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Leonhardi J, Dahms U, Schnarkowski B, Struck MF, Höhn AK, Krämer S, Ebel S, Prasse G, Frille A, Denecke T, Meyer HJ. Impact of radiomics features, pulmonary emphysema score and muscle mass on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies. Respir Res 2024; 25:320. [PMID: 39174980 PMCID: PMC11340115 DOI: 10.1186/s12931-024-02936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024] Open
Abstract
Iatrogenic pneumothorax is a relevant complication of computed tomography (CT)-guided percutaneous lung biopsy. The aim of the present study was to analyze the prognostic significance of texture analysis, emphysema score and muscle mass derived from CT-imaging to predict postinterventional pneumothorax after CT-guided lung biopsy. Consecutive patients undergoing CT-guided percutaneous lung biopsy between 2012 and 2021 were analyzed. Multivariate logistic regression analysis included clinical risk factors and CT-imaging features to detect associations with pneumothorax development. Overall, 479 patients (178 females, mean age 65 ± 11.7 years) underwent CT-guided percutaneous lung biopsy of which 180 patients (37.5%) developed pneumothorax including 55 patients (11.5%) requiring chest tube placement. Risk factors associated with pneumothorax were chronic-obstructive pulmonary disease (COPD) (p = 0.03), age (p = 0.02), total lung capacity (p < 0.01) and residual volume (p = 0.01) as well as interventional parameters needle length inside the lung (p < 0.001), target lesion attached to pleura (p = 0.04), and intervention duration (p < 0.001). The combined model demonstrated a prediction accuracy of the occurrence of pneumothorax with an AUC of 0.78 [95%CI: 0.70-0.86] with a resulting sensitivity 0.80 and a specificity of 0.66. In conclusion, radiomics features of the target lesion and the lung lobe CT-emphysema score are predictive for the occurrence of pneumothorax and need for chest insertion after CT-guided lung biopsy.
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Affiliation(s)
- Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Ulrike Dahms
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Benedikt Schnarkowski
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Sebastian Krämer
- Department of Thoracic Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Gordian Prasse
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Armin Frille
- Department of Respiratory Medicine, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany.
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Gao B, Gorgen ARH, Bhatt R, Tano ZE, Morgan KL, Vo K, Zarandi SS, Ali SN, Jiang P, Patel RM, Clayman RV, Landman J. Avoiding "Needless" nephrectomy: What is the role of small renal mass biopsy in 2024? Urol Oncol 2024; 42:236-244. [PMID: 38643022 DOI: 10.1016/j.urolonc.2024.04.002] [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: 10/24/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/22/2024]
Abstract
Current guidelines do not mandate routine preoperative renal mass biopsy (RMB) for small renal masses (SRMs), which results in a considerable rate (18%-26%) of needless nephrectomy/partial nephrectomy for benign renal tumors. In light of this ongoing practice, a narrative review was conducted to examine the role of routine RMB for SRM. First, arguments justifying the current non-biopsy approach to SRM are critically reviewed and contested. Second, as a standalone procedure, RMB is critically assessed; RMB was found to have higher sensitivity, specificity, and an equal or lower complication rate when compared with other commonly preoperatively biopsied solid organ tumors (e.g., breast, prostate, lung, pancreas, thyroid, and liver). Based on the foregoing information, we propose a paradigm shift in SRM management, advocating for an updated policy in which partial nephrectomy or nephrectomy for SRM invariably occurs only after a preoperative biopsy confirms that a SRM is indeed malignant.
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Affiliation(s)
- Bruce Gao
- Department of Urology, University of California, Irvine, Orange, CA.
| | | | - Rohit Bhatt
- Department of Urology, University of California, Irvine, Orange, CA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, CA
| | - Kalon L Morgan
- Department of Urology, University of California, Irvine, Orange, CA
| | - Kelvin Vo
- Department of Urology, University of California, Irvine, Orange, CA
| | | | - Sohrab N Ali
- Department of Urology, University of California, Irvine, Orange, CA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Orange, CA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, CA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, CA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, CA
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Yoon SK, Moon MH, Kim KS, Moon SW. Increased lung cancer recurrence following transthoracic needle biopsy. J Thorac Dis 2024; 16:4086-4096. [PMID: 39144307 PMCID: PMC11320275 DOI: 10.21037/jtd-24-419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/17/2024] [Indexed: 08/16/2024]
Abstract
Background Computed tomography (CT)-guided transthoracic needle biopsy (TNB) could damage lung structures and may disseminate tumor cells into the airway, blood vessels, and pleural cavity, affecting post-operative outcomes. Several studies have investigated the effects of TNB on the prognosis of patients, but the effects remain unclear. This study aimed to investigate whether TNB increases the risk of recurrence of resected stage IA non-small cell lung cancer (NSCLC). Methods In this retrospective study, we enrolled 1,077 patients with stage IA NSCLC who underwent curative resection from 2010 to 2020. Recurrence risk factors were evaluated using Cox regression analyses. A multiple logistic regression model, including age, sex, smoking history, total tumor size, invasive tumor size, histology, histologic differentiation, lymphatic invasion, vascular invasion, perineural invasion, and the number of harvested lymph nodes (LNs), was used to calculate the propensity score. Results According to the pre-operative TNB, patients were classified into the no-TNB (n=823) and TNB (n=190) groups. After propensity score matching analysis, 380 patients were included in the no-TNB group (1:2 matching). Multivariable Cox analysis revealed that pre-operative TNB was a negative prognostic factor in patients with surgically resected stage IA NSCLC [hazard ratio (HR), 3.15; 95% confidence interval (CI): 1.49-6.67; P=0.003]. The 5-year locoregional and overall recurrence-free survival (RFS) rates were significantly lower in the TNB group than in the no-TNB group (88.3% vs. 96.8%, P=0.001; and 84.2% vs. 93.7%, P=0.02, respectively). Conclusions For patients with stage IA NSCLC, pre-operative TNB was a negative prognostic factor for recurrence. Surgical diagnosis and treatment without pre-operative tissue diagnosis may be considered first in patients with clinically early lung cancer.
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Affiliation(s)
- Seung Keun Yoon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Jalaeian H, Richardson K, Kozlowski K, Patel A, Venkat S. Does needle gauge affect complication rates of computed tomography-guided lung biopsy? J Thorac Dis 2024; 16:4310-4318. [PMID: 39144294 PMCID: PMC11320254 DOI: 10.21037/jtd-24-240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/24/2024] [Indexed: 08/16/2024]
Abstract
Background It has been thought a larger bore biopsy needle may yield a better sample for molecular testing, but this could potentially expose the patient to higher pneumothorax rates. This study aims to determine if a larger bore biopsy system results in more complications. Methods A total of 193 patients who underwent computed tomography (CT)-guided lung biopsy in a single tertiary center from 2013-2021 were evaluated retrospectively. Patients were divided into two groups, patients who underwent lung biopsy using the 17/18-gauge (18G) biopsy system and the 19/20-gauge (20G) biopsy system. Data recorded included biopsy needle gauge, nodule location and size, plug use, positioning, the length of the intraparenchymal tract, number of biopsy passes, pneumothorax, chest tube insertion, and admission. Results The mean age was 64.1±12.4 years. The median diameter of the lung nodules was 1.95 cm, and the median depth of the intraparenchymal needle tract was 2.7 cm. Pneumothorax was identified during the procedure by CT fluoroscopy or on post-procedural chest X-ray (CXR). The overall rate of pneumothorax among all patients was 35.2%, and 10.9% of the study population (i.e., 30.1% of patients with pneumothorax) required chest tube insertion. The rate of pneumothorax or chest tube insertion was not significantly different between patients who underwent lung biopsy using 17/18G or 19/20G biopsy system. Patients who developed pneumothorax were older, with smaller-sized pulmonary nodules and longer length of the intraparenchymal tract. The pathologic sensitivity of the 18G gun was higher than that of the 20G gun (93% sensitivity, 100% specificity vs. 79.5% sensitivity, 100% specificity). In the multivariate logistic regression fitted model, the length of the intraparenchymal tract was the only factor predictive of post-procedural pneumothorax and chest tube insertion. An intraparenchymal needle tract length of greater than 2 cm was identified to have the best threshold to predict pneumothorax [sensitivity: 73.5%; false positive rate: 57.6%; area under the curve: 66.27%]. Conclusions Findings suggest similar rates of pneumothorax and chest tube insertion using small 19/20G vs. 17/18G biopsy systems. The 18G system was more sensitive compared to the 20G system in determining pathologic results. Increasing length of lung parenchyma needle tract and smaller lung nodules appear to be risk factors for pneumothorax. Physicians should plan on intraparenchymal tracts that are less than 2 cm to decrease the chance of pneumothorax.
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Affiliation(s)
- Hamed Jalaeian
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kenneth Richardson
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Konrad Kozlowski
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anmol Patel
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shree Venkat
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
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Niedermaier B, Kou Y, Tong E, Eichinger M, Klotz LV, Eichhorn ME, Muley T, Herth F, Kauczor HU, Peter Heußel C, Winter H. CT-guided needle biopsy is not associated with increased ipsilateral pleural metastasis. Lung Cancer 2024; 194:107890. [PMID: 39003936 DOI: 10.1016/j.lungcan.2024.107890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/24/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Histological confirmation of a lung tumor is the prerequisite for treatment planning. It has been suspected that CT-guided needle biopsy (CTGNB) exposes the patient to a higher risk of pleural recurrence. However, the distance between tumor and pleura has largely been neglected as a possible confounder when comparing CTGNB to bronchoscopy. METHODS All patients with lung cancer histologically confirmed by bronchoscopy or CTGNB between 2010 and 2020 were enrolled and studied. Patients' medical histories, radiologic and pathologic findings and surgical records were reviewed. Pleural recurrence was diagnosed by pleural biopsy, fluid cytology, or by CT chest imaging showing progressive pleural nodules. RESULTS In this retrospective unicenter analysis, 844 patients underwent curative resection for early-stage lung cancer between 2010 and 2020. Median follow-up was 47.5 months (3-137). 27 patients (3.2 %) with ipsilateral pleural recurrence (IPR) were identified. The distance of the tumor to the pleura was significantly smaller in patients who underwent CTGNB. A tendency of increased risk of IPR was observed in tumors located in the lower lobe (HR: 2.18 [±0.43], p = 0.068), but only microscopic pleural invasion was a significant independent predictive factor for increased risk of IPR (HR: 5.33 [± 0.51], p = 0.001) by multivariate cox analysis. Biopsy by CTGNB did not affect IPR (HR: 1.298 [± 0.39], p = 0.504). CONCLUSION CTGNB is safe and not associated with an increased incidence of IPR in our cohort of patients. This observation remains to be validated in a larger multicenter patient cohort.
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Affiliation(s)
- Benedikt Niedermaier
- Department of Thoracic Surgery, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany.
| | - Yao Kou
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Elizabeth Tong
- Department of Diagnostic and Interventional Radiology, Thoraxklinik at the Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology, Thoraxklinik at the Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura V Klotz
- Department of Thoracic Surgery, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Martin E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Thomas Muley
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Translational Research Unit, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Thoraxklinik at the Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claus Peter Heußel
- Department of Diagnostic and Interventional Radiology, Thoraxklinik at the Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
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Husta BC, Menon A, Bergemann R, Lin IH, Schmitz J, Rakočević R, Nadig TR, Adusumilli PS, Beattie JA, Lee RP, Park BJ, Rocco G, Bott MJ, Chawla M, Kalchiem-Dekel O. The incremental contribution of mobile cone-beam computed tomography to the tool-lesion relationship during shape-sensing robotic-assisted bronchoscopy. ERJ Open Res 2024; 10:00993-2023. [PMID: 39040587 PMCID: PMC11261373 DOI: 10.1183/23120541.00993-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/16/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction This study aims to answer the question of whether adding mobile cone-beam computed tomography (mCBCT) imaging to shape-sensing robotic-assisted bronchoscopy (ssRAB) translates into a quantifiable improvement in the tool-lesion relationship. Methods Data from 102 peripheral lung lesions with ≥2 sequential mCBCT orbital spins and from 436 lesions with 0-1 spins were prospectively captured and retrospectively analysed. The primary outcome was the tool-lesion relationship status across the first and the last mCBCT spins. Secondary outcomes included 1) the change in distance between the tip of the sampling tool and the centre of the lesion between the first and the last spins and 2) the per-lesion diagnostic yield. Results Compared to lesions requiring 0-1 spins, lesions requiring ≥2 spins were smaller and had unfavourable bronchus sign and intra-operative sonographic view. On the first spin, 54 lesions (53%) were designated as non-tool-in-lesion (non-TIL) while 48 lesions (47%) were designated as TIL. Of the 54 initially non-TIL cases, 49 (90%) were converted to TIL status by the last spin. Overall, on the last spin, 96 out of 102 lesions (94%) were defined as TIL and six out of 102 lesions (6%) were defined as non-TIL (p<0.0001). The mean distance between the tool and the centre of the lesion decreased from 10.4 to 6.6 mm between the first and last spins (p<0.0001). The overall diagnostic yield was 77%. Conclusion Targeting traditionally challenging lung lesions, intra-operative volumetric imaging allowed for the conversion of 90% of non-TIL status to TIL. Guidance with mCBCT resulted in a significant decrease in the distance between the tip of the needle to lesion centre.
