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
|
Li T, Zhang Q, Li W, Liu Y. Autologous blood patch intraparenchymal injection reduces the incidence of pneumothorax and the need for chest tube placement following CT-guided lung biopsy: a systematic review and meta-analysis. Eur J Med Res 2024; 29:108. [PMID: 38336678 PMCID: PMC10854056 DOI: 10.1186/s40001-024-01707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To assess the effectiveness of autologous blood patch intraparenchymal injection during CT-guided lung biopsies with a focus on the incidence of pneumothorax and the subsequent requirement for chest tube placement. METHODS A comprehensive search of major databases was conducted to identify studies that utilized autologous blood patches to mitigate the risk of pneumothorax following lung biopsies. Efficacy was next assessed through a meta-analysis using a random-effects model. RESULTS Of the 122 carefully analyzed studies, nine, representing a patient population of 4116, were incorporated into the final analysis. Conclusion deduced showed a noteworthy reduction in the overall incidence of pneumothorax (RR = 0.65; 95% CI 0.53-0.80; P = 0.00) and a significantly decline in the occasion for chest tube placement due to pneumothorax (RR = 0.45; 95% CI 0.32-0.64; P = 0.00). CONCLUSIONS Utilizing autologous blood patch intraparenchymal injection during the coaxial needle retraction process post-lung biopsy is highly effective in diminishing both the incidence of pneumothorax and consequent chest tube placement requirement.
Collapse
Affiliation(s)
- Teng Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China
| | - Qiang Zhang
- Department of Nuclear Medicine, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China
| | - Wenjun Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China
| | - Yun Liu
- Department of Hematology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, 261041, Shandong, China.
| |
Collapse
|
3
|
Xu L, McCandless L, Miller N, Alessio A, Morrison J. Machine-Learned Algorithms to Predict the Risk of Pneumothorax Requiring Chest Tube Placement after Lung Biopsy. J Vasc Interv Radiol 2023; 34:2155-2161. [PMID: 37619941 DOI: 10.1016/j.jvir.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/29/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE To develop a machine-learned algorithm to predict the risk of postlung biopsy pneumothorax requiring chest tube placement (CTP) to facilitate preprocedural decision making, optimize patient care, and improve resource allocation. MATERIALS AND METHODS This retrospective study collected clinical and imaging features of biopsy samples obtained from patients with lung nodule biopsy and included information from 59 procedures resulting in pneumothorax requiring CTP and randomly selected 67 procedures without CTP (convenience sample). The data were divided into 70 and 30 as training and testing sets, respectively. Conventional machine-learned binary classifiers were explored with preprocedural imaging and clinical data as input features and CTP as the output. RESULTS There was no single pathognomonic imaging or predictive clinical feature. For the independent test set under the high-specificity mode, a decision tree, logistic regression, and Naïve Bayes classifier achieved accuracies of identifying CTP at 0.79, 0.93, and 0.89 and area under receiver operating curves (AUROCs) of 0.68, 0.76, and 0.82, respectively. Under high-sensitivity mode, a decision tree, logistic regression, and Naïve Bayes achieved accuracies of identifying CTP of 0.60, 0.45, and 0.60 with AUROCs of 0.71, 0.81, and 0.82, respectively. High importance features included lesion character, chronic obstructive pulmonary disease, lesion depth, and age. A coarse decision tree requiring 4 inputs achieved comparable performance as other methods and previous machine learning prediction studies. CONCLUSIONS The results support the possibility of predicting pneumothorax requiring CTP after biopsy based on an automated decision support, reliant on readily available preprocedural information.
Collapse
Affiliation(s)
- Lu Xu
- Biomedical Engineering, Michigan State University, East Lansing, Michigan; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | - Lane McCandless
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Nicholas Miller
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Adam Alessio
- Biomedical Engineering, Michigan State University, East Lansing, Michigan; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan
| | - James Morrison
- College of Human Medicine, Michigan State University, East Lansing, Michigan; Advanced Radiology Services, Grand Rapids, Michigan
| |
Collapse
|
4
|
Zhou SQ, Luo F, Li K, Ran X, Lv FR. Association between needle track bleeding and postoperative immediate pneumothorax in CT-guided percutaneous transthoracic lung biopsies: a cross-sectional study. Sci Rep 2023; 13:18811. [PMID: 37914714 PMCID: PMC10620196 DOI: 10.1038/s41598-023-44560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023] Open
Abstract
The relationship between Needle Track Bleeding (NTB) and the occurrence of postoperative immediate pneumothorax remains unclear. In our cross-sectional study, we conducted a retrospective collected of data from 674 consecutive patients who underwent CT-guided percutaneous transthoracic lung biopsies between 2019 and 2022. A logistic regression model was employed to explore the association between NTB and postoperative immediate pneumothorax, and restricted cubic spline curves was used to investigate the link and its explicit curve shape. A sensitivity analysis was performed by transforming the continuous NTB into categorical variable and calculated an E-value. A total of 453 participants (47.90% male) were included in our analysis. The postoperative immediate pneumothorax rate was 41.05% (186/453). We found a negative correlation between NTB and postoperative immediate pneumothorax (OR = 0.91, 95%CI 0.88-0.95) after adjusting for confounding factors. This relationship was nonlinear, with a key inflection point at NTB of 8 mm. No significant link was noted for NTB > 8 mm (OR = 0.98, 95%CI 0.95-1.02), while a protective association was observed for NTB ≤ 8 mm (OR = 0.74, 95%CI 0.66-0.81). NTB showed a nonlinear, protective correlation with postoperative immediate pneumothorax. However, when NTB exceeded 8 mm, the protective association was not observed.
