1
|
Wang Y, Zhang Y, Ren N, Li F, Lu L, Zhao X, Zhou Z, Gao M, Wang M. Repeat biopsy versus initial biopsy in terms of complication risk factors and clinical outcomes for patients with non-small cell lung cancer: a comparative study of 113 CT-guided needle biopsy of lung lesions. Front Oncol 2024; 14:1367603. [PMID: 38803532 PMCID: PMC11129557 DOI: 10.3389/fonc.2024.1367603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives The safety and feasibility of repeat biopsy after systemic treatment for non-small cell lung cancer have received extensive attention in recent years. The purpose of this research was to compare complication rates between initial biopsy and rebiopsy in non-small cell lung cancer patients with progressive disease and to assess complication risk factors and clinical results after rebiopsy. Methods The study included 113 patients initially diagnosed with non-small cell lung cancer who underwent lung biopsy at initial biopsy and rebiopsy after progression while on epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and/or chemotherapy from January 2018 to December 2021. We compared the incidence of complications between the initial biopsy and rebiopsy and analyzed the predictors factors that influenced complications in patients who underwent rebiopsy. Results The successful rate of rebiopsy was 88.5% (100/113). With the exception of two cases where lung adenocarcinoma changed into small cell lung cancer with gefitinib treatment, 98 individuals retained their initial pathological type. The secondary EGFR T790M mutation accounts for 55.6% of acquired resistance. The total number of patients with complications in initial biopsy was 25 (22.1%) and 37 (32.7%) in the rebiopsy. The incidence of pulmonary hemorrhage increased from 7.1% at the initial biopsy to 10.6% at rebiopsy, while the incidence of pneumothorax increased from 14.2% to 20.4%. Compared with the initial biopsy, the incidence of overall complications, parenchymal hemorrhage, and pneumothorax increased by 10.6%, 3.5%, and 6.2%, respectively. In all four evaluations (pneumorrhagia, pneumothorax, pleural reaction, and overall complication), there were no significant differences between the rebiopsy and initial biopsy (all p > 0.05). The multivariate logistic regression analysis suggested that male sex (odds ratio [OR] = 5.064, p = 0.001), tumor size ≤ 2 cm (OR = 3.367, p = 0.013), EGFR-TKIs with chemotherapy (OR = 3.633, p =0.023), and transfissural approach (OR = 7.583, p = 0.026) were independent risk factors for overall complication after rebiopsy. Conclusion Compared with the initial biopsy, the complication rates displayed a slight, but not significant, elevation in rebiopsy. Male sex, tumor size ≤ 2 cm, transfissural approach, and EGFR-TKIs combined with chemotherapy were independent risk factors for rebiopsy complications.
Collapse
Affiliation(s)
- Yangyang Wang
- Department of Medical Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongyuan Zhang
- Department of Medical Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nana Ren
- Department of Medical Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangting Li
- Department of Medical Imaging, Zhengzhou People’s Hospital, Zhengzhou, China
| | - Lin Lu
- Department of Medical Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Medical Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhigang Zhou
- Department of Medical Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengyu Gao
- Department of Medical Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Wang
- Department of Medical Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
2
|
Tipaldi MA, Ronconi E, Ubaldi N, Bozzi F, Siciliano F, Zolovkins A, Orgera G, Krokidis M, Quarta Colosso G, Rossi M. Histology profiling of lung tumors: tru-cut versus full-core system for CT-guided biopsies. LA RADIOLOGIA MEDICA 2024; 129:566-574. [PMID: 38512617 PMCID: PMC11021310 DOI: 10.1007/s11547-024-01772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/03/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE We aimed to compare the diagnostic yield and procedure-related complications of two different types of systems for percutaneous CT-guided lung biopsy. MATERIAL AND METHODS All patients with a lung lesion who underwent a CT-guided lung biopsy at our institution, between January 2019 and 2021, were retrospectively analyzed. The inclusion criteria were: (a) Procedures performed using either a fully automated tru-cut or a semi-automated full-core biopsy needle, (b) CT images demonstrating the position of the needles within the lesion, (c) histopathological result of the biopsy and (d) clinical follow-up for at least 12 months and\or surgical histopathological results. A total of 400 biopsy fulfilling the inclusion criteria were selected and enrolled in the study. RESULTS Overall technical success was 100% and diagnostic accuracy was 84%. Tru-cut needles showed a significantly higher diagnostic accuracy when compared to full-core needles (91% vs. 77%, p = 0.0004) and a lower rate of pneumothorax (31% vs. 41%, p = 0.047). Due to the statistically significant different of nodules size between the two groups, we reiterated the statistical analysis splitting our population around the 20 mm cut-off for nodule size. We still observed a significant difference in diagnostic accuracy between tru-cut and full-core needles favoring the former for both smaller and larger lesions (81% vs. 71%, p = 0.025; and 92% vs. 81%; p = 0.01, respectively). CONCLUSION Our results demonstrated that the use of automated tru-cut needles is associated with higher histopathological diagnostic accuracy compared to semi-automated full-core needles for CTLB.
Collapse
Affiliation(s)
- Marcello Andrea Tipaldi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy.
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy.
| | - Edoardo Ronconi
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Nicolò Ubaldi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Fernando Bozzi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Francesco Siciliano
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Aleksejs Zolovkins
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Gianluigi Orgera
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Miltiadis Krokidis
- School of Medicine, National and Kapodistrian University of Athens Areteion Hospital 76, Vas. Sophias Ave, 11528, Athens, Greece
| | - Giulio Quarta Colosso
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Michele Rossi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| |
Collapse
|
3
|
Yasin B, Saeed H, Ahmad MA, Najam S, Niazi M, Tariq H, Khan AYY, Khaliq S, Zaidi SGEZ, Mehmood Qadri H. Efficacy of Computerized Tomography-Guided Core Biopsy in Identifying the Subtypes of Lung Adenocarcinoma: An Observational Perspective From Pakistan. Cureus 2024; 16:e57337. [PMID: 38690481 PMCID: PMC11060614 DOI: 10.7759/cureus.57337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lung carcinoma is a leading cause of death worldwide. Histological subtype of lung adenocarcinoma is an important indicator of patient's outcome as it is helpful in surgical planning and guidance of prognosis. Objective To determine the diagnostic efficacy of computerized tomography-guided core needle biopsy (CNB) in identifying the histopathological subtype of lung adenocarcinoma. Methods and materials This is a retrospective, descriptive study including clinical data of 73 patients irrespective of their age and gender, who underwent computerized tomography-guided CNB for lung masses at the Department of Pathology, Aznostics - the Diagnostic Centre, Lahore, Pakistan from January 01, 2019 to June 30, 2023. Data collected was analyzed via Google Form (Google Inc., Mountainview, CA) and Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, Version 24, released 2016; IBM Corp., Armonk, New York, United States) and was sent to statistician for descriptive analysis. Categorical data was used for calculating frequency and percentage, while continuous data was computed as mean and standard deviation. Results Seventy-three patients with adenocarcinoma underwent pulmonary biopsy. The mean age of included patients was 64.88 ± 11.39 year with a male predominance of 61.64%. Upper lobe was commonly affected by adenocarcinoma lung in 57.53% patients and 58.90% cases involved the right lung. The most common subtype was acinar with 51.65% followed by solid with 17.58% cases. Computerized tomography-guided CNB showed a diagnostic yield of 75.34% and identified histological subtypes of lung adenocarcinoma in 55 cases. Conclusion Computerized tomography-guided CNB is a useful, yet minimally invasive diagnostic tool to identify the histological subtype of lung adenocarcinoma. It not only helps in planning the surgical and adjuvant management of the patients, but also guides the patient-prognosis.
Collapse
Affiliation(s)
- Babar Yasin
- Histopathology, Aznostics - The Diagnostic Center, Lahore, PAK
| | - Hasan Saeed
- Histopathology, Shifa International Hospital Islamabad, Islamabad, PAK
| | | | - Sara Najam
- Internal Medicine, Jinnah Hospital Lahore, Lahore, PAK
| | - Mehwish Niazi
- Histopathology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Humza Tariq
- Surgery, Lahore General Hospital, Lahore, PAK
| | | | | | | | | |
Collapse
|
4
|
Lovrenski A, Gardic N, Tegeltija D, Miljkovic D. Diagnostic accuracy and adequacy of peripheral pulmonary nodules samples obtained by transthoracic needle aspiration. Cytopathology 2023; 34:35-42. [PMID: 36062401 DOI: 10.1111/cyt.13176] [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: 05/25/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the adequacy of samples and accuracy of transthoracic needle aspiration (TTNA) in patients with peripheral pulmonary nodule (PPN) diagnosis. METHODS This retrospective study included 248 patients who underwent TTNA of PPN and subsequent diagnostic and therapeutic surgical procedures during a 5-year period at the Institute for Pulmonary Diseases of Vojvodina. The following were analysed: adequacy of cytological samples for diagnosis and molecular testing, tumour localisation and dimensions, and cytological and histopathological characteristics. RESULTS The adequacy of the cytological samples was 93.15%. The proportion of adequate-diagnostic samples was higher in patients in whom the largest diameter of the lesion was >4 cm, and this difference showed statistical significance. Tumour localisation was not statistically significant for the adequacy of samples for cytological analysis. Cytological samples of lung adenocarcinoma had high projected adequacy for EGFR analyses of 91.55%, not dependent on the size and location of the lesion. The most commonly diagnosed lung tumour was adenocarcinoma (45.51%). Patients with a cytological diagnosis of non-small cell carcinoma not otherwise specified, after histopathological analyses, had adenocarcinoma in most cases (53.85%). The overall accuracy of TTNA in the diagnosis of PPN was 71%. The method's accuracy was 75.24% for malignant tumours, while it was 28.57% for benign tumours. The accuracy of cytological analysis for the histological type of tumour was 84.18%. CONCLUSION Transthoracic needle aspiration with cytological analysis is an effective and highly sensitive method in determining the aetiology of PPN.
Collapse
Affiliation(s)
- Aleksandra Lovrenski
- Department of Pathology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Deparment of Pathology and Molecular Diagnostics, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Nikola Gardic
- Department of Pathology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Dragana Tegeltija
- Department of Pathology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Deparment of Pathology and Molecular Diagnostics, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dejan Miljkovic
- Department of Histology and Embryology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
5
|
Chen Z, Yi L, Peng Z, Zhou J, Zhang Z, Tao Y, Lin Z, He A, Jin M, Zuo M. Development and validation of a radiomic nomogram based on pretherapy dual-energy CT for distinguishing adenocarcinoma from squamous cell carcinoma of the lung. Front Oncol 2022; 12:949111. [PMID: 36505773 PMCID: PMC9727167 DOI: 10.3389/fonc.2022.949111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Based on pretherapy dual-energy computed tomography (DECT) images, we developed and validated a nomogram combined with clinical parameters and radiomic features to predict the pathologic subtypes of non-small cell lung cancer (NSCLC) - adenocarcinoma (ADC) and squamous cell carcinoma (SCC). Methods A total of 129 pathologically confirmed NSCLC patients treated at the Second Affiliated Hospital of Nanchang University from October 2017 to October 2021 were retrospectively analyzed. Patients were randomly divided in a ratio of 7:3 (n=90) into training and validation cohorts (n=39). Patients' pretherapy clinical parameters were recorded. Radiomics features of the primary lesion were extracted from two sets of monoenergetic images (40 keV and 100 keV) in arterial phases (AP) and venous phases (VP). Features were selected successively through the intra-class correlation coefficient (ICC) and the least absolute shrinkage and selection operator (LASSO). Multivariate logistic regression analysis was then performed to establish predictive models. The prediction performance between models was evaluated and compared using the receiver operating characteristic (ROC) curve, DeLong test, and Akaike information criterion (AIC). A nomogram was developed based on the model with the best predictive performance to evaluate its calibration and clinical utility. Results A total of 87 ADC and 42 SCC patients were enrolled in this study. Among the five constructed models, the integrative model (AUC: Model 4 = 0.92, Model 5 = 0.93) combining clinical parameters and radiomic features had a higher AUC than the individual clinical models or radiomic models (AUC: Model 1 = 0.84, Model 2 = 0.79, Model 3 = 0.84). The combined clinical-venous phase radiomics model had the best predictive performance, goodness of fit, and parsimony; the area under the ROC curve (AUC) of the training and validation cohorts was 0.93 and 0.90, respectively, and the AIC value was 60.16. Then, this model was visualized as a nomogram. The calibration curves demonstrated it's good calibration, and decision curve analysis (DCA) proved its clinical utility. Conclusion The combined clinical-radiomics model based on pretherapy DECT showed good performance in distinguishing ADC and SCC of the lung. The nomogram constructed based on the best-performing combined clinical-venous phase radiomics model provides a relatively accurate, convenient and noninvasive method for predicting the pathological subtypes of ADC and SCC in NSCLC.
