnosis. This article gives an overview of TNB including its indications, the imaging modalities currently used for guidance, and the special techniques utilized in performing the procedure and minimizing complications with an emphasis placed upon the special case of TNB performed in lung transplant recipients.
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Affiliation(s)
- Amanda B Wallace
- Department of Radiological Sciences, UCLA Medical Center, Los Angeles, California
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19
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Feasibility of CT-guided large-bore biopsy of lung tumors with the use of an outer sheath. J Vasc Interv Radiol 2011; 22:699-701. [PMID: 21514522 DOI: 10.1016/j.jvir.2011.01.448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 01/11/2011] [Accepted: 01/26/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the feasibility, volume of biopsy specimens, and procedure-related tumor seeding of computed tomography (CT)-guided large-bore lung tumor biopsy through an outer sheath in advanced lung cancer. MATERIALS AND METHODS Eighteen procedures were performed in 18 patients with established diagnosis of advanced or recurrent lung cancer. Biopsy specimens were obtained under local anesthesia and with fluoroscopic CT guidance. First, an outer sheath was placed in the tumor. Next, a semiautomatic cutting biopsy needle (14-gauge, n = 6; 12-gauge, n = 12) was inserted through the outer sheath, and the tumor biopsy specimen was obtained. After biopsy, the outer sheath was left in place for approximately 10 minutes, during which time hemostasis was achieved. The primary goal was feasibility. Secondary goals were volume of biopsy specimens and incidence of procedure-related tumor implantation. RESULTS Bleeding volume during the procedure ranged from 0-50 g (median, 5 g; mean, 9 g) and stopped within 10 minutes in all patients. Pneumothorax occurred in two patients (11 %) and improved without chest tube insertion. Specimens could be obtained for the full needle length (2 cm) in 17 patients (94%), which enabled the chemosensitivity test to be performed in 14 patients (78%). Procedure-related tumor seeding was not apparent in any patient at a median of 16 months of follow-up after the procedure. CONCLUSIONS The present study showed that lung tumor biopsy with a 12-gauge needle through an outer sheath was feasible and enabled acquisition of specimens adequate for chemosensitivity testing without apparent procedure-related tumor seeding.
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Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems. Eur Radiol 2011; 20:2108-15. [PMID: 20393715 DOI: 10.1007/s00330-010-1783-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe our initial experience with percutaneous transthoracic biopsy (PCNB) of lung nodules using C-arm cone-beam CT (CBCT). MATERIALS Seventy-one consecutive patients with lung nodules of 30 mm or smaller underwent CBCT-guided PCNB using a coaxial cutting needle. We evaluated the procedure time, coaxial introducer dwell time, the numbers of pleural passages, coaxial introducer repositionings and CT acquisitions, as well as the technical success rate and radiation doses. Diagnostic accuracy, sensitivity, specificity and incidence of complications were also evaluated. RESULTS PCNB was performed for 71 nodules: 63 solid, 6 part-solid and 2 ground-glass nodules. The procedure time, coaxial introducer dwell time, numbers of pleural passages, coaxial introducer repositionings and CT acquisitions were 17.9+/-5.9 min, 8.7+/-3.8 min, 1.1+/-0.4, 0.2+/-0.5 and 2.9+/-0.7, respectively. The technical success rate was 100% and the radiation dose was 272+/-116 mGy. Thirty-six nodules (50.7%) were diagnosed as malignant, 25 (35.2%) as benign and 10 (14.1%) as indeterminate. Diagnostic accuracy, sensitivity, specificity and incidence of complications were 98.4%, 97%, 100% and 38%, respectively. Complications included pneumothorax in 18 patients (25.4%), haemoptysis in 10 (14.1%) and chest pain in one (1.4%). CONCLUSION Under CBCT guidance, PCNB of lung nodules can be performed accurately, providing both real-time fluoroscopic guidance and CT imaging capabilities.