Collapse
Affiliation(s)
- Shao-Quan Zhou
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
- Chongqing General Hospital, Chongqing, China
| | - Fang Luo
- The Chongqing Traditional Chinese Medicine Hospital, Chongqing Academy of Traditional Chinese Medicine, Chongqing, China
| | - Kang Li
- Chongqing General Hospital, Chongqing, China
| | - Xiong Ran
- Chongqing General Hospital, Chongqing, China
| | - Fu-Rong Lv
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
| |
Collapse
|
5
|
Cheng Z, Chen L, Wang X, Wang Y, Zhao M, Zan K, Liu W, Cui X, Chai L, Ge M, Li K, Duan Y. Role of breath-hold lung PET in stage IA pulmonary adenocarcinoma. Insights Imaging 2023; 14:100. [PMID: 37227573 DOI: 10.1186/s13244-023-01446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Respiratory motion during PET acquisition may result in image blurring and resolution loss, reduced measurement of radiotracer uptake, and consequently, inaccurate lesion quantification and description. With the introduction of the total-body PET system, short-time PET acquisition is feasible due to its high sensitivity and spatial resolution. The purpose of this study was to evaluate the additional value of 20-s breath-hold (BH) lung PET in patients with stage IA pulmonary adenocarcinoma. METHODS Forty-seven patients with confirmed stage IA pulmonary adenocarcinoma were enrolled in this retrospective study. All patients underwent a 300-s FB whole-body PET, followed by a BH lung PET. The SUVmax, TBR of the lesions and the percentage difference in nodule SUVmax (%ΔSUVmax) and TBR (%ΔTBR) between the two acquisitions was also calculated. The lesions were further divided by distance from pleura for subgroup analysis. The lesion detectability on PET images was the percentage of FDG-positive lesions. RESULTS Among 47 patients, the BH lung PET images identified all lung nodules, and there was a significant difference in overall nodule SUVmax and TBR between BH PET and FB PET (both p < 0.01). The %ΔSUVmax and %ΔTBR were significantly higher in nodules adjacent to pleura (≤ 10 mm in distance) than those away from pleura (both p < 0.05). The lesion detectability of BH lung PET was significantly higher than that of FB PET (p < 0.01). CONCLUSION BH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma. CRITICAL RELEVANCE STATEMENT BH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma.
Collapse
Affiliation(s)
- Zhaoping Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China
| | - Li Chen
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Ying Wang
- Central Research Institute, United Imaging Healthcare, Shanghai, People's Republic of China
| | - Minjie Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China
| | - Keyu Zan
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China
| | - Wen Liu
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Xiao Cui
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China
| | - Leiying Chai
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China
| | - Min Ge
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China
| | - Kun Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China
| | - Yanhua Duan
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People's Republic of China.
| |
Collapse
|
6
|
Ruud EA, Heck S, Stavem K, Søyseth V, Geitung JT, Ashraf H. Low diffusion capacity of the lung predicts pneumothorax and chest drainage after CT-guided lung biopsy. BMC Res Notes 2022; 15:353. [PMID: 36457053 PMCID: PMC9717539 DOI: 10.1186/s13104-022-06234-6] [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: 08/15/2022] [Revised: 08/15/2022] [Accepted: 10/07/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Complications after CT-guided lung biopsy is a burden both for the individual patient and for the overall healthcare. Pneumothorax is the most common complication. This study determined the association between lung function tests and pneumothorax and chest drainage following CT-guided lung biopsy in consecutive patients in a large university hospital. RESULTS We prospectively registered 875 biopsy procedures from 786 patients in one institution from January 27th 2012 to March 1st 2017 and recorded complications including pneumothorax with or without chest drainage. Lung function data from 637 patients undergoing 710 of the procedures were available. The association of lung function measures with pneumothorax with or without chest drainage was assessed using multivariable logistic regression analyses. Diffusion capacity for carbon monoxide (DLCO) below 4.70 mmol/min/kPa was associated with increased occurrence of pneumothorax and chest drainage after CT guided lung biopsy. We found no association between FEV1, RV and occurrence of pneumothorax and chest drainage. We found low DLCO to be a risk factor of pneumothorax and chest drainage after CT-guided lung biopsy. This should be taken into account in planning and performing the procedure.
Collapse
Affiliation(s)
- Espen Asak Ruud
- grid.5510.10000 0004 1936 8921Department of Imaging, Akershus University Hospital, University of Oslo, Sykehusveien 25, 1478 LØrenskog, Norway ,grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
| | - Sigurd Heck
- grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
| | - Knut Stavem
- grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XDepartment of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Vidar Søyseth
- grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XDepartment of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Jon Terje Geitung
- grid.5510.10000 0004 1936 8921Department of Imaging, Akershus University Hospital, University of Oslo, Sykehusveien 25, 1478 LØrenskog, Norway ,grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
| | - Haseem Ashraf
- grid.5510.10000 0004 1936 8921Department of Imaging, Akershus University Hospital, University of Oslo, Sykehusveien 25, 1478 LØrenskog, Norway ,grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
| |
Collapse
|
7
|
Zhao Y, Bao D, Wu W, Tang W, Xing G, Zhao X. Development and validation of a prediction model of pneumothorax after CT-guided coaxial core needle lung biopsy. Quant Imaging Med Surg 2022; 12:5404-5419. [PMID: 36465829 PMCID: PMC9703113 DOI: 10.21037/qims-22-176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/08/2022] [Indexed: 08/22/2023]
Abstract
BACKGROUND Pneumothorax is the most common complication of computed tomography-guided coaxial core needle biopsy (CCNB) and may be life-threatening. We aimed to evaluate the risk factors and develop a model for predicting pneumothorax in patients undergoing computed tomography-guided CCNB, and to further determine its clinical utility. METHODS Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for pneumothorax from 18 variables. A predictive model was established using multivariable logistic regression and presented as a nomogram based on a training cohort of 690 patients who underwent computed tomography-guided CCNB. The model was validated in 253 consecutive patients in the validation cohort and 250 patients in the test cohort. The area under the curve was used to determine the predictive accuracy of the proposed model. RESULTS The risk factors associated with pneumothorax after computed tomography-guided CCNB were sex, patient position, lung field, lesion contact with the pleura, lesion size, distance from the pleura to the lesion, presence of emphysema adjacent to the biopsy tract, and crossing fissures. The predictive model that incorporated these predictors showed good predictive performance in the training cohort [area under the curve, 0.71 (95% confidence interval: 0.67-0.75)], validation cohort [0.71 (0.64-0.78)], and internal test cohort [0.68 (0.60-0.75)]. The nomogram also provided excellent calibration and discrimination, and decision curve analysis (DCA) demonstrated its clinical utility. CONCLUSIONS The predictive model showed good performance for pneumothorax after computed tomography-guided CCNB and may help improve individualized preoperative prediction.
