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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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Zhang L, Shao Y, Chen G, Tian S, Zhang Q, Wu J, Bai C, Yang D. An artificial intelligence-assisted diagnostic system for the prediction of benignity and malignancy of pulmonary nodules and its practical value for patients with different clinical characteristics. Front Med (Lausanne) 2023; 10:1286433. [PMID: 38196835 PMCID: PMC10774219 DOI: 10.3389/fmed.2023.1286433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
Objectives This study aimed to explore the value of an artificial intelligence (AI)-assisted diagnostic system in the prediction of pulmonary nodules. Methods The AI system was able to make predictions of benign or malignant nodules. 260 cases of solitary pulmonary nodules (SPNs) were divided into 173 malignant cases and 87 benign cases based on the surgical pathological diagnosis. A stratified data analysis was applied to compare the diagnostic effectiveness of the AI system to distinguish between the subgroups with different clinical characteristics. Results The accuracy of AI system in judging benignity and malignancy of the nodules was 75.77% (p < 0.05). We created an ROC curve by calculating the true positive rate (TPR) and the false positive rate (FPR) at different threshold values, and the AUC was 0.755. Results of the stratified analysis were as follows. (1) By nodule position: the AUC was 0.677, 0.758, 0.744, 0.982, and 0.725, respectively, for the nodules in the left upper lobe, left lower lobe, right upper lobe, right middle lobe, and right lower lobe. (2) By nodule size: the AUC was 0.778, 0.771, and 0.686, respectively, for the nodules measuring 5-10, 10-20, and 20-30 mm in diameter. (3) The predictive accuracy was higher for the subsolid pulmonary nodules than for the solid ones (80.54 vs. 66.67%). Conclusion The AI system can be applied to assist in the prediction of benign and malignant pulmonary nodules. It can provide a valuable reference, especially for the diagnosis of subsolid nodules and small nodules measuring 5-10 mm in diameter.
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Affiliation(s)
- Lichuan Zhang
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yue Shao
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Guangmei Chen
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Simiao Tian
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Qing Zhang
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jianlin Wu
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Shanghai Respiratory Research Institution, Shanghai, China
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Shanghai Respiratory Research Institution, Shanghai, China
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Predictors of Invasiveness in Adenocarcinoma of Lung with Lepidic Growth Pattern. Med Sci (Basel) 2022; 10:medsci10030034. [PMID: 35893116 PMCID: PMC9326548 DOI: 10.3390/medsci10030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Lung adenocarcinoma with lepidic growth pattern (LPA) is characterized by tumor cell proliferation along intact alveolar walls, and further classified as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive lepidic predominant adenocarcinoma (iLPA). Accurate diagnosis of lepidic lesions is critical for appropriate prognostication and management as five-year survival in patients with iLPA is lower than in those with AIS and MIA. We aimed to evaluate the accuracy of CT-guided core needle lung biopsy classifying LPA lesions and identify clinical and radiologic predictors of invasive disease in biopsied lesions. Thirty-four cases of adenocarcinoma with non-invasive lepidic growth pattern on core biopsy pathology that subsequently were resected between 2011 and 2018 were identified. Invasive LPA vs. non-invasive LPA (AIS or MIA) was defined based on explant pathology. Histopathology of core biopsy and resected tumor specimens was compared for concordance, and clinical, radiologic and pathologic variables were analyzed to assess for correlation with invasive disease. The majority of explanted tumors (70.6%) revealed invasive disease. Asian race (p = 0.03), history of extrathoracic malignancy (p = 0.02) and absence of smoking history (p = 0.03) were associated with invasive disease. CT-measured tumor size was not associated with invasiveness (p = 0.15). CT appearance of density (p = 0.61), shape (p = 0.78), and margin (p = 0.24) did not demonstrate a significant difference between the two subgroups. Invasiveness of tumors with lepidic growth patterns can be underestimated on transthoracic core needle biopsies. Asian race, absence of smoking, and history of extrathoracic malignancy were associated with invasive disease.
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Li Y, Yang F, Huang YY, Cao W. Comparison between computed tomography-guided core and fine needle lung biopsy: A meta-analysis. Medicine (Baltimore) 2022; 101:e29016. [PMID: 35244081 PMCID: PMC8896491 DOI: 10.1097/md.0000000000029016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to compare the safety and diagnostic performance between computed tomography (CT)-guided core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in lung nodules/masses patients. METHODS All relevant studies in the Pubmed, Embase, and Cochrane Library databases that were published as of June 2020 were identified. RevMan version 5.3 was used for all data analyses. RESULTS In total, 9 relevant studies were included in the present meta-analysis. These studies were all retrospective and analyzed outcomes associated with 2175 procedures, including both CT-guided CNB (n = 819) and FNAB (n = 1356) procedures. CNB was associated with significantly higher sample adequacy rates than was FNAB (95.7% vs 85.8%, OR: 0.26; P < .00001), while diagnostic accuracy rates did not differ between these groups (90.1% vs 87.6%, OR: 0.8; P = .46). In addition, no differences in rates of pneumothorax (28.6% vs 23.0%, OR: 1.15; P = .71), hemorrhage (17.3% vs 20.1%, OR: 0.91; P = .62), and chest tube insertion (5.9% vs 4.9%, OR: 1.01; P = .97) were detected between these groups. Significant heterogeneity among included studies was detected for the diagnostic accuracy (I2 = 57%) and pneumothorax (I2 = 77%) endpoints. There were no significant differences between CNB and FNAB with respect to diagnostic accuracy rates for lung nodules (P = .90). In addition, we detected no evidence of significant publication bias. CONCLUSIONS CT-guided CNB could achieve better sample adequacy than FNAB did during the lung biopsy procedure. However, the CNB did not show any superiorities in items of diagnostic accuracy and safety.