Collapse
Affiliation(s)
- Zhiyong Chen
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Yi
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhiwei Peng
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianzhong Zhou
- Department of Radiology, The Quzhou City People’s Hospital, Quzhou, Zhejiang, China
| | - Zhaotao Zhang
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yahong Tao
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ze Lin
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Anjing He
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mengni Jin
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Minjing Zuo
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China,*Correspondence: Minjing Zuo,
| |
Collapse
|
6
|
Sargent T, Kolderman N, Nair GB, Jankowski M, Al-Katib S. Risk Factors for Pneumothorax Development Following CT-Guided Core Lung Nodule Biopsy. J Bronchology Interv Pulmonol 2022; 29:198-205. [PMID: 34654044 DOI: 10.1097/lbr.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aims to correlate nodule, patient, and technical risk factors less commonly investigated in the literature with pneumothorax development during computed tomography-guided core needle lung nodule biopsy. PATIENTS AND METHODS Retrospective data on 671 computed tomography-guided percutaneous core needle lung biopsies from 671 patients at a tertiary care center between March 2014 and August 2016. Univariate and multivariable logistic regression analyses were used to identify pneumothorax risk factors. RESULTS The overall incidence of pneumothorax was 26.7% (n=179). Risk factors identified on univariate analysis include anterior [odds ratio (OR)=1.98; P<0.001] and lateral (OR=2.17; P=0.002) pleural surface puncture relative to posterior puncture, traversing more than one pleural surface with the biopsy needle (OR=2.35; P=0.06), patient positioning in supine (OR=2.01; P<0.001) and decubitus nodule side up (OR=2.54; P=0.001) orientation relative to decubitus nodule side down positioning, and presence of emphysema in the path of the biopsy needle (OR=3.32; P<0.001). In the multivariable analysis, the presence of emphysematous parenchyma in the path of the biopsy needle was correlated most strongly with increased odds of pneumothorax development (OR=3.03; P=0.0004). Increased body mass index (OR=0.95; P=0.001) and larger nodule width (cm; OR=0.74; P=0.02) were protective factors most strongly correlated with decreased odds of pneumothorax development. CONCLUSION Emphysema in the needle biopsy path is most strongly associated with pneumothorax development. Increases in patient body mass index and width of the target lung nodule are most strongly associated with decreased odds of pneumothorax.
Collapse
Affiliation(s)
- Tyler Sargent
- Oakland University William Beaumont School of Medicine, Rochester
| | | | - Girish B Nair
- Division of Pulmonary Critical Care, Beaumont Health System, Royal Oak, MI
| | | | - Sayf Al-Katib
- Department of Diagnostic Radiology and Molecular Imaging
| |
Collapse
|
7
|
Larocque N, Brook OR. Lung, Pleural, and Mediastinal Biopsies: From Preprocedural Assessment to Technique and Management of Complications. Semin Intervent Radiol 2022; 39:218-225. [PMID: 36062222 PMCID: PMC9433161 DOI: 10.1055/s-0042-1751292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Biopsies of the lung, pleura, and mediastinum play a crucial role in the workup of thoracic lesions. Percutaneous image-guided biopsy of thoracic lesions is a relatively safe and noninvasive way to obtain a pathologic diagnosis which is required to direct patient management. This article reviews how to safely perform image-guided biopsies of the lung, pleura, and mediastinum, from the preprocedural assessment to reviewing intraprocedural techniques, and how to avoid and manage complications.
Collapse
Affiliation(s)
- Natasha Larocque
- Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Olga R. Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
8
|
Lakhdar S, Nassar M, Shatabdi S, Buttar C, Abrudescu A, Trandafirescu T. A Cavitary Lesion in a Patient with Antineutrophilic Cytoplasmic Antibody (ANCA) Associated Vasculitis: A Case Report and Review of the Literature. J Intensive Care Med 2022; 38:114-120. [PMID: 35437034 DOI: 10.1177/08850666221095498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis who were on immunosuppressive therapy with corticosteroids may be susceptible to cavitary lesions.1 Only a few cases have been reported in the literature to date. Immunosuppression was shown to improve prognosis in patients with vasculitis. However, adverse therapy events and the risk of opportunistic infections become a major cause of morbidity and mortality in this specific patient population. We present a case of a 75-year-old female who was diagnosed and treated in our hospital for ANCA-associated vasculitis and returned within a few weeks of medical therapy and was found to have developed cavitation concerning for worsening vasculitis or an opportunistic fungal infection or combination of both. Given the risk of severe complications from opportunistic fungal infections, close monitoring and prophylactic antifungal therapy should be considered. Further studies are needed to evaluate the benefit of prophylaxis in this patient population.
Collapse
Affiliation(s)
- Sofia Lakhdar
- 5925Icahn School of Medicine at Mount Sinai / 24843NYC Health + Hospitals Queens, Jamaica, NY, USA
| | - Mahmoud Nassar
- 5925Icahn School of Medicine at Mount Sinai / 24843NYC Health + Hospitals Queens, Jamaica, NY, USA
| | - Shabnam Shatabdi
- 5925Icahn School of Medicine at Mount Sinai / 24843NYC Health + Hospitals Queens, Jamaica, NY, USA
| | - Chandan Buttar
- 5925Icahn School of Medicine at Mount Sinai / 24843NYC Health + Hospitals Queens, Jamaica, NY, USA
| | - Adriana Abrudescu
- 5925Icahn School of Medicine at Mount Sinai / 24843NYC Health + Hospitals Queens, Jamaica, NY, USA
| | - Theo Trandafirescu
- 5925Icahn School of Medicine at Mount Sinai / 24843NYC Health + Hospitals Queens, Jamaica, NY, USA
| |
Collapse
|
9
|
Yiminniyaze R, Zhang X, Yuanyuan Z, Chen K, Li C, Zhu N, Zhou D, Li J, Zhang Y, Li S. Diagnostic Efficiency and Safety of Rapid On-Site Evaluation Combined with CT-Guided Transthoracic Core Needle Biopsy in Suspected Lung Cancer Patients. Cytopathology 2022; 33:439-444. [PMID: 35362154 PMCID: PMC9324149 DOI: 10.1111/cyt.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 11/27/2022]
Abstract
Objective The efficacy of rapid on‐site evaluation (ROSE) combined with computed tomography‐guided transthoracic core needle biopsy (CT‐guided TCNB) is rarely investigated. This study aimed to evaluate the diagnostic efficiency and safety of ROSE combined with CT‐guided TCNB for suspected lung cancer patients. Materials and Methods Clinical data from 285 patients who received CT‐guided TCNB for suspected lung cancer in Huashan Hospital from 2015 to 2018 were retrospectively analysed. Of these 163 patients underwent CT‐guided TCNB combined with ROSE (ROSE group), while the remaining 122 patients underwent without ROSE (non‐ROSE group). The smears from TCNB were quickly processed with Diff‐Quick staining and analysed by a skilled cytologist on‐site. The consistency of ROSE with the final clinicopathological diagnosis and the diagnostic efficiency and safety of ROSE combined with CT‐guided TCNB in suspected lung cancer patients were evaluated. Results ROSE was highly concordant with pathological diagnosis (κ = 0.791; P < 0.001), with an accuracy of 95.7%. Diagnostic accuracy was significantly higher in the ROSE compared with the non‐ROSE group (96.3% vs 86.1%; P = 0.002), with overall incidences of complications of 36.8% and 23.8%, respectively. Minor pneumothorax without drainage was slightly greater in the ROSE compared with the non‐ROSE group (14.1% vs 6.6%; P = 0.046). However, there was no significant difference in serious complications between the two groups. Conclusion ROSE was highly consistent with the final clinicopathological diagnosis for suspected lung cancer. ROSE further improved the diagnostic efficiency of CT‐guided TCNB with no increased incidence of serious complications.
Collapse
Affiliation(s)
- Ruzetuoheti Yiminniyaze
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiujuan Zhang
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhang Yuanyuan
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Kun Chen
- Department of Laboratory Medicine, Baoshan District of Huashan Hospital, Fudan University, Shanghai, China
| | - Chengwei Li
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ning Zhu
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Daibing Zhou
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuhai Zhang
- Department of Health Statistics, Airforce Medical University, Xi'an, China
| | - Shengqing Li
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
10
|
Li Y, Yang F, Huang YY, Cao W. Comparison between computed tomography-guided core and fine needle lung biopsy: A meta-analysis. Medicine (Baltimore) 2022; 101:e29016. [PMID: 35244081 PMCID: PMC8896491 DOI: 10.1097/md.0000000000029016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to compare the safety and diagnostic performance between computed tomography (CT)-guided core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in lung nodules/masses patients. METHODS All relevant studies in the Pubmed, Embase, and Cochrane Library databases that were published as of June 2020 were identified. RevMan version 5.3 was used for all data analyses. RESULTS In total, 9 relevant studies were included in the present meta-analysis. These studies were all retrospective and analyzed outcomes associated with 2175 procedures, including both CT-guided CNB (n = 819) and FNAB (n = 1356) procedures. CNB was associated with significantly higher sample adequacy rates than was FNAB (95.7% vs 85.8%, OR: 0.26; P < .00001), while diagnostic accuracy rates did not differ between these groups (90.1% vs 87.6%, OR: 0.8; P = .46). In addition, no differences in rates of pneumothorax (28.6% vs 23.0%, OR: 1.15; P = .71), hemorrhage (17.3% vs 20.1%, OR: 0.91; P = .62), and chest tube insertion (5.9% vs 4.9%, OR: 1.01; P = .97) were detected between these groups. Significant heterogeneity among included studies was detected for the diagnostic accuracy (I2 = 57%) and pneumothorax (I2 = 77%) endpoints. There were no significant differences between CNB and FNAB with respect to diagnostic accuracy rates for lung nodules (P = .90). In addition, we detected no evidence of significant publication bias. CONCLUSIONS CT-guided CNB could achieve better sample adequacy than FNAB did during the lung biopsy procedure. However, the CNB did not show any superiorities in items of diagnostic accuracy and safety.
