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Saggiante L, Biondetti P, Lanza C, Carriero S, Ascenti V, Piacentino F, Shehab A, Ierardi AM, Venturini M, Carrafiello G. Computed-Tomography-Guided Lung Biopsy: A Practice-Oriented Document on Techniques and Principles and a Review of the Literature. Diagnostics (Basel) 2024; 14:1089. [PMID: 38893616 PMCID: PMC11171640 DOI: 10.3390/diagnostics14111089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Computed tomography (CT)-guided lung biopsy is one of the oldest and most widely known minimally invasive percutaneous procedures. Despite being conceptually simple, this procedure needs to be performed rapidly and can be subject to meaningful complications that need to be managed properly. Therefore, knowledge of principles and techniques is required by every general or interventional radiologist who performs the procedure. This review aims to contain all the information that the operator needs to know before performing the procedure. The paper starts with the description of indications, devices, and types of percutaneous CT-guided lung biopsies, along with their reported results in the literature. Then, pre-procedural evaluation and the practical aspects to be considered during procedure (i.e., patient positioning and breathing) are discussed. The subsequent section is dedicated to complications, with their incidence, risk factors, and the evidence-based measures necessary to both prevent or manage them; special attention is given to pneumothorax and hemorrhage. After conventional CT, this review describes other available CT modalities, including CT fluoroscopy and cone-beam CT. At the end, more advanced techniques, which are already used in clinical practice, like fusion imaging, are included.
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Affiliation(s)
- Lorenzo Saggiante
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Velio Ascenti
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Anas Shehab
- Interventional Radiology Fellowship, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
- School of Radiology, Università Degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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Suh YJ, Lee JH, Hur J, Hong SR, Im DJ, Kim YJ, Hong YJ, Lee HJ, Kim YJ, Choi BW. Predictors of False-Negative Results from Percutaneous Transthoracic Fine-Needle Aspiration Biopsy: An Observational Study from a Retrospective Cohort. Yonsei Med J 2016; 57:1243-51. [PMID: 27401658 PMCID: PMC4960393 DOI: 10.3349/ymj.2016.57.5.1243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We investigated factors predictive of false-negative pulmonary lesions with nonspecific benign cytology results on percutaneous transthoracic fine-needle aspiration biopsy (FNAB). MATERIALS AND METHODS We included 222 pulmonary lesions that had a nonspecific benign result from percutaneous transthoracic FNAB between March 2005 and December 2012, and were confirmed by subsequent pathologic results or adequate clinical follow up over at least 2 years. Clinical, imaging, and biopsy procedure-related findings were compared between lesions with a final diagnosis of malignancy (false-negative) and lesions with a benign diagnosis (true-negative). Multivariate logistic regression analysis was performed to identify significant predictors of false-negatives. RESULTS Of 222 lesions, 115 lesions were proved to be false-negatives, and 107 were true-negatives. Compared with the true-negatives, false-negative lesions showed significantly older age (p=0.037), higher maximum standardized uptake value (SUVmax) on positron emission tomography (p=0.001), larger lesion size (p=0.007), and lesion characteristics of a subsolid nodule (p=0.007). On multivariate logistic regression analysis, SUVmax, lesion size, and lesion characteristics were significant predictors of false-negative results. CONCLUSION Among the clinical, radiologic, and procedure-related factors analyzed, high SUVmax, large lesion size, and subsolid lesions were useful for predicting malignancy in pulmonary lesions with nonspecific benign cytology results on FNAB.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Sae Rom Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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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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