1
|
Sekimoto Y, Sekiya M, Kohmaru M, Okuma T, Tajima M, Sato H, Takahashi K. Primary pulmonary lymphoma diagnosed by ultrasound-guided transthoracic needle biopsy. Respirol Case Rep 2023; 11:e01159. [PMID: 37292165 PMCID: PMC10245027 DOI: 10.1002/rcr2.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Ultrasound-guided transthoracic needle biopsy is a relatively safe procedure diagnosing subpleural pulmonary mass and has high sensitivity in the diagnosis of lung cancer. However, the usefulness in other rare malignancies is unknown. This case shows the effectiveness in diagnosing not only lung cancer but also rare malignancies including primary pulmonary lymphoma.
Collapse
Affiliation(s)
- Yasuhito Sekimoto
- Department of Respiratory MedicineSaitama Saiseikai Kawaguchi General HospitalSaitamaJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Mitsuaki Sekiya
- Department of Respiratory MedicineSaitama Saiseikai Kawaguchi General HospitalSaitamaJapan
| | - Makiko Kohmaru
- Department of Respiratory MedicineSaitama Saiseikai Kawaguchi General HospitalSaitamaJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Tomoko Okuma
- Department of Respiratory MedicineSaitama Saiseikai Kawaguchi General HospitalSaitamaJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Manabu Tajima
- Department of Respiratory MedicineSaitama Saiseikai Kawaguchi General HospitalSaitamaJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Hideaki Sato
- Department of PathologySaitama Saiseikai Kawaguchi General HospitalSaitamaJapan
| | - Kazuhisa Takahashi
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| |
Collapse
|
2
|
Santos A, Almeida C, Porto LM, Fernandes PD, Silva JP. Cerebral Air Embolism: A Case of a Rare Transthoracic Needle Biopsy Complication. Cureus 2023; 15:e35203. [PMID: 36960241 PMCID: PMC10031384 DOI: 10.7759/cureus.35203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
Transthoracic needle biopsy (TNB) is a fundamental procedure in the diagnosis of a wide spectrum of thoracic diseases replacing more invasive surgical procedures. The procedure may be performed with computed tomography (CT) or ultrasound imaging guidance, with CT being the more commonly utilized. Although less invasive than surgery, there is still a complication risk associated with this procedure. These can be local such as pneumothorax, parenchymal hemorrhage, tumor seeding, and hemoptysis, or systemic such as air embolism. The authors report a case of cerebral circulation air embolism as a complication of TNB in a 54-year-old male with suspected lung tumor followed by a brief review of the current literature.
Collapse
Affiliation(s)
- André Santos
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - Catarina Almeida
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - Lenea M Porto
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - Pedro D Fernandes
- Department of Pulmonology, Centro Hospitalar Tondela Viseu, Viseu, PRT
| | - João P Silva
- Department of Pulmonology, Centro Hospitalar Tondela Viseu, Viseu, PRT
| |
Collapse
|
3
|
Muacevic A, Adler JR, Khan A, Elbich J. Left Heart and Systemic Arterial Circulation Air Embolus During CT-Guided Lung Biopsy. Cureus 2022; 14:e32402. [PMID: 36644101 PMCID: PMC9833862 DOI: 10.7759/cureus.32402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
A transthoracic needle biopsy (TTNB) of the lung, commonly referred to as a "lung biopsy," is a commonly performed procedure in Interventional Radiology. It is usually associated with well-known risks including pneumothorax and hemothorax. One of the rare and lesser-known risks of TTNB, however, is a phenomenon called an air embolism. The term "air embolism" alone may be somewhat ambiguous, as it could indicate i) air entering the systemic veins, or ii) air entering the pulmonary veins. Here, we present a case of an air embolus entering the pulmonary veins. The pulmonary veins naturally drain into the left side of the heart (left atrium and ventricle) which provides oxygenated blood to the major arteries of the body including the coronary, carotid, and major abdominal visceral branches. Therefore, an air embolism in this vasculature can lead to potentially devastating hemodynamic consequences downstream.