Collapse
Affiliation(s)
- Yanfeng Zhao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Bao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenli Wu
- Medical Imaging Center, Liaocheng Tumor Hospital, Liaocheng, China
| | - Wei Tang
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gusheng Xing
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
8
|
Is Free Breathing Possible During Computed Tomography-Guided Percutaneous Transthoracic Lung Biopsy? The Clinical Experience in 585 Cases. J Comput Assist Tomogr 2022; 46:294-299. [PMID: 35297585 DOI: 10.1097/rct.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to retrospectively evaluate the safety and accuracy of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions during quiet breathing. METHODS We investigated the diagnostic performance and complication rate of 585 procedures in 563 patients (357 men; mean age, 67.7 years), who underwent CT-guided PTNBs during quiet breathing, aided by a respiratory targeting technique from May 2017 to July 2019. Differences between the cases with and without respiratory targeting were analyzed. Logistic regression analyses were performed to examine the development of pneumothorax and hemoptysis. RESULTS Percutaneous transthoracic needle biopsy samples were successfully obtained in 574 of 585 procedures (98.1%). Final diagnoses included: 410 malignant cases, 119 benign cases, and 45 indeterminate cases. The sensitivity, specificity, and accuracy of diagnosis were 94.4%, 100%, and 95.7%, respectively. Use of respiratory targeting was associated with younger age (P = 0.004), smaller lesion size (P < 0.001), peripheral location (P = 0.003), shorter distance from the diaphragm (P < 0.001), lower lobe location (P < 0.001), prone position (P = 0.004), and visible motion artifact (P < 0.001). Pneumothorax and hemoptysis rates were 22.9% and 7.9%, respectively. Upon multivariate analysis, emphysema (P = 0.002) was the only independent risk factor for pneumothorax, whereas distance from the pleura greater than 2 cm (P < 0.001), tissue sampling 3 times or more (P = 0.003), and a less experienced operator (P < 0.001) were risk factors for hemoptysis. CONCLUSIONS Computed tomography-guided PTNB during quiet breathing with respiratory targeting yielded high diagnostic performance with a slightly higher rate of complications. Free-breathing PTNB can be applied in clinical practice, based on lesion location and risk factors for complications.
Collapse
|
9
|
Abstract
ABSTRACT Percutaneous computed tomography-guided transthoracic lung biopsy is an effective and minimally invasive procedure to achieve tissue diagnosis. Radiologists are key in appropriate referral for further workup, with percutaneous computed tomography-guided transthoracic lung biopsy performed by both thoracic and general interventionalists. Percutaneous computed tomography-guided transthoracic lung biopsy is increasingly performed for both diagnostic and research purposes, including molecular analysis. Multiple patient, lesion, and technique-related variables influence diagnostic accuracy and complication rates. A comprehensive understanding of these factors aids in procedure planning and may serve to maximize diagnostic yield while minimizing complications, even in the most challenging scenarios.
Collapse
|
10
|
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
|
11
|
Türk Y, Devecioğlu İ. A Retrospective Analysis of the Effectiveness of Extrapleural Autologous Blood Patch Injection on Pneumothorax and Intervention Need in CT-guided Lung Biopsy. Cardiovasc Intervent Radiol 2021; 44:1223-1230. [PMID: 34021378 DOI: 10.1007/s00270-021-02866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the effect of extrapleural autologous blood injection (EPABI) technique on pneumothorax development before and after coaxial needle withdrawal (CNW) and intervention rate for pneumothorax. To analyze the risk factors of pneumothorax and parenchymal hemorrhage. MATERIALS AND METHODS The records of 288 patients who had lung biopsies were analyzed. Of these patients, 188 received EPABI (group-A) before penetrating the parietal pleura, and the remaining did not (group-B). Intraparenchymal autologous blood patch injection was applied at the end of the procedure. The pneumothorax rates before/after CNW and intervention requirement for pneumothorax were compared between groups. The risk factors of pneumothorax before/after CNW and parenchymal hemorrhage were assessed with stepwise logistic regression. RESULTS The pneumothorax rate before CNW was significantly lower in group-A (5.92%) than in group-B (19.10%) (p = 0.029). Pneumothorax risk before CNW was reduced if EPABI was applied and skin-to-pleura distance increased. The pneumothorax rate after CNW was similar between two groups (group-A: 6.94%, group-B: 8%), while emphysema grade along the needle path and procedure duration was the significant risk factor. The intervention requirement for pneumothorax was significantly lower in group-A (6.38%) than in group-B (16%) (p = 0.012). Needle aspiration requirement was significantly reduced in group-A. The rate of external drainage catheter and chest tube placement was similar in both groups. The risk factors of parenchymal hemorrhage were overall emphysema grade of the lung, target-to-pleura distance, and target size. CONCLUSION Use of EPABI along with IAPBI significantly decreased the pneumothorax rate during biopsy procedure and the intervention rate compared to IAPBI-alone.
