Computed tomography-guided lung biopsy: a randomized controlled trial of low-dose versus standard-dose protocol

A lung biopsy path planning algorithm based on the double spherical constraint Pareto and indicators' importance-correlation degree

Lung cancer has the highest mortality rate among cancers. The commonly used clinical method for diagnosing lung cancer is the CT-guided percutaneous transthoracic lung biopsy (CT-PTLB), but this method requires a high level of clinical experience from doctors. In this work, an automatic path planning method for CT-PTLB is proposed to provide doctors with auxiliary advice on puncture paths. The proposed method comprises three steps: preprocessing, initial path selection, and path evaluation. During preprocessing, the chest organs required for subsequent path planning are segmented. During the initial path selection, a target point selection method for selecting biopsy samples according to biopsy sampling requirements is proposed, which includes a down-sampling algorithm suitable for different nodule shapes. Entry points are selected according to the selected target points and clinical constraints. During the path evaluation, the clinical needs of lung biopsy surgery are first quantified as path evaluation indicators and then divided according to their evaluation perspective into risk and execution indicators. Then, considering the impact of the correlation between indicators, a path scoring system based on the double spherical constraint Pareto and the importance-correlation degree of the indicators is proposed to evaluate the comprehensive performance of the planned paths. The proposed method is retrospectively tested on 6 CT images and prospectively tested on 25 CT images. The experimental results indicate that the method proposed in this work can be used to plan feasible puncture paths for different cases and can serve as an auxiliary tool for lung biopsy surgery.

A systematic review and meta-analysis of randomized controlled trials comparing low-dose versus standard-dose computed tomography-guided lung biopsy

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.

Optimizing lung biopsy procedures:Comparative analysis of diagnostic efficacy and safety in experimental low-dose, conventional low-dose, and standard-dose CT-guided approaches

PURPOSE

Lung cancer is a major cause of cancer-related deaths, emphasizing the importance of early diagnosis. CT-guided percutaneous lung biopsy(CT-PLB) is a valuable method for diagnosing lung lesions, but multiple scans can elevate radiation exposure. This study aims to compare diagnostic efficacy and safety across different CT-PLB protocols.

METHODS

273 consecutive patients who underwent CT-PLB between June 2018 and February 2021 were enrolled, and were divided into standard-dose, conventional low-dose, and experimental low-dose groups. The study mainly evaluated technical success, diagnostic efficacy, radiation dose, complications, and image quality.

RESULTS

93 patients were assigned to standard-dose group, 85 to conventional low-dose group, and 95 to experimental low-dose group. Technical success rates in these groups were 97.9%, 100%, and 97.9%, respectively. Procedure-related complications rates were similar across the groups(pneumothorax:p=0.71, hemorrhage:p=0.59). Sensitivity, specificity, and overall diagnostic accuracy were comparable among three groups(p=0.59,1.0,0.65), with respective values of 90.5%, 100%, and 93.2% in standard-dose group, 88.1%, 100%, and 90.5% in conventional low-dose group, and 91.9%, 100%, and 93.4% in experimental low-dose group. The effective dose (ED) in the experimental low-dose group was significantly lower compared to both the standard-dose and conventional low-dose CT-PLB groups[ED: 1.49(1.0∼1.97) mSv vs 5.42(3.92∼6.91) mSv vs 3.15(2.52∼4.22) mSv, p<0.001].

CONCLUSIONS

This study has developed a standardized six-step procedure for CT-PLB using experimental low-dose settings. It can achieve comparable diagnostic efficacy to conventional low-dose and standard-dose CT-PLB protocols while substantially reducing radiation exposure. These findings indicate that the experimental low-dose protocol could serve as a safe and effective alternative for CT-PLB.