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Affiliation(s)
- Yong Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fang Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ya-Yong Huang
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China
| | - Wei Cao
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China
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Verhoeven RLJ, Vos S, van der Heijden EHFM. Multi-modal tissue sampling in cone beam CT guided navigation bronchoscopy: comparative accuracy of different sampling tools and rapid on-site evaluation of cytopathology. J Thorac Dis 2021; 13:4396-4406. [PMID: 34422366 PMCID: PMC8339773 DOI: 10.21037/jtd-21-518] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/23/2021] [Indexed: 12/26/2022]
Abstract
Background Advanced technological aids are frequently used to improve outcome of transbronchial diagnostics for peripheral pulmonary lesions. Even when lesion access has been confirmed by 3D imaging, obtaining an accurate tissue sample however remains difficult. In this single institution study, we evaluate the comparative accuracy of different sampling methodologies and the accuracy of rapid on-site evaluation of cytopathology (ROSE) in navigation bronchoscopy cases where imaging has confirmed the catheter to have accurately accessed the lesion. Methods All consecutive navigation bronchoscopies in between December 2017– June 2020 performed in a room with a cone beam CT (CBCT) system where catheter position was intra-procedurally confirmed to be within or adjacent to the lesion by cone beam CT and augmented fluoroscopy were included. Individual tool outcomes were compared against one another and follow-up outcome. Results A mean of 11.39 samples using 2.93 tools were obtained in 225 lesions (median diameter 15 mm, 195 patients). A correct diagnosis was most often obtained by forceps (accuracy 70.6%), followed by 1.1 mm cryoprobe (68.4%), needle aspiration (46.7%), 1.9 mm cryoprobe (41.2%), brush (30.3%) and lavage (23.7%). Procedural outcome corresponded to follow-up outcome in 75.1% of lesions (80.5% of patients). Accurately diagnosed lesions were sampled significantly more often (11.91 vs. 9.72 samples, P=0.014). In cases where procedural outcome proved malignant, ROSE had also detected this in 47.5%. Conclusions Of all clinically available biopsy tools, the forceps showed most often accurate. However, extensive multi-modal sampling resulted in highest diagnostic accuracy. A hypothetical multi-modal approach of only using forceps and needle aspiration provided eventual diagnostic outcome in 91.7% of successfully diagnosed lesions. In the circumstances of our study, confirmation of malignancy on ROSE did not reduce number of biopsies taken nor biopsy time. Future research on how to improve the accuracy and effectivity of tissue sampling is needed.
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Affiliation(s)
- Roel L J Verhoeven
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shoko Vos
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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Dziedzic R, Marjański T, Rzyman W. A narrative review of invasive diagnostics and treatment of early lung cancer. Transl Lung Cancer Res 2021; 10:1110-1123. [PMID: 33718049 PMCID: PMC7947400 DOI: 10.21037/tlcr-20-728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The diagnosis and treatment of early-stage lung cancer remains a clinical challenge. The broadening implementation of lung cancer screening has resulted in positive findings in numerous patients that are mostly non-malignant. Many other patients have indeterminate nodules that are difficult to assess through simple observation. The critical interpretation of such screening results remains a challenge for radiologists and multidisciplinary teams involved in screening for lung cancer. The evaluation and diagnosis of each participant suspected for malignancy should be based on the basic clinical principles such as a carefully collected medical history, physical examination, and detailed analysis of all imaging tests performed. Indeed, the decision to go ahead with more invasive diagnostics requires consideration of the both the risks and benefits, with reflection upon the complete clinical and radiological picture. Although transthoracic needle aspiration biopsy remains the first-choice method of diagnosis, several newer technologies have slowly begun to emerge as potential replacements. The guiding strategy for method selection is to choose the least harmful approach that offers the most relevant potential insights. Transthoracic biopsy is an effective method that allows the collection of cytological and tissue material from small, peripheral tumors, but it carries a moderate risk of complications. Bronchofiberoscopy, especially in combination with electromagnetic navigation, fluoroscopy or radial EBUS, also allows effective diagnosis of the peripheral pulmonary nodules. One of the most important diagnostic methods is the EBUS examination, which allows determining of staging in addition to diagnosis. Anatomical lung lobe resection and lymphadenectomy or sampling of the hilar and mediastinal lymph nodes is currently the treatment of choice for patients with stage I and II non-small cell lung cancer (NSCLC), but sublobar resections are recommended when a patient has limited pulmonary function or other significant comorbidities. Notably, several studies have highlighted the potential utility of more limited resections in small malignant lesions less than 2cm in diameter, with pure AIS histology, when more than 50% of the diameter of pulmonary nodule has ground-glass opacity (GGO) attenuation on CT, or long volume doubling time (VDT). Videothoracoscopy is the preferred surgical approach for resection of early-stage lung cancer. Patients who are not candidates for surgery or do not agree to surgery can be offered radical radiotherapy. Stereotactic body radiation therapy (SBRT) is a type of radical radiotherapy with proven effectiveness, a high rate of local control and an acceptable risk of the development of later complications. Future trials are expected to define the role of SBRT in the treatment of early lung cancer in healthy subjects.
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Affiliation(s)
- Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Marjański
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
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Azour L, Ko JP, Naidich DP, Moore WH. Shades of Gray: Subsolid Nodule Considerations and Management. Chest 2020; 159:2072-2089. [PMID: 33031828 PMCID: PMC7534873 DOI: 10.1016/j.chest.2020.09.252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022] Open
Abstract
Subsolid nodules are common on chest CT imaging and may be either benign or malignant. Their varied features and broad differential diagnoses present management challenges. Although subsolid nodules often represent lung adenocarcinomas, other possibilities are common and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review highlights the similarities and differences among these algorithms, with the intent of providing a resource for comparison and aid in choosing management options.
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Affiliation(s)
- Lea Azour
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY.
| | - Jane P Ko
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
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Computed Tomography Fluoroscopy-Guided Versus Conventional Computed Tomography-Guided Lung Biopsy: A Systematic Review and Meta-analysis. J Comput Assist Tomogr 2020; 44:571-577. [PMID: 32558768 DOI: 10.1097/rct.0000000000001044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
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.
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Pagnini F, Cervi E, Maestroni U, Agostini A, Borgheresi A, Piacentino F, Angileri SA, Ierardi AM, Floridi C, Carbone M, Ziglioli F, De Filippo M. Imaging guided percutaneous renal biopsy: do it or not? ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:81-88. [PMID: 32945282 PMCID: PMC7944675 DOI: 10.23750/abm.v91i8-s.9990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 01/03/2023]
Abstract
Since its first reported application, renal biopsy became an important part of the diagnostic algorithm, considered advantages and risks, to better manage therapeutic options. The biopsy can be performed with different techniques (open, laparoscopic, transjugular, transurethral and percutaneous). Currently, the percutaneous approach is the modality of choice. Percutaneous biopsy can be performed under CT or US guidance, but critical benefits and disadvantages have to be considered. Core needle biopsy is usually preferred to fine-needle aspiration because of the sample quality, usually obtaining multiple cores, especially in heterogeneous tumors. Principal complications are hematuria (1-10%), perinephric hematoma (10-90%), pneumothorax (0,6%), clinically significant pain (1,2%).
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Affiliation(s)
- Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Parma, Italy.
| | - Eleonora Cervi
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Parma, Italy.
| | - Umberto Maestroni
- Department of Urology, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy.
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Ancona, Italy.
| | - Alessandra Borgheresi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Ancona, Italy.