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Affiliation(s)
- Bryan C. Husta
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anu Menon
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Reza Bergemann
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - I-Hsin Lin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaclyn Schmitz
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rastko Rakočević
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tejaswi R. Nadig
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S. Adusumilli
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason A. Beattie
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert P. Lee
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard J. Park
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gaetano Rocco
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J. Bott
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohit Chawla
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Or Kalchiem-Dekel
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Liu Q, Guo X, Wang Z, Xu H, Huang W, Liu J, Wang Z, Yan F, Wu Z, Ding X. Computed Tomography-guided Percutaneous Lung Biopsy With Electromagnetic Navigation Compared With Conventional Approaches: An Open-label, Randomized Controlled Trial. J Thorac Imaging 2024; 39:247-254. [PMID: 37982518 DOI: 10.1097/rti.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE The purpose of this study was to assess the efficiency and safety of computed tomography (CT)-guided percutaneous biopsy of lung lesions with electromagnetic (EM) navigation and compare them with those of conventional approaches. MATERIALS AND METHODS Seventy-nine patients with lung or liver lesions who needed biopsies were enrolled in this trial. All patients were randomly assigned to the E group underwent CT-guided percutaneous biopsies with the EM navigation system or to the C group treated with conventional approaches. RESULTS In total, 27 patients with lung lesions were assigned to the E group, and 20 patients were assigned to the C group. The diagnostic success rate was 92.6% and 95% in both groups, respectively ( P >0.9999). The median number of needle repositions in the E group was less than that in the C group (2.0 vs. 2.5, P =0.03). The positioning success rate with 1 or 2 needle repositions for the E group was significantly higher than the C group (81.5% vs. 50%, P =0.03). The median accuracy of the puncture location in the E group was better than that in the C group (2.0 vs. 6.6 mm, P <0.0001). The total procedure time lengthened in the E group compared with the C group (30.5±1.6 vs. 18.3±1.7 min, P <0.0001), but the number of CT acquisitions was not significantly different ( P =0.08). There was no significant difference in complication incidence between the 2 groups ( P =0.44). CONCLUSION The EM navigation system is an effective and safe auxiliary tool for CT-guided percutaneous lung biopsy, but lengthen the procedure time. TRIAL REGISTRATION ChiCTR2100043361, registered February 9, 2021-retrospectively registered ( http://www.medresman.org.cn/uc/project/projectedit.aspx?proj=7591 ).
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Affiliation(s)
- Qin Liu
- Departments of Interventional Radiology
| | | | | | - Hao Xu
- Departments of Interventional Radiology
- Department of Vascular Surgery and Interventional Radiology, Suzhou DuShu Lake Hospital, Soochow University, Suzhou, China
| | - Wei Huang
- Departments of Interventional Radiology
| | | | | | - Fuhua Yan
- Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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Balbi M, Capelli S, Caroli A, Culasso NC, Barba M, Senkeev R, Filipello F, Napoli F, Levra S, Bironzo P, Sverzellati N, Novello S, Righi L, Veltri A. CT-Guided Core Needle Biopsy of Pulmonary Lesions Associated With Cystic Airspaces: A Case-Control Study. AJR Am J Roentgenol 2024; 223:e2431042. [PMID: 38717239 DOI: 10.2214/ajr.24.31042] [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] [Indexed: 05/30/2024]
Abstract
BACKGROUND. Concern may exist that pulmonary lesions associated with cystic airspaces are at risk of increased biopsy complications or lower biopsy accuracy given challenges in targeting tissue abutting or intermingled with the cystic airspaces. OBJECTIVE. The purpose of this study was to evaluate the safety and diagnostic performance of CT-guided core needle biopsy (CNB) of pulmonary lesions associated with cystic airspaces. METHODS. This retrospective study included 90 patients (median age, 69.5 years; 28 women, 62 men) who underwent CT-guided CNB of pulmonary lesions associated with cystic airspaces (based on review of procedural images) from February 2010 to December 2022 and a matched control group (2:1 ratio) of 180 patients (median age, 68.0 years; 56 women, 124 men) who underwent CNB of noncystic noncavitary lesions during the same period. The groups were compared in terms of complications, nondiagnostic biopsies (i.e., nonspecific benignities, atypical cells, or insufficient specimens), and CNB diagnostic performance for detecting malignancy using as reference the final diagnosis from a joint review of all available records. For lesions associated with cystic airspaces that underwent surgical resection after CNB, histologic slides were reviewed to explore the nature of the cystic airspace. RESULTS. The final diagnosis was malignant in 90% (81/90) of lesions associated with cystic airspaces and 92% (165/180) of noncystic noncavitary lesions. Patients with lesions associated with cystic airspaces and patients with noncystic noncavitary lesions showed no significant difference in frequency of complications (overall: 40% [36/90] vs 38% [68/180], p = .79; major: 4% [4/90] vs 6% [10/180], p = .78; minor: 36% [32/90] vs 32% [58/180], p = .59), frequency of nondiagnostic biopsies (12% [11/90] vs 9% [16/180], p = .40), or diagnostic performance (accuracy: 94% [85/90] vs 97% [175/180], p = .50; sensitivity: 94% [76/81] vs 97% [160/165], p = .50; specificity: 100% [9/9] vs 100% [15/15]; p > .99), respectively. All false-negative results for malignancy in both groups occurred in patients with nondiagnostic CNB results. Among lesions associated with cystic airspaces that were resected after CNB (all malignant), the cystic airspaces most commonly represented tumor degeneration (22/31 [71%]). CONCLUSION. CT-guided CNB is safe and accurate for assessing pulmonary lesions associated with cystic airspaces. CLINICAL IMPACT. CNB may help avoid a missed or delayed cancer diagnosis in pulmonary lesions with cystic airspaces.
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Affiliation(s)
- Maurizio Balbi
- Radiology Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Serena Capelli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Italy
| | - Anna Caroli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Italy
| | - Noemi C Culasso
- Radiology Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Matteo Barba
- Radiology Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Rouslan Senkeev
- Radiology Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Federica Filipello
- Department of Pathology, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Francesca Napoli
- Department of Oncology, University of Turin, Orbassano, Italy
- Pathology Unit, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Stefano Levra
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, Orbassano, Italy
- Oncology Unit, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Italy
- Oncology Unit, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, Orbassano, Italy
- Pathology Unit, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Andrea Veltri
- Radiology Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
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Senyei GD, Sagar AES, Tran B, Shah A, Miller R, Patel N, Van Nostrand K, Casal RF, Cheng GZ. Incremental Application of Positive End-Expiratory Pressure for the Evaluation of Atelectasis During RP-EBUS and Bronchoscopy (I-APPEAR). J Bronchology Interv Pulmonol 2024; 31:e0969. [PMID: 38953737 DOI: 10.1097/lbr.0000000000000969] [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: 02/04/2024] [Accepted: 04/09/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND CT-to-body divergence-described as the difference between preprocedural CT scans and intraprocedural lung architecture-is a significant barrier to improving diagnostic yield during navigational bronchoscopy. A major proposed contributor to CT-to-body divergence is the development of atelectasis, which can confound visualization of peripheral lung lesions via radial probe endobronchial ultrasound (RP-EBUS). High positive end-expiratory pressure (PEEP) ventilatory strategies have been used to decrease atelectasis, allowing the lesion to re-APPEAR on intraprocedure imaging. However, standardized PEEP levels may not be appropriate for all patients due to hemodynamic and ventilatory impacts. METHODS We performed a multicenter, prospective observational study in which patients were imaged with RP-EBUS under general anesthesia to determine if subsegmental atelectasis would resolve as incremental increases in PEEP were applied. Resolution of atelectasis was based on the transition from a non-aerated pattern to an aerated appearance on RP-EBUS. RP-EBUS images were reviewed by 3 experienced operators to determine correlation. RESULTS Forty-three patients underwent RP-EBUS examination following navigational bronchoscopy. Thirty-seven patients underwent incremental PEEP application and subsequent RP-EBUS imaging. Atelectasis was determined to have resolved in 33 patients (88.2%) following increased PEEP. The intraclass correlation coefficient between reviewers was 0.76. A recruitment maneuver was performed in 7 (16.3%) patients after atelectasis persisted at maximal PEEP. Atelectasis was not identified in the examined subsegments in 6 (10.8%) patients despite zero PEEP. CONCLUSION RP-EBUS is an effective tool to monitor what pressure atelectasis within a lung segment has resolved with increasing levels of PEEP.
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Affiliation(s)
- Grant D Senyei
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ala Eddin S Sagar
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | - Brian Tran
- Department of Pulmonary Medicine, Naval Hospital Camp Pendleton, San Diego, CA
| | - Archan Shah
- Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Russell Miller
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA
- Department of Pulmonary Medicine, Naval Medical Center San Diego, San Diego, CA
| | - Niral Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA
| | - Keriann Van Nostrand
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George Z Cheng
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA
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Lee B, Hwang HS, Jang SJ, Oh SY, Kim MY, Choi C, Ji W. Optimal approach for diagnosing peripheral lung nodules by combining electromagnetic navigation bronchoscopy and radial probe endobronchial ultrasound. Thorac Cancer 2024; 15:1638-1645. [PMID: 38886915 PMCID: PMC11260552 DOI: 10.1111/1759-7714.15376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Electromagnetic navigation bronchoscopy (ENB) and radial probe endobronchial ultrasound (RP-EBUS) are essential bronchoscopic procedures for diagnosing peripheral lung lesions. Despite their individual advantages, the optimal circumstances for their combination remain uncertain. METHODS This single-center retrospective study enrolled 473 patients with 529 pulmonary nodules who underwent ENB and/or RP-EBUS biopsies between December 2021 and December 2022. Diagnostic yield was calculated using strict, intermediate, and liberal definitions. In the strict definition, only malignant and specific benign lesions were deemed diagnostic at the time of the index procedure. The intermediate and liberal definitions included additional results from the follow-up period. RESULTS The diagnostic yield of the strict definition was not statistically different among the three groups (ENB/Combination/RP-EBUS 63.8%/64.2%/62.6%, p = 0.944). However, the diagnostic yield was superior in the ENB + RP-EBUS group for nodules with a bronchus type II or III and a solid part <20 mm (odds ratio 1.96, 95% confidence interval 1.09-3.53, p = 0.02). In terms of complications, bleeding was significantly higher in the ENB + RP-EBUS group (ENB/Combination/RP-EBUS 3.7% /6.2/0.6%, p = 0.002), but no major adverse event was observed. CONCLUSION The combination of ENB and RP-EBUS enhanced the diagnostic yield for nodules with bronchus type II or III and solid part <20 mm, despite a slightly elevated risk of bleeding. Careful patient selection based on nodule characteristics is important to benefit from this combined approach.
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Affiliation(s)
- Bora Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Se Jin Jang
- Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Sang Young Oh
- Department of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Mi Young Kim
- Department of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Chang‐Min Choi
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Wonjun Ji
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
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11
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Ezenagu OC, Gabriel GE, Saha SP. Computed Tomography (CT)-Guided Needle Biopsy of Lung Lesions: A Single Center Experience. Healthcare (Basel) 2024; 12:1260. [PMID: 38998796 PMCID: PMC11240914 DOI: 10.3390/healthcare12131260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Objective: Lung cancer is one of the leading causes of cancer death among men and women across the globe. The accurate and timely diagnosis of lung lesions is of paramount importance for prognosis. This single-center study is the first to assess the diagnostic yield and complication rate of a computed tomography (CT)-guided needle biopsy of pulmonary parenchymal and pleural nodules in an academic training center in the United States. (2) Methods: This is a retrospective study approved by IRB. Patients who underwent CT-guided needle biopsy between 2016 and 2020 were reviewed. A CT-guided needle biopsy involving mediastinal lesions was excluded, focusing only on lung parenchymal and pleural lesions. A CT-guided needle biopsy aborted at any point during the procedure was also excluded from this study. (3) Results: 1063 patients were included in this study; 532 were males, and 531 were females. Lesion size ranged from 0.26 cm to 9.2 cm. 1040 patients received diagnoses, among which 772 had a specific diagnosis, and 268 had nonspecific inflammatory or non-malignant diagnoses. Twenty-three cases were non-diagnostic. Among the patients with specific diagnoses, 691 were malignant, 5 were hamartomas, 30 were fungal infections, 6 were acid-fast-positive organisms, and 40 were unspecified atypical cells. Of the patients that had a malignant diagnosis, 317 were adenocarcinoma, 197 were squamous cell carcinoma, 26 were a neuroendocrine tumor, 45 were non-small cell carcinoma (undifferentiated), 17 were small cell carcinoma, and 89 were other metastatic malignancies to the lung. Various common complications, including pneumothorax (337), hemorrhage (128), and hemoptysis (17), were observed, and 42 of the cases required chest tube intervention; others were treated with observation. Other rare complications observed included hemothorax (4) and oxygen desaturation (2), and there was no death in this series. (4) Conclusions: CT-guided needle biopsy is a reliable diagnostic modality for patients with lung parenchymal and pleural nodules, and it can effectively distinguish between benign and cancerous lesions before invasive procedures such as video-assisted thoracoscopy (VATs) or thoracotomy are planned. Our study showed a higher rate of pneumothorax and pulmonary hemorrhage compared to the rates established in guidelines, attributable to the varying experience level in a busy training academic center.