Collapse
Affiliation(s)
- Yong Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fang Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ya-Yong Huang
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China
| | - Wei Cao
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China
| |
Collapse
|
11
|
Schroeder C, Loebelenz LI, Heverhagen JT, Noeldge G, Brönnimann MP, Kim SY. Full core technology versus notch sampling technology: evaluation of the diagnostic accuracy and the risk of a pneumothorax after transthoracic needle biopsy of suspicious lung lesions. Acta Radiol 2022; 63:35-41. [PMID: 33356359 DOI: 10.1177/0284185120981575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Percutaneous needle biopsy of the lung (PCBL) under image guidance has become a safe and effective minimal invasive method to obtain a specimen related histological diagnosis of pulmonary lesions. PURPOSE To evaluate the diagnostic yield and safety of two different coaxial biopsy technologies: full core and notch sampling technology. The former allowing the removal of full punch cylinders and the latter using a cutting-edge mechanism. MATERIAL AND METHODS A retrospective analysis of 48 consecutive PCBL procedures has been carried out for this prognostic study, involving patients with a documented pulmonary nodule or mass lesion on previous computed tomography (CT) scans. The study population included 38 men and 10 women (mean age = 67 years). Of these 48 patients who underwent a procedure with a co-axial cutting system, 24 have been performed with notch sampling technology and 24 with full core technology. RESULTS Out of the 48 biopsy procedures, 46 yielded specimens were adequate for histopathological evaluation, consistent with a technical success rate of 96%. The most common induced image-guided biopsy complication was a pneumothorax, occurring in 14 patients (35%). Seven patients with a pneumothorax were attributed to the full core technology and seven to the notch sampling technology (odds ratio = 1, 95% confidence interval = 0.28-3.51, P = 1). CONCLUSION In the setting of full core versus notch sampling percutaneous CT-guided coaxial needle biopsy of the lung, no significant difference in the diagnostic accuracy and the incidence of pneumothoraces could be shown, while both technologies have an excellent diagnostic performance.
Collapse
Affiliation(s)
- Christophe Schroeder
- Institute for Diagnostic, Interventional, and Pediatric Radiology, (DIPR), Inselspital, University Hospital Bern, Bern, Switzerland
| | - Laura I Loebelenz
- Institute for Diagnostic, Interventional, and Pediatric Radiology, (DIPR), Inselspital, University Hospital Bern, Bern, Switzerland
| | - Johannes T Heverhagen
- Institute for Diagnostic, Interventional, and Pediatric Radiology, (DIPR), Inselspital, University Hospital Bern, Bern, Switzerland
| | - Gerd Noeldge
- Institute for Diagnostic, Interventional, and Pediatric Radiology, (DIPR), Inselspital, University Hospital Bern, Bern, Switzerland
| | - Michael P Brönnimann
- Institute for Diagnostic, Interventional, and Pediatric Radiology, (DIPR), Inselspital, University Hospital Bern, Bern, Switzerland
| | - Soung Yung Kim
- Department of Radiology and Nuclear Medicine, Kantonsspital, Spitäler Schaffhausen, Schaffhausen, Switzerland
| |
Collapse
|
12
|
Sarajlic V, Vesnic S, Udovicic-Gagula D, Kuric H, Akhan O. Diagnostic accuracy and complication rates of percutaneous CT-guided coaxial needle biopsy of pulmonary lesions. ACTA ACUST UNITED AC 2021; 27:553-557. [PMID: 33769291 DOI: 10.5152/dir.2021.20844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this retrospective study was to evaluate and compare diagnostic accuracy and complication rates of percutaneous computed tomography (CT)-guided biopsies of pulmonary lesions 10-35 mm, 35-50 mm, and >50 mm, using the coaxial biopsy technique. METHODS Over a 4-year period, 235 lung biopsies were performed using the coaxial biopsy technique with 18G semi-automated true-cut needle. There were 163 (69.4%) male and 72 (30.6%) female patients, with a mean age of 64.01±9.18 years (18-85 years). The mean lesion size was 59.6±29.3 mm. The lesions were stratified into three groups according to size: lesions <35 mm (n=42, 17.9%), lesions 35-50 mm (n=53, 22.5%), and lesions >50 mm (n=140, 59.6%). Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for all biopsies, and for each group separately, as well as the incidence of complications. RESULTS The overall diagnostic accuracy was 95.4%, with 95.52% sensitivity, 100% specificity, 100% PPV, and 47.37% NPV. For lesions <35 mm, diagnostic accuracy, sensitivity, and PPV were 100%. The lowest diagnostic accuracy was 93.9% in lesions >50 mm, with 93.65% sensitivity, 100% specificity, 100% PPV, and 42.86% NPV. An adequate sample was obtained in 219 core biopsies (93.2%), while 16 biopsies (6.8%) were nondiagnostic due to necrosis (4.25%) and insufficient biopsy material (2.55%). The most frequent complication was minor pneumothorax, which was seen at a rate of 19.1%; pneumothorax requiring chest tube placement occurred in 3 patients (1.3%). CONCLUSION Diagnostic accuracy decreased with increasing lesion size. On the other hand, complication rates were higher in smaller lesions, more distanced from the pleura.
Collapse
Affiliation(s)
- Vesna Sarajlic
- Clinic for Radiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sanela Vesnic
- Clinic for Radiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Dalma Udovicic-Gagula
- Department of Pathology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Haris Kuric
- Clinic for Radiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Okan Akhan
- Department of Radiology, Hacettepe University, Ankara, Turkey
| |
Collapse
|
13
|
Mortani Barbosa EJ, Sachs N. CT Fluoroscopy Guided Thoracic Biopsies (CTTB) Are Highly Accurate and Safe: Outcomes and Predictive Modeling of Complications Utilizing Machine Learning. Acad Radiol 2021; 28:608-618. [PMID: 32473783 DOI: 10.1016/j.acra.2020.03.036] [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: 02/04/2020] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE CT guided transthoracic biopsy (CTTB) is an established, minimally invasive method for diagnostic evaluation of a variety of thoracic diseases. We assessed a large CTTB cohort diagnostic accuracy, complication rates, and developed machine learning models to predict complications. MATERIALS AND METHODS We retrospectively identified 796 CTTB patients in a tertiary hospital (5-year interval). We gathered and coded patient demographics, characteristics of each lesion biopsied, type of biopsy, diagnostic yield, type of diagnosis, and complication rates. Statistical analyses included summary statistics, multivariate logistic regression and machine learning (neural network) methods. RESULTS Seven hundred ninety-six CTTBs were performed (43% fine needle aspirations, 5% core biopsies, 52% both). Diagnostic yield was 97.0% (73.9% malignant, 23.1% benign). Complications occurred in 14.7% (12.7% minor, 2.0% major). The most common complication was pneumothorax (13.1%), mostly minor. Multivariate logistic regression models could predict severity of complications with accuracies ranging from 65.5% to 83.5%, with smaller lesion dimension the strongest predictor. Type of biopsy was not a statistically significant predictor. A neural network model improved accuracy to 77.0%-94.2%. CONCLUSION CTTB performed by thoracic radiologists in a tertiary hospital demonstrate excellent diagnostic yield (97.0%) with a low clinically important complication rate (2.0%). Machine learning methods including neural networks can accurately predict the likelihood of complications, offering pathways to potentially improve patient selection and procedural technique, in order to further optimize the risk-benefit ratio of CTTB.
Collapse
|
14
|
Ünal E, Arslan S, Aghayeva G, Sarıkaya Y, Çiftçi T, Önder S, Akıncı D, Akhan O. Rare pulmonary tumors and carcinoma mimickers; experience from an interventional radiology unit with radiologic-pathologic correlation-A pictoral essay. Curr Med Imaging 2021; 17:1183-1190. [PMID: 33881972 DOI: 10.2174/1573405617666210420105624] [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: 12/25/2020] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although imaging findings along with patients' clinical history may give clue for the etiology of a pulmonary lesion, the differentiation of benign pulmonary lesions from lung cancer could be challenging. OBJECTIVE The aim of this review article was to increase the awareness of the carcinoma mimicking lung lesions. METHODS This paper was designed to illustrate rare pulmonary tumors and carcinoma mimickers with emphasis on radiologic-pathologic correlation. Pitfalls encountered on CT images and also false positivity of PET-CT scans were also presented. CONCLUSION Several benign pulmonary lesions may grow in size on follow-up and some may show pathologic FDG (18F-fluorodeoxyglucose) uptake, which makes them indistinguishable from lung carcinoma by imaging. In addition, some slow-growing malignant lesions, such as carcinoid, may be false-negative on PET/CT scans.
Collapse
Affiliation(s)
- Emre Ünal
- Hacettepe University, School of Medicine, Department of Radiology Ankara, Turkey
| | - Sevtap Arslan
- Hacettepe University, School of Medicine, Department of Radiology Ankara, Turkey
| | - Gulnar Aghayeva
- Hacettepe University, School of Medicine, Department of Radiology Ankara, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Türkmen Çiftçi
- Hacettepe University, School of Medicine, Department of Radiology Ankara, Turkey
| | - Sevgen Önder
- Hacettepe University, School of Medicine, Department of Pathology Ankara, Turkey
| | - Devrim Akıncı
- Hacettepe University, School of Medicine, Department of Radiology Ankara, Turkey
| | - Okan Akhan
- Hacettepe University, School of Medicine, Department of Radiology Ankara, Turkey
| |
Collapse
|
15
|
Lajara S, Trejo Bittar HE, Monaco SE, Pantanowitz L. Pulmonary carcinomas arising in association with scar: Cytomorphologic features in histologically confirmed cases. Diagn Cytopathol 2021; 49:753-760. [PMID: 33764698 DOI: 10.1002/dc.24737] [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: 07/04/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lung carcinoma arising in association with scar tissue is a well-reported but much debated phenomenon. Scar tissue complicates imaging and pathologic tumor measurement for cancer staging. To the best of our knowledge, the cytological findings in lung scar carcinoma (LSC) have not been described in the literature. Therefore, the aim of this study was to characterize the findings in fine-needle aspirations (FNA) from histologically confirmed LSCs. METHODS LSCs were identified on retrospective search. Cases with preoperative FNA material were reviewed, including non-scar cases that were used for comparison. The clinical and histopathology findings were recorded. RESULTS Twenty-seven cases associated with scar tissue had material for review and 35 cases not associated with scar tissue were used for comparison. The proportion of fibrosis in resection specimens ranged from 10% to 80%. Five (19%) FNA cases were hypocellular. There was no statistically significant difference between the scar and non-scar groups in terms of overall cellularity and diagnostic categories (P = .113 and P = .17, respectively). There was correlation between cytology and dominant pattern on histology in 19 (79%) adenocarcinoma cases. Spindle cells and fibrous or fibroelastotic fragments were present in 22 (81%) cases. CONCLUSION This is the first study describing the cytology associated with LSCs. The presence of fibrosis did not adversely impact cellularity, which is likely due to multiple excursions and selective microdissection of tumor cells by the FNA needle. The cytomorphological and histological patterns correlated in most cases. FNA is able to provide a preoperative diagnosis of carcinoma despite the presence of fibrosis.