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Salvatore Alessio Angileri
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Ancona, Italy.
| | - Mattia Carbone
- Department of Radiology, San Giovanni E Ruggi D'Aragona Hospital, Salerno, Italy.
| | - Francesco Ziglioli
- Department of Urology, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy.
| | - Massimo De Filippo
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Parma, Italy.
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Saba L, Saba F, Fellini F. CT-guided biopsy of subdiaphragmatic small renal nodule with the coaxial technique using MPR images. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:426-431. [PMID: 31910166 PMCID: PMC7233787 DOI: 10.23750/abm.v90i4.7479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/06/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To demonstrate the advantages of CT-guided biopsy of subdiaphragmatic small renal nodule with the coaxial technique using MPR images. METHODS The study included retrospectively 12 patients who underwent CT-guided biopsy with 18 G needle of subdiaphragmatic small renal nodule (<15 mm) suspected. Histology reports have been the reference standard. RESULTS The histology was diagnostic in 12 biopsies (100%): out of 10 neoplastic nodule (83.3%), 8 were malignant (80%) and 2 were benign (20%); 2 out of 12 were non-neoplastic (16.6%). No procedural complications were observed (0%). CONCLUSIONS By using MPR images there is an effective improvement during coaxial CT-guided biopsy of subdiaphragmatic small renal nodule difficult to reach and to reduce the complication as pneumothorax. (www.actabiomedica.it).
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Affiliation(s)
- Luca Saba
- Goupe ELSAN: Clinique du Cap-d'Or 1361 Avenue des Anciens Combattants Français d'Indochine, 83500 La Seyne-sur-Mer.
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Chae KJ, Hong H, Yoon SH, Hahn S, Jin GY, Park CM, Goo JM. Non-diagnostic Results of Percutaneous Transthoracic Needle Biopsy: A Meta-analysis. Sci Rep 2019; 9:12428. [PMID: 31455841 PMCID: PMC6711972 DOI: 10.1038/s41598-019-48805-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/12/2019] [Indexed: 02/06/2023] Open
Abstract
Non-diagnostic results can affect the diagnostic performance of percutaneous transthoracic needle biopsy (PTNB) but have not been critically meta-analyzed yet. To meta-analyze the incidence and malignancy rate of non-diagnostic results, 3-by-2 table approaches rather than the conventional 2-by-2 approaches are needed to know its impact on the diagnostic performance of PTNB. A systematic literature search identified studies evaluating the diagnostic performance of PTNB with extractable outcomes. A total of 143 studies with 35,059 biopsies were included. The pooled incidence of non-diagnostic results was 6.8% (95% CI, 6.0-7.6%; I2 = 0.91). The pooled malignancy rate of non-diagnostic results was 59.3% (95% CI, 51.7-66.8%; I2 = 0.80), and was correlated with the prevalence of malignancy (correlation coefficient, 0.66; 95% CI, 0.42-0.91). Pooled percentage decrease of sensitivity and specificity due to non-diagnostic results were 4.5% (95% CI, 3.2-5.7%; I2 = 0.64) and 10.7% (95% CI, 7.7-13.7%; I2 = 0.70), respectively, and the pooled incidence of non-diagnostic results was 4.4% (95% CI, 3.2-5.8%; I2 = 0.83) in lesions ultimately diagnosed as malignancies and 10.4% (95% CI, 7.5-13.8%; I2 = 0.74) in benign disease. In conclusion, non-diagnostic results averagely occurred in 6.8% of PTNB and more than half of the results were malignancies. The non-diagnostic results decreased specificity and sensitivity by 10.7% and 4.5%, respectively, demanding efforts to minimize the non-diagnostic results in PTNB.
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Affiliation(s)
- Kum Ju Chae
- Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Seokyung Hahn
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gong Yong Jin
- Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Zhou Y, Gong G, Wang H, Habibabady ZA, Lang P, Hales R, Askin F, Gabrielson E, Li QK. Transthoracic fine-needle aspiration diagnosis of solid, subsolid, and partially calcified lung nodules: A retrospective study from a single academic center. Cytojournal 2019; 16:16. [PMID: 31516538 PMCID: PMC6712899 DOI: 10.4103/cytojournal.cytojournal_43_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background: The large-scale National Lung Cancer Screening Trial demonstrated an increased detection of early-stage lung cancers using low-dose computed tomography scan in the screening population. It also demonstrated a 20% reduction of lung cancer-related deaths in these patients. Aims: Although both solid and subsolid lung nodules are evaluated in studies, subsolid and partially calcified lung nodules are often overlooked. Materials and Methods: We reviewed transthoracic fine-needle aspiration (FNA) cases from lung nodule patients in our clinics and correlated cytological diagnoses with radiologic characteristics of lesions. A computer search of the pathology archive was performed over a period of 12 months for transthoracic FNAs, including both CT- and ultrasound-guided biopsies. Results: A total of 111 lung nodule cases were identified. Lesions were divided into three categories: solid, subsolid, and partially calcified nodules according to radiographic findings. Of 111 cases, the average sizes of the solid (84 cases), subsolid (22 cases), and calcified (5 cases) lesions were 1.952 ± 2.225, 1.333 ± 1.827, and 1.152 ± 1.984 cm, respectively. The cytological diagnoses of three groups were compared. A diagnosis of malignancy was made in 64.28% (54 cases) in solid, 22.72% (5 cases) in subsolid, and 20% (1 case) in partially calcified nodules. Among benign lesions, eight granulomatous inflammations were identified, including one case of solid, five cases of subsolid, and two cases of calcified nodules. Conclusions: Our study indicates that solid nodules have the highest risk of malignancy. Furthermore, the cytological evaluation of subsolid and partially calcified nodules is crucial for the accurate diagnosis and appropriate clinical management of lung nodule patients.