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Choi SJ, Shin EA, Kim JS. Efficacy of Fluoroscopy-Guided Cutting Needle Lung Biopsy in Patients with Diffuse Infiltrative Lung Disease. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Soo Jeon Choi
- Division of Respirology, Department of Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Eun Ah Shin
- Department of Pathology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Joung Sook Kim
- Department of Health Promotion Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Jornet J, Pallardó Y, Revert AJ, Marcelo Galbis J, Mollá E, Sales G. [Treating iatrogenic pneumothorax with small-bore chest tube]. RADIOLOGIA 2009; 51:57-62. [PMID: 19303481 DOI: 10.1016/s0033-8338(09)70406-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 01/16/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the feasibility of small-bore chest tube placement to treat pneumothorax caused by percutaneous procedures. MATERIAL AND METHODS Between November 2004 and July 2006 we performed 151 interventional chest procedures (127 biopsies and 24 radiofrequency ablations) in 131 patients (25 women and 106 men; mean age, 63 years, range, 36-83 years). Fine needles (21-25 G) were used in 70 procedures and large core needles (14-20 G) were used in the remaining 81. Pneumothorax occurred in 16 diagnostic procedures (13 of these were treated with small-bore catheter placement) and in two radiofrequency procedures (both cases were treated with small-bore catheter placement). Chest tubes were placed immediately after pneumothorax occurred in all cases because the pneumothorax was greater than 20% or caused symptoms or occurred in patients with emphysema. RESULTS Chest tubes were successfully placed without incidents in all cases and a Heimlich valve evacuated the air completely. Mean hospital stay was 43 hours (range, 24-72 hours). It was not necessary to place a larger-bore chest tube in any case. CONCLUSION Small-bore chest tube placement is the treatment of choice for iatrogenic pneumothorax greater than 20% or less than 20% when symptomatic or occurring in patients with emphysema. The procedure is easy, effective, and well tolerated; furthermore, it shortens the hospital stay. The effectiveness of the procedure makes it possible to safely perform percutaneous procedures on patients with emphysema or difficult lesions and to finish an interventional procedure when pneumothorax occurs.
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Affiliation(s)
- J Jornet
- Servicio de Radiología, Hospital de la Ribera, Alzira, Valencia, Spain.
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25
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Necrotizing granuloma of the lung: imaging characteristics and imaging-guided diagnosis. AJR Am J Roentgenol 2007; 189:1397-401. [PMID: 18029876 DOI: 10.2214/ajr.07.2389] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess CT findings and the sensitivities of imaging-guided fine-needle aspiration (FNA) biopsy and core needle biopsy in the diagnosis of necrotizing granuloma of the lung. CONCLUSIONS The CT characteristics of necrotizing granuloma are indistinguishable from those of malignant tumors; tissue diagnosis therefore is necessary. Core needle biopsy is a sensitive method for diagnosing necrotizing granuloma of the lung, but FNA biopsy is insufficient for diagnosis.
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Yankelevitz DF, Cham MD, Farooqi AO, Henschke CI. CT-Directed Diagnosis of Peripheral Lung Lesions Suspicious for Cancer. Thorac Surg Clin 2007; 17:143-58. [PMID: 17626393 DOI: 10.1016/j.thorsurg.2007.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Small peripheral pulmonary nodules continue to be a diagnostic challenge and because of improved technology are also being identified with increased frequency. TNB, performed properly, is a highly accurate procedure and with careful attention to technical factors, nodules of any size in any location may undergo biopsy. A skilled cytologist is an essential part of the team. Continued advances in molecular diagnostics allow for an expanded role of the usefulness of this procedure.
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Affiliation(s)
- David F Yankelevitz
- Division of Chest Imaging, Department of Radiology, Weill Medical College of Cornell University, 525 East 68th Street, Box 586, New York, NY 10021, USA.
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Abstract
Lung cancer is the most frequently occurring cancer in the world, and in the United States it is the second most common cancer diagnosed. Accurate staging by imaging can have a significant impact on appropriate treatment and surgical options. Familiarity with the different histologic subtypes of lung cancer and the typical and atypical appearances of lung cancer is vital. Radiologists serve a critical role in the diagnosis, staging, and follow-up of patients with lung cancer.
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MESH Headings
- Aged
- Aged, 80 and over
- Biopsy
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/diagnostic imaging
- Carcinoma, Small Cell/pathology
- Diagnosis, Computer-Assisted
- Female
- Fluorodeoxyglucose F18
- Follow-Up Studies
- Humans
- Incidence
- Lung/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/epidemiology
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lymphatic Metastasis/diagnosis
- Magnetic Resonance Imaging
- Male
- Mediastinum
- Middle Aged
- Neoplasm Staging
- Positron-Emission Tomography
- Radiography, Thoracic
- Radiopharmaceuticals
- Risk Factors
- Sex Factors
- Time Factors
- Tomography, X-Ray Computed
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Affiliation(s)
- Michelle S Ginsberg
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Cleary K, Watson V, Lindisch D, Taylor RH, Fichtinger G, Xu S, White CS, Donlon J, Taylor M, Patriciu A, Mazilu D, Stoianovici D. Precision placement of instruments for minimally invasive procedures using a “needle driver” robot. Int J Med Robot 2006; 1:40-7. [PMID: 17518377 DOI: 10.1002/rcs.40] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical practice continues to move toward less invasive procedures. Many of these procedures require the precision placement of a needle in the anatomy. Over the past several years, our research team has been investigating the use of a robotic needle driver to assist the physician in this task. This paper summarizes our work in this area. The robotic system is briefly described, followed by a description of a clinical trial in spinal nerve blockade. The robot was used under joystick control to place a 22 gauge needle in the spines of 10 patients using fluoroscopic imaging. The results were equivalent to the current manual procedure. We next describe our follow-up clinical application in lung biopsy for lung cancer screening under CT fluoroscopy. The system concept is discussed and the results of a phantom study are presented. A start-up company named ImageGuide has recently been formed to commercialize the robot. Their revised robot design is presented, along with plans to install a ceiling-mounted version of the robot in the CT fluoroscopy suite at Georgetown University.