Collapse
Affiliation(s)
- Sigfred Lajara
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Humberto E Trejo Bittar
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
16
|
Liang T, Du Y, Guo C, Wang Y, Shang J, Yang J, Niu G. Ultra-low-dose CT-guided lung biopsy in clinic: radiation dose, accuracy, image quality, and complication rate. Acta Radiol 2021; 62:198-205. [PMID: 32460511 DOI: 10.1177/0284185120917622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Computed tomography (CT)-guided percutaneous lung biopsy is usually performed by helical scanning. However, there are no studies on radiation dose, diagnostic accuracy, image quality, and complications based on axial scan mode. PURPOSE To determine radiation dose, accuracy, image quality, and complication rate following an ultra-low-dose (ULD) protocol for CT-guided lung biopsy in clinic. MATERIAL AND METHODS A total of 105 patients were enrolled to receive CT-guided lung biopsy. The use of an ULD protocol (axial scan) for CT-guided biopsy was initiated. Patients were randomly assigned to axial mode (Group A) and conventional helical mode (Group B) CT groups. 64-slice CT was performed for CT-guided pulmonary biopsy with an 18-G coaxial cutting biopsy needle. The radiation dose, accuracy, image quality, and complication rate were measured. RESULTS Ninety-seven patients were selected for the final phase of the study. There was no significant difference between the two groups for pulmonary nodule characteristics (P > 0.05). The mean effective dose in group A (0.077 ± 0.010 mSv) was significantly reduced relative to group B (0.653 ± 0.177 mSv, P < 0.001). There was no significant difference in accuracy, image quality, and complication rate (P > 0.050) between the two modes. CONCLUSION An ULD protocol for CT-guided lung nodule biopsy yields a reduction in the radiation dose without significant change in the accuracy, image quality, and complication rate relative to the conventional helical mode scan.
Collapse
Affiliation(s)
- Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
- Department of Biomedical Engineering the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology of Xi’an Jiaotong University, Xi’an, PR China
| | - Yonghao Du
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Chenguang Guo
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Yuan Wang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
- Department of Biomedical Engineering the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology of Xi’an Jiaotong University, Xi’an, PR China
| | - Gang Niu
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| |
Collapse
|
17
|
Parigi M, Hui M, Uppin SG, Kapoor A, Kumar NN, Bhaskar K, Stalin BJ, Sadashivudu G, Paramjyothi GK. Percutaneous core needle biopsy in the diagnosis of lung lesions: An experience on 280 consecutive cases from a university hospital in southern India. Lung India 2021; 38:41-52. [PMID: 33402637 PMCID: PMC8066924 DOI: 10.4103/lungindia.lungindia_326_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context: Percutaneous needle biopsy of lung (PCNBL) is advantageous over bronchoscopic biopsies to obtain adequate sample for peripheral lung lesions. Objective: The objective was to evaluate the diagnostic yield of image-guided PCNBL in the diagnosis of lung lesions and to classify lung carcinomas as per the recently proposed International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society/European Respiratory Society classification for small biopsies modified and adopted by the World Health Organization, 2015. Materials and Methods: A total of 280 image-guided PCNBL were analyzed. The radiological findings and routine hematoxylin and eosin (H&E)-stained sections along with immunohistochemistry (IHC) were analyzed in all the cases. Molecular testing was done depending on tissue diagnosis and availability. Results: Majority (81%) were diagnosed as malignant lesions, with adenocarcinoma (ADC) being the most common. More than 70% were diagnosed on H&E morphology alone, with thirty cases requiring IHC to categorize as ADC. Nearly 60% were categorized as squamous cell carcinoma on morphology alone and the rest required IHC. Though TTF1 showed higher sensitivity than napsin A, the latter is more specific. Both p63 and p40 were found to be highly sensitive for squamous cell carcinoma, but p40 was more specific than p63. Epidermal growth factor receptor could be evaluated on 94.4% of ADC samples, indicating good yield for molecular testing. Conclusion: PCNBL yields adequate sampling for tissue diagnosis and ancillary testing with minimal complications. The use of IHC markers reduces the number of non-small-cell not otherwise specified cases significantly.
Collapse
Affiliation(s)
- Madhavi Parigi
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Monalisa Hui
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Anu Kapoor
- Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - N Narendra Kumar
- Department of Pulmonology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K Bhaskar
- Department of Pulmonology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Bala Joseph Stalin
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - G Sadashivudu
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - G K Paramjyothi
- Department of Pulmonology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
18
|
Robotic-assisted computed tomography-guided 18F-FDG PET/computed tomography-directed biopsy for diagnosis of intra thoracic lesions: An experience from a tertiary care centre in North India. Nucl Med Commun 2020; 41:246-251. [PMID: 31939902 DOI: 10.1097/mnm.0000000000001148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic yield of robotic-assisted computed tomography (CT)-guided F-FDG PET/CT-directed biopsy for the evaluation of intrathoracic space occupying lesions. METHODS Twenty-four patients being evaluated for intrathoracic masses were included in the study. The indications were patients with unknown/likely primary detected from PET-CT, suspicious lesions identified from PET-CT in a known primary disease and fine needle aspiration cytology/CT-guided biopsy negative lesions with a high index of suspicion for malignancy. Biopsies were carried out with the help of automated radiology arm (ROBIO-EX) which is essentially a needle positioning and holding device. A two-day protocol was followed in which PET-CT scan was done on the first day, biopsy procedure was done on the next scheduled day. PET images were refused with the CT images done on the second day in the console by using manual alignment and then a biopsy was carried out with the help of a robotic arm. Primary outcome was histopathological yield from the obtained specimens. RESULTS Tissue yield was 100% (n = 24) and histopathological diagnosis rate was 96% (n = 23). Out of the 24 lesions biopsied 30% (n = 8) were benign and 70% (n = 16) turned out to be malignant. The complication rates were pneumothorax 4% (n = 1) and haemothorax 4% (n = 1). CONCLUSION Robotic-assisted CT-guided F-FDG PET/CT-directed biopsy is a useful and accurate technique for diagnostic evaluation of intrathoracic neoplasms with minimal complications rates as compared with conventional imaging techniques.
Collapse
|
19
|
Huang ZG, Sun HL, Wang CL, Gao BX, Chen H, Yang MX, Chen XL. CT-guided transthoracic needle biopsy of pulmonary lesions: comparison between the cutting needle and aspiration needle. Br J Radiol 2020; 94:20190930. [PMID: 33245675 DOI: 10.1259/bjr.20190930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To compare CT-guided transthoracic cutting needle biopsy (TCNB) with transthoracic aspiration needle biopsy (TANB) for pulmonary lesions with respect to the diagnostic accuracy and complication rate. METHODS Of the 859 cases that underwent consecutive CT-guided biopsy of pulmonary lesions, 713 cases confirmed by surgical pathology or clinical follow-up were enrolled. Of these, the first consecutive 275 cases underwent TANB, and the remaining 438 received TCNB. The final diagnosis determined the accuracy of biopsy. Based on the post-biopsy CT and clinical medical records, the presence or absence of biopsy-related complications was determined. The χ2 test was used to compare the differences between TCNB and TANB in terms of diagnostic accuracy and complication rate. RESULTS Among the 713 biopsy lesions, the final diagnosis was malignant in 411 cases and benign in 302 cases. As compared to TANB, the diagnostic accuracy of TCNB (98.9% vs 93.8%, χ2 = 14.35, p < 0.01), sensitivity to malignant lesions (97.8% vs 90.6%, χ2 = 10.58, p < 0.01), negative predictive value (97.6% vs 84.8%, χ2 = 19.03, p < 0.01), and specific diagnostic rate for benign lesions (73.4% vs 57.9%, χ2 = 7.29, p < 0.01) were improved. On the other hand, a statistical difference was detected between TCNB and TANB with respect to the incidence of pneumothorax (20.6% vs 13.1%, χ2 = 6.46, p = 0.01), hemorrhage (32.2% vs 13.1%, χ2 = 33.03, p < 0.01), and hemoptysis (8.2% vs 3.3%, χ2 = 6.87, p < 0.01). One patient died just several minutes after TCNB due to severe hemorrhage with hemoptysis. CONCLUSIONS Compared to TANB, CT-guided TCNB improves the diagnostic accuracy of pulmonary lesions, but complication rate increases significantly. ADVANCES IN KNOWLEDGE In general, TCNB should be recommended, especially for highly suspicious benign lesions. For patients with small lesions adjacent to vessels or vessels within the lesion, TANB should be considered.
Collapse
Affiliation(s)
- Zhen-Guo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Hong-Liang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Cun-Li Wang
- Department of Radiology, No.3 Hospital of Bao Tou City, Baotou, China
| | - Bao-Xiang Gao
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - He Chen
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Min-Xing Yang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xiao-Liang Chen
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
20
|
Turgut B, Duran FM, Bakdık S, Arslan S, Tekin AF, Esme H. Effectiveness of autologous blood injection in reducing the rate of pneumothorax after percutaneous lung core needle biopsy. ACTA ACUST UNITED AC 2020; 26:470-475. [PMID: 32755876 DOI: 10.5152/dir.2020.19202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the effectiveness and safety of autologous intraparenchymal blood patch (IBP) application in reducing the frequency of pneumothorax (PTX) after percutaneous transthoracic pulmonary core needle biopsy. METHODS The records of patients who underwent the transthoracic pulmonary core needle biopsy procedure under CT guidance between January 2015 and October 2018 were screened retrospectively. Patients whose traversed pulmonary parenchymal length was ≥20 mm during biopsy were included in the study irrespective of lesion size. The IBP procedure was made a department policy in November 2017; patients who underwent biopsy after this date comprised the IBP group, while those who underwent the procedure before this date comprised the control group. IBP recipients received 2-5 mL of autologous blood injection to the needle tract. Demographic data, procedural reports, tomography images, and the follow-up records of patients were assessed. RESULTS A total of 262 patients were included in the study. Of the 91 patients that received an IBP, PTX developed in 13 (14.1%), with 7 (7.7%) requiring a thoracic tube. Of the 171 patients who did not receive an IBP, PTX developed in 45 (26.3%), with 19 (11.1%) requiring a thoracic tube. Patients who received an autologous IBP showed a significantly lower rate of PTX development versus those who did not (P = 0.01). Similarly, a significantly lower number of patients who received the blood patch required chest tube placement (P = 0.015). CONCLUSION Autologous IBP is a safe, inexpensive and easy to use method that reduces the rate of PTX development and thoracic tube application after percutaneous core needle biopsies of the lung.