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Affiliation(s)
- Yangying Zhou
- Address: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Gary Gong
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Haiyan Wang
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Peggy Lang
- Department of Oncology, Sidney Kimmel Cancer Center at Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Russell Hales
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Frederic Askin
- Address: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, Sidney Kimmel Cancer Center at Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ed Gabrielson
- Address: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, Sidney Kimmel Cancer Center at Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Qing Kay Li
- Address: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, Sidney Kimmel Cancer Center at Johns Hopkins Medical Institutions, Baltimore, MD, USA
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13
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Accuracy and complications of CT-guided pulmonary core biopsy in small nodules: a single-center experience. Cancer Imaging 2019; 19:51. [PMID: 31337425 PMCID: PMC6651998 DOI: 10.1186/s40644-019-0240-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/16/2019] [Indexed: 01/05/2023] Open
Abstract
Background Computed tomography (CT)-guided pulmonary core biopsies of small pulmonary nodules less than 15 millimeters (mm) are challenging for radiologists, and their diagnostic accuracy has been shown to be variable in previous studies. Common complications after the procedure include pneumothorax and pulmonary hemorrhage. The present study compared the diagnostic accuracy of small and large lesions using CT-guided core biopsies and identified the risk factors associated with post-procedure complications. Methods Between January 1, 2016, and December 31, 2017, 198 CT-guided core biopsies performed on 195 patients at our institution were retrospectively enrolled. The lesions were separated into group A (< or = 15 mm) and group B (> 15 mm) according to the longest diameter of the target lesions on CT. Seventeen-gauge introducer needles and 18-gauge automated biopsy instruments were coaxially used for the biopsy procedures. The accuracy and complications, including pneumothorax and pulmonary hemorrhage, of the procedures of each group were recorded. The risk factors for pneumothorax and pulmonary hemorrhage were determined using univariate analysis of variables. Results The diagnostic accuracies of group A (n = 43) and group B (n = 155) were 83.7 % and 96.8 %, respectively (p = 0.005). The risk factors associated with post-biopsy pneumothorax were longer needle path length from the pleura to the lesion (p = 0.020), lesion location in lower lobes (p = 0.002), and patients with obstructive lung function tests (p = 0.034). The risk factors associated with post-biopsy pulmonary hemorrhage were longer needle path length from the pleura to the lesion (p < 0.001), smaller lesions (p < 0.001), non-pleural contact lesions (p < 0.001), patients without restrictive lung function tests (p = 0.034), and patients in supine positions (p < 0.003). Conclusion CT-guided biopsies of small nodules equal to or less than 15 mm using 17-gauge guiding needles and 18-gauge biopsy guns were accurate and safe. The biopsy results of small lesions were less accurate than those of large lesions, but the results were a reliable reference for clinical decision-making. Understanding the risk factors associated with the complications of CT-guided biopsies is necessary for pre-procedural planning and communication.
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14
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Kiranantawat N, McDermott S, Petranovic M, Mino-Kenudson M, Muniappan A, Sharma A, Shepard JAO, Digumarthy SR. Determining malignancy in CT guided fine needle aspirate biopsy of subsolid lung nodules: Is core biopsy necessary? Eur J Radiol Open 2019; 6:175-181. [PMID: 31080850 PMCID: PMC6502735 DOI: 10.1016/j.ejro.2019.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To assess the success of determining malignancy in subsolid lung nodules by fine needle aspirate of CT-guided transthoracic needle biopsy. Material and method This IRB approved retrospective study analyzed CTguided transthoracic needle biopsy of 86 consecutive subsolid nodules (size 25 + 14 mm; Age 71 + 10 years: M: F, 27:59), with ground glass opacity of = 50% in 64 (74%) and size < 2 cm in 38 (44%). Fine needle aspirate was performed in all and additional core biopsy in 21 (24%). The biopsy results were correlated with resected surgical pathology in 59 (69%) and by long term clinical and imaging follow-up in 27 (31%). The statistical analysis was performed by Fischer exact test to determine the success rate in < 2cm and =2cm nodules and those with <50% and =50% ground glass opacity. Results The technical success of performing the biopsy was 94.7%. The sensitivity for making a diagnosis of malignancy in small and large subsolid nodules was 88.6 and 95.6% (p=>0.05), with a specificity 100% in both groups. Core biopsy altered the diagnosis only in 1/21 (4.8%). The nondiagnostic biopsy rate was 18 and 11% for lesions with =50% and <50% ground glass opacity (p=>0.05). The incidence of pneumothorax was 21%, none requiring chest tube, and mild hemoptysis in 8%. Conclusion CT-guided transthoracic needle biopsy of both small and large subsolid nodules is highly sensitive and very specific for making the diagnosis of malignancy with a low rate of complications. Additional core biopsy offered no significant advantage over fine needle aspirate biopsy alone.
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Affiliation(s)
- Nantaka Kiranantawat
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Milena Petranovic
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Ashok Muniappan
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Jo-Anne O Shepard
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
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15
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McNulty W, Baldwin D. Management of pulmonary nodules. BJR Open 2019; 1:20180051. [PMID: 33178935 PMCID: PMC7592490 DOI: 10.1259/bjro.20180051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/05/2022] Open
Abstract
Pulmonary nodules are frequently detected during clinical practice and require a structured approach in their management in order to identify early lung cancers and avoid harm from over investigation. The article reviews the 2015 British Thoracic Society guidelines for the management of pulmonary nodules and the evidence behind them.
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Affiliation(s)
- William McNulty
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - David Baldwin
- Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham, England
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16
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Loverdos K, Fotiadis A, Kontogianni C, Iliopoulou M, Gaga M. Lung nodules: A comprehensive review on current approach and management. Ann Thorac Med 2019; 14:226-238. [PMID: 31620206 PMCID: PMC6784443 DOI: 10.4103/atm.atm_110_19] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In daily clinical practice, radiologists and pulmonologists are faced with incidental radiographic findings of pulmonary nodules. Deciding how to manage these findings is very important as many of them may be benign and require no further action, but others may represent early disease and importantly early-stage lung cancer and require prompt diagnosis and definitive treatment. As the diagnosis of pulmonary nodules includes invasive procedures which can be relatively minimal, such as bronchoscopy or transthoracic aspiration or biopsy, but also more invasive procedures such as thoracic surgical biopsies, and as these procedures are linked to anxiety and to cost, it is important to have clearly defined algorithms for the description, management, and follow-up of these nodules. Clear algorithms for the imaging protocols and the management of positive findings should also exist in lung cancer screening programs, which are already established in the USA and which will hopefully be established worldwide. This article reviews current knowledge on nodule definition, diagnostic evaluation, and management based on literature data and mainly recent guidelines.
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Affiliation(s)
| | - Andreas Fotiadis
- 7th Respiratory Medicine Department, Athens Chest Hospital, Athens, Greece
| | | | | | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital, Athens, Greece
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17
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Braggio C, Bocchialini G, Ventura L, Carbognani P, Rusca M, Ampollini L. Linezolid-induced black hairy tongue. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:408-410. [PMID: 30333468 PMCID: PMC6502130 DOI: 10.23750/abm.v89i3.7060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 02/08/2023]
Abstract
Black hairy tongue (BHT) is a self-limiting disorder characterized by abnormal hypertrophy and elongation of filiform papillae on the surface of the tongue. The exact mechanism of drug-induced BHT is unknown. Several factors have been implicated and included smoking or chewing tobacco, drinking alcohol, poor oral hygiene and antibiotics such as tetracyclines and penicillins. We report a quite uncommon case of Linezolid-induced BHT in a patient with a long-lasting history of chest wall infection.
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Affiliation(s)
- Cesare Braggio
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma.