Patient Dose Estimation in Computed Tomography-Guided Biopsy Procedures

This study establishes typical Diagnostic Reference Levels (DRL) values and assesses patient doses in computed tomography (CT)-guided biopsy procedures. The Effective Dose (ED), Entrance Skin Dose (ESD), and Size-Specific Dose Estimate (SSDE) were calculated using the relevant literature-derived conversion factors. A retrospective analysis of 226 CT-guided biopsies across five categories (Iliac bone, liver, lung, mediastinum, and para-aortic lymph nodes) was conducted. Typical DRL values were computed as median distributions, following guidelines from the International Commission on Radiological Protection (ICRP) Publication 135. DRLs for helical mode CT acquisitions were set at 9.7 mGy for Iliac bone, 8.9 mGy for liver, 8.8 mGy for lung, 7.9 mGy for mediastinal mass, and 9 mGy for para-aortic lymph nodes biopsies. In contrast, DRLs for biopsy acquisitions were 7.3 mGy, 7.7 mGy, 5.6 mGy, 5.6 mGy, and 7.4 mGy, respectively. Median SSDE values varied from 7.6 mGy to 10 mGy for biopsy acquisitions and from 11.3 mGy to 12.6 mGy for helical scans. Median ED values ranged from 1.6 mSv to 5.7 mSv for biopsy scans and from 3.9 mSv to 9.3 mSv for helical scans. The study highlights the significance of using DRLs for optimizing CT-guided biopsy procedures, revealing notable variations in radiation exposure between helical scans covering entire anatomical regions and localized biopsy acquisitions.

Comparison between percutaneous transthoracic co-axial needle CT-guided biopsy and transbronchial lung biopsy for the diagnosis of persistent pulmonary consolidation

BACKGROUND

Diagnosing persistent pulmonary consolidation still faces challenges. The purpose of this study is to compare the diagnostic yield and the complication rate between percutaneous transthoracic CT-guided coaxial needle biopsy (PTCNB) and transbronchial lung biopsy (TBLB) of persistent pulmonary consolidation.

MATERIALS

From January 1, 2016, to December 31, 2020, we have retrospectively enrolled a total of 155 consecutive patients (95 males, 60 females) with persistent pulmonary consolidation who underwent both TBLB and PTCNB. According to the standard reference, the diagnostic yield, accuracy, sensitivity and specificity of PTCNB and TBLB were assessed and compared.

RESULTS

According to the standard reference, the final biopsy diagnoses of 11 cases were confirmed true malignant based on the surgical resections, the remaining were confirmed by clinical and imaging follow-up for at least 12 months. The overall diagnostic accuracy, sensitivity and specificity of PTCNB for malignant diagnosis were 91.61%, 72.34% and 100%, whereas of TBLB were 87.74%, 59.57% and 100%. The diagnostic yield of PTCNB and TBLB were 50.32% and 25.16%, respectively. For the TBLB-based negative cases, PTCNB provided a definite diagnostic yield of 37.93%. There were 45 (29.03%), 22 (14.19%) and 13 (8.39%) patients who experienced pneumothorax, intrapulmonary hemorrhage and hemoptysis, respectively, in PTCNB, while there were only 5 (3.22%) cases of mild intraprocedural bleeding occurring in TBLB.

CONCLUSIONS

CT-guided co-axial needle biopsy is an effective and safe modality, associated with higher diagnostic yield and better diagnostic accuracy compared to transbronchial lung biopsy for malignancy presenting as persistent consolidation, especially as the complementary method for TBLB-based negative lung lesions.

KEY POINTS

Both PTCNB and TBLB showed high diagnostic accuracy for malignancy. PTCNB had a higher diagnostic yield than TBLB for persistent pulmonary consolidation. PTCNB could provide a complementary diagnosis for TBLB-based negative lung consolidation.

Computed tomography-guided lung biopsy with rapid on-site evaluation for diagnosis of lung lesions: a meta-analysis

BACKGROUND

Lung biopsy (LB) procedures performed with computed tomography (CT guidance can enable the reliable diagnosis of lung lesions. These diagnostic efforts can be further expedited through a rapid on-site evaluation (ROSE) approach, allowing for the rapid assessment of collected tissue samples to gauge the adequacy of these samples, their features, and associated cytomorphological characteristics. The present analysis was developed to examine the safety and efficacy of CT-guided LB with ROSE as a means of diagnosing lung lesions.

METHODS

Studies published as of July 31, 2022 in the PubMed, Embase, and Wanfang databases were identified for this meta-analysis. Diagnostic accuracy was the primary endpoint, while secondary endpoints included the operative duration, the number of punctures, and rates of lung hemorrhage, pneumothorax, and secondary LB.

RESULTS

This meta-analysis included 6 total studies. Relative to CT alone, CT with ROSE was associated with a significant increase in diagnostic accuracy (P < 0.00001). In contrast, there were no significant differences between these two groups with respect to the operative duration (P = 0.86), the number of punctures (P = 0.60), or the rates of pneumothorax (P = 0.82) or lung hemorrhage (P = 0.81). Pooled secondary LB rates were significantly lower for patients that underwent CT with ROSE relative to patients in the CT only group (P = 0.0008). Significant heterogeneity was detected for the operative duration (I² = 94%) and number of punctures (I² = 98%) endpoints, while no publication bias was detected for any study endpoints.