Collapse
|
4
|
Vachani A, Zhou M, Ghosh S, Zhang S, Szapary P, Gaurav D, Kalsekar I. Complications After Transthoracic Needle Biopsy of Pulmonary Nodules: A Population-Level Retrospective Cohort Analysis. J Am Coll Radiol 2022; 19:1121-1129. [PMID: 35738412 DOI: 10.1016/j.jacr.2022.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To provide recent population-based estimates of transthoracic needle biopsy (TTNB) complications and risk factors associated with these complications. METHODS This retrospective cohort analysis included adults from a nationally representative longitudinal insurance claims data set who underwent TTNB in 2017 or 2018. Complications that were evaluated included pneumothorax, hemorrhage, and air embolism. Separate logistic regression models estimated the association of pneumothorax or hemorrhage with the setting of care (ie, inpatient or outpatient) and selected baseline patient demographic and clinical characteristics including age, gender, history of chronic obstructive pulmonary disease, diagnosis of pleural effusion, tobacco use, use of oral anticoagulants and antiplatelet agents, prior lung cancer screening, previous bronchoscopy within 1 year, and Elixhauser comorbidity index. RESULTS Among 16,971 patients who underwent TTNB, 25.8% experienced a complication within 3 days of the procedure (pneumothorax 23.3%, hemorrhage 3.6%, and air embolism 0.02%). Among patients who experienced pneumothorax, 31.9% required chest tube drainage. Among patients undergoing an outpatient TTNB (n = 12,443), 6.9% were hospitalized within 7 days. Biopsy in an inpatient setting, chronic obstructive pulmonary disease diagnosis, and prior bronchoscopy were associated with higher rates of both pneumothorax and hemorrhage. Prior lung cancer screening was associated with an increased risk of pneumothorax, and prior use of oral anticoagulants or antiplatelets was associated with higher rates of hemorrhage. CONCLUSION This contemporary population-based cohort study demonstrated that approximately one-quarter of patients undergoing TTNB experienced a complication. Pneumothorax was the most frequent complication, and hemorrhage and air embolism were rare. Among outpatients, complications from TTNB are an important cause of hospitalization.
Collapse
Affiliation(s)
- Anil Vachani
- Associate Professor of Medicine, Division of Pulmonary and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
| | - Meijia Zhou
- Manager, Medical Device Epidemiology & Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Sudip Ghosh
- Director, Global Health Economics and Market Access, Johnson & Johnson (Ethicon), Cincinnati, Ohio
| | - Shumin Zhang
- Senior Director, Medical Device Epidemiology & Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Philippe Szapary
- Vice-President, Lung Cancer Initiative, Johnson & Johnson Enterprise Innovation, New Brunswick, New Jersey
| | | | - Iftekhar Kalsekar
- Senior Director, Lung Cancer Initiative, Johnson & Johnson Enterprise Innovation, New Brunswick, New Jersey
| |
Collapse
|
5
|
Abstract
Image-guided lung needle biopsy allows for minimally invasive diagnosis of lung pathology. In the setting of suspected malignancy, the biopsy not only confirms the diagnosis but also allows for molecular profiling, a requisite for tailored systemic therapy. Needle biopsy can also characterize non-neoplastic entities such as infections not responding to treatment and other inflammatory processes. A successful and safe lung needle biopsy starts with lesion and patient selection and careful pre-procedural evaluation. Here we review the indications and contraindications, diagnostic alternatives, approach planning and sequential procedural steps with the goal of maximizing both yield and patient safety. We discuss technical tips for preventing complications such as pleural anesthesia, the saline seal, the blood patch, the banana bend, hydro dissection, and the rapid needle out/patient rollover maneuver. We also review how to manage complications, avoid non-diagnostic biopsies, and provide recommendations for post-procedural observation and imaging follow-up.