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18
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Clinical Impact of Radioguided Localization in the Treatment of Solitary Pulmonary Nodule. Clin Nucl Med 2018; 43:317-322. [DOI: 10.1097/rlu.0000000000001997] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Cao Y, Xu H. A new predictive scoring system based on clinical data and computed tomography features for diagnosing EGFR-mutated lung adenocarcinoma. ACTA ACUST UNITED AC 2018; 25:e132-e138. [PMID: 29719437 DOI: 10.3747/co.25.3805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background We aimed to develop a new EGFR mutation-predictive scoring system to use in screening for EGFR-mutated lung adenocarcinomas (lacs). Methods The study enrolled 279 patients with lac, including 121 patients with EGFR wild-type tumours and 158 with EGFR-mutated tumours. The Student t-test, chi-square test, or Fisher exact test was applied to discriminate clinical and computed tomography (ct) features between the two groups. Using a principal component analysis (pca) model, we derived predictive coefficients for the presence of EGFR mutation in lac. Results The EGFR mutation-predictive score includes sex, smoking history, homogeneity, ground-glass opacity (ggo) on imaging, and the presence of pericardial effusion. The pca predictive model took this form: [Formula: see text]Model scores ranged from 79 to 147. The area under the receiver operating characteristic curve was 0.752 [95% confidence interval (ci): 0.697 to 0.801] in the lac population at the optimal cut-off value of 109, and the sensitivity and specificity were 68.4% (95% ci: 60.5% to 75.5%) and 74.4% (95% ci: 65.6% to 81.9%) respectively. Conclusions The EGFR mutation risk scoring system based on clinical data and ct features is noninvasive and user-friendly. The model appears to frame a positive predictive value and was able to determine the value of repeating a biopsy if tissue is limited.
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Affiliation(s)
- Y Cao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R.C
| | - H Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R.C
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20
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Medan G, Joskowicz L. Reduced-Dose Imageless Needle and Patient Tracking in Interventional CT Procedures. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:2449-2456. [PMID: 28841553 DOI: 10.1109/tmi.2017.2742898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper describes a new method for imageless needle and patient tracking in interventional CT procedures based on fractional CT scanning. Our method accurately locates a needle with a spherical marker attached to it at a known distance from the tip with respect to the patient in the CT scanner coordinate frame with online sparse scan sampling and without reconstructing the CT image. The key principle of our method is to detect the needle and attached spherical marker in projection (sinogram) space based on the strongly attenuated X-ray signal due to the metallic composition of the needle and the needle's thin cylindrical geometry, and based on the marker's spherical geometry. A transformation from projection space to physical space uniquely determines the location and orientation of the needle and the needle tip position. Our method works directly in projection space and simultaneously performs patient registration and needle localization for every fractional CT scanning acquisition using the same sparse set of views. We performed registration and needle tip localization in five abdomen phantom scans using a rigid needle, and obtained a voxel-size tip localization error. Our experimental results indicate a voxel-sized deviation of the localization from a comparable method in 3-D image space, with the benefit of allowing X-ray dose reduction via fractional scanning at each localization. This benefit enables more frequent tip localizations during needle insertion for a similar total dose, or a reduced total dose for the same frequency of tip localization.
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21
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Floridi C, Reginelli A, Capasso R, Fumarola E, Pesapane F, Barile A, Zappia M, Caranci F, Brunese L. Percutaneous needle biopsy of mediastinal masses under C-arm conebeam CT guidance: diagnostic performance and safety. Med Oncol 2017; 34:67. [PMID: 28341937 DOI: 10.1007/s12032-017-0911-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study is to evaluate the feasibility of percutaneous needle biopsy of mediastinal masses under conebeam computed tomography (CBCT) and "XperGuide" navigation guidance. From September 2013 to April 2016, 40 patients (25 men and 15 women; mean age 52.5 years; range 18.7-86.4 years) with 40 mediastinal masses underwent CBCT-/"XperGuide"-guided percutaneous needle biopsies. Technical success, sensibility, specificity, positive predictive value (ppv), negative predictive value (npv) and complications rate were evaluated. Technical success evaluated as the correct positioning of the needle inside the lesion was 100%. Based on histopathological diagnosis, 2 of 40 biopsies (5%) resulted a false negative. Diagnostic accuracy was 95%, sensitivity was 95%, specificity was 100%, ppv was 100%, and npv was 33%. The mean total procedure time was 32 min (range 15-60 min) revealing a reduction in time comparing the first group of 20 patients (mean time 45 min) with the last group of 20 patients (mean time 17 min). No major complications were recorded. Only three patients (7.5%) had mild pneumothorax as demonstrated by post-procedural CBCT, resolved spontaneously. CBCT/"XperGuide" navigation system is a new, safe and accurate technique that can be used as guidance for mediastinal mass biopsies. It also permits the use of CT machines for diagnostic examinations relieving them from interventional procedures burden.
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Affiliation(s)
- Chiara Floridi
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Alfonso Reginelli
- Department of Internal and Experimental Medicine, Second University of Naples, Naples, Italy
| | | | - Enrico Fumarola
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Filippo Pesapane
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of l'Aquila, L'Aquila, Italy
| | - Marcello Zappia
- Department of Radiology, University of Molise, Campobasso, Italy
| | | | - Luca Brunese
- Department of Radiology, University of Molise, Campobasso, Italy.
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22
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Yan GW, Bhetuwal A, Yan GW, Sun QQ, Niu XK, Zhou Y, Li LF, Li BZ, Zeng H, Zhang C, Li B, Xu XX, Yang HF, Du Y. A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules. Pol J Radiol 2017; 82:152-160. [PMID: 28392852 PMCID: PMC5370428 DOI: 10.12659/pjr.899626] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/25/2016] [Indexed: 12/18/2022] Open
Abstract
Background A systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB) using a C-Arm Cone-Beam CT (CBCT) system in patients with lung nodules. Material/Methods Thedatabases of PUBMED, OVID, EBSCO, EMBASE, and China National Knowledge Infrastructure (CNKI) were systematically searched for relevant original articles on the diagnostic accuracy of CBCT-guided PTNB for the diagnosis of nodules in the lungs. Diagnostic indices including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and diagnostic score (DS) were calculated. Moreover,summary receiver operating characteristic curves (SROC) were constructed with Stata (version 13.0), Rev Man (version 5.3), and Meta-disc (version 1.4) software. Other clinical indices such as incidence of complications were also recorded. Results Eight studies met the inclusion and exclusion criteria for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, DS, and SROC with 95% confidence intervals were 0.96 (0.93–0.98), 1.00 (0.91–1.00), 711.15 (9.48–53325.89), 0.04 (0.02–0.07), 16585.29 (284.88–9.7e+05), 9.72 (5.65–13.78), and 0.99 (0.97–0.99), respectively. The incidence of pneumothorax and hemorrhage was 10–29.27% and 1.22–47.25%, respectively. Conclusions CBCT-guided PTNB has an acceptable rate of complications and is associated with a reasonable radiation exposure. Moreover, it is a highly accurate and safe technique for the diagnosis of lung nodules and can be recommended to be used in routine clinical practice.