CONCLUSIONS

These results suggest that ROSE may contribute to significant improvements in the diagnostic accuracy of CT-guided LB without contributing to higher rates of complications.

Low-dose versus standard-dose computed tomography-guided biopsy for pulmonary nodules: a randomized controlled trial

BACKGROUND

To assess relative safety and diagnostic performance of low- and standard-dose computed tomography (CT)-guided biopsy for pulmonary nodules (PNs).

MATERIALS AND METHODS

This was a single-center prospective randomized controlled trial (RCT). From June 2020 to December 2020, consecutive patients with PNs were randomly assigned into low- or standard-dose groups. The primary outcome was diagnosis accuracy. The secondary outcomes included technical success, diagnostic yield, operation time, radiation dose, and biopsy-related complications. This RCT was registered on 3 January 2020 and listed within ClinicalTrials.gov (NCT04217655).

RESULTS

Two hundred patients were randomly assigned to low-dose (n = 100) and standard-dose (n = 100) groups. All patients achieved the technical success of CT-guided biopsy and definite final diagnoses. No significant difference was found in operation time (n = 0.231) between the two groups. The mean dose-length product was markedly reduced within the low-dose group compared to the standard-dose group (31.5 vs. 333.5 mGy-cm, P < 0.001). The diagnostic yield, sensitivity, specificity, and accuracy of the low-dose group were 68%, 91.5%, 100%, and 94%, respectively. The diagnostic yield, sensitivity, specificity, and accuracy were 65%, 88.6%, 100%, and 92% in the standard-dose group. There was no significant difference observed in diagnostic yield (P = 0.653), diagnostic accuracy (P = 0.579), rates of pneumothorax (P = 0.836), and lung hemorrhage (P = 0.744) between the two groups.

CONCLUSIONS

Compared with standard-dose CT-guided biopsy for PNs, low-dose CT can significantly reduce the radiation dose, while yielding comparable safety and diagnostic accuracy.

An ultra-low-dose protocol for computed tomography-guided lung radiofrequency ablations

To evaluate the safety and efficacy of ultra-low-dose (ULD) protocol for computed tomography (CT)-guided lung radiofrequency ablation (RFA). Patients who had undergone lung RFA between November 2017 and January 2021 were consecutively and retrospectively included. Thirty patients were treated using a conventional standard protocol (SP), including helical acquisitions with mA automatic adjustment and sequential CT at 80 kVp; and 31, with a ULD protocol defined with helical acquisitions with fixed mA and sequential series at 100 kVp. These parameters were selected from those used for a diagnostic lung low-dose CT scanner. Patient characteristics, dose indicators, technical efficacy (minimal margin [MM], recurrence during follow-up), and complications (pneumothorax, alveolar haemorrhage, and haemoptysis) were recorded. We included 61 patients (median age, 65 [54-73] and 33 women), with no significant differences according to the type of protocol, except for the type of anaesthesia. Even if the number of helical acquisitions did not significantly change, all dose indicators significantly decreased by 1.5-fold-3-fold. The median dose-length-product and effective dose, with their ranges, respectively, were 465 mGy cm (315-554) and 6.5 mSv (4.4-7.8) in the SP group versus 178 mGy cm (154-267) and 2.5 mSv (2.2-3.7) in the ULD group, (p< 001). The ULD group exhibited lower intraoperator variability and better interoperator alignment than those of the SP group. The MM was not significantly different between the two groups (4.6 mm versus 5 mm,p= 16). One local recurrence was observed in each group at 8 months in the SP and at one year in the ULD group (p= 1). The complication rates did not differ significantly. Implementing an ULD protocol during lung RFA may provide similar efficacy, a reduction of dose indicators, and intra- and interoperator variability, without increasing complication rates, compared to those associated with an SP.

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

AIM

To determine whether the injection of haemocoagulase into the biopsy tract can reduce pneumothorax and pulmonary haemorrhage after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB).

MATERIALS AND METHODS

A retrospective study was performed involving patients with undiagnosed pulmonary lesions scheduled for PTLB between January 2020 and March 2021. Patients were assigned to the haemocoagulase group or the non-haemocoagulase group. After CT-guided biopsies were performed with a 17 G coaxial system, patients in the haemocoagulase group received a haemocoagulase injection (0.2-0.5 units) in the biopsy tract as the sheath was withdrawn. Postoperative image studies were performed to evaluate complications, including pneumothorax and pulmonary haemorrhage. Factors, including the patient's position, lesion location, and pathological results, were evaluated to determine their associations with the complications.