Collapse
Affiliation(s)
- Bekir Turgut
- Department of Radiology, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey
| | - Ferdane Melike Duran
- Department of Thoracic Surgery, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey
| | - Süleyman Bakdık
- Department of Radiology, Necmettin Erbakan University Training and Research Hospital, Konya, Turkey
| | - Serdar Arslan
- Department of Radiology, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey
| | - Ali Fuat Tekin
- Department of Radiology, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey
| | - Hıdır Esme
- Department of Thoracic Surgery, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey
| |
Collapse
|
21
|
Zhang Z, Zou H, Yuan A, Jiang F, Zhao B, Liu Y, Chen J, Zuo M, Gong L. A Single Enhanced Dual-Energy CT Scan May Distinguish Lung Squamous Cell Carcinoma From Adenocarcinoma During the Venous phase. Acad Radiol 2020; 27:624-629. [PMID: 31447258 DOI: 10.1016/j.acra.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate whether iodine quantification extracted from enhanced dual energy-computed tomography (DE-CT) is useful for distinguishing lung squamous cell carcinoma from adenocarcinoma and to evaluate whether a single scan evaluated during the venous phase (VP) can be substituted for scans evaluated during other phases. MATERIALS AND METHODS Sixty-two patients with lung cancer (32 squamous cell carcinomas; 30 adenocarcinomas) underwent enhanced dual-phase DE-CT scans, including an arterial phase and VP. The iodine concentration (IC), normalized iodine concentration (NIC), and slope of the curve (K) in lesions were measured during two scanning phases in two different pathological types of lung cancers. The differences in parameters (IC, NIC, and K) between these two types of lung cancers were statistically analyzed. In addition, the receiver operating characteristic curves of these parameters were performed to discriminate squamous cell carcinoma from adenocarcinoma. RESULTS The mean IC, NIC, and K in adenocarcinomas were all higher than those in squamous cell carcinomas during the two scanning phases. However, the differences in these parameters between the two types of cancers were significant only during the VP, not during the arterial phase. Receiver operating characteristic analysis demonstrated that the optimal thresholds of the IC, NIC, and K for discriminating squamous cell carcinoma from adenocarcinoma were 1.550, 0.227, and 1.608, respectively. In addition, the sensitivity, specificity, and area under the curve were 81.2%, 83.3%, and 0.871 for the IC; 56.2%, 93.3%, and 0.800 for the NIC; and 65.6%, 80%, and 0.720 for the K; 81.3%, 83.3%, and 0.874 for the IC + NIC; 68.8%, 93.3%, and 0.891 for the IC + NIC + K, respectively. The "IC + NIC + K" had the highest diagnostic efficiency for discriminating two types of lung cancers, but with low sensitivity. Whereas, "IC"and "IC + NIC" had the similar lower diagnostic efficiency, but with high sensitivity and specificity. CONCLUSION The iodine quantification parameters derived from enhanced DE-CT during the VP may be useful for distinguishing lung squamous cell carcinoma from adenocarcinoma.
Collapse
|
22
|
Passiglia F, Bertolaccini L, Del Re M, Facchinetti F, Ferrara R, Franchina T, Malapelle U, Menis J, Passaro A, Pilotto S, Ramella S, Rossi G, Trisolini R, Novello S. Diagnosis and treatment of early and locally advanced non-small-cell lung cancer: The 2019 AIOM (Italian Association of Medical Oncology) clinical practice guidelines. Crit Rev Oncol Hematol 2020; 148:102862. [PMID: 32062311 DOI: 10.1016/j.critrevonc.2019.102862] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022] Open
Abstract
The Italian Association of Medical Oncology (AIOM) has developed clinical practice guidelines for the diagnosis and treatment of patients with early and locally advanced non-small cell lung cancer. In the current paper a panel of AIOM experts in the field of thoracic malignancies discussed these topics, analyzing available scientific evidences, with the final aim of providing a summary of clinical recommendations, which may guide physicians in their current practice.
Collapse
Affiliation(s)
- F Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - L Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Italy
| | - F Facchinetti
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
| | - R Ferrara
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - T Franchina
- Department of Human Pathology "G. Barresi", University of Messina, Italy
| | - U Malapelle
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - J Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy, Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Pilotto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - S Ramella
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - G Rossi
- Pathologic Anatomy, Azienda USL della Romagna, S. Maria delle Croci Hospital of Ravenna and Degli Infermi Hospital of Rimini, Italy
| | - R Trisolini
- Interventional Pulmonology Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - S Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy.
| |
Collapse
|
23
|
Brooks ED, Verma V, Senan S, De Baere T, Lu S, Brunelli A, Chang JY. Salvage Therapy for Locoregional Recurrence After Stereotactic Ablative Radiotherapy for Early-Stage NSCLC. J Thorac Oncol 2020; 15:176-189. [PMID: 31712134 PMCID: PMC7058490 DOI: 10.1016/j.jtho.2019.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/20/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022]
Abstract
Although isolated local (LRs) and regional recurrences (RRs) constitute a minority of post-stereotactic ablative radiotherapy (SABR) relapses, their management is becoming increasingly important as the use of SABR continues to expand. However, few evidence-based strategies are available to guide treatment of these potentially curable recurrences. On behalf of the Advanced Radiation Technology Committee of the International Association for the Study of Lung Cancer, this article was written to address management of recurrent disease. Topics discussed include diagnosis and workup, including the roles of volumetric and functional imaging as well as histopathologic methods; clinical outcomes after salvage therapy; patterns of recurrence after salvage therapy; and management options. Our main conclusions are that survival for patients with adequately salvaged LRs is similar to that for patients after primary SABR without recurrence, and survival for those with salvaged RRs (regardless of nodal burden or location) is similar to that of patients with de novo stage III disease. Although more than half of patients who undergo salvage do not develop a second relapse, the predominant pattern of second failure is distant, especially for RRs. Management requires rigorous multidisciplinary coordination. Isolated LRs can be managed with resection and nodal dissection, repeat SABR, thermal ablation, or systemic therapies. RRs can be treated with combined chemoradiotherapy, radiation or chemotherapy alone, or supportive services. Finally, regular and structured follow-up is recommended after post-SABR salvage therapy.
Collapse
Affiliation(s)
- Eric D Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Thierry De Baere
- Département d'imagerie, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Shun Lu
- Department of Medical Oncology, Shanghai Chest Hospital, Shanghai Jiao University, Shanghai, China
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
24
|
Chae KJ, Hong H, Yoon SH, Hahn S, Jin GY, Park CM, Goo JM. Non-diagnostic Results of Percutaneous Transthoracic Needle Biopsy: A Meta-analysis. Sci Rep 2019; 9:12428. [PMID: 31455841 PMCID: PMC6711972 DOI: 10.1038/s41598-019-48805-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/12/2019] [Indexed: 02/06/2023] Open
Abstract
Non-diagnostic results can affect the diagnostic performance of percutaneous transthoracic needle biopsy (PTNB) but have not been critically meta-analyzed yet. To meta-analyze the incidence and malignancy rate of non-diagnostic results, 3-by-2 table approaches rather than the conventional 2-by-2 approaches are needed to know its impact on the diagnostic performance of PTNB. A systematic literature search identified studies evaluating the diagnostic performance of PTNB with extractable outcomes. A total of 143 studies with 35,059 biopsies were included. The pooled incidence of non-diagnostic results was 6.8% (95% CI, 6.0-7.6%; I2 = 0.91). The pooled malignancy rate of non-diagnostic results was 59.3% (95% CI, 51.7-66.8%; I2 = 0.80), and was correlated with the prevalence of malignancy (correlation coefficient, 0.66; 95% CI, 0.42-0.91). Pooled percentage decrease of sensitivity and specificity due to non-diagnostic results were 4.5% (95% CI, 3.2-5.7%; I2 = 0.64) and 10.7% (95% CI, 7.7-13.7%; I2 = 0.70), respectively, and the pooled incidence of non-diagnostic results was 4.4% (95% CI, 3.2-5.8%; I2 = 0.83) in lesions ultimately diagnosed as malignancies and 10.4% (95% CI, 7.5-13.8%; I2 = 0.74) in benign disease. In conclusion, non-diagnostic results averagely occurred in 6.8% of PTNB and more than half of the results were malignancies. The non-diagnostic results decreased specificity and sensitivity by 10.7% and 4.5%, respectively, demanding efforts to minimize the non-diagnostic results in PTNB.
Collapse
Affiliation(s)
- Kum Ju Chae
- Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Seokyung Hahn
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gong Yong Jin
- Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| |
Collapse
|
25
|
Lee K, Lee SJ, Yoon S, Ryoo BY, Kim SW, Choi SH, Lee SM, Chae EJ, Park Y, Jang SJ, Park SY, Yoon YK, Park SH, Kim TW. Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center. PLoS One 2019; 14:e0221065. [PMID: 31404103 PMCID: PMC6690517 DOI: 10.1371/journal.pone.0221065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Research biopsies are an essential component of cancer clinical trials for studying drug efficacy and identifying biomarkers. Site-level clinical investigators, however, do not have access to results on the adequacy of research biopsies for histological or molecular assays, because samples are sent to central labs and the test results are seldom reported back to site-level investigators unless requested. We evaluated the feasibility, safety, and adequacy of research biopsies performed at an academic medical center. Materials and methods We retrospectively reviewed the data on 122 research biopsy sessions conducted in 99 patients via percutaneous core needle biopsy for 39 clinical trials from January 2017 to February 2018 at a single institute. We asked the sponsors of each clinical trial for the adequacy of the biopsy samples for histological or molecular assays. Results The biopsy success rate was 93.4% (113/122), with nine samples categorized as inadequate for obtaining pathologic diagnosis. Post-biopsy complications occurred in 9.8% (12/122) of biopsies, all of which were mild and completely recovered by the day after the biopsy. The sponsors of clinical trials provided feedbacks on the adequacy of 76 biopsy samples, and noted that a total of 8 biopsy samples from 7 patients were inadequate for analysis, resulting in an adequacy rate of 89.5% (68/76): the reasons for inadequacy were insufficient tumor content for immunohistochemistry (n = 3) and low RNA yield for sequencing (n = 5). Conclusion Research biopsies performed at an experienced, multidisciplinary center had acceptable safety for patients as well as practicality in terms of obtaining adequate tissue samples for molecular studies.
Collapse
Affiliation(s)
- Kyoungmin Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So Jung Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se-Jin Jang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Yeon Park
- Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Kwang Yoon
- Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (TWK); (SHP)
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (TWK); (SHP)
| |
Collapse
|
26
|
Rodriguez EF, Pastorello R, Osmani L, Hopkins M, Kryatova M, Kawamoto S, Maleki Z. Ultrasound-Guided Transthoracic Fine-Needle Aspiration: A Reliable Tool in Diagnosis and Molecular Profiling of Lung Masses. Acta Cytol 2019; 64:208-215. [PMID: 31362293 DOI: 10.1159/000501421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pulmonary adenocarcinoma is a major cause of mortality worldwide. The majority of patients present with advanced stage disease, and minimally invasive procedures are desirable for diagnosis and treatment plans. Herein, we report our experience with percutaneous/transthoracic needle aspiration (TT-NA) in the cytologic diagnosis of pulmonary adenocarcinoma. MATERIAL AND METHODS After institutional review board approval, the cytopathology electronic data system was searched for all consecutive TT-NA of the lung masses from January 2011 to November 2015. Patients' medical records were reviewed and cytologic materials were evaluated. RESULTS A total of 151 specimens were identified, with a mean age of 62.8 years; 62.9% of the patients had a prior history of malignancy. Carcinoma/adenocarcinoma was the most common (80%) diagnosis. The targeted lesions were predominantly located in the lung (56.3%, 81/151) and pleural based (27.8%, 42/151). The mean size of the lesions was 3.6 cm. Cytology specimens were adequate in 70.9% of the cases, while 72.8% (110/151) of the cases also had concurrent core biopsy. A malignant diagnosis was rendered in the majority of the cases (64.9%). In 71% of the cases, immunohistochemistry/histochemistry studies were successfully performed. Molecular/genetic studies were requested in 80% of the cases and had adequate material. Complications of the procedure were seen in 9.9% of the patients including pneumothorax (7.9%) and hemoptysis (1.9%). CONCLUSION TT-NA is a relatively safe and reliable technique in the assessment of pulmonary lesions.