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Affiliation(s)
- Gao-Wu Yan
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Gao-Wen Yan
- Department of Radiology, The First People's Hospital of Suining City, Suining, Sichuan, P.R. China
| | - Qin-Quan Sun
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Xiang-Ke Niu
- Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, P.R. China
| | - Yu Zhou
- Department of Cardio-Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Li-Fa Li
- Department of Gastrointestinal of Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Bin-Zhong Li
- School of Basic Medical Sciences, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Hao Zeng
- Department of Radiology, Suining Central Hospital, Suining, Sichuan, P.R. China
| | - Chuan Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Bing Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Xiao-Xue Xu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Han-Feng Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Yong Du
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
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Caranci F, Leone G, Ugga L, Cesarano E, Capasso R, Schipani S, Bianco A, Fonio P, Briganti F, Brunese L. Imaging of post-surgical treatment and of related complications in spinal trauma. Musculoskelet Surg 2017; 101:63-73. [PMID: 28168635 DOI: 10.1007/s12306-017-0457-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 11/26/2022]
Abstract
Spinal trauma is a devastating event with a high morbidity and mortality. The rationale of imaging is to diagnose the traumatic abnormalities and characterize the type of injury, to estimate the severity of the lesions, to evaluate the potential spinal instability. In case of spinal instability, the goals of operative treatment are decompression of the spinal cord canal and stabilization of the disrupted vertebral column. Particularly, diagnostic imaging, mainly by CT and MR, has a main role in the post-treatment evaluation. The neuroradiological evaluation of the postoperative spine requires a general knowledge of the surgical approach to each spinal region and of the normal temporal evolution of expected postoperative changes. The neuroradiologist should evaluate the devices implanted, their related complications and promptly alert the surgeon of acute complications, mainly vascular and infective. During the follow-up, it is mandatory to know and search chronic complications as pseudomeningocele, accelerated degenerative disease, arachnoiditis, peridural fibrosis. Knowledge of specific complications relating to each surgical approach will assist the neuroradiologist in interpretation of postoperative images.
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Affiliation(s)
- F Caranci
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy.
| | - G Leone
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Ugga
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - E Cesarano
- Radiology Section, Health Service, Navy Command of Brindisi, Brindisi, Italy
| | - R Capasso
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - S Schipani
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - A Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Briganti
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
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Tian P, Wang Y, Li L, Zhou Y, Luo W, Li W. CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing. J Thorac Dis 2017; 9:333-343. [PMID: 28275482 PMCID: PMC5334098 DOI: 10.21037/jtd.2017.02.16] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions. METHODS This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample's adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed. RESULTS The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing. CONCLUSIONS The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.
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Affiliation(s)
- Panwen Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongzhao Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wenxin Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Yang W, Jiang H, Khan AN, Allen C, Bertolaccini L, Lv T, Song Y. Transthoracic needle aspiration in solitary pulmonary nodule. Transl Lung Cancer Res 2017; 6:76-85. [PMID: 28331827 DOI: 10.21037/tlcr.2017.02.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With improved awareness of public health and the recent advances in various imaging technologies, the detection rate of solitary pulmonary nodules (SPN) is continuously increasing. Transthoracic needle aspiration (TTNA) has represented a major approach for the diagnosis and differential diagnosis of pulmonary masses, owing to its simplicity and minimal invasiveness. This paper demonstrates the role of TTNA in SPN.
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Affiliation(s)
- Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Hongli Jiang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Ali Nawaz Khan
- Department of Radiology, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsall, Manchester M8 6RB, UK
| | - Carolyn Allen
- Department of Radiology, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsall, Manchester M8 6RB, UK
| | - Luca Bertolaccini
- Thoracic Surgery - AUSL Romagna, Santa Maria delle Croci Teaching Hospital, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
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Capasso R, Nizzoli R, Tiseo M, Pedrazzi G, Brunese L, Rotondo A, De Filippo M. Extra-pleuric coaxial system for CT-guided percutaneous fine-needle aspiration biopsy (FNAB) of small (≤20 mm) lung nodules: a novel technique using multiplanar reconstruction (MPR) images. Med Oncol 2016; 34:17. [PMID: 28035579 DOI: 10.1007/s12032-016-0871-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/19/2016] [Indexed: 12/14/2022]
Abstract
The aim of the study is to present the diagnostic feasibility, usefulness, and safety of a novel technique for coaxial CT-guided fine-needle aspiration biopsy of small (≤20 mm in diameter) lung nodules. A 18-gauge (G) (1.2 × 40 mm) needle is inserted through the skin in the depth of the thoracic wall tissues remaining outside the pleura. Its positioning is planned and adjusted using multiplanar reconstruction (MPR) images along the 18-G guide needle axis tracing a reference outline extended from the needle tip to the target nodule. When the insertion of the 18-G extra-pleuric needle (EPN) proves to be precise, a 22-G Chiba needle is then passed through the outer 18-G EPN until it reaches the thoracic lesion for the sampling procedure. Patient population included 153 males and 94 females, with a mean age of 61.3 ± 21.6 years. Mean nodule diameter was 14.1 ± 2.2 mm. The lesion depth from pleural plane ranged from 0 mm to 127 mm. An average of 1.29 aspirates were performed per lesion. The most common complication was pneumothorax in 27 cases; there were no cases of PNX requiring chest tube insertion. Intrapulmonary bleeding along the needle track was observed in 32 patients. Exploiting the advantage of MPR images, our novel technique of extra-pleuric coaxial system with a 18-G EPN allows the operator to multiple samplings of small (≤20 mm) target lesions in various locations with a thinner (22-G Chiba) needle, thus reducing the degree of pleural, parenchymal, or adjacent organs damage.