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Affiliation(s)
| | - Gaby E Gabriel
- College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Sibu P Saha
- College of Medicine, University of Kentucky, Lexington, KY 40506, USA
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12
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Liu X, Meng N, Zhou Y, Fu F, Yuan J, Wang Z, Yang Y, Xiong Z, Zou C, Wang M. Tri-Compartmental Restriction Spectrum Imaging Based on 18F-FDG PET/MR for Identification of Primary Benign and Malignant Lung Lesions. J Magn Reson Imaging 2024. [PMID: 38886922 DOI: 10.1002/jmri.29438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Restriction spectrum imaging (RSI), as an advanced quantitative diffusion-weighted magnetic resonance imaging technique, has the potential to distinguish primary benign and malignant lung lesions. OBJECTIVE To explore how well the tri-compartmental RSI performs in distinguishing primary benign from malignant lung lesions compared with diffusion-weighted imaging (DWI), and to further explore whether positron emission tomography/magnetic resonance imaging (PET/MRI) can improve diagnostic efficacy. STUDY TYPE Prospective. POPULATION 137 patients, including 108 malignant and 29 benign lesions (85 males, 52 females; average age = 60.0 ± 10.0 years). FIELD STRENGTH/SEQUENCE T2WI, T1WI, multi-b value DWI, MR-based attenuation correction, and PET imaging on a 3.0 T whole-body PET/MR system. ASSESSMENT The apparent diffusion coefficient (ADC), RSI-derived parameters (restricted diffusionf 1 $$ {f}_1 $$ , hindered diffusionf 2 $$ {f}_2 $$ , and free diffusionf 3 $$ {f}_3 $$ ) and the maximum standardized uptake value (SUVmax) were calculated and analyzed for diagnostic efficacy individually or in combination. STATISTICAL TESTS Student's t-test, Mann-Whitney U test, receiver operating characteristic (ROC) curves, Delong test, Spearman's correlation analysis. P < 0.05 was considered statistically significant. RESULTS Thef 1 $$ {f}_1 $$ , SUVmax were significantly higher, andf 3 $$ {f}_3 $$ , ADC were significantly lower in the malignant group [0.717 ± 0.131, 9.125 (5.753, 13.058), 0.194 ± 0.099, 1.240 (0.972, 1.407)] compared to the benign group [0.504 ± 0.236, 3.390 (1.673, 6.030), 0.398 ± 0.195, 1.485 ± 0.382]. The area under the ROC curve (AUC) values ranked from highest to lowest as follows: AUC (SUVmax) > AUC (f 3 $$ {f}_3 $$ ) > AUC (f 1 $$ {f}_1 $$ ) > AUC (ADC) > AUC (f 2 $$ {f}_2 $$ ) (AUC = 0.819, 0.811, 0.770, 0.745, 0549). The AUC (AUC = 0.900) of the combined model of RSI with PET was significantly higher than that of either single-modality imaging. CONCLUSION RSI-derived parameters (f 1 $$ {f}_1 $$ ,f 3 $$ {f}_3 $$ ) might help to distinguish primary benign and malignant lung lesions and the discriminatory utility off 2 $$ {f}_2 $$ was not observed. The RSI exhibits comparable or potentially enhanced performance compared with DWI, and the combined RSI and PET model might improve diagnostic efficacy. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Xue Liu
- Department of Medical Imaging, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, China
| | - Nan Meng
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yihang Zhou
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Medical Imaging, Xinxiang Medical University Henan Provincial People's Hospital, Zhengzhou, China
| | - Fangfang Fu
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jianmin Yuan
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Zhe Wang
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Yang Yang
- Beijing United Imaging Research Institute of Intelligent Imaging, United Imaging Healthcare Group, Beijing, China
| | - Zhongyan Xiong
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chao Zou
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Meiyun Wang
- Department of Medical Imaging, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, China
- Laboratory of Brain Science and Brain-Like Intelligence Technology, Biomedical Research Institute, Henan Academy of Sciences, Zhengzhou, China
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13
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Sadoughi A, Synn S, Chan C, Schecter D, Hernandez Romero G, Virdi S, Sarkar A, Kim M. Ultrathin Bronchoscopy Without Virtual Navigation for Diagnosis of Peripheral Lung Lesions. Lung 2024:10.1007/s00408-024-00695-1. [PMID: 38864890 DOI: 10.1007/s00408-024-00695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The increasing incidence of encountering lung nodules necessitates an ongoing search for improved diagnostic procedures. Various bronchoscopic technologies have been introduced or are in development, but further studies are needed to define a method that fits best in clinical practice and health care systems. RESEARCH QUESTION How do basic bronchoscopic tools including a combination of thin (outer diameter 4.2 mm) and ultrathin bronchoscopes (outer diameter 3.0 mm), radial endobronchial ultrasound (rEBUS) and fluoroscopy perform in peripheral pulmonary lesion diagnosis? STUDY DESIGN AND METHODS This is a retrospective review of the performance of peripheral bronchoscopy using thin and ultrathin bronchoscopy with rEBUS and 2D fluoroscopy without a navigational system for evaluating peripheral lung lesions in a single academic medical center from 11/2015 to 1/2021. We used a strict definition for diagnostic yield and assessed the impact of different variables on diagnostic yield, specifically after employment of the ultrathin bronchoscope. Logistic regression models were employed to assess the independent associations of the most impactful variables. RESULTS A total of 322 patients were included in this study. The median of the long axis diameter was 2.2 cm and the median distance of the center of the lesion from the visceral pleural surface was 1.9 cm. Overall diagnostic yield was 81.3% after employment of the ultrathin bronchoscope, with more detection of concentric rEBUS views (93% vs. 78%, p < 0.001). Sensitivity for detecting malignancy also increased from 60.5% to 74.7% (p = 0.033) after incorporating the ultrathin scope into practice, while bronchus sign and peripheral location of the lesion were not found to affect diagnostic yield. Concentric rEBUS view, solid appearance, upper/middle lobe location and larger size of the nodules were found to be independent predictors of successful achievement of diagnosis at bronchoscopy. INTERPRETATION This study demonstrates a high diagnostic yield of biopsy of lung lesions achieved by utilization of thin and ultrathin bronchoscopes. Direct visualization of small peripheral airways with simultaneous rEBUS confirmation increased localization rate of small lesions in a conventional bronchoscopy setting without virtual navigational planning.
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Affiliation(s)
- Ali Sadoughi
- Division of Pulmonary, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA.
| | - Shwe Synn
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA
| | - Christine Chan
- Division of Pulmonary, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA
| | - David Schecter
- Division of Pulmonary, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA
| | | | - Sahil Virdi
- Division of pulmonary and critical care, United Hospital Center, West Virginia University Health System, Charleston, USA
| | - Abhishek Sarkar
- Section of Interventional Pulmonology, Department of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center / New York Medical College, Valhalla, USA
| | - Mimi Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, USA
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14
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Issa MA, Clementsen PF, Laursen CB, Christiansen IS, Crombag L, Vilmann P, Bodtger U. Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer. Eur Clin Respir J 2024; 11:2362995. [PMID: 38859948 PMCID: PMC11164041 DOI: 10.1080/20018525.2024.2362995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
Background Bronchoscopy and EBUS are standard procedures in lung cancer work-up but have low diagnostic yield in lesions outside the central airways and hilar/mediastinal lymph nodes. Growing evidence on introducing the EBUS endoscope into the oesophagus (EUS-B) in the same session as bronchoscopy/EBUS gives access to new anatomical areas that can be safely biopsied. Objective To summarize the current evidence of the added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in lung cancer work-up. Methods A narrative review. Results Few randomized trials or prospective studies are available. Prospective studies show that add-on EUS-B-FNA increases diagnostic yield when sampling abnormal mediastinal lymph nodes, para-oesophageal lung and left adrenal gland. A large retrospective series on EUS-B-FNA from retroperitoneal lymph nodes suggests high diagnostic yield without safety concerns, as do casuistic reports on EUS-B-FNA from mediastinal pleural thickening, pancreatic lesions, ascites fluid and pericardial effusions. No study has systematically assessed both diagnostic yield, safety, patient reported outcomes, adverse events and costs. Conclusion The diagnostic value of add-on EUS-B to standard bronchoscopy and EBUS in lung cancer work-up appears very promising without safety concerns, giving the pulmonologist access to a variety of sites out of reach with other minimally invasive techniques. Little is known on patient-reported outcomes and costs. Future and prospective research should focus on effectiveness aspects to clarify whether overall benefits of add-on EUS-B sufficiently exceed overall downsides.
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Affiliation(s)
- Mohammad A. Issa
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
| | - Paul F. Clementsen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ida S. Christiansen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Laurence Crombag
- Department of Respiratory Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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15
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Bhagavatula SK, Graur A, Fintelmann FJ. Lung Needle Biopsy and Lung Ablation: Indications, Patient Management, and Postprocedure Imaging Findings. Clin Chest Med 2024; 45:307-323. [PMID: 38816090 DOI: 10.1016/j.ccm.2024.02.005] [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] [Indexed: 06/01/2024]
Abstract
The clinical role and use of percutaneous transthoracic needle biopsy (TTNB) and ablation of lung tumors are evolving. Here we discuss important considerations for referring providers, including current and emerging indications supported by guidelines, critical aspects of pre and postprocedure patient management, and expected postprocedure imaging findings.
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Affiliation(s)
- Sharath K Bhagavatula
- Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alexander Graur
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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16
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Shah R, Sun L, Ridge CA. Image guided lung biopsy. Lung Cancer 2024; 192:107803. [PMID: 38749073 DOI: 10.1016/j.lungcan.2024.107803] [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: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Image guided lung biopsy is vital in the evaluation of pulmonary abnormalities. Various modalities can be used including Ultrasound, Computed Tomography and Navigational Bronchoscopy. In this paper, we review the indications, techniques, diagnostic accuracy and complications of image guided biopsies and the role of novel techniques such as navigational and robot-assisted bronchoscopy.
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Affiliation(s)
- R Shah
- Royal Brompton and Harefield Hospitals, United Kingdom
| | - L Sun
- Royal Brompton and Harefield Hospitals, United Kingdom
| | - C A Ridge
- National Heart and Lung Institute, Imperial College London, United Kingdom
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17
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Sarnaik KS, Linden PA, Gasnick A, Bassiri A, Manyak GA, Jarrett CM, Sinopoli JN, Tapias Vargas L, Towe CW. Computational risk model for predicting 2-year malignancy of pulmonary nodules using demographic and radiographic characteristics. J Thorac Cardiovasc Surg 2024; 167:1910-1924.e2. [PMID: 37717851 DOI: 10.1016/j.jtcvs.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To determine whether discriminatory performance of a computational risk model in classifying pulmonary lesion malignancy using demographic, radiographic, and clinical characteristics is superior to the opinion of experienced providers. We hypothesized that computational risk models would outperform providers. METHODS Outcome of malignancy was obtained from selected patients enrolled in the NAVIGATE trial (NCT02410837). Five predictive risk models were developed using an 80:20 train-test split: univariable logistic regression model based solely on provider opinion, multivariable logistic regression model, random forest classifier, extreme gradient boosting model, and artificial neural network. Area under the receiver operating characteristic curve achieved during testing of the predictive models was compared to that of prebiopsy provider opinion baseline using the DeLong test with 10,000 bootstrapped iterations. RESULTS The cohort included 984 patients, 735 (74.7%) of which were diagnosed with malignancy. Factors associated with malignancy from multivariable logistic regression included age, history of cancer, largest lesion size, lung zone, and positron-emission tomography positivity. Testing area under the receiver operating characteristic curve were 0.830 for provider opinion baseline, 0.770 for provider opinion univariable logistic regression, 0.659 for multivariable logistic regression model, 0.743 for random forest classifier, 0.740 for extreme gradient boosting, and 0.679 for artificial neural network. Provider opinion baseline was determined to be the best predictive classification system. CONCLUSIONS Computational models predicting malignancy of pulmonary lesions using clinical, demographic, and radiographic characteristics are inferior to provider opinion. This study questions the ability of these models to provide additional insight into patient care. Expert clinician evaluation of pulmonary lesion malignancy is paramount.