Collapse
Affiliation(s)
- Erika F Rodriguez
- Department of Pathology, Division of Cytopathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA,
| | - Ricardo Pastorello
- Department of Pathology, Division of Cytopathology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Lais Osmani
- Department of Pathology, Division of Cytopathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mark Hopkins
- Department of Pathology, Division of Cytopathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Maria Kryatova
- Department of Pathology, Division of Cytopathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Satomi Kawamoto
- Department of Radiology, Division of Ultrasound, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Zahra Maleki
- Department of Pathology, Division of Cytopathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| |
Collapse
|
27
|
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: 12] [Impact Index Per Article: 2.4] [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.
Collapse
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
| |
Collapse
|
28
|
CT-guided Transthoracic Core-Needle Biopsies of Mediastinal and Lung Lesions in 235 Consecutive Patients: Factors Affecting the Risks of Complications and Occurrence of a Final Diagnosis of Malignancy. Arch Bronconeumol 2018; 55:297-305. [PMID: 30527558 DOI: 10.1016/j.arbres.2018.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/29/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the impact of patient-, lesion- and procedure-related factors on the risks of complications and final diagnosis of malignancy in PCNB of mediastinal and lung lesions. MATERIAL AND METHODS We studied a large single-center cohort of 235 consecutive patients (66.8% men; 58.5±18.0 years) with a range of thoracic benign and malignant lesions, who underwent PCNB performed along 24 months by a single experienced radiologist. Diagnostic accuracy analyses of PCNB for malignancy were performed, as well as estimations of relative risk and logistic regression models in order to assess possible associations between such factors and malignancy/complications. RESULTS 155 lesions (65.9%) were diagnosed as malignant. Overall accuracy was 91.1%, with sensitivity of 87.1%, specificity of 98.8%, positive predictive value of 99.3%, and negative predictive value of 79.8%. Pneumothorax (49/235; 20.8%) and hemorrhage (37/235; 15.7%) were the most common complications. Emphysema, smoking, older age, intrapulmonary location, deeper location, smaller size, presence of cavitations and irregular contours of the lesions, and smaller needle-pleural angles were the most consistent factors related to the occurrence of complications. Emphysema, older age, smoking, solid and deeper lesions were also significantly associated with a final diagnosis of malignancy after PCNB. CONCLUSION CT-guided PCNB of mediastinal and lung lesions is a safe procedure with high diagnostic accuracy for malignancy.
Collapse
|
29
|
Guo Z, Shi H, Li W, Lin D, Wang C, Liu C, Yuan M, Wu X, Xiong B, He X, Duan F, Han J, Yang X, Yu H, Si T, Xu L, Xing W, Jinhua H, Wang Y, Xie H, Cui L, Gao W, He D, Liu C, Liu Z, Ma C, Pan J, Shao H, Tu Q, Yong L, Xu Y, Weihao Z, Qiang Z, Wang S. Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy. Thorac Cancer 2018; 9:1530-1543. [PMID: 30221455 PMCID: PMC6209790 DOI: 10.1111/1759-7714.12849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
Biopsy has been used to diagnose thoracic diseases for more than a century. Percutaneous needle biopsy plays a crucial role in the diagnosis, staging, and treatment planning for tumors in the lungs, thoracic wall, hilum, and mediastinum. With the continuous improvement in imaging techniques, the range of clinical applications for percutaneous needle biopsy is also expanding. It has become important to improve Chinese professionals’ and technicians’ understanding of percutaneous transthoracic needle biopsy (PTNB) in order to standardize operating procedures and to strengthen perioperative management. However, there is currently no Chinese expert consensus that provides systematic standardization and guidance for PTNB in clinical practice. The Committee of Chinese Society of Interventional Oncology (CSIO) of the Chinese Anti‐Cancer Association (CACA) initiated a Chinese multidisciplinary expert consensus on PTNB. The consensus includes image‐guided methods, indications, contraindications, multidisciplinary team recommendations, biopsy procedures, daytime/outpatient biopsy, complications, pathological examination, and management of negative results.
Collapse
Affiliation(s)
- Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Committee of Chinese Society of Interventional Oncology, China Anti-Cancer Association, Tianjin, China
| | - Hong Shi
- Chinese Medical Association Publishing House, Beijing, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital, Beijing, China
| | - Changli Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chen Liu
- Department of Pathology, Peking University Cancer Hospital, Beijing, China
| | - Min Yuan
- Department of Interventional Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Xia Wu
- Department of Interventional Radiology, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Xiong
- Department of Interventional Radiology, Huazhong University of Science and Technology Affiliated with Union Hospital of Tongji Medical College, Wuhan, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Feng Duan
- Department of Interventional Therapy, The General Hospital of People's Liberation Army, Beijing, China
| | - Jianjun Han
- Department of Interventional Therapy, Shandong Cancer Hospital, Jinan, China
| | - Xueling Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haipeng Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Tongguo Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Linfeng Xu
- Department of Interventional Therapy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenge Xing
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Huang Jinhua
- Department of Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yingjuan Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hui Xie
- Department of Interventional Therapy, 302 Military Hospital of China, Beijing, China
| | - Li Cui
- Department of Interventional Therapy, The General Hospital of People's Liberation Army, Beijing, China
| | - Wei Gao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dongfeng He
- The Affiliated Cancer Hospital of Harbin Medical University, Harbin, China
| | - Changfu Liu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhou Liu
- Department of Interventional Therapy, Shenzhen Cancer Hospital, Shenzhen, China
| | - Chunhua Ma
- Department of Interventional Therapy, Tianjin Huanhu Hospital, Tianjin, China
| | - Jie Pan
- Department of Interventional Therapy, Peking Union Medical College Hospital, Beijing, China
| | - Haibo Shao
- Department of Interventional Therapy, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qiang Tu
- Department of Interventional Therapy, Jiangxi Cancer Hospital, Nanchang, China
| | - Li Yong
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yan Xu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhang Weihao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zou Qiang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Sen Wang
- Department of Interventional Therapy, Tianjin Third Central Hospital, Tianjin, China
| |
Collapse
|
30
|
Suresh S, Salama GR, Ramjit A, Mahfoud Z, Lee KS, Pua BB. CT-Guided Fine-Needle Aspiration Biopsy of Pulmonary Nodules 8 mm or Less Has a Higher Diagnostic Accuracy than Positron Emission Tomography–CT. J Vasc Interv Radiol 2018; 29:520-523. [DOI: 10.1016/j.jvir.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/07/2017] [Accepted: 10/07/2017] [Indexed: 11/30/2022] Open
|
31
|
Xu C, Yuan Q, Chi C, Zhang Q, Wang Y, Wang W, Yu L, Zhan P, Lin Y. Computed tomography-guided percutaneous transthoracic needle biopsy for solitary pulmonary nodules in diameter less than 20 mm. Medicine (Baltimore) 2018; 97:e0154. [PMID: 29620630 PMCID: PMC5902292 DOI: 10.1097/md.0000000000010154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To evaluate the diagnostic value of computed tomography (CT)-guided percutaneous lung biopsy for solitary pulmonary nodules (SPN) < 20 mm.A total of 248 patients who were diagnosed a SPN of < 20 mm underwent CT-guided percutaneous transthoracic needle biopsy were reviewed.Specimens of 248 patients were obtained successfully. Around 174 cases were proved to be malignancies and 74 cases of benign lesions by biopsy. About 178 malignancies (71.8%) and 70 benign lesions were proved by surgery and clinical course. The diagnostic accuracy was 96.8%. The diagnostic accuracy of large nodules group (>10 and < 20 mm) was 99.3%, higher than 93.5% of small nodules group (≤10 mm) with statistical significance. The incidence of phenmothorax and hemorrhage was 16.1% and 6.8%, respectively. No death-related complications happened. The incidence of phenmothorax was related to puncture times (P = .013) and the length of puncture needle in lung tissues (P = .019).CT-guided percutaneous lung biopsy for SPN of < 20 mm is an efficient and safe diagnostic method.
Collapse
Affiliation(s)
- Chunhua Xu
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Qi Yuan
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Chuanzhen Chi
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Qian Zhang
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Yuchao Wang
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Wei Wang
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Like Yu
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Ping Zhan
- Endoscopic Center of Nanjing Chest Hospital
- Clinical Center of Nanjing Respiratory Diseases and Imaging
| | - Yong Lin
- Department of Respiratory Medicine, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| |
Collapse
|
32
|
Coaxial technique-promoted diagnostic accuracy of CT-guided percutaneous cutting needle biopsy for small and deep lung lesions. PLoS One 2018; 13:e0192920. [PMID: 29447239 PMCID: PMC5814003 DOI: 10.1371/journal.pone.0192920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/16/2018] [Indexed: 12/02/2022] Open
Abstract
Coaxial technique is extensively applied to facilitate percutaneous lung lesion biopsy. However, the impact of coaxial technique on diagnostic accuracy remains undecided. We reviewed 485 patients who underwent percutaneous CT-guided needle biopsies of lung lesions in our hospital. All of these biopsies were performed using either a cutting needle alone (n = 268) or a cutting needle combined with a coaxial needle (n = 217). The diagnostic accuracy and complications resulting from the two techniques were then compared. The diagnostic accuracies of the two techniques were comparably high, at 98.2% (with coaxial technique) and 95.9% (without coaxial technique), p = 0.24. Subgroup analysis discovered that for patients with lesions measuring < 1.5 cm and needle path length ≥ 4 cm, the coaxial technique achieved a higher diagnostic accuracy (95.5% vs. 72.7%, p = 0.023). The biopsy was well tolerated in all of the patients. Pneumothorax occurred less often in patients who were biopsied with the coaxial technique (19 versus 43, p = 0.024). Thus, the application of the coaxial technique could improve diagnostic accuracy in patients with small and deep lung lesions, and could reduce the risk of pneumothorax. The combined use of cutting needles with coaxial needles is the preferred technique for performing percutaneous CT-guided lung biopsies.
Collapse
|
33
|
Complications of CT-guided transthoracic lung biopsy : A short report on current literature and a case of systemic air embolism. Wien Klin Wochenschr 2018; 130:288-292. [PMID: 29362884 PMCID: PMC5916998 DOI: 10.1007/s00508-018-1317-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/08/2018] [Indexed: 12/30/2022]
Abstract
Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (PCNB) is a common diagnostic procedure and is especially indispensable in thoracic oncology. Complications, such as pulmonary hemorrhage and pneumothorax are frequent, but usually easy to manage. Systemic air embolism is a rare but relevant adverse event and its true incidence is probably underestimated, as not all cases may become clinically apparent. We present a case of systemic air embolism following a core-needle biopsy of a left upper lobe lesion, where immediately after the procedure CT scans documented air in the thoracic aorta and in the left ventricle. In this context, we review the current literature on technical aspects as well as on frequent and infrequent major complications of PCNB, together with risk factors, emergency treatment and prevention strategies.