RESULTS

A total of 100 patients were included, with 44 men and a mean age of 53 years old. The overall incidences of pneumothorax and pulmonary haemorrhage were 15% and 13%, respectively. The incidences of pneumothorax and pulmonary haemorrhage were statistically significantly lower in the haemocoagulase group (8% and 6%, respectively) than in the non-haemocoagulase group (22% and 20%, respectively; p=0.04 and 0.03, respectively). There was no statistically significant difference in haemoptysis between the haemocoagulase (6%) and non-haemocoagulase (2%) groups (p=0.23). There were also no statistically significant associations of pneumothorax or pulmonary haemorrhage with the patients' positions, lesion location, or pathological results.

CONCLUSION

Biopsy tract haemocoagulase injection reduced the incidences of postoperative pneumothorax and pulmonary haemorrhage after PTLB.

Low-dose CT with tin filter combined with iterative metal artefact reduction for guiding lung biopsy

Background

Computed tomography (CT) is currently the imaging modality of choice for guiding pulmonary percutaneous procedures. The use of a tin filter allows low-energy photons to be absorbed which contribute little to image quality but increases the radiation dose that a patient receives. Iterative metal artefact reduction (iMAR) was developed to diminish metal artefacts. This study investigated the impact of using tin filtration combined with an iMAR algorithm on dose reduction and image quality in CT-guided lung biopsy.

Methods

Ninety-nine consecutive patients undergoing CT-guided lung biopsy were randomly assigned to routine-dose CT protocols (groups A and B; without and with iMAR, respectively) or tin filter CT protocols (groups C and D; without or with iMAR, respectively). Subjective image quality was analysed using a 5-point Likert scale. Objective image quality was assessed, and the noise, contrast-to-noise ratio, and figure of merit were compared among the four groups. Metal artefacts were quantified using CT number reduction and metal diameter blurring. The radiation doses, diagnostic performance, and complication rates were also estimated.

Results

The subjective image quality of the two scan types was compared. Images with iMAR reconstruction were superior to those without iMAR reconstruction (group A: 3.49±0.65 vs. group B: 4.63±0.57; P<0.001, and group C: 3.88±0.66 vs. group D: 4.82±0.39; P<0.001). Images taken with a tin filter were found to have a significantly higher figure-of-merit than those taken without a tin filter (group A: 14,041±7,230 vs. group C: 21,866±10,656; P=0.001, and group B: 13,836±6,849 vs. group D: 21,639±9,964; P=0.001). In terms of metal artefact reduction, tin filtration combined with iMAR showed the lowest CT number reduction (116.62±103.48 HU) and metal diameter blurring (0.85±0.30) among the protocols. The effective radiation dose in the tin filter groups was 73.2% lower than that in the routine-dose groups. The complication rate and diagnostic performance (sensitivity, specificity, and overall accuracy) did not differ significantly between the tin filter and routine-dose groups (all P>0.05).

Conclusions

Tin filtration combined with an iMAR algorithm may reduce the radiation dose compared to the routine-dose CT protocol, while maintaining comparable diagnostic accuracy and image quality and producing fewer metal artefacts.

The use of carcinoembryonic antigen levels to predict lung nodule malignancy: a meta-analysis

OBJECTIVES

To assess the diagnostic value of serum carcinoembryonic antigen (CEA) as a diagnostic biomarker that can be used to differentiate between benign and malignant lung nodules (LNs).

METHODS

PubMed, Cochrane Library, and Embase were reviewed from January 2000 to April 2020 for eligible studies. Stata v12.0 was used to conduct this meta-analysis.

RESULTS

Our initial literature search identified 511 potentially relevant studies, of which 11 were ultimately included in the present meta-analysis. Ten studies were retrospective and only 1 study was prospective. Overall these studies incorporated 2760 patients and 2760 total LNs (1733 malignant, 1027 benign). Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) values for these studies were 0.33 (95% CI: 0.20-0.49), 0.92 (95% CI: 0.85-0.96), 3.96 (95% CI: 2.84-5.54), 0.73 (95% CI: 0.62-0.87), and 5.42 (95% CI: 3.77-7.78), respectively. The area under curve (AUC) value was 0.77, consistent with moderate diagnostic accuracy. We detected significant heterogeneity when calculating pooled sensitivity (I² = 95.9%, P = 0.00), specificity (I² = 92.0%, P = 0.00), PLR (I² = 61.7%, P = 0.00), NLR (I² = 92.8%, P = 0.00), and DOR (I² = 93.8%, P = 0.00). No significant evidence of publication bias was detected via Deeks' funnel plot asymmetry test (P = 0.371). Meta-regression analysis revealed different reference standards to be closely associated with both sensitivity and specificity.