Collapse
Affiliation(s)
- Yaşar Türk
- Radiology Department, Medical Faculty, Tekirdağ Namık Kemal University, Namik Kemal Mh., Kampus CdSuleymanpasa, 59100, Tekirdag, Turkey. .,Radiology Department, Medical Faculty, Zonguldak Bülent Ecevit University, Esenköy, 67000, Kozlu/Zonguldak, Turkey.
| | - İsmail Devecioğlu
- Biomedical Engineering Department, Çorlu Engineering Faculty, NKU Corlu Muhendislik Fakultesi, Tekirdağ Namık Kemal University, Silahtaraga Mh, Çorlu, Tekirdağ, Turkey
| |
Collapse
|
12
|
Zhou M, Wang T, Wei D, Zhu Y, Jiang Y, Zuo C, Jiang L, Chen H, Guo S, Yang L. Incidence, severity and tolerability of pneumothorax following low-dose CT-guided lung biopsy in different severities of COPD. CLINICAL RESPIRATORY JOURNAL 2020; 15:84-90. [PMID: 32935471 DOI: 10.1111/crj.13272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The feasibility of pneumothorax following low-dose CT-guided puncture lung biopsy in different severities of COPD has not been reported. METHODS The data of the patients with pulmonary lesion who underwent low-dose CT-guided lung biopsy by one experienced operator in our hospital from January 1st to September 30th in 2019 were retrospectively collected. They were divided into COPD group and non-COPD group. The risk factors, incidence and severity of pneumothorax with the severity of COPD and changes in MMRC score, treatment way and discharge time after pneumothorax were assessed. RESULTS Two hundred and nineteen patients were retrospectively enrolled in this study with 64 in the COPD group and 155 in the non-COPD group. The average age, MMRC score and the incidence of pneumothorax after biopsy were significantly higher in the COPD group (64.7 ± 1.27 years, 1.02 ± 0.13, 31.3%) than in the non-COPD group (58.8 ± 1.16 years, 0.35 ± 0.06, 17.4%, P < 0.05). The incidence of pneumothorax between I-II and III-IV in COPD did not reach the significant difference (P = 0.863). COPD was the only independent risk factor for pneumothorax after biopsy in a multivariable regression (P < 0.05). MMRC score was significantly increased at post-pneumothorax in the two groups (P < 0.001). There was no significant difference in diagnostic rate, severity of pneumothorax, the proportion of delayed pneumothorax, the changes in treatment way and discharge time between the two groups (P > 0.05). CONCLUSION Although the incidence of pneumothorax after low dose CT-guided lung biopsy is increased in COPD, there was no difference in the severity of pneumothorax amongst the different severities of COPD and it is well-tolerated without increasing medical burden.
Collapse
Affiliation(s)
- Mi Zhou
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongshan Wei
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Zhu
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yudan Jiang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cui Zuo
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Yang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
13
|
Appel E, Dommaraju S, Camacho A, Nakhaei M, Siewert B, Ahmed M, Brook A, Brook OR. Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax. Eur Radiol 2020; 30:6369-6375. [PMID: 32591892 DOI: 10.1007/s00330-020-07025-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/20/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the impact of patient positioning during CT-guided lung biopsy on patients' outcomes. METHODS In this retrospective, IRB-approved, HIPAA-compliant study, consecutive CT-guided lung biopsies performed on 5/1/2015-12/26/2017 were included. Correlation between incidence of pneumothorax, chest tube placement, pulmonary bleeding with patient, and procedure characteristics was evaluated. Lesion-trachea-table angle (LTTA) was defined as an angle between the lesion, trachea, and horizontal line parallel to the table. Lesion above trachea has a positive LTTA. Univariate and multivariate logistic regression analysis was performed. RESULTS A total of 423 biopsies in 409 patients (68 ± 11 years, 231/409, 56% female) were included in the study. Pneumothorax occurred in 83/423 (20%) biopsies with chest tube placed in 11/423 (3%) biopsies. Perilesional bleeding occurred in 194/423 (46%) biopsies and hemoptysis in 20/423 (5%) biopsies. Univariate analysis showed an association of pneumothorax with smaller lesions (p = 0.05), positive LTTA (p = 0.002), and lesions not attached to pleura (p = 0.026) with multivariate analysis showing lesion size and LTTA to be independent risk factors. Univariate analysis showed an association of increased pulmonary bleeding with smaller lesions (p < 0.001), no attachment to the pleura (p < 0.001), needle throw < 16 mm (p = 0.05), and a longer needle path (p < 0.001). Multivariate analysis showed lesion size, a longer needle path, and lesions not attached to the pleura to be independently associated with perilesional bleeding. Risk factors for hemoptysis were longer needle path (p = 0.002), no attachment to the pleura (p = 0.03), and female sex (p = 0.04). CONCLUSIONS Interventional radiologists can reduce the pneumothorax risk during the CT-guided biopsy by positioning the biopsy site below the trachea. KEY POINTS • Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy results in lower rate of pneumothorax, as compared with the lesion above the trachea. • Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy does not affect rate of procedure-associated pulmonary hemorrhage or hemoptysis.