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Affiliation(s)
- K Cleary
- Division of Computer Aided Interventions and Medical Robotics (CAIMR), Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University Medical Center, Washington, DC, USA.
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Maher MM, Kalra MK, Titton RL, Boland GW, Wittram C, Aquino S, Mueller PR, Shepard JAO. Percutaneous Lung Biopsy in a Patient with a Cavitating Lung Mass: Indications, Technique, and Complications. AJR Am J Roentgenol 2005; 185:989-94. [PMID: 16177421 DOI: 10.2214/ajr.05.0489] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Michael M Maher
- Division of Thoracic Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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Zekas LJ, Crawford JT, O'Brien RT. Computed tomography-guided fine-needle aspirate and tissue-core biopsy of intrathoracic lesions in thirty dogs and cats. Vet Radiol Ultrasound 2005; 46:200-4. [PMID: 16050276 DOI: 10.1111/j.1740-8261.2005.00043.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Medical records and computed tomography (CT) images were reviewed retrospectively for 30 animals (27 dogs, two cats, one cougar) in which CT-guided intrathoracic fine-needle aspirates (FNA) (12), core biopsies (10) or both (8) were performed. Sample interpretation was listed as diagnostic or nondiagnostic and nonneoplasia or neoplasia. Diagnostic results were inconclusive in 35% FNA and 17% biopsies. FNA and biopsy interpretations were in agreement in seven patients, one nonneoplasia, and six neoplasia. A clinical diagnosis was made in 65% FNA and 83% biopsies. When 18 patients with confirmed diagnoses were used, overall accuracy for diagnosis was 92% for FNA and biopsy and the sensitivity for neoplasia was 91% using fine needle aspirate and 80% using biopsy. Complications seen on CT images were noted in 43% of patients, four pneumothorax, five pulmonary hemorrhage, and four with both. No clinical manifestations were noted and treatment was not necessary. Significant correlation was noted between complications and penetration of aerated lung, but not with lesion location, type of disease, method of sampling, width of mass and depth of aerated lung penetrated. CT-guided sampling is relatively safe and useful in the diagnosis of intra-thoracic lesions, especially neoplasia. FNA samples are nondiagnostic more often than biopsy samples. Sub-clinical pneumothorax and hemorrhage are common when aerated lung is penetrated.
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Affiliation(s)
- Lisa J Zekas
- Department of Surgical Sciences, School of Veterinary Medicine, University of WI, 2015 Linden Drive, Madison, WI, USA.
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Oblique approach of computed tomography guided needle biopsy using multiplanar reconstruction image by multidetector-row CT in lung cancer. Eur J Radiol 2005; 52:206-11. [PMID: 15489081 DOI: 10.1016/j.ejrad.2004.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Revised: 01/13/2004] [Accepted: 01/15/2004] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to establish the technique of multiplanar reconstruction (MPR) with multidetector-row (MDR) computed tomography (CT) guided needle biopsy for the diagnosis to access very difficult lesions. The CT guided percutaneous biopsy are well-established methods to obtain cytological and histological material such as the peripheral tumors in lung cancer. Occasionally, the conventional CT cannot permit planning a trajectory to avoid passage through bones, avoidance of bullae, fissures or vessels. In addition, some lesions are situated in less favorable locations such as those in the costophrenic recess or close to the mediastinum. Rarely can we diagnose them. MPR with MDR-CT has recently become widely available with applications for thoracic lesions. MPR images have been used to evaluate the location of small peripheral lung nodules to the relation of bullaes, vessels, and costophrenic recess. To diagnose these lesions, the usefulness of MPR were evaluated for an planning of an oblique approach of CT guided needle biopsy. MPR images were reconstructed as a line from the needle entry point to the target lesion. The first oblique image applied as the direction of posterior-anterior and cranio-caudal axis, and the second oblique image applied as the direction of posterior-anterior and left-right. Eleven out of 151 patients were required MPR technique to allow possible access to target, because of avoidance of bone and fissures in the needle pass or located in the costophrenic recess, between April 2001 and December 2002. The 5/11 patients were at the upper site (segment 1, 2 and 6) behind the scapula and ribs, 3/11 patients were at the lower lobe (segment 10) in the costophrenic recess, and 3/11 were middle lobe or segment 3 covered by the ribs and fissures. All the lesions except one were histologically diagnosed. Five patients were adenocarcinoma, and the other five patients were benign tumors. Pneumothorax occurred in one patient before we obtained the specimens. MPR guided needle biopsy with oblique approach was thought to be useful for diagnosis of very difficult thoracic lesions and would obviate an unnecessary surgical thoracoscopy.