CONCLUSIONS

Serum CEA can achieve moderate diagnostic performance as a means of differentiating between malignant and benign LNs.

[Clinical efficacy of ct-guided transthoracic needle biopsy of peripheral lung lesions]

OBJECTIVE

To evaluate the effectiveness of a step-by-step protocol for GT-guided transthoracic biopsy in verification of peripheral lung tumors.

MATERIAL AND METHODS

A retrospective analysis of the results of GT-guided transthoracic biopsies of focal lung neoplasms was performed between October 2019 and December 2020. The analysis included the results of 176 biopsies in 158 patients.

RESULTS

Primary biopsy was informative in 139 (87.97%) out of 158 patients. There were 155 (88.07%) informative and 21 (11.93%) non-informative biopsies. Lung adenocarcinoma was diagnosed in 41 (25.95%) patients, squamous cell carcinoma in 35 (22.15%) patients, and small cell carcinoma in 9 (5.7%) patients. There were 17 (10.76%) patients with uninformative biopsy results. Sensitivity, specificity and accuracy were 86%, 95.5%, and 87.8%, respectively. PPV was 98.9%, NPV - 58.3%. Various complications occurred after 65 (36.93%) out of 176 biopsies (95% CI 30.15-44.27). Pneumothorax followed by pleural drainage was detected after 8 (4.55%) biopsies.

CONCLUSION

Accuracy of a step-by-step protocol for transthoracic biopsy was 88% that is not inferior to similar results in large-scale studies devoted to specialized navigation systems.

Value of low-dose and optimized-length computed tomography (CT) scan in CT-guided percutaneous transthoracic needle biopsy of pulmonary nodules

Objective

To investigate the value of application of low-dose and optimized length CT scan on puncture results, complications and patients’ radiation dosage during CT-guided percutaneous biopsy of pulmonary nodules (PTNB).

Methods

A total of 231 patients with PTNB under CT guidance were collected. Low dose scanning utilized tube current of 20 mA as compared with 40 mA in conventional dosage. Optimized length in CT is defined as intentionally narrowing the range of CT scanning just to cover 25 mm (5 layers) around the target layer during needle adjustment. According to whether low-dose scans and optimized length scans techniques were utilized, patients were divided into three groups: conventional group (conventional sequence + no optimization), optimized length group (conventional sequence + optimized length), and low-dose optimized length group (low dose sequence + optimized length). The ED (effective dose), the DLP (dose length product), the average CTDIvol (Volume CT dose index), total milliampere second between subgroups were compared.

Results

Compared with the conventional group, ED, intraoperative guidance DLP, total milliseconds and operation time in the optimized length group were reduced by 18.2% (P=0.01), 37% (P=0.003), 17.5% (P=0.013) and 13.3% (P=0.021) respectively. Compared with the optimized length group, the ED was reduced by 87%, preoperative positioning, intraoperative guidance and postoperative review DLP were also reduced by 88%, total milliampere second was reduced by 79%, with an average CTDIvol was reduced by 86%, in the low-dose optimized length group (P<0.001 for all).

Conclusion

Optimizing the length during CT scanning can effectively reduce the intraoperative radiation dose and reduce the operation time compared with conventional plan; low-dose and optimized length CT scan can further reduce the total radiation dose compared with optimized length group with no differences on intraoperative complications, biopsy results and operation time.

Calcification sign for prediction of benignity in pulmonary nodules: A meta-analysis

BACKGROUND

The calcification sign assessed by computed tomography appears to be a potential marker for benignities among patients diagnosed with pulmonary nodules (PNs). The following meta-analysis has been purposefully designed to figure-out the diagnostic value of the calcification signature as a way of identifying benignities from PNs.

METHODS

Cochrane Library, Embase and PubMed were considered as a reference to obtain the required data from January 2000 until October 2020. Stata v12.0 was used as a standard tool for statistical assessment.