Collapse
Affiliation(s)
- Elisabeth Appel
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Sujithraj Dommaraju
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Andrés Camacho
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Masoud Nakhaei
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA.
| |
Collapse
|
14
|
Sinha I, Aluthge DP, Chen ES, Sarkar IN, Ahn SH. Machine Learning Offers Exciting Potential for Predicting Postprocedural Outcomes: A Framework for Developing Random Forest Models in IR. J Vasc Interv Radiol 2020; 31:1018-1024.e4. [PMID: 32376173 PMCID: PMC10625161 DOI: 10.1016/j.jvir.2019.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To demonstrate that random forest models trained on a large national sample can accurately predict relevant outcomes and may ultimately contribute to future clinical decision support tools in IR. MATERIALS AND METHODS Patient data from years 2012-2014 of the National Inpatient Sample were used to develop random forest machine learning models to predict iatrogenic pneumothorax after computed tomography-guided transthoracic biopsy (TTB), in-hospital mortality after transjugular intrahepatic portosystemic shunt (TIPS), and length of stay > 3 days after uterine artery embolization (UAE). Model performance was evaluated with area under the receiver operating characteristic curve (AUROC) and maximum F1 score. The threshold for AUROC significance was set at 0.75. RESULTS AUROC was 0.913 for the TTB model, 0.788 for the TIPS model, and 0.879 for the UAE model. Maximum F1 score was 0.532 for the TTB model, 0.357 for the TIPS model, and 0.700 for the UAE model. The TTB model had the highest AUROC, while the UAE model had the highest F1 score. All models met the criteria for AUROC significance. CONCLUSIONS This study demonstrates that machine learning models may suitably predict a variety of different clinically relevant outcomes, including procedure-specific complications, mortality, and length of stay. Performance of these models will improve as more high-quality IR data become available.
Collapse
Affiliation(s)
- Ishan Sinha
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; Brown Center for Biomedical Informatics, Brown University, 233 Richmond Street, Box G-R, Providence, RI 02912.
| | - Dilum P Aluthge
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; Brown Center for Biomedical Informatics, Brown University, 233 Richmond Street, Box G-R, Providence, RI 02912
| | - Elizabeth S Chen
- Brown Center for Biomedical Informatics, Brown University, 233 Richmond Street, Box G-R, Providence, RI 02912
| | - Indra Neil Sarkar
- Brown Center for Biomedical Informatics, Brown University, 233 Richmond Street, Box G-R, Providence, RI 02912
| | - Sun Ho Ahn
- Division of Interventional Radiology, Department of Diagnostic Imaging, Providence, Rhode Island
| |
Collapse
|
15
|
Moussa AM, Ziv E, Solomon SB, Camacho JC. Microwave Ablation in Primary Lung Malignancies. Semin Intervent Radiol 2019; 36:326-333. [PMID: 31680724 DOI: 10.1055/s-0039-1700567] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide. Eighty-five percent of cases correspond to non-small cell lung cancer (NSCLC) and pivotal nonsurgical options for early-stage disease include percutaneous ablation and stereotactic body radiation therapy (SBRT). Microwave Ablation (MWA) is a locoregional treatment option that has many advantages over radiofrequency ablation and has been able to overcome the limitations of this technique in the treatment of early-stage NSCLC. In this review article, we highlight the current evidence supporting the use of MWA in patients with early-stage NSCLC and discuss the technical considerations of the procedure, including optimal patient selection and planning strategies, as well as the potential complications and reported outcomes. Finally, we mention future trends involving ablation in NSCLC, including its role in combination with SBRT in central tumors, management of post-SBRT local recurrence, and its potential as an adjuvant treatment option for patients with resistance to systemic therapy or in combination with checkpoint inhibitors.
Collapse
Affiliation(s)
- Amgad M Moussa
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Etay Ziv
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan C Camacho
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
16
|
Liu C, Xu B, Li Q, Li A, Li L, Yue J, Hu Q, Yu J. Smoking history influences the prognostic value of peripheral naïve CD4+ T cells in advanced non-small cell lung cancer. Cancer Cell Int 2019; 19:176. [PMID: 31320838 PMCID: PMC6617618 DOI: 10.1186/s12935-019-0899-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/04/2019] [Indexed: 12/31/2022] Open
Abstract
Background Considering the effect of smoking on tumor immunity, we attempted to investigate the impact of smoking history on the prognostic value of circulating naïve and memory CD4+ and CD8+ T cells in advanced non-small cell lung cancer (NSCLC) treated with chemo(radio)therapy. Methods Of 196 histologically confirmed advanced NSCLC, 98 eligible ones were enrolled. Naïve and memory CD4+ and CD8+ T cells from peripheral blood were measured by flow cytometry. Kaplan-Meier curves helped estimate patients' survival. The uni- and multivariate Cox proportional hazards regression model was employed in the assessment of the prognostic value of factors. Results Multivariate survival analyses showed that peripheral naïve CD4+ T cells independently predicted favorable overall survival (OS) in ever smokers with advanced NSCLC (P = 0.007), but unfavorable OS in never smokers with the same ailment (P = 0.012). Ever smokers presented a different distribution of naïve and memory T cells: low expression levels of naïve CD4+ T (P = 0.005), naïve CD8+ T (P = 0.031), CD4+ naïve/memory ratio (P = 0.020), and CD8+ naïve/memory ratio (P = 0.019), and high distributions of memory CD4 + T (P = 0.004), memory CD8 + T (P = 0.034), and naïve CD8/CD4 ratio (P = 0.020), when compared to never smokers. Conclusions We revealed the impact of cigarette-smoking on peripheral naïve CD4+ T cells' prognostic value in advanced NSCLC patients. These results could help in refining personalized treatment for advanced NSCLC patients.