Collapse
|
6
|
Abstract
Pathologic diagnosis of thymic tumors (TTs) can be made by surgical or nonsurgical procedures. About 20% of TTs had been diagnosed by pretreatment biopsy methods while the rest had gone to surgery for diagnosis and treatment. However, in the last two decades there was an increase in pretreatment procedures for optimal management of locally advanced or metastatic TTs. Pretreatment tissue diagnosis of a noninvasive TT is not a standard option but is required if there is suspect or atypical clinical presentation and imaging, an invasive tumor requiring a nonsurgical approach or preoperative chemotherapy or chemo-radiotherapy, strong possibility of lymphoma or unclear differential diagnosis between lymphoma or other solid tumor by imaging studies, or suspicion of a metastatic lesion. In surgical diagnosis anterior mediastinotomy, video-assisted thoracic surgery or mediastinoscopy can be chosen for invasive TTs whereas total resection is performed for small, noninvasive tumors. Nonsurgical diagnosis can be made by transthoracic fine or core needle biopsies (TTFNA, TTCNB), conventional bronchoscopy, endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or medical thoracoscopy depending on procedural amenability according to tumor extension. TTFNA and TTCNB have been the most frequently used nonsurgical methods. However, there is an upward trend in using conventional bronchoscopy, EBUS-TBNA, EUS-FNA and medical thoracoscopy recently. To increase the diagnostic performance of these procedures in TTs, recommendations are (I) obtaining histologic specimens, (II) combining smears or liquid based cytology preparations and cell blocks, (III) obtaining multiple sufficient samples, (IV) combining histologic and cytologic specimens, (V) performing morphologic, immunohistochemical and molecular analyses on all specimens, (VI) using rapid onsite evaluation for cytologic specimens, (VII) correlating pathologic, clinical and radiologic findings, (VIII) consulting experienced pathologists.
Collapse
Affiliation(s)
- Semra Bilaçeroğlu
- University of Health Sciences-Turkey, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey
| |
Collapse
|
7
|
Porrello C, Gullo R, Gagliardo CM, Vaglica A, Palazzolo M, Giangregorio F, Iadicola D, Catanzaro A, Scerrino G, Lo Faso F, Carini F, Tomasello G. CT-guided transthoracic needle biopsy: advantages in histopathological and molecular tests. Future Oncol 2019; 16:27-32. [PMID: 31596139 DOI: 10.2217/fon-2019-0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: The present study aimed to demonstrate that computed tomography-guided transthoracic needle biopsy (TTNB) is a safe procedure that gives a more accurate pre-operative tissue diagnosis for peripheral lung nodules than transthoracic needle aspiration, obtaining suitable samples for molecular test in lung adenocarcinomas. Patients & methods: Between December 2016 and March 2018 at Thoracic Surgery Department of the University of Palermo - Policlinico Paolo Giaccone hospital, TTNB was performed in 42 patients with computed tomography-detected peripheral lung nodules >10 mm, using 16-18-Gauge Tru-Cut needles. Results: With TTNB, we have estimated an accuracy for tissue diagnosis of 97.6%. At the molecular test, EGFR overexpression and ALK mutation resulted positive for 12/23 patients with lung adenocarcinoma. Conclusion: TTNB has showed a low rate of complications and it is adoptable as standard diagnostic procedure for peripheral lung nodules.
Collapse
Affiliation(s)
- Calogero Porrello
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Paolo Giaccone di Palermo, Palermo, Italy
| | | | - Carola Maria Gagliardo
- Department of Surgical, Oncological & Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Antonino Vaglica
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Paolo Giaccone di Palermo, Palermo, Italy
| | - Manuela Palazzolo
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Paolo Giaccone di Palermo, Palermo, Italy
| | - Filippo Giangregorio
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Paolo Giaccone di Palermo, Palermo, Italy
| | - Dario Iadicola
- Department of Surgical, Oncological & Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Andrea Catanzaro
- Department DIID (Department of Industrial and Digital Innovation) of Engineering, University of Palermo, Palermo, Italy
| | - Gregorio Scerrino
- Department of General & Emergency Surgery, Azienda Ospedaliera Universitaria Paolo Giaccone di Palermo, Palermo, Italy
| | - Felice Lo Faso
- UOS Chirurgia Toracica Generale e Mininvasiva, Azienda Ospedaliera Marche Nord, Italy
| | - Francesco Carini
- Department of Experimental Biomedicine & Clinical Neuroscience, Section of Anatomy, (BIONEC), University of Palermo, Palermo, Italy
| | - Giovanni Tomasello
- Department of Experimental Biomedicine & Clinical Neuroscience, Section of Anatomy, (BIONEC), University of Palermo, Palermo, Italy
| |
Collapse
|
8
|
Christiansen IS, Clementsen PF, Bodtger U, Naur TMH, Pietersen PI, Laursen CB. Transthoracic ultrasound-guided biopsy in the hands of chest physicians - a stepwise approach. Eur Clin Respir J 2019; 6:1579632. [PMID: 30815241 PMCID: PMC6383606 DOI: 10.1080/20018525.2019.1579632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background: The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will be met by increasing demands with regard to biopsy techniques including ultrasound-guided transthoracic needle biopsy (US-TTNB).Objective: The aim of this paper is to present the pulmonologist to a systematic step-by-step guide for performing US-TTNB and to assess the evidence for this approach. Method/results: Indications, contraindications and a step-by-step guide for the techniques used when performing US-TTNB are presented, and major complications and handling of these are described. Conclusion: US-TTNB performed by pulmonologists is a safe and feasible procedure.