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Affiliation(s)
- Kunaal S Sarnaik
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Philip A Linden
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Allison Gasnick
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aria Bassiri
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Grigory A Manyak
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Craig M Jarrett
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jillian N Sinopoli
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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18
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Huang YS, Chen JLY, Ko WC, Chang YH, Chang CH, Chang YC. Clinical Variables and Radiomics Features for Predicting Pneumothorax in Patients Undergoing CT-guided Transthoracic Core Needle Biopsy. Radiol Cardiothorac Imaging 2024; 6:e230278. [PMID: 38780426 PMCID: PMC11211933 DOI: 10.1148/ryct.230278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 02/02/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024]
Abstract
Purpose To develop a prediction model combining both clinical and CT texture analysis radiomics features for predicting pneumothorax complications in patients undergoing CT-guided core needle biopsy. Materials and Methods A total of 424 patients (mean age, 65.6 years ± 12.7 [SD]; 232 male, 192 female) who underwent CT-guided core needle biopsy between January 2021 and October 2022 were retrospectively included as the training data set. Clinical and procedure-related characteristics were documented. Texture analysis radiomics features were extracted from the subpleural lung parenchyma traversed by needle. Moderate pneumothorax was defined as a postprocedure air rim of 2 cm or greater. The prediction model was developed using logistic regression with backward elimination, presented by linear fusion of the selected features weighted by their coefficients. Model performance was assessed using the area under the receiver operating characteristic curve (AUC). Validation was conducted in an external cohort (n = 45; mean age, 58.2 years ± 12.7; 19 male, 26 female) from a different hospital. Results Moderate pneumothorax occurred in 12.0% (51 of 424) of the training cohort and 8.9% (four of 45) of the external test cohort. Patients with emphysema (P < .001) or a longer needle path length (P = .01) exhibited a higher incidence of moderate pneumothorax in the training cohort. Texture analysis features, including gray-level co-occurrence matrix cluster shade (P < .001), gray-level run-length matrix low gray-level run emphasis (P = .049), gray-level run-length matrix run entropy (P = .003), gray-level size-zone matrix gray-level variance (P < .001), and neighboring gray-tone difference matrix complexity (P < .001), showed higher values in patients with moderate pneumothorax. The combined clinical-radiomics model demonstrated satisfactory performance in both the training (AUC 0.78, accuracy = 71.9%) and external test cohorts (AUC 0.86, accuracy 73.3%). Conclusion The model integrating both clinical and radiomics features offered practical diagnostic performance and accuracy for predicting moderate pneumothorax in patients undergoing CT-guided core needle biopsy. Keywords: Biopsy/Needle Aspiration, Thorax, CT, Pneumothorax, Core Needle Biopsy, Texture Analysis, Radiomics, CT Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Yu-Sen Huang
- From the Department of Medical Imaging (Y.S.H., W.C.K., Y.C.C.) and
Statistical Consulting Unit (Y.H.C., C.H.C.), National Taiwan University
Hospital, No. 7 Chung-Shan S. Rd, Taipei 100, Taiwan; Department of Radiology,
National Taiwan University College of Medicine, Taipei, Taiwan (Y.S.H.,
J.L.Y.C., Y.C.C.); and Department of Radiation Oncology, National Taiwan
University Cancer Center, Taipei, Taiwan (J.L.Y.C.)
| | - Jenny Ling-Yu Chen
- From the Department of Medical Imaging (Y.S.H., W.C.K., Y.C.C.) and
Statistical Consulting Unit (Y.H.C., C.H.C.), National Taiwan University
Hospital, No. 7 Chung-Shan S. Rd, Taipei 100, Taiwan; Department of Radiology,
National Taiwan University College of Medicine, Taipei, Taiwan (Y.S.H.,
J.L.Y.C., Y.C.C.); and Department of Radiation Oncology, National Taiwan
University Cancer Center, Taipei, Taiwan (J.L.Y.C.)
| | - Wei-Chun Ko
- From the Department of Medical Imaging (Y.S.H., W.C.K., Y.C.C.) and
Statistical Consulting Unit (Y.H.C., C.H.C.), National Taiwan University
Hospital, No. 7 Chung-Shan S. Rd, Taipei 100, Taiwan; Department of Radiology,
National Taiwan University College of Medicine, Taipei, Taiwan (Y.S.H.,
J.L.Y.C., Y.C.C.); and Department of Radiation Oncology, National Taiwan
University Cancer Center, Taipei, Taiwan (J.L.Y.C.)
| | - Yu-Han Chang
- From the Department of Medical Imaging (Y.S.H., W.C.K., Y.C.C.) and
Statistical Consulting Unit (Y.H.C., C.H.C.), National Taiwan University
Hospital, No. 7 Chung-Shan S. Rd, Taipei 100, Taiwan; Department of Radiology,
National Taiwan University College of Medicine, Taipei, Taiwan (Y.S.H.,
J.L.Y.C., Y.C.C.); and Department of Radiation Oncology, National Taiwan
University Cancer Center, Taipei, Taiwan (J.L.Y.C.)
| | - Chin-Hao Chang
- From the Department of Medical Imaging (Y.S.H., W.C.K., Y.C.C.) and
Statistical Consulting Unit (Y.H.C., C.H.C.), National Taiwan University
Hospital, No. 7 Chung-Shan S. Rd, Taipei 100, Taiwan; Department of Radiology,
National Taiwan University College of Medicine, Taipei, Taiwan (Y.S.H.,
J.L.Y.C., Y.C.C.); and Department of Radiation Oncology, National Taiwan
University Cancer Center, Taipei, Taiwan (J.L.Y.C.)
| | - Yeun-Chung Chang
- From the Department of Medical Imaging (Y.S.H., W.C.K., Y.C.C.) and
Statistical Consulting Unit (Y.H.C., C.H.C.), National Taiwan University
Hospital, No. 7 Chung-Shan S. Rd, Taipei 100, Taiwan; Department of Radiology,
National Taiwan University College of Medicine, Taipei, Taiwan (Y.S.H.,
J.L.Y.C., Y.C.C.); and Department of Radiation Oncology, National Taiwan
University Cancer Center, Taipei, Taiwan (J.L.Y.C.)
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Tan S, Di Loreto M, Melsom S, Jefferies R, Padgham C, Boardman G, Saffar B. Post-CT-guided lung biopsy optimisation of the observation period by identifying patients at risk of delayed pneumothorax. J Med Imaging Radiat Oncol 2024; 68:369-376. [PMID: 38591166 DOI: 10.1111/1754-9485.13646] [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: 08/08/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Identify the risk factors for delayed pneumothorax after lung biopsy. METHODS A retrospective study of 355 CT-guided lung biopsies was performed at Fiona Stanley Hospital, Western Australia over 42 months. A comprehensive range of patient, lesion and procedural variables were recorded. All post-procedural complications including time, size of pneumothorax and post-biopsy radiographs were reviewed. Lasso logistic regression model was utilised to determine factors predicting patient complications. RESULTS A total of 167 patients (47%) developed a pneumothorax, in which 34% were significant, requiring longer observation or drain insertion. The majority of pneumothoraces occurred within the first hour (86%), with 90% detected at the time of the procedure. Then, 12% were detected more than 3 h post-procedure, of which 8 patients (5%) had a significant delayed pneumothorax. Factors increasing the likelihood of significant pneumothorax include the length of lung traversed, smaller nodule size, surrounding emphysema, increased age and lateral patient position with the lesion in the non-dependent aspect. Increasing patient age, longer length of lung traversed and smaller nodule diameter increase the risk of delayed onset of pneumothorax (more than 3 h). CONCLUSION The results of this study align with other studies indicating it is safe to discharge stable patients within an hour post-lung biopsy. However, specific risk factors, including age, small lesion size and deep lesions, may identify patients who could benefit from a longer observation period.
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Affiliation(s)
- Samantha Tan
- Medical Imaging Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Murray Di Loreto
- Medical Imaging Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Stephen Melsom
- Medical Imaging Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Reece Jefferies
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Christopher Padgham
- Department of Respiratory Medicine, Logan Hospital, QLD Health, Meadowbrook, Queensland, Australia
| | - Glenn Boardman
- South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Bann Saffar
- Medical Imaging Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
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20
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Saggiante L, Biondetti P, Lanza C, Carriero S, Ascenti V, Piacentino F, Shehab A, Ierardi AM, Venturini M, Carrafiello G. Computed-Tomography-Guided Lung Biopsy: A Practice-Oriented Document on Techniques and Principles and a Review of the Literature. Diagnostics (Basel) 2024; 14:1089. [PMID: 38893616 PMCID: PMC11171640 DOI: 10.3390/diagnostics14111089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Computed tomography (CT)-guided lung biopsy is one of the oldest and most widely known minimally invasive percutaneous procedures. Despite being conceptually simple, this procedure needs to be performed rapidly and can be subject to meaningful complications that need to be managed properly. Therefore, knowledge of principles and techniques is required by every general or interventional radiologist who performs the procedure. This review aims to contain all the information that the operator needs to know before performing the procedure. The paper starts with the description of indications, devices, and types of percutaneous CT-guided lung biopsies, along with their reported results in the literature. Then, pre-procedural evaluation and the practical aspects to be considered during procedure (i.e., patient positioning and breathing) are discussed. The subsequent section is dedicated to complications, with their incidence, risk factors, and the evidence-based measures necessary to both prevent or manage them; special attention is given to pneumothorax and hemorrhage. After conventional CT, this review describes other available CT modalities, including CT fluoroscopy and cone-beam CT. At the end, more advanced techniques, which are already used in clinical practice, like fusion imaging, are included.
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Affiliation(s)
- Lorenzo Saggiante
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Velio Ascenti
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Anas Shehab
- Interventional Radiology Fellowship, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
- School of Radiology, Università Degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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21
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Li T, Xu G, Li W, Liu Y. A systematic review and meta-analysis of randomized controlled trials comparing low-dose versus standard-dose computed tomography-guided lung biopsy. J Cardiothorac Surg 2024; 19:297. [PMID: 38778306 PMCID: PMC11110412 DOI: 10.1186/s13019-024-02792-x] [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: 08/29/2023] [Accepted: 05/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Despite the existence of several Randomized Controlled Trials (RCTs) investigating Low-Dose Computed Tomography (LDCT) as a guide in lung biopsies, conclusive findings remain elusive. To address this contention, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LDCT-guided lung biopsies. METHODS A comprehensive search across major databases identified RCTs comparing the effectiveness of LDCT-guided with Standard-Dose Computed Tomography (SDCT)-guided lung biopsies. Subsequently, we utilized a random-effects model meta-analysis to assess diagnostic accuracy, radiation dose, operation duration, and clinical complications associated with these procedures. RESULTS Out of 292 scrutinized studies, six RCTs representing 922 patients were included in the final analysis. Results indicated the differences between the LDCT and SDCT groups were not different with statistical significance in terms of diagnostic accuracy rates (Intent-to-Treat (ITT) populations: Relative Risk (RR) 1.01, 95% Confidence interval [CI] 0.97-1.06, p = 0.61; Per-Protocol (PP) populations: RR 1.01, 95% CI 0.98-1.04, p = 0.46), incidence of pneumothorax (RR 1.00, 95% CI 0.75-1.35, p = 0.98), incidence of hemoptysis (RR 0.95, 95% CI 0.63-1.43, p = 0.80), and operation duration (minutes) (Mean Differences [MD] -0.34, 95% CI -1.67-0.99, p = 0.61). Notably, LDCT group demonstrated a lower radiation dose (mGy·cm) with statistical significance (MD -188.62, 95% CI -273.90 to -103.34, p < 0.0001). CONCLUSIONS The use of LDCT in lung biopsy procedures demonstrated equivalent efficacy and safety to standard methods while notably reducing patient radiation exposure.
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Affiliation(s)
- Teng Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Guanghui Xu
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Wenjun Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Yun Liu
- Department of Hematology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China.
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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.
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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
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23
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Bourgeais G, Frampas E, Liberge R, Nicolas A, Defrance C, Blanc FX, Coudol S, Morla O. Pneumothorax Incidence with Normal Saline Instillation for Sealing the Needle Track After Computed Tomography-Guided Percutaneous Lung Biopsy. Cardiovasc Intervent Radiol 2024; 47:604-612. [PMID: 38263525 DOI: 10.1007/s00270-023-03648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE To determine whether instillation of normal saline solution for sealing the needle track reduces incidence of pneumothorax and chest tube placement after computed tomography-guided percutaneous lung biopsy. MATERIALS AND METHODS A total of 242 computed tomography-guided percutaneous lung biopsies performed at a single institution were retrospectively reviewed, including 93 biopsies in which the needle track was sealed by instillation of 3-5 ml of normal saline solution during needle withdrawal (water seal group) and 149 biopsies without sealing (control group). Patient and lesion characteristics, procedure-specific variables, pneumothorax and chest tube placement rates were recorded. RESULTS Baseline characteristics were comparable in both groups. There was a statistically significant decrease in the pneumothorax rate (19.4% [18/93] vs. 40.9% [61/149]; p < 0.001) and a numerically lower chest tube placement rate without significant reduction (4.3% [4/93] vs. 10.7% [16/149]; p = 0.126) with using normal saline instillation for sealing the needle track versus not using sealant material. Using a multiple logistic regression analysis, using normal saline instillation to seal the needle track, having a senior radiologist as operator of the procedure and putting patients in prone position were significantly associated with a decreased risk of pneumothorax. The presence of emphysema along the needle track was significantly associated with an increased risk of pneumothorax. No complication was observed due to normal saline injection. CONCLUSION Normal saline solution instillation for sealing the needle track after computed tomography-guided percutaneous lung biopsy is a simple, low-cost and safe technique resulted in significantly decreased pneumothorax occurrence and a numerically lower chest tube placement rate, and might help to reduce both hospitalization risks and costs for the healthcare system. Level of evidence 3 Non-controlled retrospective cohort study.