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Affiliation(s)
- Elizabeth H Moore
- University of California Davis Medical Center, 4860 Y St., Suite 3100, Sacramento, CA 95817, USA.
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Izumi Y, Oyama T, Kawamura M, Kobayashi K. Lung biopsy with a 12-gauge cutting needle is possible using an insertion sheath in animal models. Acad Radiol 2004; 11:1278-81. [PMID: 15561575 DOI: 10.1016/j.acra.2004.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Accepted: 07/28/2004] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES The volume of lung tumor core biopsy specimens has been restricted because of concerns for complications such as bleeding and air leakage. In this animal experiment, we investigated the possibility of larger bore biopsies through the peripheral lung parenchyma. MATERIALS AND METHODS Lung biopsy was done in male domestic pigs (n= 4) under thoracotomy. A single biopsy using a 12-gauge cutting biopsy needle was done with sheath (sheath group, eight biopsies) or without sheath (nonsheath group, eight biopsies). After biopsy, bleeding time, bleeding amount, and positive airway pressure causing air leakage from the insertion site was compared between groups (Mann-Whitney U test). To observe long-term effects in closed-chest animals, percutaneous lung biopsy with the use of a sheath was carried out percutaneously in male beagles (n = 9). The animals were observed for 3 weeks. RESULTS In the pigs (sheath group) after biopsy, bleeding flowed through the sheath and formed a sheath-molded fibrin plug that secured the insertion site. Bleeding time and amount decreased significantly in the sheath group compared with the nonsheath group (115 +/- 108 versus 295 +/- 150 seconds, P = .018, and 37 +/- 41 versus 98 +/- 72 grams, P= .027, respectively). Air leakage pressure was significantly higher in the sheath group compared with the nonsheath group (37 +/- 6 versus 18 +/- 5 cmH2O, P = .001). In the beagles, no complications such as pneumothorax, hemothorax, or airway bleeding was apparent. CONCLUSION Although we have not evaluated lung tumor biopsy per se, lung tumor biopsy with a 12-gauge cutting needle may be possible with a use of a sheath.
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Affiliation(s)
- Yotaro Izumi
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Lencioni R, Crocetti L, Cioni R, Mussi A, Fontanini G, Ambrogi M, Franchini C, Cioni D, Fanucchi O, Gemignani R, Baldassarri R, Angeletti CA, Bartolozzi C. Radiofrequency ablation of lung malignancies: where do we stand? Cardiovasc Intervent Radiol 2004; 27:581-90. [PMID: 15578133 DOI: 10.1007/s00270-004-0008-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Percutaneous radiofrequency (RF) ablation is a minimally invasive technique used to treat solid tumors. Because of its ability to produce large volumes of coagulation necrosis in a controlled fashion, this technique has gained acceptance as a viable therapeutic option for unresectable liver malignancies. Recently, investigation has been focused on the clinical application of RF ablation in the treatment of lung malignancies. In theory, lung tumors are well suited to RF ablation because the surrounding air in adjacent normal parenchyma provides an insulating effect, thus facilitating energy concentration within the tumor tissue. Experimental studies in rabbits have confirmed that lung RF ablation can be safely and effectively performed via a percutaneous, transthoracic approach, and have prompted the start of clinical investigation. Pilot clinical studies have shown that RF ablation enables successful treatment of relatively small lung malignancies with a high rate of complete response and acceptable morbidity, and have suggested that the technique could represent a viable alternate or complementary treatment method for patients with non-small cell lung cancer or lung metastases of favorable histotypes who are not candidates for surgical resection. This article gives an overview of lung RF ablation, discussing experimental animal findings, rationale for clinical application, technique and methodology, clinical results, and complications.
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Affiliation(s)
- Riccardo Lencioni
- Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplants, and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, I-56126, Pisa, Italy.