Collapse
Affiliation(s)
- Ida Skovgaard Christiansen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
| |
Collapse
|
9
|
Gill RR, Murphy DJ, Kravets S, Sholl LM, Janne PA, Johnson BE. Success of genomic profiling of non-small cell lung cancer biopsies obtained by trans-thoracic percutaneous needle biopsy. J Surg Oncol 2018; 118:1170-1177. [PMID: 30261097 DOI: 10.1002/jso.25241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/24/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Genomic profiling for personalized targeted therapy has become standard of care. We report the success of genomic profiling of non-small cell lung cancer (NSCLC) obtained by trans-thoracic needle biopsy (TTNB) in a single center experience. MATERIALS AND METHODS Patients with NSCLC who underwent TTNB for genomic were identified. Pathology specimens were evaluated for tumor adequacy and then analyzed for selected exons of epidermal growth factor receptor, KRAS, BRAF, PIK3CA, and ERBB2. ALK rearrangements were detected with fluorescence in situ hybridization and/or immunohistochemistry. Technical success was recorded and the factors affecting successful profiling were evaluated. Complications (pneumothorax, hemorrhage, and admission) were recorded. Comparison of yield and complications were done between the two groups (core biopsy and fine needle aspiration only group). Utility of PET-CT to guide the needle track for optimized yield was assessed in a subset of patients. RESULTS Between December 6, 2009, and December 30, 2016, 765 patients with NSCLC underwent TTNB. Five-hundred and seventy-seven of 765 (75%) of all TTNB were profiled, for genomic analysis. Five-hundred and eight of 577 (88%) were successfully profiled. The number of samples obtained ranged from 1 to 10 (1 to 2 cm, 18 to 20 G). Lesions biopsied ranged in size from 0.6 to 16 cm. No statistically significant difference was observed in the incidence of pneumothorax between two groups (P = 0.26). PET guidance was not found to be statistically significant ( P = 0.79) in the overall yield. CONCLUSION Computed tomographic guided TTNB is a safe and efficacious technique for genomic profiling, enables the acquisition of sufficient tissue for genetic mutation analyses allowing for personalized therapy with an acceptable complication rate.
Collapse
Affiliation(s)
- Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David John Murphy
- Department of Radiology, Guy's & St Thomas, NHS Foundation Trust & King's College, London, UK
| | - Sasha Kravets
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lynnette Mary Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pasi Antero Janne
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bruce Evan Johnson
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
10
|
Kavanagh J, Siemienowicz M, Keshavjee S, Rogalla P, Singer L, Kandel S. Utility of transthoracic needle biopsy after lung transplantation. Clin Transplant 2017; 32. [PMID: 29194758 DOI: 10.1111/ctr.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess the diagnostic yield and complications of CT-guided transthoracic needle biopsy (TTNB) after lung transplantation. A database search identified all TTNB performed in lung transplant patients over a 14-year period. Forty-two biopsies in transplant patients (transplant group) were identified and matched to the next biopsy performed in native lungs by the same operator (nontransplant group) as a control. Primary outcomes recorded were diagnosis, diagnostic yield, pneumothorax requiring intervention, and symptomatic pulmonary hemorrhage. Biopsy outcomes were classified as diagnostic, not specifically diagnostic, and nondiagnostic. Patients in the transplant group were younger (P < .002). Emphysema along the biopsy trajectory was more commonly seen in the nontransplant group (P < .0006). Needle gauge, size of lesion, pleural punctures, lesion depth, and number of passes were not significantly different. Diagnostic yield was 71% in the transplant group and 91% in the nontransplant group. There were 20 of 42 (48%) malignant nodules in the transplant group compared to 31 of 44 (70%) nodules in the nontransplant group (P = .05). There were no complications in the transplant group. The nontransplant group had two pneumothoraces requiring intervention. TTNB after lung transplant is safe with a moderate diagnostic yield. Nonmalignant lesions are more common after lung transplantation.