Collapse
|
34
|
Mills M, Choi J, El-Haddad G, Sweeney J, Biebel B, Robinson L, Antonia S, Kumar A, Kis B. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions. Clin Radiol 2017; 72:1038-1046. [DOI: 10.1016/j.crad.2017.07.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 01/05/2023]
|
35
|
Dong Z, Li H, Zhou J, Zhang W, Wu C. The value of cell block based on fine needle aspiration for lung cancer diagnosis. J Thorac Dis 2017; 9:2375-2382. [PMID: 28932542 DOI: 10.21037/jtd.2017.07.91] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Computed tomography (CT)-guided percutaneous lung fine needle aspiration (FNA) is a convenient method to obtain samples from pulmonary lesions. FNA has a lower rate of complications than the use of a core needle biopsy, but is more difficult for the diagnosis of cytological samples. We use cell block (CB) and immunocytochemistry (ICC) to improve the accuracy of cytological diagnoses based on CT-guided percutaneous lung FNA. METHODS We collected 526 cytological samples obtained using CT-guided percutaneous lung FNA at Shanghai Pulmonary Hospital from May 2015 to October 2015. CBs were created from these samples, and ICC was performed to help the further histological classification and confirmation of tumor as primary or metastatic. An automated Ventana ALK with clone D5F3 was used to identify ALK fusion protein. RESULTS After assessment of the CBs, 32 (6.08%) diagnoses of suspected malignancy were reduced to 10 (1.90%) such diagnoses (P<0.05), and 161 (30.61%) cases of non-small-cell lung carcinoma (NSCLC) were reduced to 33 (6.27%) cases (P<0.05) after their division into specific subtypes. We also diagnosed eight (1.52%, P<0.05) cases of metastatic carcinoma of the lung that were difficult to diagnose by cytological smear alone. Six (3.73%) of 161 NSCLC cases exhibited ALK rearrangement. CONCLUSIONS CB and ICC are useful for accurate cytological diagnosis using CT-guided percutaneous lung FNA. These approaches are valuable for providing individualized treatment and prognostic evaluations with minor complications.
Collapse
Affiliation(s)
- Zhengwei Dong
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Hui Li
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jun Zhou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Wei Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| |
Collapse
|
36
|
Efficacy of a Dehydrated Hydrogel Plug to Reduce Complications Associated With Computed Tomography-guided Percutaneous Transthoracic Needle Biopsy. J Thorac Imaging 2017; 32:57-62. [PMID: 27870824 DOI: 10.1097/rti.0000000000000247] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to determine whether a hydrogel plug, when placed in the needle tract after a computed tomography-guided percutaneous transthoracic needle lung biopsy, reduces the rate of complications. MATERIALS AND METHODS This retrospective analysis included biopsies of lung lesions from 200 consecutive patients. The first 100 consecutive biopsies made up the control group, in which no plug intervention was used. The next 100 consecutive biopsies made up the treatment group, in which a hydrogel plug was deployed through a 19-G coaxial needle system after 20-G core samples were obtained. RESULTS The overall mean age was 64.92 years. No statistically significant differences in patient characteristics and procedure parameters were found between the control and treatment groups except for age (mean age, 62.92 vs. 66.92 y, P=0.022) and procedure duration (mean minutes, 7.81 vs. 6.47 min, P=0.021). The rate of pneumothorax in the control versus treatment group was 31% vs. 29% (P=0.498) and the rate of hemoptysis was 6% vs. 3% (P=0.354). The rate of chest tube insertion after pneumothorax was significantly higher in the control group than in the treatment group (10% vs. 2%, P=0.032) and the average length of hospital stay was longer in the control group (0.44 vs. 0.07 d, P=0.041). The difference was still statistically significant for the chest tube insertion rate (P=0.030) and close to statistically significant for the length of hospital stay (P=0.063), after adjusting for the confounding effect of age and procedure duration. CONCLUSION These data show that the deployment of a hydrogel plug after a computed tomography-guided lung biopsy significantly reduced the rate of chest tube insertion along with a reduced length of hospital stay.
Collapse
|
37
|
Görgülü FF, Öksüzler FY, Arslan SA, Arslan M, Özsoy İE, Görgülü O. Computed tomography-guided transthoracic biopsy: Factors influencing diagnostic and complication rates. J Int Med Res 2017; 45:808-815. [PMID: 28415930 PMCID: PMC5536670 DOI: 10.1177/0300060517698064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to assess the complication and diagnostic rates of computed tomography (CT)-guided transthoracic needle biopsy of pulmonary parenchymal and mediastinal lesions. Methods Patients who were suspected to have a malignancy based on chest imaging and CT and could not be otherwise diagnosed were evaluated. Results Sixty-five patients were included; 48 (73.8%) were male and 17 (26.2%) were female. Their average age was 58 years. The lesion size ranged from 11 to 105 mm. The most common specific histologic subtype was adenocarcinoma, and the least common was lymphoma. The diagnostic rate was 90.8%. The mean complication rate was 15.4%. Statistically significant associations were found between the complication rate and needle size and between the needle path length and lesion size. Conclusion CT-guided needle biopsy is an effective diagnostic method for patients with mediastinal and parenchymal lesions before thoracotomy. This method can also reliably differentiate benign and malignant tumors.
Collapse
Affiliation(s)
- Feride Fatma Görgülü
- 1 Radiology Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
| | - Fatma Yasemin Öksüzler
- 1 Radiology Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
| | | | - Muhammet Arslan
- 1 Radiology Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
| | - İbrahim Ethem Özsoy
- 3 Chest Surgery Department, University of Health Sciences, Kayseri Research and Training Hospital, Kayseri, Turkey
| | - Orhan Görgülü
- 4 ENT Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
| |
Collapse
|
38
|
Nguyen TK, Palma DA. Pros: After stereotactic ablative radiotherapy for a peripheral early-stage non-small cell lung cancer, radiological suspicion of a local recurrence can be sufficient indication to proceed to salvage therapy. Transl Lung Cancer Res 2016; 5:647-650. [PMID: 28151535 DOI: 10.21037/tlcr.2016.12.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Liu M, Huang J, Xu Y, He X, Li L, Lü Y, Liu Q, Sequeiros RB, Li C. MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open high-field MRI scanner with respiratory gating. Eur Radiol 2016; 27:1459-1466. [PMID: 27516355 DOI: 10.1007/s00330-016-4518-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/27/2016] [Accepted: 07/19/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To prospectively evaluate the feasibility, safety and accuracy of MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open MR scanner with respiratory gating. METHODS Sixty-five patients with 65 solitary pulmonary lesions underwent MR-guided percutaneous coaxial cutting needle biopsy using a 1.0-T open MR scanner with respiratory gating. Lesions were divided into two groups according to maximum lesion diameters: ≤2.0 cm (n = 31) and >2.0 cm (n = 34). The final diagnosis was established in surgery and subsequent histology. Diagnostic accuracy, sensitivity and specificity were compared between the groups using Fisher's exact test. RESULTS Accuracy, sensitivity and specificity of MRI-guided percutaneous pulmonary biopsy in diagnosing malignancy were 96.9 %, 96.4 % and 100 %, respectively. Accuracy, sensitivity and specificity were 96.8 %, 96.3 % and 100 % for lesions 2.0 cm or smaller and 97.1 %, 96.4 % and 100 %, respectively, for lesions larger than 2.0 cm. There was no significant difference between the two groups (P > 0.05). Biopsy-induced complications encountered were pneumothorax in 12.3 % (8/65) and haemoptysis in 4.6 % (3/65). There were no serious complications. CONCLUSIONS MRI-guided percutaneous biopsy using a 1.0-T open MR scanner with respiratory gating is an accurate and safe diagnostic technique in evaluation of pulmonary lesions. KEY POINTS • MRI-guided percutaneous lung biopsy using a 1.0-T open MR scanner is feasibility. • 96.9 % differentiation accuracy of malignant and benign lung lesions is possible. • No serious complications occurred in MRI-guided lung biopsy.
Collapse
Affiliation(s)
- Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Jie Huang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Lei Li
- Department of Interventional Radiology, Qingdao Central Hospital, Qingdao, Shandong, People's Republic of China
| | - Yubo Lü
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Qiang Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | | | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China.
| |
Collapse
|
41
|
Lazguet Y, Maarouf R, Karrou M, Skiker I, Alloubi I. CT guided percutaneous needle biopsy of the chest: initial experience. Pan Afr Med J 2016; 23:211. [PMID: 27347300 PMCID: PMC4907752 DOI: 10.11604/pamj.2016.23.211.7865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/20/2016] [Indexed: 11/23/2022] Open
Abstract
The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015. Diagnosis was achieved in 18 patients (75%), negative results were found in 3 patients (12,5%). Biopsy was repeated in these cases with two positive results. Complications were seen in 7 patients (29%), Hemoptysis in 5 patients (20%), Pneumothorax in 1 patient (4,1%) and vaso-vagal shock in 1 patient (4,1%). CT Guided Percutaneous Needle Biopsy of the Chest is a safe, minimally invasive procedure with high sensitivity, specificity and accuracy for diagnosis of lung lesions.
Collapse
Affiliation(s)
- Younes Lazguet
- Department of Radiology, University Hosiptal Mohammed VI, Oujda, Morocco
| | - Rachid Maarouf
- Department of Thoracic Surgery, University Hosiptal Mohammed VI, Oujda, Morocco
| | - Marouan Karrou
- Department of Thoracic Surgery, University Hosiptal Mohammed VI, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, University Hosiptal Mohammed VI, Oujda, Morocco
| | - Ihsan Alloubi
- Department of Thoracic Surgery, University Hosiptal Mohammed VI, Oujda, Morocco
| |
Collapse
|
42
|
Diagnostic Accuracy and Safety of CT-Guided Percutaneous Transthoracic Needle Biopsies: 14-Gauge versus 22-Gauge Needles. J Vasc Interv Radiol 2016; 27:674-81. [PMID: 27017121 DOI: 10.1016/j.jvir.2016.01.134] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the diagnostic accuracy and safety of a 14-gauge core needle versus a 22-gauge fine needle in the evaluation of thoracic lesions by CT-guided percutaneous transthoracic needle biopsy (TTNB). MATERIALS AND METHODS Medical charts of all patients who underwent CT-guided percutaneous transthoracic core-needle biopsies (CNBs) with a 14-gauge Spirotome device (99 patients, 102 procedures) and fine-needle biopsies (FNBs) with a 22-gauge Rotex needle (92 patients, 102 procedures) between 2007 and 2013 at a single academic institution were retrospectively reviewed. Variables that could influence diagnostic accuracy and safety were collected. RESULTS The overall and cancer-specific diagnostic accuracy rates were 90% and 94%, respectively, with CNB, versus 82% and 89% with FNB. Precise cancer type/subtype was provided by 97% of CNBs versus 65% of FNBs (P < .001). In patients with lung cancer considered for targeted therapy, biomarker analyses were feasible in 80% of CNBs versus 0% of FNBs (P < .001). The rate of pneumothorax was significantly higher with CNB versus FNB (31% vs 19%; P = .004), but chest tube insertion rates were similar (10% vs 11%, respectively). Major bleeding complications occurred in 1% of CNBs versus 2% of FNBs and were associated with one death in the CNB group. CONCLUSIONS Percutaneous transthoracic CNB with a 14-gauge Spirotome needle provided better characterization of cancer lesions and allowed biomarker analyses without a significant increase in major procedural complications.