Collapse
Affiliation(s)
- Chao Liu
- 1Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060 China.,2Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117 Shandong China.,3Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, 100071 China
| | - Bin Xu
- 1Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Qian Li
- 1Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Aijie Li
- 4Weifang Medical University, Weifang, 261053 Shandong China
| | - Lan Li
- 1Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Jinbo Yue
- 2Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117 Shandong China
| | - Qinyong Hu
- 1Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Jinming Yu
- 1Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060 China.,2Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117 Shandong China
| |
Collapse
|
17
|
Yan W, Guo X, Zhang J, Zhou J, Chen C, Wang M, Zhang Z, Liu Y. Lobar location of lesions in computed tomography-guided lung biopsy is correlated with major pneumothorax: A STROBE-compliant retrospective study with 1452 cases. Medicine (Baltimore) 2019; 98:e16224. [PMID: 31277134 PMCID: PMC6635229 DOI: 10.1097/md.0000000000016224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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
Pneumothorax is a common complication in computed tomography (CT)-guided percutaneous lung biopsy (CPLB). Whether the lobar location of lesions contributes to the incidence of pneumothorax should be further clarified.A total of 1452 consecutive patients who underwent CPLB between January 2010 and March 2018 were retrospectively analyzed. The incidence of pneumothorax was compared among 5 different lobe biopsies. Minor pneumothorax was defined as pneumothorax without chest tube placement and major pneumothorax was defined as pneumothorax with chest tube placement.The positive diagnosis rate of pathology for this cohort was approximately 84%, with 22.5% (326/1452) of the patients experiencing pneumothorax. The rates of pneumothorax were 19.5%, 24.5%, 33.9%, 21.4%, and 23.9% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively (P = .09). Chest tube placement was necessary in 19.0% (62/326) of the patients with pneumothorax. The rates of major pneumothorax were 5.3%, 2.6%, 10.2%, 4.7%, and 2.6% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe biopsies, respectively (P = .02). This result was further confirmed by the propensity score-matching method. Moreover, 8.7% (127/1452) of the patients experienced puncture of fissure, the rates of which were 13.5%, 5%, 10.2%, 9.1%, and 4.3% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively (P < .001). Within the pneumothorax patient group, the rate of lobe fissure puncture (15.2%) was significantly lower in patients with minor pneumothorax than (51.6%) in those with major pneumothorax (P < .001).Upper and middle lobe lesion biopsies show a significantly high rate of major pneumothorax, which may be due to more puncture of fissure. It is crucial to carefully distinguish the fissure around lesions and bypass it to avoid major pneumothorax.
Collapse
Affiliation(s)
| | | | | | | | | | - Manxiang Wang
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | | | | |
Collapse
|
18
|
Perl RM, Risse E, Hetzel J, Bösmüller H, Kloth C, Fritz J, Horger M. The effect of intraparenchymal blood patching on the rate of pneumothorax in patients undergoing percutaneous CT-guided core biopsy of the lung. Eur J Radiol 2019; 116:14-20. [PMID: 31153555 DOI: 10.1016/j.ejrad.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung. MATERIALS AND METHODS We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician. RESULTS The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001). CONCLUSIONS IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.
Collapse
Affiliation(s)
- R M Perl
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany.
| | - E Risse
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - J Hetzel
- Department of Internal Medicine II, Eberhard Karls University, Tübingen, Germany
| | - H Bösmüller
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, Eberhard Karls University, Tübingen, Germany
| | - C Kloth
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - J Fritz
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Caroline Street, JHOC 3140A, Baltimore, MD, 21287, United States
| | - M Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| |
Collapse
|
19
|
Drumm O, Joyce EA, de Blacam C, Gleeson T, Kavanagh J, McCarthy E, McDermott R, Beddy P. CT-guided Lung Biopsy: Effect of Biopsy-side Down Position on Pneumothorax and Chest Tube Placement. Radiology 2019; 292:190-196. [PMID: 31084480 DOI: 10.1148/radiol.2019182321] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Supine or prone positioning of the patient on the gantry table is the current standard of care for CT-guided lung biopsy; positioning biopsy side down was hypothesized to be associated with lower pneumothorax rate. Purpose To assess the effect of positioning patients biopsy side down during CT-guided lung biopsy on the incidence of pneumothorax, chest drain placement, and hemoptysis. Materials and Methods This retrospective study was performed between January 2013 and December 2016 in a tertiary referral oncology center. Patients undergoing CT-guided lung biopsy were either positioned in (a) the standard prone or supine position or (b) the lateral decubitus position with the biopsy side down. The relationship between patient position and pneumothorax, drain placement, and hemoptysis was assessed by using multivariable logistic regression models. Results A total of 373 consecutive patients (mean age ± standard deviation, 68 years ± 10), including 196 women and 177 men, were included in the study. Among these patients, 184 were positioned either prone or supine depending on the most direct path to the lesion and 189 were positioned biopsy side down. Pneumothorax occurred in 50 of 184 (27.2%) patients who were positioned either prone or supine and in 20 of 189 (10.6%) patients who were positioned biopsy side down (P < .001). Drain placement was required in 10 of 184 (5.4%) patients who were positioned either prone or supine and in eight of 189 (4.2%) patients who were positioned biopsy side down (P = .54). Hemoptysis occurred in 19 of 184 (10.3%) patients who were positioned prone or supine and in 10 of 189 (5.3%) patients who were positioned biopsy side down (P = .07). Prone or supine patient position (P = .001, odds ratio [OR] = 2.7 [95% confidence interval {CI}: 1.4, 4.9]), emphysema along the needle path (P = .02, OR = 2.1 [95% CI: 1.1, 4.0]), and lesion size (P = .02, OR = 1.0 [95% CI: 0.9, 1.0]) were independent risk factors for developing pneumothorax. Conclusion Positioning a patient biopsy side down for percutaneous CT-guided lung biopsy reduced the incidence of pneumothorax compared with the supine or prone position. © RSNA, 2019.