Collapse
Affiliation(s)
- John Kavanagh
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Shaf Keshavjee
- Toronto Lung Transplantation Programme, Division of Thoracic Surgery, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Patrik Rogalla
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lianne Singer
- Toronto Lung Transplantation Programme, Division of Respirology, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Sonja Kandel
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
12
|
Galluzzo A, Genova C, Dioguardi S, Midiri M, Cajozzo M. Current role of computed tomography-guided transthoracic needle biopsy of metastatic lung lesions. Future Oncol 2015; 11:43-6. [PMID: 25662328 DOI: 10.2217/fon.14.258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. MATERIALS & METHODS 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. RESULTS CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). CONCLUSION CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases.
Collapse
Affiliation(s)
- Anna Galluzzo
- IBFM-CNR at Department of Radiology (Department of Biotechnology, Biopathology and Forensic Medicine), University of Palermo, via del Vespro 127, 90129 Palermo, Italy
| | | | | | | | | |
Collapse
|
13
|
Demetrian A, Dobrinescu A, Bălă S, Demetrian C, Gheonea IA, Albulescu DM. Transthoracic Needle Biopsy (TNB) under Different Guiding Methods - the Experience of the Thoracic Surgery Clinic of Craiova after the First 235 Cases. Curr Health Sci J 2015; 41:239-45. [PMID: 30534428 DOI: 10.12865/CHSJ.41.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/15/2015] [Indexed: 11/29/2022]
Abstract
ABSTRACT: Transthoracic needle biopsy (TNB) is a fast and safe method used to establish definitive diagnosis for most thoracic lesions, whether the lesion is located in the pleura, the lung parenchyma, or the mediastinum. Diffuse disease and solitary lesions are equally approachable.TNB can avoid (when technically possible) more complex diagnostic interventions such asmediastinoscopy, thoracoscopy and exploratory thoracotomy. This article focuses on the advantages of TNB which is a safe, affordable and quick method to obtain histopathological confirmation of intrathoracic tumors. Material and MethodsThe study included a total of 235 cases over a period of 4 and a half years (01.01.2011-30.04.2015). We investigated the demographic and clinical parameters, the guiding methods, the histological results and the complications of the procedure. ResultsThe median age of the patients was 62 years and the predominent sex was male. We could obtain a tissue biopsy in 99% with a histopathological confirmation of 88%. The most frequently used guiding method was the previous CT scan of the patient and the anathomical landmarks (53%). The main histopathological result was squamous cell carcinoma.ConclusionsTNB is generally a safe procedure with limited morbidity and extremely rare mortality. It is an affordable and quick method to obtain histopathological confirmation of intrathoracic tumors.Most TNBs can be performed by using local anesthesia without conscious sedation and virtually any location in the chest can be safely addressed.
Collapse
|
14
|
Abstract
There are an increased number of pulmonary nodules discovered on CT scan images in part due to those performed for lung cancer screening. Risk stratification and patient involvement is critical in determining management ranging from interval imaging to invasive biopsy or surgery. A definitive diagnosis requires tissue biopsy. The choice of a particular biopsy technique depends on the risks/benefits of the procedure, the diagnostic yield and local expertise. This review will focus on the evaluation and management of pulmonary nodules based on the Fleischner Society and American College of Chest Physician guidelines. There have been recent changes to both societies' recommendations for incidental detection of solid and subsolid nodules, risk stratification, imaging, minimally invasive diagnostic techniques and definitive surgical options.
Collapse
Affiliation(s)
- Rebecca Krochmal
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 South Paca Street, Second Floor, Baltimore, MD 21201, USA
| | | | | | | | | |
Collapse
|