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Abstract
OBJECTIVE to evaluate the factors that could effect the risk of pneumothorax in patients undergoing transthoracic biopsy. MATERIAL AND METHODS variables that could increase the risk of pneumothorax were evaluated in 453 CT-guided transthoracic biopsies. Factors were evaluated in two groups: (1) lesion related (presence of emphysema around the lesion, lesion depth, cavitation, presence of fissure/atelectasis and pleural tag in the needle trajectory); and (2) procedure related (biopsy type, needle size, number of passages, level of experience of the operator). All variables were analysed by chi2 test and multivariate logistic regression statistics. RESULTS pneumothorax was developed in 85 (18.8%) out of 453 procedures. A chest tube was inserted in ten (11.7%) of them. Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P<0.001) and severity of the emphysema (P<0.01). CONCLUSION the length of the lung parenchyma traversed during the biopsy is the predominant risk factor for pneumothorax in patients undergoing CT-guided transthoracic biopsy. The risk of pneumothorax was also increased with the severity of the emphysema around the lesion.
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Affiliation(s)
- Uğur Topal
- Department of Radiology, Uludağ University Medical School, Görükle Campus, 16059 Bursa, Turkey.
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Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, Pointon K, Richardson C, Sawicka E. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58:920-36. [PMID: 14586042 PMCID: PMC1746503 DOI: 10.1136/thorax.58.11.920] [Citation(s) in RCA: 289] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Manhire
- Department of Radiology, Nottingham City Hospital, UK.
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Mesurolle B, Mignon F, Meingan P, Domenge C, Vasile M, Sigal R. Head and neck cancer patients with pulmonary nodules: Value and role of CT-guided transthoracic needle aspiration biopsies. Head Neck 2003; 25:889-94. [PMID: 14603448 DOI: 10.1002/hed.10303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate transthoracic needle aspiration biopsies of pulmonary lesions in patients with squamous cell cancer of head and neck. METHODS Retrospective series of 85 patients with squamous cell cancer of head and neck cancer and pulmonary nodules who underwent CT-guided needle aspiration biopsy. RESULTS Diagnostic samples were obtained in 85% of patients. There were 8 benign and 77 malignant lesions. Among the 73 proved cases, 4 were false-negative cases. CT-guided biopsy had an accuracy of 81%, a sensitivity of 94%, and a negative predictive value of 60%. Accuracies were 68% for lesions of 20 mm or smaller and 89% for lesions greater than 20 mm. In a subset of 45 solitary lesions, among 30 positive biopsies, 15 were categorized as primary malignancies, 3 as metastatic, and 12 as indeterminate malignancies. CONCLUSIONS In head and neck cancer patients, the prevalence of thoracic malignancies is high when a pulmonary lesion is detected. CT-guided biopsy of pulmonary lesion is an accurate procedure. However, a third of positive biopsies were categorized as indeterminate malignancies.
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Affiliation(s)
- Benoît Mesurolle
- Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, F-94805 Villejuif Cedex, France.
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Shankar S, vanSonnenberg E, Silverman SG, Tuncali K, Morrison PR. Management of pneumothorax during percutaneous radiofrequency ablation of a lung tumor: technical note. J Thorac Imaging 2003; 18:106-9. [PMID: 12700487 DOI: 10.1097/00005382-200304000-00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Percutaneous radiofrequency ablation (RFA) is a new procedure to treat lung cancer. Pneumothorax (PTX) may occur intraprocedurally, especially with the large RFA probes, and complicate the completion of the treatment. The authors describe a case of PTX developing during RFA and its successful management.
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Affiliation(s)
- Sridhar Shankar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
This paper presents current indications, contraindications, technical aspects, complications and yield of diagnosis of percutaneous lung biopsy in the setting of lung cancer. Percutaneous lung biopsy should be performed each time that the therapeutic strategy can be significantly influenced, when the procedure is technically feasible and to patients for which the benefits outweigh the risks, that are pneumothorax and pulmonary haemorrhage. Factors identified as potentially favouring post-biopsy pneumothorax are numerous whereas the use of a needle size larger than 18 gauge is the major risk factor of bleeding. Although a coaxial system is highly suitable in any case, two categories of needles can be used; those providing aspiration and those for core biopsies. Both offer similar yields for the diagnosis of malignancy, but core biopsies are more efficient for the specific diagnosis of benignity and lymphoma. Technical improvements of guidance, needle design and pathological techniques may contribute to lower the size limit of the nodule to be biopsied, to decrease the complication rate and their severity and to increase the yield of diagnosis.
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Affiliation(s)
- François Laurent
- Unité d'Imagerie Thoracique et Cardiovasculaire, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Avenue de Magellan, Pessac 33604, France.
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