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Affiliation(s)
- Geoffrey Bourgeais
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France.
| | - Eric Frampas
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Renan Liberge
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Aymeric Nicolas
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Claire Defrance
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - François-Xavier Blanc
- Department of Pneumology, Nantes University Hospital, Boulevard Jacques-Monod, 44093, Saint-Herblain, France
| | - Sandrine Coudol
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire, 11: Santé Publique, Clinique Des Données, INSERM, CIC 1413, 44000, Nantes, France
| | - Olivier Morla
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
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24
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Rigiroli F, Hamam O, Kavandi H, Brook A, Berkowitz S, Ahmed M, Siewert B, Brook OR. Routine radiology-pathology concordance evaluation of CT-guided percutaneous lung biopsies increases the number of cancers identified. Eur Radiol 2024; 34:3271-3283. [PMID: 37857902 DOI: 10.1007/s00330-023-10353-4] [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: 06/27/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Routine concordance evaluation between pathology and imaging findings was introduced for CT-guided biopsies. PURPOSE To analyze malignancy rate in concordant, discordant, and indeterminate non-malignant results of CT-guided lung biopsies. METHODS Concordance between pathology results and imaging findings of consecutive patients undergoing CT-guided lung biopsy between 7/1/2016 and 9/30/2021 was assessed during routine meetings by procedural radiologists. Concordant was defined as pathology consistent with imaging findings; discordant was used when pathology could not explain imaging findings; indeterminate when pathology could explain imaging findings but there was concern for malignancy. Recommendations for discordant and indeterminate were provided. All the malignant results were concordant. Pathology of repeated biopsy, surgical sample, or follow-up was considered reference standard. RESULTS Consecutive 828 CT-guided lung biopsies were performed on 795 patients (median age 70 years, IQR 61-77), 423/828 (51%) women. On pathology, 224/828 (27%) were non-malignant. Among the non-malignant, radiology-pathology concordance determined 138/224 (62%) to be concordant with imaging findings, 54/224 (24%) discordant, and 32/224 (14%) indeterminate. When compared to the reference standard, 33/54 (61%) discordant results, 6/30 (20%) indeterminate, and 3/133 (2%) concordant were malignant. The prevalence of malignancy in the three groups was significantly different (p < 0.001). Time to diagnosis was significantly different between patients who reached the diagnosis with imaging follow-up (median 114 days, IQR 69-206) compared to repeat biopsy (33 days, IQR 18-133) (p = 0.01). CONCLUSION Routine radiology-pathology concordance evaluation of CT-guided lung biopsy correctly identifies patients at high risk for missed diagnosis of malignancy. Repeat biopsy is the fastest method to reach diagnosis. CLINICAL RELEVANCE STATEMENT A routine radiology-pathology concordance assessment identifies patients with non-malignant CT-guided lung biopsy result who are at greater risk of missed diagnosis of malignancy. KEY POINTS • A routine radiology-pathology concordance evaluation of CT-guided lung biopsies classified 224 non-malignant results as concordant, discordant, or indeterminate. • The percentage of malignancy on follow-up was significantly different in concordant (2%), discordant (61%), and indeterminate (20%) (p < 0.001). • Time to definitive diagnosis was significantly shorter with repeat biopsy (33 days), compared to imaging follow-up (114 days), p = 0.01.
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Affiliation(s)
- Francesca Rigiroli
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MD, USA.
| | - Omar Hamam
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MD, USA
| | - Hadiseh Kavandi
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MD, USA
| | - Seth Berkowitz
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MD, USA
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MD, USA
| | - Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MD, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MD, USA
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Goetz A, Poschenrieder F, Steer FG, Zeman F, Lange TJ, Thurn S, Greiner B, Stroszczynski C, Uller W, Hamer O, Hammer S. Intravenous Opioid Medication with Piritramide Reduces the Risk of Pneumothorax During CT-Guided Percutaneous Core Biopsy of the Lung. Cardiovasc Intervent Radiol 2024; 47:621-631. [PMID: 38639781 DOI: 10.1007/s00270-024-03717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax. MATERIALS AND METHODS One hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis. RESULTS The overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate. CONCLUSION Procedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung. LEVEL OF EVIDENCE 4: small study cohort.
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Affiliation(s)
- Andrea Goetz
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Florian Poschenrieder
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Frederike Georgine Steer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Sylvia Thurn
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Okka Hamer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Yuan M, Hu Y, Wang L, Yin W, Xiao Y. Diagnostic outcomes of radial endobronchial ultrasound bronchoscopy guided by manual navigation in the evaluation of peripheral pulmonary lesions: An observational study. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13768. [PMID: 38685753 PMCID: PMC11058397 DOI: 10.1111/crj.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND AIMS Manual navigation (MN), drawing a bronchoscopic road map simply by looking at the consecutive computed tomography (CT), is feasible and economical. However, scant data about the use of MN in radial endobronchial ultrasound (r-EBUS) bronchoscopy have been documented till now. We aimed to evaluate the diagnostic performance of r-EBUS bronchoscopy guided by MN for diagnosing peripheral pulmonary lesions (PPLs) and to determine clinical factors affecting the diagnostic yield. METHODS We performed a retrospective, cohort study of consecutive patients with PPLs who underwent r-EBUS bronchoscopic biopsy via guidance of MN from May 2020 to June 2021 in our Respiratory Endoscopic Division. The overall diagnostic yield of MN-guided r-EBUS, the factors affecting the yield, and the diagnostic performance for malignancy were evaluated. RESULTS A total of 102 patients (103 lesions) were evaluated. The overall diagnostic yield of MN-guided r-EBUS was 82.0%, and it ranged from 79.6% to 82.5%, assuming the undermined cases were all positive cases (79.6%) or negatives (82.5%). The sensitivity of MN-guided r-EBUS for malignancy was 71.4%, ranging from 68.2% to 71.4%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 67.3%, ranging from 63.8% to 69.0%. The multivariate logistic regression showed that "bronchus sign on CT" was the only predictor of the overall diagnostic yield (odds ratio = 11.5, 95% confidence interval: 1.9-70.9, P = 0.009). CONCLUSIONS MN-guided r-EBUS is feasible in diagnosing PPLs, especially for lesions with bronchus sign on CT.
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Affiliation(s)
- Mingli Yuan
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yi Hu
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Liangchao Wang
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wen Yin
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yang Xiao
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Park JY, Han JY, Choi SJ, Baek JW, Yun SY, Lee SK, Lee HY, Hong S. Impact of Respiratory Phase during Pleural Puncture on Complications in CT-Guided Percutaneous Lung Biopsy. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:566-578. [PMID: 38873383 PMCID: PMC11166586 DOI: 10.3348/jksr.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/22/2023] [Accepted: 11/09/2023] [Indexed: 06/15/2024]
Abstract
Purpose This study investigated whether the respiratory phase during pleural puncture in CT-guided percutaneous transthoracic needle biopsy (PTNB) affects complications. Materials and Methods We conducted a retrospective review of 477 lung biopsy CT scans performed during free breathing. The respiratory phases during pleural puncture were determined based on the table position of the targeted nodule using CT scans obtained during free breathing. We compared the rates of complications among the inspiratory, mid-, and expiratory respiratory phases. Logistic regression analysis was performed to control confounding factors associated with pneumothorax. Results Among the 477 procedures, pleural puncture was performed during the expiratory phase in 227 (47.6%), during the mid-phase in 108 (22.6%), and during the inspiratory phase in 142 (29.8%). The incidence of pneumothorax was significantly lower in the expiratory puncture group (40/227, 17.6%; p = 0.035) and significantly higher in the mid-phase puncture group (31/108, 28.7%; p = 0.048). After controlling for confounding factors, expiratory-phase puncture was found to be an independent protective factor against pneumothorax (odds ratio = 0.571; 95% confidence interval = 0.360-0.906; p = 0.017). Conclusion Our findings suggest that pleural puncture during the expiratory phase may reduce the risk of pneumothorax during image guided PTNB.
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Tian S, Li X, Liu J, Wang X, Chen H, Dai Z, Chen Q, Shi H, Li Y, Huang H, Bai C. Radial endobronchial ultrasound - guided bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis of prospective trials. Heliyon 2024; 10:e29446. [PMID: 38660275 PMCID: PMC11040069 DOI: 10.1016/j.heliyon.2024.e29446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
Background The diagnostic yield of radial endobronchial ultrasound (r-EBUS) for the diagnosis of peripheral pulmonary lesions (PPLs) varies between studies and is affected by multiple factors. We aimed to evaluate the efficacy and safety of r-EBUS, and to explore the factors influencing the diagnostic yield of r-EBUS in patients with PPLs. Methods The PubMed, Web of Science, and EMBASE databases were searched to identify relevant studies that used r-EBUS for diagnosing PPLs from the date of inception to Dec 2022. Meta-analysis was conducted using Review Manager 5.4 and Stata 15.1. Results An analysis of 46 studies with a total of 7252 PPLs was performed. The pooled diagnostic yield of r-EBUS was 73.4 % (95 % CI: 69.9%-76.7 %), with significant heterogeneity detected among studies (I2 = 90 %, P < 0.001). Further analysis demonstrated PPLs located in the middle or lower lobe, >2 cm in size, malignant in type, solid in appearance on computerized tomography (CT), present in bronchus sign, the within probe location, and the addition of rapid on-site evaluation (ROSE) were associated with increased diagnostic yield, whereas use of a guide sheath (GS), bronchoscopy type, and a multimodality approach failed to influence the outcome. The pooled incidence rates of overall complications, pneumothorax and moderate and severe bleeding were 3.1 % (95 % CI: 2.1%-4.3 %), 0.4 % (95 % CI: 0.1%-0.7 %) and 1.1 % (95 % CI: 0.5%-2.0 %), respectively. Conclusions r-EBUS has an appreciable diagnostic yield and an excellent safety manifestation when used to deal with PPLs.
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Affiliation(s)
- Sen Tian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Xiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, China
| | - Jian Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xinyu Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hui Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Zeyu Dai
- Department of Orthopaedic Oncology, The Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qian Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Cardiothoracic Surgery, No. 904 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Wuxi, China
| | - Hui Shi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yonghua Li
- Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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Fernandez-Bussy S, Garza-Salas A, Barrios-Ruiz A, Balasubramanian P, Yu Lee-Mateus A, Koirala T, Hazelett BN, Chadha R, Patel NM, Reisenauer JS, Abia-Trujillo D. Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event. Respiration 2024; 103:397-405. [PMID: 38648757 DOI: 10.1159/000538910] [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: 10/06/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION The widespread use of computed tomography as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure. METHODS This is a single-center, retrospective review of 22 patients who underwent ssRAB for evaluation of two or more PPN, between November 2021 and April 2023 at Mayo Clinic, FL, USA. RESULTS A total of 46 PPNs were biopsied in 22 patients. All lesions were ≤2 cm with a median minimum and maximum cross-sectional lesion size of 1.40 cm and 1.05 cm, respectively. Diagnostic yield was 86.9% (n = 40), and target reach was 91.3% (n = 42). Most lesions were in the upper lobes, a solid pattern was found in 78.3% (n = 36), bronchus sign was present in 82.6% of cases (n = 38), 54.4% (n = 25) were malignant nodules, and 32.6% (n = 15) were benign. Fourteen patients had at least one malignant lesion out of two or more nodules sampled, and 10 patients had a malignant diagnosis for all sampled lesions. The complication rate was 9% (n = 2) with one case of bleeding and one of pneumothorax. CONCLUSION This study is, to our knowledge, the first to assess the use and safety of ssRAB for diagnosis of multiple PPN in a single anesthetic event. This procedure will mainly impact management decisions and subsequently shorten the time from diagnosis to treatment.
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Affiliation(s)
| | - Ana Garza-Salas
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Alanna Barrios-Ruiz
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Tapendra Koirala
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Britney N Hazelett
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan Chadha
- Division of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Neal M Patel
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Janani S Reisenauer
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Trimble EJ, Stewart K, Reinersman JM. Early comparison robotic bronchoscopy versus electromagnetic navigational bronchoscopy for biopsy of pulmonary nodules in a thoracic surgery practice. J Robot Surg 2024; 18:149. [PMID: 38564059 DOI: 10.1007/s11701-024-01898-7] [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: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
Pulmonary nodules are frequently encountered in high-risk patients. Often these require biopsy which can be challenging. We relate our experience comparing use of electromagnetic navigational bronchoscopy (ENB) to a robotic bronchoscopy system (RB). A retrospective review of patients undergoing bronchoscopic biopsy from 2015 to 2021. The timeframe overlapped with transition from ENB using Veran SPiN system to RB using Ion system by Intuitive. Patient and nodule characteristics were collected. Primary end point was overall diagnostic yield which was defined by pathologic confirmation of malignancy or benign finding. Secondary outcomes included diagnostic yield based on overall size of nodules and need for further work up and testing. 116 patients underwent ENB or RB of 134 nodules. No perioperative complications occurred. Diagnostic yield of ENB was 49.5% (41/91 nodules) versus 86.1% (37/43 nodules) for RB. Average nodule size for ENB was 2.55 cm versus 1.96 cm for RB. When divided based on size, ENB had a 30% diagnostic yield for nodules 1-2 cm (11/37 nodules, mean size 1.46 cm) and 64% yield for nodules 2-3 cm (14/22 nodules, mean size 2.38 cm). RB had an 81% yield for nodules 1-2 cm (mean size 1.41 cm) and 100% yield for nodules 2-3 cm (mean 2.3 cm). RB showed superiority over ENB in early implementation trials for biopsy of suspicious pulmonary nodules. It is a safe technology allowing for increased access to all lung fields and utilization in the thoracic surgical practice will be paramount to advancing the field.