RESULTS

Eleven retrospective studies were assessed via this meta-analysis, which included 6136 PNs (1827 benign and 4309 malignant). The pooled diagnostic odd ratios, positive likelihood ratio (PLR), negative likelihood ratio (NLR), sensitivity and specificity were 6.79, 6.06, 0.89, 13% and 98%, respectively. The value obtained for the area under the curve was 0.65, showing moderate overall diagnostic accuracy. A significant heterogeneity was found while calculating the pooled sensitivity (I²  = 85.5%), specificity (I²  = 75.0%), PLR (I²  = 59.0%), NLR (I²  = 79.5%) and DOR (I²  = 100.0%) in the current analysis. Sub-group analyses presented better PLR and specificity values for the study with a sample size ≥ 400. Deeks' funnel plot asymmetry test detected no potential evidence of significant publication bias (p = 0.091).

CONCLUSIONS

Calcification signs have been identified as moderate regulators corresponding to overall diagnostic performance (via marking a distinct differentiation between malignant and benign) for PNs. However, the manifestation of the calcification sign had a good directive property for benign PNs.

Clinical-radiological predictive model in differential diagnosis of small (≤ 20 mm) solitary pulmonary nodules

BACKGROUND

There is a lack of clinical-radiological predictive models for the small (≤ 20 mm) solitary pulmonary nodules (SPNs). We aim to establish a clinical-radiological predictive model for differentiating malignant and benign small SPNs.

MATERIALS AND METHODS

Between January 2013 and December 2018, a retrospective cohort of 250 patients with small SPNs was used to construct the predictive model. A second retrospective cohort of 101 patients treated between January 2019 and December 2020 was used to independently test the model. The model was also compared to two other models that had previously been identified.

RESULTS

In the training group, 250 patients with small SPNs including 156 (62.4%) malignant SPNs and 94 (37.6%) benign SPNs patients were included. Multivariate logistic regression analysis indicated that older age, pleural retraction sign, CT bronchus sign, and higher CEA level were the risk factors of malignant small SPNs. The predictive model was established as: X = - 10.111 + [0.129 × age (y)] + [1.214 × pleural retraction sign (present = 1; no present = 0)] + [0.985 × CT bronchus sign (present = 1; no present = 0)] + [0.21 × CEA level (ug/L)]. Our model had a significantly higher region under the receiver operating characteristic (ROC) curve (0.870; 50% CI: 0.828-0.913) than the other two models.

CONCLUSIONS

We established and validated a predictive model for estimating the pre-test probability of malignant small SPNs, that can help physicians to choose and interpret the outcomes of subsequent diagnostic tests.

Computed tomography-guided core needle biopsy for lung nodules: low-dose versus standard-dose protocols

Introduction

Computed tomography (CT)-guided core needle biopsy (CNB) is an essential step in the management of lung nodules (LNs). Low-dose CT (LDCT)-guided CNB has been used to decrease the radiation exposure.

Aim

To evaluate the technical success, safety, diagnostic capacity, and radiation exposure to patients between LDCT-guided and standard-dose CT (SDCT)-guided CNB for LNs.

Material and methods

This is a retrospective, single-centre study. Patients who underwent LDCT-guided or SDCT-guided CNB for LNs from January 2015 to December 2017 were included. Data on technical success, diagnostic performance, complications, and radiation exposure were collected and analysed.

Results

A total of 70 and 65 patients underwent LDCT-guided and SDCT-guided CNB procedure, respectively. The technical success rates were 100% in both groups. The diagnostic yield, sensitivity, specificity, and overall diagnostic accuracy in the LDCT and SDCT groups were 71.4% and 67.7% (p = 0.637), 97.8% and 93.2% (p = 0.625), 100%, and 100%, and 98.6% and 95.4% (p = 0.560), respectively. The independent risk factor of diagnostic failure was less sample tissues (p = 0.012; 95% confidence interval: 0.033–0.651). Pneumothorax was found in 9 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.369). Lung haemorrhage was found in 11 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.671). The mean dose-length product was 38.3 ±17.0 mGy · cm and 376.0 ±118.7 mGy · cm in the LDCT and SDCT groups, respectively (p < 0.001).

Conclusions

Compared to SDCT, LDCT-guided CNB can provide comparable safety and diagnostic performance for LNs while reducing exposure to radiation.