Collapse
|
43
|
De Filippo M, Saba L, Silva M, Zagaria R, Concari G, Nizzoli R, Bozzetti C, Tiseo M, Ardizzoni A, Lipia S, Paladini I, Macarini L, Carrafiello G, Brunese L, Rotondo A, Rossi C. CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage? Diagn Interv Radiol 2015; 20:421-5. [PMID: 25163758 DOI: 10.5152/dir.2014.14019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the correlation between pulmonary hemorrhage and pneumothorax in computed tomography (CT)-guided transthoracic fine needle aspiration (TTFNA), particularly its possible value as protection against the development of pneumotorax. MATERIALS AND METHODS We reviewed the CT images of 538 patients (364 males and 174 females, mean age 70 years, range 36-90 years) who underwent CT-guided TTFNA of pulmonary nodules between January 2008 and September 2013. The following CT findings were assessed: pulmonary hemorrhage (type 1, along the needle track; type 2, perilesional; low-grade, ≤6 mm; high-grade, >6 mm), pneumothorax, distance between the target nodule and the pleural surface, and emphysema. RESULTS Pneumothorax occurred in 154 cases (28.6%) and pulmonary hemorrhage occurred in 144 cases (26.8%). The incidence of pneumothorax was lower in patients showing type 1 and high-grade pulmonary hemorrhage pattern. The incidence of pneumothorax in biopsies ≥30 mm from pleural surface was 26% (12/46) in cases showing this pattern, while it was 71.4% (30/42) when this pattern was not seen. Similarly, the incidence of pneumothorax in biopsies <30 mm from the pleural surface was 0% (0/28) in cases showing this hemorrhage pattern, while it was 19% (76/394) when this pattern was not seen. CONCLUSION Pulmonary hemorrhage during TTFNA is a frequent event that protects against pneumothorax. A bleeding greater than 6 mm along the needle track is associated with lower incidence of pneumothorax, especially in biopsies deeper than 3 cm.
Collapse
Affiliation(s)
- Massimo De Filippo
- Department of Surgical Sciences, Section of Diagnostic Imaging, University Hospital of Parma, Parma, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients. Cardiovasc Intervent Radiol 2015; 39:261-70. [DOI: 10.1007/s00270-015-1167-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
|
45
|
Lalji UC, Wildberger JE, Zur Hausen A, Bendek M, Dingemans AMC, Hochstenbag M, Das M. CT-Guided Percutaneous Transthoracic Needle Biopsies Using 10G Large-Core Needles: Initial Experience. Cardiovasc Intervent Radiol 2015; 38:1603-10. [PMID: 25968475 PMCID: PMC4648960 DOI: 10.1007/s00270-015-1098-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/25/2015] [Indexed: 01/15/2023]
Abstract
Purpose Using large-core biopsy needles in CT-guided percutaneous transthoracic needle biopsies (PTNB) may be advantageous in terms of larger specimens, which facilitate more extensive histopathological, immunohistochemical, and molecular examination of tumor tissue. The aim of this study was to evaluate the success rate and safety in CT-guided PTNB using 10G large-core biopsy needles. Methods and Materials 35 patients with intrathoracic lesions suspected of malignancy underwent CT-guided PTNB using dedicated large-core biopsy needles (10G Spirotome™, Medinvents, Hasselt, Belgium). Location, tumor size, number of pleural passes, number of biopsies, histologic result, and complications (pneumothorax, bleeding) were recorded. Results Lesion location varied from pleural to hilar location. Mean tumor size was 3.5 cm (range 0.7–9.2 cm). Only one pleural passage was necessary in all patients. Mean distance from the pleura to the lesion was 2.6 cm (max 9.2 cm). Large-core biopsy (10G) was successful in 88.6 %. Pneumothorax was found in 40 %. Minor intraparenchymal bleeding was present in 14 patients. No major complications were recorded. Conclusion Large-core biopsy with 10G did not show higher complication rates compared to literature. It is technically feasible and safe. The obtained larger specimens may especially be helpful for the increasing demands of extensive molecular analysis for stratified patient care.
Collapse
Affiliation(s)
- Ulrich C Lalji
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 Z, Maastricht, The Netherlands.
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 Z, Maastricht, The Netherlands
| | - Axel Zur Hausen
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 Z, Maastricht, The Netherlands.,Department of Pathology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Matyas Bendek
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 Z, Maastricht, The Netherlands.,Department of Pathology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Anne-Marie C Dingemans
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 Z, Maastricht, The Netherlands.,Department of Pulmonology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Monique Hochstenbag
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 Z, Maastricht, The Netherlands.,Department of Pulmonology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 Z, Maastricht, The Netherlands.
| |
Collapse
|
46
|
Abstract
CLINICAL/METHODICAL ISSUE The management of solitary lung nodules poses a common clinical problem and biopsy is oftten required. Several guidelines provide slightly different recommendations and there are no uniform recommendations regarding the ideal technique of puncture guidance (e.g. percutaneous versus bronchoscopic or thoracoscopic). STANDARD RADIOLOGICAL METHODS Fine needle aspiration biopsy (FNA) and core biopsy are well established techniques. Both can be performed under CT and to some extent ultrasound guidance. PERFORMANCE Diagnostic accuracies of FNA and core biopsy for malignant lesions are around 95 %. Core biopsy is superior to FNA for establishing a specific diagnosis with a diagnostic yield of 81-88 % versus 17-21 %. ACHIEVEMENTS In clinical routine practice core biopsy is the superior tool when compared to FNA. PRACTICAL RECOMMENDATIONS Central lesions in close proximity to bronchi may be biopsied with endobronchial ultrasound (EBUS)-guided bronchoscopy. In all other lesions percutaneous, ideally CT-guided biopsy should be the method of first choice.
Collapse
Affiliation(s)
- A H Mahnken
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland,
| |
Collapse
|
47
|
Nour-Eldin NEA, Alsubhi M, Naguib NN, Lehnert T, Emam A, Beeres M, Bodelle B, Koitka K, Vogl TJ, Jacobi V. Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients. Eur J Radiol 2014; 83:1945-52. [PMID: 25063212 DOI: 10.1016/j.ejrad.2014.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the risk factors involved in the development of pulmonary hemorrhage complicating CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques. MATERIALS AND METHODS Retrospective study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD: 5.2) from November 2008 to June 2013. Patients were classified according to lung biopsy technique in coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were: lesions <5mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension or refusal of the procedure. Risk factors for pulmonary hemorrhage complicating lung biopsy were classified into: (a) patient's related risk factors, (b) lesion's related risk factors and (d) technical risk factors. Radiological assessments were performed by two radiologists in consensus. Mann-Whitney U test and Fisher's exact tests for statistical analysis. p values <0.05 were considered statistically significant. RESULTS Incidence of pulmonary hemorrhage was 19.6% (65/332) in non-coaxial group and 22.3% (71/318) in coaxial group. The difference in incidence between both groups was statistically insignificant (p=0.27). Hemoptysis developed in 5.4% (18/332) and in 6.3% (20/318) in the non-coaxial and coaxial groups respectively. Traversing pulmonary vessels in the needle biopsy track was a significant risk factor of the development pulmonary hemorrhage (incidence: 55.4% (36/65, p=0.0003) in the non-coaxial group and 57.7% (41/71, p=0.0013) in coaxial group). Other significant risk factors included: lesions of less than 2 cm (p value of 0.01 and 0.02 in non-coaxial and coaxial groups respectively), basal and middle zonal lesions in comparison to upper zonal lung lesions (p=0.002 and 0.03 in non-coaxial and coaxial groups respectively), increased lesion's depth from the pleural surface (p=0.021 and 0.018 in non-coaxial and coaxial groups respectively), increased distance of traversed lung in the needle track of more than 2.5 cm (p=0.001 in both groups). Insignificant risk factors were patient's age, gender or emphysema in both groups (p value >0.1 in both groups). Concomitant incidence of pneumothorax was 32.3% (21/65) in non-coaxial group and 36.6% (26/71) in coaxial group. Pulmonary hemorrhage in the majority of cases was treated conservatively. CONCLUSION Pulmonary hemorrhage complicating CT-guided core biopsy of pulmonary lesions, showed insignificant difference between coaxial and non-coaxial techniques. Significant risk factors of pulmonary hemorrhage included small and basal lesions, increased lesion's depth from pleural surface, increased length of aerated lung parenchyma crossed by biopsy needle and passing through vessels within the lung during puncture.
Collapse
Affiliation(s)
- Nour-Eldin A Nour-Eldin
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Diagnostic and Interventional Radiology Department, Cairo University Hospital, Cairo, Egypt.
| | - Mohammed Alsubhi
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Nagy N Naguib
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Diagnostic and Interventional Radiology Department, Alexandria University Hospital, Alexandria, Egypt
| | - Thomas Lehnert
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ahmed Emam
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Martin Beeres
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Boris Bodelle
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Karen Koitka
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Volkmar Jacobi
- Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| |
Collapse
|
48
|
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: 96] [Impact Index Per Article: 9.6] [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.
Collapse
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
| |
Collapse
|
49
|
Winokur RS, Pua BB, Sullivan BW, Madoff DC. Percutaneous lung biopsy: technique, efficacy, and complications. Semin Intervent Radiol 2014; 30:121-7. [PMID: 24436527 DOI: 10.1055/s-0033-1342952] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Computed tomography-guided percutaneous needle biopsy of the lung is an indispensable tool in the evaluation of pulmonary abnormalities due to its high diagnostic accuracy in the detection of malignancy. Percutaneous biopsy in the lung plays a critical role in obtaining pathologic proof of malignancy, guiding staging and planning treatment. This article reviews biopsy techniques and their related efficacy and complications.
Collapse
Affiliation(s)
- Ronald S Winokur
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Brian W Sullivan
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| |
Collapse
|
50
|
Saqi A, Coley SM, Crapanzano JP. Granulomatous inflammation and organizing pneumonia: Role of computed tomography-guided lung fine needle aspirations, touch preparations and core biopsies in the evaluation of common non-neoplastic diagnoses. Cytojournal 2014; 11:2. [PMID: 24678338 PMCID: PMC3952395 DOI: 10.4103/1742-6413.126223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/04/2013] [Indexed: 12/04/2022] Open
Abstract
Background: Fine-needle aspirations (FNAs) and core biopsies (CBs), with or without touch preparations (TPs), are performed to characterize pulmonary lesions. Although a positive (P) or suspicious report is sufficient for further management, the significance of unsatisfactory (U), negative (N) and atypical (A) cytological diagnoses remains uncertain. The aims of the study were to correlate U, N and A cytological diagnoses with histological and/or clinical/radiological follow-up and evaluate the utility of FNAs, TPs and CBs. Materials and Methods: We performed a retrospective search and examined 30 consecutive computed tomography-guided transthoracic U, N and A lung FNAs (n = 23) and TPs (n = 7) with surgical pathology (SP) (n = 17) and/or clinical/radiological follow-up (n = 13) and compared them to 10 SP-confirmed P FNAs, which served as controls. Results: The 30 FNAs and TPs were from 29 patients. All 6 U specimens were scantly cellular. Granulomas, the most common specific benign cytological diagnosis, were evident in 8 (of 13) and 7 (of 11) N and A cytology cases, respectively. Histology corroborated the presence of granulomas identified on cytology. Organizing pneumonia was the second leading benign specific diagnosis (5/17), but it was rendered on histology (n = 5) and not FNAs or TPs. Evaluation of the A cases revealed that type II pneumocytes were the source of “atypical”, diagnoses often associated with granulomas or organizing pneumonia and lacked 3-D clusters evident in all P cases. Discussion: U, N and A FNAs and TPs lacked 3-D clusters seen in carcinomas and were negative on follow-up. Granulomas and organizing pneumonia were the most common specific benign diagnoses, but the latter was recognized on histology only. In the absence of a definitive FNA result at the time of on-site assessment, a CB with a TP containing type II pneumocytes increases the likelihood of a specific benign diagnosis.
Collapse
Affiliation(s)
- Anjali Saqi
- Address: Department of Pathology and Cell Biology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Shana M Coley
- Address: Department of Pathology and Cell Biology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY 10032, USA
| | - John P Crapanzano
- Address: Department of Pathology and Cell Biology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY 10032, USA
| |
Collapse
|