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Affiliation(s)
- Elizabeth J Trimble
- Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, Suite 9000, Oklahoma City, OK, 73104, USA
| | - Kenneth Stewart
- Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, Suite 9000, Oklahoma City, OK, 73104, USA
| | - J Matthew Reinersman
- Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, Suite 9000, Oklahoma City, OK, 73104, USA.
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Ricciardella F, Mannetta G, Caruso V, Cocco G, Mantini C, Piccirilli E, Caulo M, Delli Pizzi A. Air embolism as a rare complication of lung biopsy: A case report. Radiol Case Rep 2024; 19:1547-1551. [PMID: 38317699 PMCID: PMC10839755 DOI: 10.1016/j.radcr.2024.01.027] [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: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
Lung biopsy is an important interventional radiology procedure allowing the characterization of lesions with suspected malignancy. The most frequent complications are pneumothorax and hemorrhage. Air embolism is a rare but potentially fatal occurrence. In this case report, we present an air embolism after core needle CT-guided biopsy showing CT and MRI features that radiologists should expect in the everyday clinical practice.
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Affiliation(s)
- Federica Ricciardella
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Gianluca Mannetta
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Valentina Caruso
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Cesare Mantini
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Eleonora Piccirilli
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Massimo Caulo
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
- Department of Innovative Technologies in Medicine & Odontoiatry, “G. d'Annunzio” University, Chieti, Italy
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Koratala A, Chandra NC, Balasubramanian P, Yu Lee-Mateus A, Barrios-Ruiz A, Garza-Salas A, Bowman A, Grage R, Fernandez-Bussy S, Abia-Trujillo D. Diagnostic Accuracy of a Computed Tomography-Guided Transthoracic Needle Biopsy for Ground-Glass Opacities and Subsolid Pulmonary Nodules. Cureus 2024; 16:e57414. [PMID: 38694634 PMCID: PMC11061815 DOI: 10.7759/cureus.57414] [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] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Purpose The increasing use of computed tomography (CT) imaging has led to the detection of more ground-glass nodules (GGNs) and subsolid nodules (SSNs), which may be malignant and require a biopsy for proper diagnosis. Approximately 75% of persistent GGNs can be attributed to adenocarcinoma in situ or minimally invasive adenocarcinoma. A CT-guided biopsy has been proven to be a reliable procedure with high diagnostic performance. However, the diagnostic accuracy and safety of a CT-guided biopsy for GGNs and SSNs with solid components ≤6 mm are still uncertain. The aim of this study is to assess the diagnostic accuracy of a CT-guided core needle biopsy (CNB) for GGN and SSNs with solid components ≤6 mm. Methods This is a retrospective study of patients who underwent CT-guided CNB for the evaluation of GGNs and SSNs with solid components ≤6 mm between February 2020 and January 2023. Biopsy findings were compared to the final diagnosis determined by definite histopathologic examination and clinical course. Results A total of 22 patients were enrolled, with a median age of 74 years (IQR: 68-81). A total of 22 nodules were assessed, comprising 15 (68.2%) SSNs with a solid component measuring ≤6 mm and seven (31.8%) pure GGNs. The histopathological examination revealed that 12 (54.5%) were diagnosed as malignant, nine (40.9%) as benign, and one (4.5%) as non-diagnostic. The overall diagnostic accuracy and sensitivity for malignancy were 86.36% and 85.7%, respectively. Conclusion A CT-guided CNB for GGNs and SSNs with solid components measuring ≤6 mm appears to have a high diagnostic accuracy.
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Affiliation(s)
- Anoop Koratala
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | - Nikitha C Chandra
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | | | | | | | - Ana Garza-Salas
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Rolf Grage
- Radiology, Mayo Clinic, Jacksonville, USA
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Ferrando Blanco D, Persiva Morenza Ó, Cabanzo Campos LB, Sánchez Martínez AL, Varona Porres D, Del Carpio Bellido Vargas LA, Andreu Soriano J. Utility of artificial intelligence for detection of pneumothorax on chest radiopgraphs done after transthoracic percutaneous transthoracic biopsy guided by computed tomography. RADIOLOGIA 2024; 66 Suppl 1:S40-S46. [PMID: 38642960 DOI: 10.1016/j.rxeng.2023.07.006] [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: 05/01/2023] [Accepted: 07/27/2023] [Indexed: 04/22/2024]
Abstract
OBJETIVE To assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. MATERIAL AND METHODS We included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. RESULTS A total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers' interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. CONCLUSIONS The software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.
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Affiliation(s)
- D Ferrando Blanco
- Servicio de Radiología, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
| | - Ó Persiva Morenza
- Servicio de Radiología, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - L B Cabanzo Campos
- Servicio de Radiología, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | - D Varona Porres
- Servicio de Radiología, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | - J Andreu Soriano
- Servicio de Radiología, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
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Rigiroli F, Camacho A, Chung A, Andrabi SY, Brook A, Siewert B, Ahmed M, Brook OR. Safety profile and technical success of narrow window CT-guided percutaneous biopsy with blunt needle approach in the abdomen and pelvis. Eur Radiol 2024; 34:2364-2373. [PMID: 37707549 DOI: 10.1007/s00330-023-10231-z] [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: 03/08/2023] [Revised: 07/06/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To assess success and safety of CT-guided procedures with narrow window access for biopsy. METHODS Three hundred ninety-six consecutive patients undergoing abdominal or pelvic CT-guided biopsy or fiducial placement between 01/2015 and 12/2018 were included (183 women, mean age 63 ± 14 years). Procedures were classified into "wide window" (width of the needle path between structures > 15 mm) and "narrow window" (≤ 15 mm) based on intraprocedural images. Clinical information, complications, technical and clinical success, and outcomes were collected. The blunt needle approach is preferred by our interventional radiology team for narrow window access. RESULTS There were 323 (81.5%) wide window procedures and 73 (18.5%) narrow window procedures with blunt needle approach. The median depth for the narrow window group was greater (97 mm, interquartile range (IQR) 82-113 mm) compared to the wide window group (84 mm, IQR 60-106 mm); p = 0.0017. Technical success was reached in 100% (73/73) of the narrow window and 99.7% (322/323) of the wide window procedures. There was no difference in clinical success rate between the two groups (narrow: 86.4%, 57/66; wide: 89.5%, 265/296; p = 0.46). There was no difference in immediate complication rate (narrow: 1.3%, 1/73; wide: 1.2%, 4/323; p = 0.73) or delayed complication rate (narrow: 1.3%, 1/73; wide: 0.6%, 1/323; p = 0.50). CONCLUSION Narrow window (< 15 mm) access biopsy and fiducial placement with blunt needle approach under CT guidance is safe and successful. CLINICAL RELEVANCE STATEMENT CT-guided biopsy and fiducial placement can be performed through narrow window access of less than 15 mm utilizing the blunt-tip technique. KEY POINTS • A narrow window for CT-guided abdominal and pelvic biopsies and fiducial placements was considered when width of the needle path between vital structures was ≤ 15 mm. • Seventy-three biopsies and fiducial placements performed through a narrow window with blunt needle approach had a similar rate of technical and clinical success and complications compared to 323 procedures performed through a wide window approach, with traditional approach (> 15 mm). • This study confirmed the safety of the CT-guided percutaneous procedures through < 15 mm window with blunt-tip technique.
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Affiliation(s)
- Francesca Rigiroli
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA.
| | - Andrés Camacho
- Department of Radiology, Mount Sinai Medical Center Miami Beach, Miami, FL, USA
| | - Andrew Chung
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Syed Yasir Andrabi
- Department of Radiology, Temple Health, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA
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WANG X, ZHANG H, ZHANG X. [Analysis of Influencing Factors of Complications for CT-guided
Percutaneous Lung Biopsy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:179-186. [PMID: 38590192 PMCID: PMC11002188 DOI: 10.3779/j.issn.1009-3419.2024.101.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Computed tomography guided percutaneous lung biopsy (CT-PLB) is a widely used method for the diagnosis of lung lesions. However, it is invasive, and the most common complications are pneumothorax and pulmonary hemorrhage, which can be life-threatening in severe cases. Therefore, the aim of this study is to analyze the independent risk factors affecting the occurrence of different complications of CT-PLB, so as to reduce the incidence of complications. METHODS The 605 patients with complete clinical data who underwent CT-PLB in our hospital from May 2018 to December 2019 were retrospectively analyzed. According to the location of the lesions, they were divided into subpleural group and non-subpleural group. The patients were divided into pneumothorax group, pulmonary hemorrhage group, pneumothorax with pulmonary hemorrhage group and non-pneumothorax/pulmonary hemorrhage group according to the complications. The risk factors affecting the incidence of different complications and the independent risk factors of each complication were analyzed. RESULTS The incidence of pneumothorax was 34.1%, the incidence of pulmonary hemorrhage was 28.1%, and the incidence of pneumothorax complicated with pulmonary hemorrhage was 10.8% (63 cases). The independent risk factor affecting the incidence of subpleural pneumothorax was lesion size (P=0.002). The independent risk factors affecting the occurrence of pneumothorax in the non-subpleural group were plain scan CT value (P=0.035), length of needle through lung tissue (P=0.003), and thickness of needle through chest wall (P=0.020). Independent risk factors affecting the occurrence of pulmonary hemorrhage in the non-subpleural group were length of needle through lung tissue (P<0.001), △CT value of needle travel area (P=0.001), lesion size (P=0.034) and body position (P=0.014). The independent risk factors affecting the co-occurrence of pneumothorax and pulmonary hemorrhage were the length of needle through lung tissue (P<0.001) and the △CT value of needle travel area (P<0.001). CONCLUSIONS CT-PLB is a safe and effective diagnostic method, which of high diagnostic value for lung lesions. Selecting the appropriate puncture program can reduce complications such as pneumothorax and pulmonary hemorrhage, and improve diagnosis and treatment efficiency.
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Fernandez-Bussy S, Yu Lee-Mateus A, Reisenauer J, Balasubramanian P, Barrios-Ruiz A, Garza-Salas A, Chandra NC, Koratala A, Nadrous A, Edell ES, Bowman AW, Grage RA, Reisenauer CJ, Kurup AN, Patel NM, Chadha R, Hazelett BN, Abia-Trujillo D. Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules. Respiration 2024; 103:280-288. [PMID: 38471496 DOI: 10.1159/000538132] [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: 08/23/2023] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) are scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN. METHODS A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6 mm from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB. RESULTS A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5 mm (IQR: 4.5, 6). Patients were divided into two groups: 27 in the ssRAB group and 38 in the CTTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p = 0.646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs. 88.5%; p = 0.828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs. 2; p = 0.135). CONCLUSION Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure.
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Affiliation(s)
| | | | - Janani Reisenauer
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alanna Barrios-Ruiz
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ana Garza-Salas
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Nikitha C Chandra
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Anoop Koratala
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Anthony Nadrous
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew W Bowman
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Rolf A Grage
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Anil N Kurup
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Neal M Patel
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Britney N Hazelett
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Meng N, Song C, Sun J, Liu X, Shen L, Zhou Y, Dai B, Yu X, Wu Y, Yuan J, Yang Y, Wang Z, Wang M. Amide proton transfer-weighted imaging and stretch-exponential model DWI based 18F-FDG PET/MRI for differentiation of benign and malignant solitary pulmonary lesions. Cancer Imaging 2024; 24:33. [PMID: 38439101 PMCID: PMC10910843 DOI: 10.1186/s40644-024-00677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To differentiate benign and malignant solitary pulmonary lesions (SPLs) by amide proton transfer-weighted imaging (APTWI), mono-exponential model DWI (MEM-DWI), stretched exponential model DWI (SEM-DWI), and 18F-FDG PET-derived parameters. METHODS A total of 120 SPLs patients underwent chest 18F-FDG PET/MRI were enrolled, including 84 in the training set (28 benign and 56 malignant) and 36 in the test set (13 benign and 23 malignant). MTRasym(3.5 ppm), ADC, DDC, α, SUVmax, MTV, and TLG were compared. The area under receiver-operator characteristic curve (AUC) was used to assess diagnostic efficacy. The Logistic regression analysis was used to identify independent predictors and establish prediction model. RESULTS SUVmax, MTV, TLG, α, and MTRasym(3.5 ppm) values were significantly lower and ADC, DDC values were significantly higher in benign SPLs than malignant SPLs (all P < 0.01). SUVmax, ADC, and MTRasym(3.5 ppm) were independent predictors. Within the training set, the prediction model based on these independent predictors demonstrated optimal diagnostic efficacy (AUC, 0.976; sensitivity, 94.64%; specificity, 92.86%), surpassing any single parameter with statistical significance. Similarly, within the test set, the prediction model exhibited optimal diagnostic efficacy. The calibration curves and DCA revealed that the prediction model not only had good consistency but was also able to provide a significant benefit to the related patients, both in the training and test sets. CONCLUSION The SUVmax, ADC, and MTRasym(3.5 ppm) were independent predictors for differentiation of benign and malignant SPLs, and the prediction model based on them had an optimal diagnostic efficacy.