Collapse
Affiliation(s)
- Orla Drumm
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| | - Eimear A Joyce
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| | - Catherine de Blacam
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| | - Tom Gleeson
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| | - John Kavanagh
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| | - Eoghan McCarthy
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| | - Ronan McDermott
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| | - Peter Beddy
- From the Department of Radiology, St James's Hospital and Trinity College, James's Street, Dublin 8, Ireland (O.D., E.A.J., C.d.B., T.G., E.M., R.M., P.B.); and Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (J.K.)
| |
Collapse
|
20
|
Maybody M, Muallem N, Brown KT, Moskowitz CS, Hsu M, Zenobi CL, Jihad M, Getrajdman GI, Sofocleous CT, Erinjeri JP, Covey AM, Brody LA, Yarmohammadi H, Deipolyi AR, Bryce Y, Alago W, Siegelbaum RH, Durack JC, Gonzalez-Aguirre AJ, Ziv E, Boas FE, Solomon SB. Autologous Blood Patch Injection versus Hydrogel Plug in CT-guided Lung Biopsy: A Prospective Randomized Trial. Radiology 2018; 290:547-554. [PMID: 30480487 DOI: 10.1148/radiol.2018181140] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the effect of autologous blood patch injection (ABPI) with that of a hydrogel plug on the rate of pneumothorax at CT-guided percutaneous lung biopsy. Materials and Methods In this prospective randomized controlled trial ( https://ClinicalTrials.gov , NCT02224924), a noninferiority design was used for ABPI, with a 10% noninferiority margin when compared with the hydrogel plug, with the primary outcome of pneumothorax rate within 2 hours of biopsy. A type I error rate of 0.05 and 90% power were specified with a target study population of 552 participants (276 in each arm). From October 2014 to February 2017, all potential study participants referred for CT-guided lung biopsy (n = 2052) were assessed for enrollment. Results The data safety monitoring board recommended the trial be closed to accrual after an interim analysis met prespecified criteria for early stopping based on noninferiority. The final study group consisted of 453 participants who were randomly assigned to the ABPI (n = 226) or hydrogel plug (n = 227) arms. Of these, 407 underwent lung biopsy. Pneumothorax rates within 2 hours of biopsy were 21% (42 of 199) and 29% (60 of 208); chest tube rates were 9% (18 of 199) and 13% (27 of 208); and delayed pneumothorax rates within 2 weeks after biopsy were 1.4% (three of 199) and 1.5% (three of 208) in the ABPI and hydrogel plug arms, respectively. Conclusion Autologous blood patch injection is noninferior to a hydrogel plug regarding the rate of pneumothorax after CT-guided percutaneous lung biopsy. © RSNA, 2018 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Majid Maybody
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Nadim Muallem
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Karen T Brown
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Chaya S Moskowitz
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Meier Hsu
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Christina L Zenobi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Marwah Jihad
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - George I Getrajdman
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Constantinos T Sofocleous
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Joseph P Erinjeri
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Anne M Covey
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Lynn A Brody
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Hooman Yarmohammadi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Amy R Deipolyi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Yolanda Bryce
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - William Alago
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Robert H Siegelbaum
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Jeremy C Durack
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Adrian J Gonzalez-Aguirre
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Etay Ziv
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - F Edward Boas
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Stephen B Solomon
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| |
Collapse
|
21
|
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
|
22
|
Rui Y, Han M, Zhou W, He Q, Li H, Li P, Zhang F, Shi Y, Su X. Non-malignant pathological results on transthoracic CT guided core-needle biopsy: when is benign really benign? Clin Radiol 2018; 73:757.e1-757.e7. [PMID: 29884525 DOI: 10.1016/j.crad.2018.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 03/12/2018] [Indexed: 12/21/2022]
Abstract
AIM To determine true negatives and characterise the variables associated with false-negative results when interpreting non-malignant results of computed tomography (CT)-guided lung biopsy. MATERIALS AND METHODS Nine hundred and fifty patients with initial non-malignant findings on their first transthoracic CT-guided core-needle biopsy (TTNB) were included in the study. Initial biopsy results were compared to definitive diagnoses established later. RESULTS The negative predictive value (NPV) of non-malignant diseases upon initial TTNB was 83.6%. When the biopsy results indicated specific infection or benign tumour (n=225, 26.1%), they all were confirmed true negative for malignancy later. Only one inconclusive "granuloma" diagnosis was false negative. All 141 patients (141/861, 16.4%) who were false negative for malignancy were from the "infection not otherwise specified (NOS)", "inflammatory diseases", or "inconclusive" groups. Age (p=0.002), cancer history (p<0.001), target size (p=0.003), and pneumothorax during lung biopsy (p=0.003) were found to be significant predictors of false-negative results; 47.6% (410/861) of patients underwent additional invasive examinations to reach a final diagnosis. Ultimately, 52.7% (216/410) were successfully diagnosed. CONCLUSION Specific infection, benign tumour, and granulomatous inflammation of first TTNBs were mostly true negative. Older age, history of cancer, larger target size, and pneumothorax were highly predictive of false-negative results for malignancies. In such cases, additional invasive examinations were frequently necessary to obtain final diagnoses.