Cutting Staff Radiation Exposure and Improving Freedom of Motion during CT Interventions: Comparison of a Novel Workflow Utilizing a Radiation Protection Cabin versus Two Conventional Workflows

This study aimed to evaluate the radiation exposure to the radiologist and the procedure time of prospectively matched CT interventions implementing three different workflows—the radiologist—(I) leaving the CT room during scanning; (II) wearing a lead apron and staying in the CT room; (III) staying in the CT room in a prototype radiation protection cabin without lead apron while utilizing a wireless remote control and a tablet. We prospectively evaluated the radiologist’s radiation exposure utilizing an electronic personal dosimeter, the intervention time, and success in CT interventions matched to the three different workflows. We compared the interventional success, the patient’s dose of the interventional scans in each workflow (total mAs and total DLP), the radiologist’s personal dose (in µSV), and interventional time. To perform workflow III, a prototype of a radiation protection cabin, with 3 mm lead equivalent walls and a foot switch to operate the doors, was built in the CT examination room. Radiation exposure during the maximum tube output at 120 kV was measured by the local admission officials inside the cabin at the same level as in the technician’s control room (below 0.5 μSv/h and 1 mSv/y). Further, to utilize the full potential of this novel workflow, a sterile packed remote control (to move the CT table and to trigger the radiation) and a sterile packed tablet anchored on the CT table (to plan and navigate during the CT intervention) were operated by the radiologist. There were 18 interventions performed in workflow I, 16 in workflow II, and 27 in workflow III. There were no significant differences in the intervention time (workflow I: 23 min ± 12, workflow II: 20 min ± 8, and workflow III: 21 min ± 10, p = 0.71) and the patient’s dose (total DLP, p = 0.14). However, the personal dosimeter registered 0.17 ± 0.22 µSv for workflow II, while I and III both documented 0 µSv, displaying significant difference (p < 0.001). All workflows were performed completely and successfully in all cases. The new workflow has the potential to reduce interventional CT radiologists’ radiation dose to zero while relieving them from working in a lead apron all day.

Propensity-score-matching analysis to compare efficacy and safety between 16-gauge and 18-gauge needle in ultrasound-guided biopsy for peripheral pulmonary lesions

Background

Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications.

Materials and methods

In total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC.

Results

The overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05).

Conclusion

Higher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.

Trans-scapular approach coil localization for scapular-blocked pulmonary nodules: a retrospective study

BACKGROUND

Preoperative computed tomography (CT)-guided coil localization (CL) is commonly used to facilitate video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) of pulmonary nodules (PNs). When a scapular-blocked PN (SBPN) is localized, the trans-scapular CL (TSCL) is commonly performed. In this study, we investigated the safety, feasibility, and clinical efficacy of preoperative CT-guided TSCL for SBPNs.

MATERIALS AND METHODS

From January 2014 to September 2020, a total of 152 patients with PNs underwent CT-guided CL prior to VATS-guided WR. Of these patients, 14 had SBPNs and underwent the TSCL procedure.

RESULTS

A total of 14 SBPNs were localized in the 14 patients. The mean diameter of the 14 SBPNs was 7.4 ± 2.4 mm. The technical success rate of the scapula puncture was 100%. No complications occurred near the scapula. The technical success rate of CL was 92.9%. One coil dropped off when performing the VATS procedure. The mean duration of the TSCL was 14.2 ± 2.7 min. Two patients (14.3%) developed asymptomatic pneumothorax after TSCL. The technical success rate of VATS-guided WR was 92.9%. The patient who experienced technical failure of TSCL directly underwent lobectomy. The mean duration of the VATS was 90.0 ± 42.4 min and the mean blood loss was 62.9 ± 37.2 ml. The final diagnoses of the 14 SBPNs included invasive adenocarcinoma (n = 4), adenocarcinoma in situ (n = 9), and benign disease (n = 1).

CONCLUSIONS

Preoperative CT-guided TSCL is a safe and simple procedure that can facilitate high success rates of VATS-guided WR of SBPNs.

Computed tomography-guided cutting needle biopsy for lung nodules: A comparative study between low-dose and standard dose protocols