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Affiliation(s)
- Nan Meng
- Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China.
- Laboratory of Brain Science and Brain-Like Intelligence Technology, Institute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, China.
- Biomedical Research Institute, Henan Academy of Sciences, Zhengzhou, China.
| | - Chen Song
- Hematology Laboratory, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jing Sun
- Department of Pediatrics, Zhengzhou Central Hospital Affiliated to Zhengzhou University & Zhengzhou Central Hospital, Zhengzhou, China
| | - Xue Liu
- Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China
| | - Lei Shen
- Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yihang Zhou
- Department of Medical Imaging, Xinxiang Medical University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, China
| | - Bo Dai
- Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xuan Yu
- Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yaping Wu
- Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jianmin Yuan
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Yang Yang
- Beijing United Imaging Research Institute of Intelligent Imaging, United Imaging Healthcare Group, Beijing, China
| | - Zhe Wang
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China.
- Laboratory of Brain Science and Brain-Like Intelligence Technology, Institute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, China.
- Biomedical Research Institute, Henan Academy of Sciences, Zhengzhou, China.
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Yasin B, Saeed H, Ahmad MA, Najam S, Niazi M, Tariq H, Khan AYY, Khaliq S, Zaidi SGEZ, Mehmood Qadri H. Efficacy of Computerized Tomography-Guided Core Biopsy in Identifying the Subtypes of Lung Adenocarcinoma: An Observational Perspective From Pakistan. Cureus 2024; 16:e57337. [PMID: 38690481 PMCID: PMC11060614 DOI: 10.7759/cureus.57337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lung carcinoma is a leading cause of death worldwide. Histological subtype of lung adenocarcinoma is an important indicator of patient's outcome as it is helpful in surgical planning and guidance of prognosis. Objective To determine the diagnostic efficacy of computerized tomography-guided core needle biopsy (CNB) in identifying the histopathological subtype of lung adenocarcinoma. Methods and materials This is a retrospective, descriptive study including clinical data of 73 patients irrespective of their age and gender, who underwent computerized tomography-guided CNB for lung masses at the Department of Pathology, Aznostics - the Diagnostic Centre, Lahore, Pakistan from January 01, 2019 to June 30, 2023. Data collected was analyzed via Google Form (Google Inc., Mountainview, CA) and Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, Version 24, released 2016; IBM Corp., Armonk, New York, United States) and was sent to statistician for descriptive analysis. Categorical data was used for calculating frequency and percentage, while continuous data was computed as mean and standard deviation. Results Seventy-three patients with adenocarcinoma underwent pulmonary biopsy. The mean age of included patients was 64.88 ± 11.39 year with a male predominance of 61.64%. Upper lobe was commonly affected by adenocarcinoma lung in 57.53% patients and 58.90% cases involved the right lung. The most common subtype was acinar with 51.65% followed by solid with 17.58% cases. Computerized tomography-guided CNB showed a diagnostic yield of 75.34% and identified histological subtypes of lung adenocarcinoma in 55 cases. Conclusion Computerized tomography-guided CNB is a useful, yet minimally invasive diagnostic tool to identify the histological subtype of lung adenocarcinoma. It not only helps in planning the surgical and adjuvant management of the patients, but also guides the patient-prognosis.
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Affiliation(s)
- Babar Yasin
- Histopathology, Aznostics - The Diagnostic Center, Lahore, PAK
| | - Hasan Saeed
- Histopathology, Shifa International Hospital Islamabad, Islamabad, PAK
| | | | - Sara Najam
- Internal Medicine, Jinnah Hospital Lahore, Lahore, PAK
| | - Mehwish Niazi
- Histopathology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Humza Tariq
- Surgery, Lahore General Hospital, Lahore, PAK
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Prado RMG, Cicenia J, Almeida FA. Robotic-Assisted Bronchoscopy: A Comprehensive Review of System Functions and Analysis of Outcome Data. Diagnostics (Basel) 2024; 14:399. [PMID: 38396438 PMCID: PMC10888048 DOI: 10.3390/diagnostics14040399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The past two decades have witnessed a revolutionary era for peripheral bronchoscopy. Though the initial description of radial endobronchial ultrasound can be traced back to 1992, it was not until the mid-2000s that its utilization became commonplace, primarily due to the introduction of electromagnetic navigation (EMN) bronchoscopy. While the diagnostic yield of EMN-assisted sampling has shown substantial improvement over historical fluoroscopy-assisted bronchoscopic biopsy, its diagnostic yield plateaued at around 70%. Factors contributing to this relatively low diagnostic yield include discrepancies in computed tomography to body divergence, which led to unsuccessful lesion localization and resultant unsuccessful sampling of the lesion. Furthermore, much of peripheral bronchoscopy utilized a plastic extended working channel whose tips were difficult to finely aim at potential targets. However, the recent introduction of robotic-assisted bronchoscopy, and its associated stability within the peripheral lung, has ignited optimism for its potential to significantly enhance the diagnostic performance for peripheral lesions. Moreover, some envision this technology eventually playing a pivotal role in the therapeutic delivery to lung tumors. This review aims to describe the currently available robotic-assisted bronchoscopy technologies and to discuss the existing scientific evidence supporting these.
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Affiliation(s)
- Renan Martins Gomes Prado
- School of Medicine, Center of Health Sciences, State University of Ceara, Fortaleza 60714-903, Brazil
| | - Joseph Cicenia
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
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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.
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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.
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Rendon FO, Del Valle JB, Savluk JL, Ducrey G, Borensztein MA. CT-Guided Trans-osseous Biopsy: Experience in 24 Patients. Cardiovasc Intervent Radiol 2024; 47:234-237. [PMID: 38010502 DOI: 10.1007/s00270-023-03616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The objective of this study is to assess the effectiveness of computed tomography-guided trans-osseous biopsies in deep-seated lesions and report encountered complications. MATERIALS AND METHODS A retrospective cohort study was performed which included twenty-four patients with pathologic medical history and lesions non-accessible by common approaches. Exclusion criteria include patients who could be biopsied without trans-osseous access, as for example procedures aided with hydro- or pneumo-dissection. The population studied included 13 females (54.2%) and the overall average age was 64.5 (IIQ 43-69). The procedures were carried out through the following bones: sternum (n = 6), vertebral (n = 5), iliac (n = 5), scapula (n = 3), rib (n = 2), sacral (n = 2), and pubis (n = 1). RESULTS The efficiency for these procedures was 87.5%, while 8.33% of them were non-diagnostic and 4.17% were inconclusive due to vital risk during the procedure. CONCLUSION Computed tomography-guided trans-osseous biopsy resulted in a safe and effective technique for those lesions blocked by vital structures or apparently directly inaccessible.
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Affiliation(s)
- Fausto Omar Rendon
- Department of Radiology, Hospital Italiano de Buenos Aires, Querandíes 4430, Buenos Aires, Argentina.
| | - Juan Bautista Del Valle
- Department of Radiology, Hospital Italiano de Buenos Aires, Querandíes 4430, Buenos Aires, Argentina
| | - Jésica Lorena Savluk
- Department of Radiology, Hospital Italiano de Buenos Aires, Querandíes 4430, Buenos Aires, Argentina
| | - Gabriel Ducrey
- Department of Radiology, Hospital Italiano de Buenos Aires, Querandíes 4430, Buenos Aires, Argentina
| | - Matías Adrián Borensztein
- Department of Radiology, Hospital Italiano de Buenos Aires, Querandíes 4430, Buenos Aires, Argentina
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Sadoughi A, Sarkar A, Novotney C, Chan C, Moreno G, Oren S, Moss L, Aharoni K, Bari SE, Edery N, Ohri N. Bronchoscopic deployment and implantation of Diffusing alpha-emitters Radiation Therapy into the lung and mediastinum for treatment of lung cancer: a pre-clinical safety and feasibility study. Transl Lung Cancer Res 2024; 13:60-75. [PMID: 38404993 PMCID: PMC10891399 DOI: 10.21037/tlcr-23-639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/10/2024] [Indexed: 02/27/2024]
Abstract
Background Radiotherapy is a standard treatment modality in cancer therapy, particularly for lung cancer. Diffusing alpha-emitters Radiation Therapy sources (hereafter, "Alpha DaRTs") are fixed with Ra-244 (half-life =3.6 days) that releases alpha-emitting atoms into the tumor tissue to an effective range of a few millimeters. Methods The feasibility, usability, and safety of Alpha DaRTs deployment and implantation via bronchoscopy into the lung parenchyma and mediastinum in a big animal model of healthy swine was studied in two phases: (I) inert and (II) active Alpha DaRTs deployment. The Alpha DaRTs were inserted in both individual and cluster patterns based on a predefined plan. Swine health was monitored throughout the study. The usability of bronchoscopic deployment and implantation was evaluated using a user questionnaire. The movement and migration of the Alpha DaRTs were assessed. Necropsy was performed, and lungs were evaluated via gross pathology and histopathology. Results A total of 158 Alpha DaRTs were inserted successfully in the lung parenchyma and mediastinum of five swine in two phases. It was possible to deliver and place the Alpha DaRTs in clusters of no more than 4 mm distance between the Alpha DaRTs. No adverse event or change in the health and general condition of animals was observed. Hematologic evaluation did not show any clinically significant abnormality related to the Alpha DaRTs. Histopathology demonstrated local mild inflammatory changes, minimal fibrosis, and dystrophic mineralization with giant cells. Minimal movement and no migration of Alpha DaRTs were observed. Conclusions Bronchoscopic deployment of Alpha DaRTs in the lung parenchyma and mediastinum of the porcine animal is feasible, precise, and safe.
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Affiliation(s)
- Ali Sadoughi
- Department of Medicine, Division of Pulmonology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Abhishek Sarkar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Carol Novotney
- Center for Animal Resources and Education (C.A.R.E.), Montefiore Medical Center, Bronx, NY, USA
| | - Christine Chan
- Department of Medicine, Division of Pulmonology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gerardo Moreno
- Center for Animal Resources and Education (C.A.R.E.), Montefiore Medical Center, Bronx, NY, USA
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Yang Y, Ma J, Peng Z, Zhou X, Du N, Zhang W, Yan Z. Pneumothorax and pulmonary hemorrhage after C-arm cone-beam computed tomography-guided percutaneous transthoracic lung biopsy: incidence, clinical significance, and correlation. BMC Pulm Med 2024; 24:33. [PMID: 38218792 PMCID: PMC10787482 DOI: 10.1186/s12890-023-02822-9] [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: 06/25/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE This study aimed to assess the incidence and clinical significance of pneumothorax (PTX) and pulmonary hemorrhage (PH) after percutaneous transthoracic lung biopsy (PTLB) guided by C-arm cone-beam computed tomography (CBCT). Furthermore, this study aimed to examine the relationships between PTX and PH with demographics, clinical characteristics, imaging, and PTLB parameters. METHODS A retrospective analysis was conducted on 192 patients who underwent PTLB at our hospital between January 2019 and October 2022. Incidences of PTX and PH were recorded. PTX was considered clinically significant if treated with chest tube insertion (CTI), and PH if treated with bronchoscopes or endovascular treatments. The various factors on PTX and PH were analyzed using the Chi-squared test and Student t-test. Logistic regression analyses were then used to determine these factors on the correlation to develop PTX and PH. RESULTS PTX occurred in 67/192 cases (34.9%); CTI was required in 5/67 (7.5%). PH occurred in 63/192 cases (32.8%) and none of these cases required bronchoscopes or endovascular treatments. Lesion diameter (ORPTX = 0.822; ORPH = 0.785), presence of pulmonary emphysema (ORPH = 2.148), the number of samples (ORPH = 1.834), the use of gelfoam (ORPTX = 0.474; ORPH = 0.341) and ablation (ORPTX = 2.351; ORPH = 3.443) showed statistically significant correlation to PTX and PH. CONCLUSIONS CBCT-guided PTLB is a safe and effective method for performing lung biopsies. The use of gelfoam has been shown to reduce the occurrence of PTX and PH. However, caution should be exercised when combining radiofrequency ablation with PTLB, as it may increase the risk of PTX and PH.
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Affiliation(s)
- Yanjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhijie Peng
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Nan Du
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
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Park B, Lim JK, Shin KM, Hong J, Cha JG, Cho SH, Park SY, Ryeom HK, Kim SH, Seo AN, Cha SI, Lee J, Lee H, Park J. Clinical Role of Upfront F-18 FDG PET/CT in Determining Biopsy Sites for Lung Cancer Diagnosis. Diagnostics (Basel) 2024; 14:153. [PMID: 38248030 PMCID: PMC10813933 DOI: 10.3390/diagnostics14020153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE This study aimed to investigate the impact of FDG PET/CT timing for biopsy site selection in patients with stage IV lung cancer regarding complications and diagnostic yield. METHODS This retrospective analysis was performed on 1297 patients (924 men and 373 women with a mean age of 71.4 ± 10.2 years) who underwent percutaneous needle biopsy (PNB) for stage IV lung cancer diagnosis in two hospitals. Data collected included the patient's characteristics, order date of the biopsy and PET/CT exams, biopsy target site (lung or non-lung), guidance modality, complications, sample adequacy, and diagnostic success. Based on the order date of the PNB and PET/CT exams, patients were categorized into upfront and delayed PET/CT groups. RESULTS PNB for non-lung targets resulted in significantly lower rates of minor (8.1% vs. 16.2%), major (0.2% vs. 3.4%), and overall complications (8.3% vs. 19.6%) compared to PNB for lung targets (p < 0.001 for all types of complications). Compared to the delayed PET/CT group, the upfront PET/CT group exhibited a lower probability of lung target selection of PNB (53.9% vs. 67.1%, p < 0.001), including a reduced incidence of major complications (1.0% vs. 2.9%, p = 0.031). Moreover, there was no significant difference in the occurrence of minor and total complications between the two groups. Upfront PET/CT and delayed PET/CT groups showed no significant difference regarding sample adequacy and diagnostic success. CONCLUSIONS Upfront PET/CT may have an impact on the selection of the biopsy site for patients with advanced lung cancer, which could result in a lower rate of major complications with no change in the diagnostic yield. Upfront PET/CT demonstrates potential clinical implications for enhancing the safety of lung cancer diagnosis in clinical practice.