Collapse
Affiliation(s)
- Y Rui
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - M Han
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - W Zhou
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Q He
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - H Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, 510515, China
| | - P Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - F Zhang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Y Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - X Su
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
23
|
Faiella E, Frauenfelder G, Santucci D, Luppi G, Schena E, Beomonte Zobel B, Grasso RF. Percutaneous low-dose CT-guided lung biopsy with an augmented reality navigation system: validation of the technique on 496 suspected lesions. Clin Imaging 2017; 49:101-105. [PMID: 29207301 DOI: 10.1016/j.clinimag.2017.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To validate a CT-navigation system during percutaneous lung biopsy (PLB). METHODS Four hundred-ninety-six patients underwent low-dose CT-guided PLB. Lesion diameter (LD), procedural time (PT), histologic validity, lesion distance from pleural surface (DPS), needle distance travelled during procedure (DTP), complications and radiation exposure were recorded. RESULTS Hysto-patological diagnosis was obtained in 96.2% cases. Mean PT, DPS, DTP, LD were respectively 29.5min, 12.4mm, 17.9mm, 20.7mm. In cases of major complications (4.6%), higher values of DTP were measured. CONCLUSIONS CT-navigation system allowed a good success in terms of diagnosis in small lesions and when a long DTP is required.
Collapse
Affiliation(s)
- Eliodoro Faiella
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Giulia Frauenfelder
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Domiziana Santucci
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Giacomo Luppi
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Emiliano Schena
- Department of Measurement and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - Bruno Beomonte Zobel
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Rosario Francesco Grasso
- Department of Diagnostic and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| |
Collapse
|
24
|
Zhao Y, Wang X, Wang Y, Zhu Z. Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy. J Thorac Dis 2017; 9:4750-4757. [PMID: 29268546 DOI: 10.21037/jtd.2017.09.47] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Pneumothorax is the most common complication of computed tomography (CT)-guided needle biopsy. The purpose of this study was to investigate independent risk factors of pneumothorax, other than emphysema, after CT-guided needle biopsy and to establish a risk prediction model. Methods A total of 864 cases of CT-guided needle biopsy with an 18-gauge cutting needle were enrolled in this study. The relevant risk factors associated with pneumothorax included age, sex, emphysema, short-axis size of the lesion, depth of the lesion, body position, and the number of pleural punctures. Several independent risk factors of pneumothorax were found, and a predictive model for pneumothorax was established using univariate and multivariate logistic regression analyses. Results Pneumothorax occurred in 31.4% (271/864) of cases. Univariate analysis showed that significant risk factors of pneumothorax included age, emphysema, small lesion size, no contact between the lesion and the pleura, prone or lateral body position, and multiple punctures. Independent risk factors of pneumothorax in the multivariate logistic regression analysis included emphysema (P=0.000), no contact between the lesion and the pleura (P=0.000), prone or lateral body position (P=0.002), and the number of pleural punctures (P=0.000). The sensitivity, specificity, and accuracy of the predictive model for pneumothorax were 56.8%, 79.6%, and 72.5%, respectively. Conclusions Pneumothorax is a common complication of CT-guided lung biopsy. Independent risk factors of pneumothorax include emphysema, no contact between the lesion and the pleura, and prone or lateral body position. The predictive model developed in this study was highly accurate in predicting the incidence of pneumothorax.
Collapse
Affiliation(s)
- Yanfeng Zhao
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaoyi Wang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong Wang
- Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zheng Zhu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
25
|
Lim WH, Park CM, Yoon SH, Lim HJ, Hwang EJ, Lee JH, Goo JM. Time-dependent analysis of incidence, risk factors and clinical significance of pneumothorax after percutaneous lung biopsy. Eur Radiol 2017; 28:1328-1337. [PMID: 28971242 DOI: 10.1007/s00330-017-5058-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the time-dependent incidence, risk factors and clinical significance of percutaneous lung biopsy (PLB)-related pneumothorax. METHODS From January 2012-November 2015, 3,251 patients underwent 3,354 cone-beam CT-guided PLBs for lung lesions. Cox, logistic and linear regression analyses were performed to identify time-dependent risk factors of PLB-related pneumothorax, risk factors of drainage catheter insertion and those of prolonged catheter placement, respectively. RESULTS Pneumothorax occurred in 915/3,354 PLBs (27.3 %), with 230/915 (25.1 %) occurring during follow-ups. Risk factors for earlier occurrence of PLB-related pneumothorax include emphysema (HR=1.624), smaller target (HR=0.922), deeper location (HR=1.175) and longer puncture time (HR=1.036), while haemoptysis (HR=0.503) showed a protective effect against earlier development of pneumothorax. Seventy-five cases (8.2 %) underwent chest catheter placement. Mean duration of catheter placement was 3.2±2.0 days. Emphysema (odds ratio [OR]=2.400) and longer puncture time (OR=1.053) were assessed as significant risk factors for catheter insertion, and older age (parameter estimate=1.014) was a predictive factor for prolonged catheter placement. CONCLUSION PLB-related pneumothorax occurred in 27.3 %, of which 25.1 % developed during follow-ups. Smaller target size, emphysema, deeply-located lesions were significant risk factors of PLB-related pneumothorax. Emphysema and older age were related to drainage catheter insertion and prolonged catheter placement, respectively. KEY POINTS • One-fourth of percutaneous lung biopsy (PLB)-related pneumothorax occurs during follow-up. • Smaller, deeply-located target and emphysema lead to early occurrence of pneumothorax. • Emphysema is related to drainage catheter insertion for PLB-related pneumothorax. • Older age may lead to prolonged catheter placement for PLB-related pneumothorax. • Tailored management can be possible with time-dependent information of PLB-related pneumothorax.
Collapse
Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hyun-Ju Lim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40:1501-1513. [PMID: 28523447 DOI: 10.1007/s00270-017-1658-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Veltri
- Radiology Unit, Oncology Department, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy.
| | - Irene Bargellini
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | - Luigi Giorgi
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | | | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| |
Collapse
|
27
|
CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years. Eur Radiol 2017; 27:3401-3407. [DOI: 10.1007/s00330-016-4718-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 11/27/2022]
|