We aim to compare the diagnostic accuracy, safety, and radiation exposure between low-dose and standard-dose computed tomography (CT)-guided cutting needle biopsy (CNB) for lung nodules.From January 2016 to August 2017, all consecutive patients admitted with lung nodule underwent low-dose or standard-dose CT-guided CNB procedure in our center. Diagnostic accuracy and radiation dose were compared.A total of 67 and 69 patients who underwent low-dose and standard-dose CT-guided CNB procedure were included in this study. Each patient underwent CT-guided CNB for 1 nodule. The technical success rates were 100% in both groups. The sensitivity, specificity, and overall diagnostic accuracy were 97.7%, 100%, and 98.5% for low-dose group and 91.5%, 100%, and 94.2% for standard-dose group. There was no significant difference in diagnostic accuracy (P = .380) between 2 groups. Pneumothorax was found in 8 and 15 patients in the low-dose and standard-dose groups, respectively (11.9% vs 21.7%, P = .127). Hemoptysis was found in 10 and 10 patients in the low-dose and standard-dose groups, respectively (14.9% vs 14.5%, P = .943). The mean dose-length product was 38.2 ± 17.2 mGy-cm and 375.3 ± 115.7 mGy-cm in the low-dose and standard-dose groups (P < .001). The mean dose-length product was 38.2 ± 17.2 mGy-cm and 375.3 ± 115.7 mGy-cm in the low-dose and standard-dose groups, respectively (P < .001). The mean effective dose was 0.5 ± 0.2 mSv and 5.3 ± 1.6 mSv in the low-dose and standard-dose groups, respectively (P < .001).Low-dose CT-guided CNB of lung nodules significantly decreased radiation dose compared with standard-dose CT. The low-dose protocol could provide similar diagnostic accuracy and safety as standard-dose CT-guided CNB for lung nodules.

Endobronchial ultrasound-guided versus computed tomography-guided biopsy for peripheral pulmonary lesions: A meta-analysis

BACKGROUND

Both endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) and computed tomography-guided transthoracic needle biopsy (CT-TTNB) are approaches commonly utilized to diagnose peripheral pulmonary lesions (PPLs). The present meta-analysis was, therefore, designed to provide more reliable evidence regarding the relative advantages of these two approaches to PPL diagnosis in order to guide clinical decision making.

METHODS

The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published as of May 2020. Endpoint data pertaining to technical success rates, diagnostic accuracy, and complication rates were then extracted from these studies. Meta-analyses were conducted using RevMan v5.3.

RESULTS

We identified nine total relevant studies for inclusion in the present meta-analysis, incorporating 2025 total patients (2035 total procedures) that underwent EBUS-TBB (n = 994) or CT-TTNB (n = 1041) for the purposes of PPL diagnosis. Rates of technical success were comparable between these two groups (odds ratio [OR]: 0.16; P = 0.21). However, CT-TTNB was associated with higher diagnostic yield (OR: 0.23; P < 0.00001), greater accuracy (OR: 0.43; P = 0.002), and higher rates of complications (OR: 7.27; P < 0.00001) than was EBUS-TBB. Subgroup analyses revealed that CT-TTNB was associated with better diagnostic yield and accuracy when analyzing small lesions and lesions that were proximal to the pleura. Significant heterogeneity among studies was detected with respect to both technical success rates and diagnostic yield, but there was no evidence of publication bias.

CONCLUSIONS

When diagnosing PPLs, CT-TTNB is associated with higher diagnostic yield and accuracy but with poorer safety outcomes than EBUS-TBB.

Computed Tomography Fluoroscopy-Guided Versus Conventional Computed Tomography-Guided Lung Biopsy: A Systematic Review and Meta-analysis

PURPOSE

This study aimed to compare the feasibility, safety, diagnostic accuracy, and radiation dose between computed tomography (CT) fluoroscopy (CTF)-guided and conventional CT (CCT)-guided lung biopsy.

METHODS

Relevant articles up until February 2020 were identified within the PubMed, Embase, and Cochrane Library databases. Diagnostic accuracy rate, pneumothorax, and pneumothorax requiring chest tube served as primary end points, with technical success, hemoptysis, operative time, and radiation dose serving as secondary end points. Pooled odds ratios (ORs) were calculated for the dichotomous variables. Pooled estimates of the mean difference (MD) were measured for the continuous variables.

RESULTS

This meta-analysis included 9 studies. Seven studies were retrospective, and 2 studies were randomized controlled trials. A total of 6998 patients underwent either CTF-guided (n = 3858) or CCT-guided (n = 3154) lung biopsy. The diagnostic accuracy rate was significantly higher in the CTF group compared with the CCT group (OR, 0.32; P < 0.00001). No significant differences were detected between the CTF and CCT groups in terms of incidence rates of pneumothorax (OR, 0.95; P = 0.84), rates of pneumothorax requiring chest tube insertion (OR, 0.95; P = 0.84), technical success rates (OR, 0.41; P = 0.15), incidence rates of hemoptysis (OR, 1.19; P = 0.61), operative time (MD, -4.38; P = 0.24), and radiation dose (MD, 158.60; P = 0.42). A publication bias was found for the end points of pneumothorax requiring chest tube insertion and operative time.

CONCLUSIONS

Compared with CCT-guided lung biopsy, CTF-guided lung biopsy could yield a higher diagnostic accuracy with similar safety and radiation exposure.