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Affiliation(s)
- Byunggeon Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Kyung Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seo Young Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hoseok Lee
- Department of Radiology, Semyung Radiology Clinic, Gumi 39254, Gyeongsangbuk-do, Republic of Korea
| | - Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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Ierardi AM, Ascenti V, Lanza C, Carriero S, Amato G, Pellegrino G, Giurazza F, Torcia P, Carrafiello G. Is it a complication or a consequence - a new perspective on adverse outcomes in Interventional Radiology. CVIR Endovasc 2024; 7:6. [PMID: 38180623 PMCID: PMC10769947 DOI: 10.1186/s42155-023-00417-3] [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: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
The aim of the article is to introduce a new term in post-procedural events related to the procedure itself. All the Societies and Councils report these events as complications and they are divided in mild, moderate and severe or immediate and delayed.On the other hand the term error is known as the application of a wrong plan, or strategy to achieve a goal.For the first time, we are trying to introduce the term "consequence"; assuming that the procedure is the only available and the best fit to clinical indication, a consequence should be seen as an expected and unavoidable occurrence of an "adverse event" despite correct technical execution.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Serena Carriero
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Gaetano Amato
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | | | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Pierluca Torcia
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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Chen JY, Yang H, Lin XD, Yang H, Wen J, Liu QW, Zhang LJ, Lin P, Fu JH, Leng CS, Yi R, Luo KJ. Diagnostic yield using electromagnetic navigation bronchoscopy for peripheral pulmonary nodules <2 cm. Ther Adv Respir Dis 2024; 18:17534666241249150. [PMID: 38757612 PMCID: PMC11102688 DOI: 10.1177/17534666241249150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Although electromagnetic navigation bronchoscopy (ENB) is highly sensitive in the diagnosis of peripheral pulmonary nodules (PPNs), its diagnostic yield for subgroups of smaller PPNs is under evaluation. OBJECTIVES Diagnostic yield evaluation of biopsy using ENB for PPNs <2 cm. DESIGN The diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value of the ENB-mediated biopsy for PPNs were evaluated. METHODS Patients who had PPNs with diameters <2 cm and underwent ENB-mediated biopsy between May 2015 and February 2020 were consecutively enrolled. The final diagnosis was made via pathological examination after surgery. RESULTS A total of 82 lesions from 65 patients were analyzed. The median tumor size was 11 mm. All lesions were subjected to ENB-mediated biopsy, of which 29 and 53 were classified as malignant and benign, respectively. Subsequent segmentectomy, lobectomy, or wedge resection, following pathological examinations were performed on 64 nodules from 57 patients. The overall sensitivity, specificity, positive predictive value, and negative predictive value for nodules <2 cm were 53.3%, 91.7%, 92.3%, and 51.2%, respectively. The receiver operating curve showed an area under the curve of 0.721 (p < 0.001). Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value were 62.5%, 100%, 100%, and 42.9%, respectively, for nodules with diameters equal to or larger than 1 cm; and 30.8%, 86.7%, 66.7%, and 59.1%, respectively, for nodules less than 1 cm. In the subgroup analysis, neither the lobar location nor the distance of the PPNs to the pleura affected the accuracy of the ENB diagnosis. However, the spiculated sign had a negative impact on the accuracy of the ENB biopsy (p = 0.010). CONCLUSION ENB has good specificity and positive predictive value for diagnosing PPNs <2 cm; however, the spiculated sign may negatively affect ENB diagnostic accuracy. In addition, the diagnostic reliability may only be limited to PPNs equal to or larger than 1 cm.
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Affiliation(s)
- Jun-Ying Chen
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Han Yang
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Dan Lin
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hong Yang
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Wen
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qian-Wen Liu
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lan-Jun Zhang
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Peng Lin
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jian-Hua Fu
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chang-Sen Leng
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong Yi
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Kong-Jia Luo
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, 651 East Dongfeng Rd, Guangzhou 510060, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Chung C, Kim Y, Lee JE, Kang DH, Park D. Diagnostic Value of Transbronchial Lung Cryobiopsy Using an Ultrathin Cryoprobe and Guide Sheath for Peripheral Pulmonary Lesions. J Bronchology Interv Pulmonol 2024; 31:13-22. [PMID: 36991530 PMCID: PMC10763711 DOI: 10.1097/lbr.0000000000000917] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The addition of cryobiopsy to conventional biopsy methods improves the diagnostic yield of peripheral pulmonary lesions. Moreover, cryobiopsy with a guide sheath (GS) provides additional diagnostic benefits. Semi-real-time biopsy can be repeatedly performed using conventional biopsy devices and a GS, and subsequent cryobiopsy can be easily performed at the same location. Recently, a disposable 1.1 mm-diameter ultrathin cryoprobe has been developed and can be used with a 1.95 mm GS in a 2.0 mm working channel. In this study, we evaluated the diagnostic performance of transbronchial lung cryobiopsy (TBLC) with the 1.1 mm cryoprobe and a GS in patients with peripheral pulmonary lesions. METHODS We retrospectively reviewed the medical records of patients who underwent endobronchial ultrasound transbronchial lung biopsy with a guide sheath and TBLC from July 23, 2021 to April 30, 2022 at Chungnam National University Hospital. RESULTS Of a consecutive series of 229 patients, 199 were included. The diagnostic yields of forceps biopsy and cryobiopsy were 65.3% (130/199) and 84.4% (168/199), respectively, and the total diagnostic yield was 91.5% (182/199) ( P <0.001 vs. forceps biopsy). Multivariate analysis showed that solid lesion morphology [adjusted odds ratio (OR) 3.659, P =0.002] was associated with a significantly greater diagnostic yield of cryobiopsy, whereas a lesion diameter >20 mm ( P =0.026; adjusted OR 3.816) and 'within' orientation ( P =0.004; adjusted OR 6.174) were associated with a significantly greater overall diagnostic yield. CONCLUSION TBLC using an ultrathin cryoprobe and GS markedly improves the diagnostic yield.
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48
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Pyarali FF, Hakami-Majd N, Sabbahi W, Chaux G. Robotic-assisted Navigation Bronchoscopy: A Meta-Analysis of Diagnostic Yield and Complications. J Bronchology Interv Pulmonol 2024; 31:70-81. [PMID: 37700435 DOI: 10.1097/lbr.0000000000000942] [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: 02/10/2023] [Accepted: 07/03/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Robotic-assisted navigation bronchoscopy (RANB) is a novel method to biopsy lung nodules, with initial reports demonstrating excellent accuracy. We aimed to evaluate pooled estimates of diagnostic yields and complication rates with RANB by performing a meta-analysis of the available literature. METHODS We searched 3 databases, including PubMed, EmBase, and Web of Science. The resulting abstracts were reviewed by 2 investigators. Analyses were performed using random effects models, and diagnostic yield and complication rates were estimated after the Freeman-Tukey transformation. RESULTS A total of 23 articles, comprising 1409 patients and 1541 nodules, were included in the final analysis. Mean ages ranged from 63.2 to 69.3 years. The average size of the nodules ranged between 5.9 and 25.0 mm. Most patients (54.0% to 92.0%) had a current or prior smoking history in studies that reported them (n=8). The pooled diagnostic yield was 81.9% (12 studies, 838 nodules, 95% CI: 83.4%-91.0%), and the pooled sensitivity for malignancy was 87.6% (8 studies, 699 nodules, 95% CI: 81.3%-89.5%). The pooled incidence of pneumothorax rates was 0.60% (95% CI: 0.11%-1.35%). The pooled incidence of major bleeding was <0.01%. CONCLUSION Diagnostic yield for patients with pulmonary nodules undergoing RANB is high, though may be impacted by the prevalence of malignancy, participant selection, and publication bias. Complication rates, including pneumothoraces and bleeding rates, appear low across all studies. If RANB is available, clinicians should consider utilizing this platform to biopsy pulmonary nodules.
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Affiliation(s)
- Fahim F Pyarali
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Niv Hakami-Majd
- Division of Pulmonary and Critical Care, Cedars Sinai Medical Center, Los Angeles, CA
| | - Wesam Sabbahi
- Division of Pulmonary and Critical Care, Cedars Sinai Medical Center, Los Angeles, CA
| | - George Chaux
- Division of Pulmonary and Critical Care, Cedars Sinai Medical Center, Los Angeles, CA
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Harter J, Buth E, Johaenning J, Battke F, Kopp M, Zelba H, Schulze M, Koedding J, Biskup S. Analytical Performance Evaluation of a 523-Gene Circulating Tumor DNA Assay for Next-Generation Sequencing-Based Comprehensive Tumor Profiling in Liquid Biopsy Samples. J Mol Diagn 2024; 26:61-72. [PMID: 37865292 DOI: 10.1016/j.jmoldx.2023.10.001] [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: 07/14/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/23/2023] Open
Abstract
Next-generation sequencing (NGS)-based comprehensive tumor profiling from liquid biopsy samples can significantly improve diagnosis and monitoring of tumors when high-quality tissue material is difficult to obtain. In addition, it offers the potential to capture the entire complexity of the tumor, which is particularly important for highly heterogeneous or metastatic tumors. Here, we report the findings of an analytical performance evaluation of the TruSight Oncology 500 circulating tumor DNA (ctDNA) assay, a 523-gene NGS panel developed for ctDNA-based comprehensive genomic profiling of tumors, using reference and patient samples. Using 30 ng cell-free DNA, the assay showed high sensitivity and low variant detection variability for single-nucleotide variants, insertions and deletions, and fusions down to a variant allele frequency (VAF) of 0.5% in the reference samples and VAFs that were highly concordant with previous digital droplet PCR results in the patient samples. At reduced input amounts (20, 15, and 5 ng) and below VAFs of 0.5%, sensitivity was considerably lower and variant detection variability increased. Covering 523 tumor-associated genes, the assay demonstrated a convincing performance comparable to NGS-based ctDNA assays with smaller gene panels, highlighting its value to screen large numbers of different genes.
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Affiliation(s)
| | | | | | | | | | - Henning Zelba
- Center for Human Genetics Tuebingen, Tuebingen, Germany
| | | | | | - Saskia Biskup
- CeGaT GmbH, Tuebingen, Germany; Center for Human Genetics Tuebingen, Tuebingen, Germany
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50
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Yu Lee-Mateus A, Sawal N, Hartley C, Edell E, Vierkant RA, Reisenauer J. Efficacy of Robotic Bronchoscopy for Molecular Marker Analysis in Primary Lung Cancer. Clin Lung Cancer 2024; 25:e11-e17. [PMID: 37932179 DOI: 10.1016/j.cllc.2023.10.003] [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: 07/04/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Molecular testing has become a more frequent necessity in NSCLC management. Using next-generation sequencing, multiple targets for therapy can be identified with small amounts of nuclear material. The authors evaluated the performance of robotic-assisted bronchoscopy in acquiring tissue that meets pre-analytic criteria for PD-L1 immunohistochemistry and/or next-generation sequencing. MATERIALS AND METHODS Patients with a diagnosis of primary lung cancer identified through robotic bronchoscopy were retrospectively reviewed. Pathology reports were assessed for results of molecular testing and detection of programmed death-ligand 1 (PD-L1). An independent pathologist evaluated each specimen type (smears, cell block, tissue biopsy, and/or touch prep) to determine whether each tissue type would meet pre-analytic criteria for attempting next-generation sequencing and/or PD-L1 immunohistochemistry. RESULTS Seventy-eight patients with primary lung were reviewed. By independent pathologic assessment of cytological smears, cell block, biopsy, and/or touch preparations, 72% of samples were found to be adequate for molecular and PD-L1 testing. Preanalytic adequacy (%) for next-generation sequencing (NGS) and PD-L1 staining was determined based on specimen type: cytological smear 48.6% for NGS; cell block 14.3% for NGS and 32.9% for PD-L1; biopsy 29.2% for NGS and 62.5% for PD-L1; and touch prep 61.4% for NGS. CONCLUSION Robotic-assisted bronchoscopy yielded samples that met preanalytic criteria for molecular testing in 72% of cases. These results support the use of robotic-assisted bronchoscopy for both the diagnosis and molecular testing of early-stage lung cancer.
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Affiliation(s)
| | - Naina Sawal
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Eric Edell
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Janani Reisenauer
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN.
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