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Affiliation(s)
- Raffaella Capasso
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy.
| | - Rita Nizzoli
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43100, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43100, Parma, Italy
| | - Giuseppe Pedrazzi
- Department of Neuroscience, University of Parma, Via Gramsci, 14, 43100, Parma, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy
| | - Antonio Rotondo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Massimo De Filippo
- Department of Radiology, University of Parma, Parma Hospital, Via Gramsci, 14, 43100, Parma, Italy
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Levrini G, Magnani A, Sghedoni R, Pattacini P, Bertolini M, Botti A, Iotti V. CT-guided biopsy of pulmonary nodules; predictive factors for diagnosis: Is there room for more prognostic factors? Radiol Med 2016; 122:121-122. [PMID: 27817052 DOI: 10.1007/s11547-016-0704-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Gabriele Levrini
- Dipartimento di Diagnostica per Immagini e Medicina di Laboratorio, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50, 42123, Reggio Emilia, Italy.
| | - Antonia Magnani
- Dipartimento di Statistica, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Roberto Sghedoni
- Dipartimento di Fisica Sanitaria, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Pierpaolo Pattacini
- Dipartimento di Diagnostica per Immagini e Medicina di Laboratorio, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Marco Bertolini
- Dipartimento di Fisica Sanitaria, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Andrea Botti
- Dipartimento di Fisica Sanitaria, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Valentina Iotti
- Dipartimento di Diagnostica per Immagini e Medicina di Laboratorio, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
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Reginelli A, Silvestro G, Fontanella G, Sangiovanni A, Conte M, Nuzzo I, Di lecce A, Martino A, Grassi R, Murino P, Cappabianca S. Performance status versus anatomical recovery in metastatic disease: The role of palliative radiation treatment. Int J Surg 2016; 33 Suppl 1:S126-31. [DOI: 10.1016/j.ijsu.2016.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Decline in the Use of Surgical Biopsy for Diagnosis of Pulmonary Disease in Hematopoietic Cell Transplantation Recipients in an Era of Improved Diagnostics and Empirical Therapy. Biol Blood Marrow Transplant 2016; 22:2243-2249. [PMID: 27590103 PMCID: PMC7128129 DOI: 10.1016/j.bbmt.2016.08.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/22/2016] [Indexed: 11/22/2022]
Abstract
Use of biopsy for diagnosis of post-HCT lung disease has declined significantly. Improved testing and increased azole use are associated with this decrease. Less invasive methods have improved diagnostics for respiratory pathogens. We outline an algorithm for appropriate use of lung biopsy in these patients.
Historically, diagnosis of enigmatic pulmonary disease after hematopoietic cell transplantation (HCT) required lung biopsy, but recent advancements in diagnosis and therapy for respiratory infections have changed how clinicians approach pulmonary abnormalities. We examined temporal trends in the use of lung biopsy after HCT. We retrospectively reviewed patients who underwent their first allogeneic HCT at the Fred Hutchinson Cancer Research Center between the years 1993 to 1997, 2003 to 2007, and 2013 to 2015 and subsequently underwent surgical lung biopsy for any reason. Lung biopsy between cohorts were analyzed using a Cox proportional hazards model with death and relapse considered competing risks. Of 1418 patients, 52 (3.7%) underwent 54 post-HCT surgical lung biopsies during 1993 to 1997 compared with 24 (2.1%) and 25 biopsies in the 2003 to 2007 cohort; 2 cases of surgical lung biopsies out of 786 HCT recipients occurred during the 2013 to 2015 cohort (.25%). The median time to biopsy post-HCT was 71.5 days (IQR, 31 to 89) for the early cohort and 97 days (IQR, 42 to 124) for the late cohort, for an overall biopsy incidence of .15 and .075 per 1000 patient days in the first year after HCT, respectively. Patients in the 2003 to 2007 cohort were less likely to undergo a lung biopsy (adjusted HR, .50; 95% CI, .29 to .83; P = .008) when compared with patients in the early cohort, but more patients in the early cohort underwent lung biopsy without antecedent bronchoscopy (25/54 [46%] versus 3/25 [12%], P = .005). Although infections were a more common finding at biopsy in the early cohort (35/1418 versus 8/1148, P < .001), the number of biopsies demonstrating noninfectious lesions was similar between the two cohorts (19/1418 versus 17/1148, P = .76). Fungal infections were the major infectious etiology in both cohorts (32/35 [91%] versus 5/8 [63%], P = .07), but there was a significant reduction in the number of Aspergillus species found at biopsy between the cohorts (30/54 versus 1/25, P < .001). A similar percentage underwent biopsy with therapeutic intent for invasive fungal disease in the 2 cohorts (8/54 [15%] versus 4/25 [16%]). Surgical evaluation of lung disease in HCT recipients significantly declined over a span of 2 decades. The decline from the years 1993 to 1997 compared with 2003 to 2007 was because of a reduction in the number of biopsies for post-transplant infections due to aspergillosis, which is temporally related to improved diagnostic testing by minimally invasive means and the increased use of empiric therapy with extended-spectrum azoles. This practice of primary nonsurgical diagnostic and treatment approaches to pulmonary disease post-HCT have continued, shown by low numbers of surgical biopsies over the last 3 years.
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Reginelli A, D'Amora M, Del Vecchio L, Monaco L, Barillari MR, Di Martino N, Barillari U, Motta G, Cappabianca S, Grassi R. Videofluoroscopy and oropharyngeal manometry for evaluation of swallowing in elderly patients. Int J Surg 2016; 33 Suppl 1:S154-8. [PMID: 27392720 DOI: 10.1016/j.ijsu.2016.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Presbyphagia represents the physiological aging evolution of the swallowing function. It is related to the natural changes of the anatomical structures involved in the swallowing process. These age-related modifications can be asymptomatic in the early stages of life, but in the late stages, they could lead to dysphagia, aspiration pneumonia, dehydration, or malnutrition, reducing the quality of life. Videofluoromanometry (VFM) is the combined study of videofluoroscopy (VFS) and oropharyngeal manometry that allows simultaneous identification of functional and morphological features of the presbyphagia, also in asymptomatic otherwise healthy elderly adults. This study retrospectively evaluated the effectiveness of the VFM and the role of a multidisciplinary team of specialists in the analysis of a large cohort of old patients with presbyphagia, with the objective of achieving early diagnosis of the disease and the best therapy to delay the development of complications such as aspiration pneumonia, malnutrition, and dehydration.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Marilina D'Amora
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Lucia Del Vecchio
- Department of Anesthesiological, Surgical and Emergency Sciences Department, Second University of Naples, Italy.
| | - Luigi Monaco
- Department of General Surgery, Second University of Naples, Italy.
| | - Maria Rosaria Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | | | - Umberto Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy.
| | - Gaetano Motta
- Department of Anesthesiological, Surgical and Emergency Sciences Department, Second University of Naples, Italy.
| | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Roberto Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
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Reginelli A, Silvestro G, Fontanella G, Sangiovanni A, Conte M, Nuzzo I, Calvanese M, Traettino M, Ferraioli P, Grassi R, Manzo R, Cappabianca S. Validation of DWI in assessment of radiotreated bone metastases in elderly patients. Int J Surg 2016; 33 Suppl 1:S148-53. [PMID: 27392721 DOI: 10.1016/j.ijsu.2016.06.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bone metastases are commonly observed in oncologic patients with advanced disease. These metastases are considered the main cause of neoplastic pain, with more than half of oncologic patients experiencing neoplastic pain during the course of the disease due to bone involvement. Lung, breast, and prostate cancers are the primary causes of bone metastases. Magnetic resonance imaging (MRI), especially diffusion weighted imaging (DWI) sequences, is the focus of our research, as it has been proven to be an optimal predictive index to assess the radiation treatment in many patients. We included patients treated with standard fractioning of radiation therapy. First, we examined the irradiated lesions with the MRI-DWI technique, before treatment and 30 and 60 days after its completion. Then we combined the MRI results and clinical parameters in a table with a predictive score for the quality of life in patients with bone metastases. This was a significant predictor of the efficacy of radiation treatment, from both clinical and psychological points of view, as it can allow an early assessment of the response to RT and therefore better scheduling of the next therapeutic steps to be performed. The table of the score we proposed helped guide patient monitoring, enabling us to undertake, where possible, follow-up with therapeutic strategies tailored to each patient's needs.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
| | | | - Giovanni Fontanella
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
| | - Angelo Sangiovanni
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
| | - Mario Conte
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
| | - Iolanda Nuzzo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
| | | | - Marianna Traettino
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
| | - Piera Ferraioli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
| | - Roberta Grassi
- Department of Radiotherapy, University of Sassari, Sassari, Italy.
| | - Roberto Manzo
- Department of Radiotherapy, Cardinale Ascalesi Hospital, Naples, Italy.
| | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology and Radiotherapy, Second University of Naples, Naples, Italy.
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Riquet M, Pricopi C, Rivera C, Badia A, Arame A, Dujon A, Foucault C, Le Pimpec Barthes F, Fabre E. [Lung cancer measuring 1cm or less: A miniature subset requiring surgery]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:171-178. [PMID: 27113613 DOI: 10.1016/j.pneumo.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/23/2015] [Accepted: 12/04/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Lung cancer measuring 1cm or less has an apparently very good outcome. However, the characteristics permitting their oncological management are unappreciated. PATIENT AND METHOD We reviewed 187 patients with such a cancer (145 men and 42 women, mean age 60.2years) and studied the type of surgery performed, the pTNM, and the histological features. RESULTS Surgery (19 wedge-resections, 12 segmentectomies, 136 lobectomies, 20 pneumonectomies) was complete (R0) in 97.3%. The tumors, each precisely defined among 98 adenocarcinomas (52.4%), 83 squamous cell carcinomas (44.4%), and 6 others, measured 1mm to 10mm:<5mm (n=41), 6 to 9mm (n=43), and 10mm (n=103). There were 161 pT1 (86.1%), 22 pT2 (11.8%) and 4 pT3; 148 pN0 (79.6%), 18 pN1 (9.7%) and 20 pN2 (10.7%). pN1 and pN2 were present in tumors<5mm (12/41, 29.3%) as well as in the others (26/146, 17.8% P=0.11). Histological examination frequently discovered visceral pleura involvement (tumors:<5mm 12.2% (5/41), 6 to 9mm 7% (3/43), 10mm 13.6% (14/103), P=0.53) and lympho-vascular invasion (12.9%). Five-year survival rate (66.4%) was adversely influenced by age, type of resection, pN and histological features. The survival rate was not better in tumor<5mm. CONCLUSION Surgical resection allows the local control of lung cancers<1cm and their complete histological study, a key issue in the therapy of the future, which renders surgery an absolute must even in very small tumors.
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Affiliation(s)
- M Riquet
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - C Pricopi
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - C Foucault
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Fabre
- Service d'oncologie médicale, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Chiappetta M, Rosella F, Dall'armi V, Pomes LM, Petracca Ciavarella L, Nachira D, Pirronti T, Margaritora S, Granone P. CT-guided fine-needle ago-biopsy of pulmonary nodules: predictive factors for diagnosis and pneumothorax occurrence. Radiol Med 2016; 121:635-43. [PMID: 27132130 DOI: 10.1007/s11547-016-0639-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate variables that could predict diagnosis during CT-guided fine-needle aspiration. METHODS Data from 249 patients who underwent FNAB from January 2010 to December 2012 were analyzed in a retrospective observational study. RESULTS Mean age was 66.7 ± 11.5 years, male/female ratio 158/91 (63 vs. 37 %). The nodules were in right lung in 123 patients (49 %), in left lung in 126 patients (51 %), the upper, lower and middle lobe localizations were, respectively in 122 (49 %), 100 (40 %) and 17 (6 %) patients. Mean nodule-chest wall distance was 63.89 ± 21.38 mm. The tumor location, the needle diameter, the presence of necrosis or cavitation, the node-chest wall distance and the number of passages were not related to the diagnostic outcome (p = NS). The nodule diameter was predictive of diagnosis. Odds ratio for a 10-30 mm tumor was 2.51 (95 % OR: 1.24-5.08, p value = 0.011), the odds ratio for a 30-50 mm tumor was 2.39 (95 % OR: 1.22-4.69, p value = 0.011), and the odds ratio for a tumor larger than 50 mm was 4.44 (95 % OR: 1.89-10.44, p value = 0.001). Post-procedure pneumothorax occurred in 62 cases (25 %). The determinant factors for pneumothorax occurrence were emphysema, odds ratio 6.87 (95 % CI 1.07-44.10, p value = 0.04), and the number of pleural passages, odds ratio of 5.47 (95 % OR: 1.92-15.58), 7.44 (95 % OR: 2.58-21.5), 6.13 (95 % OR: 2.07-18.11) p value = 0.001 for one, two, three or more of three passages, respectively. CONCLUSIONS In our experience, nodule size is the most important diagnostic factor during fine-needle aspiration, while the number of passages and the presence of emphysema constitute risk factors for pneumothorax occurrence.
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Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy.
| | - Francesco Rosella
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital-Catholic University, Rome, Italy
| | - Valentina Dall'armi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Leda Marina Pomes
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
| | | | - Dania Nachira
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
| | - Tommaso Pirronti
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital-Catholic University, Rome, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
| | - Pierluigi Granone
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Largo F. Vito n 1, Rome, Italy
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Yan GW, Yan GW, Sun QQ, Niu XK, Li B, Bhetuwal A, Xu XX, Du Y, Yang HF. Computed tomography fluoroscopy guided percutaneous lung biopsy for ground-glass opacity pulmonary lesions: A meta-analysis. World J Meta-Anal 2016; 4:55-62. [DOI: 10.13105/wjma.v4.i2.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/11/2016] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To obtain the diagnostic performance of percutaneous transthoracic needle biopsy (PTNB) under Computed tomography (CT) fluoroscopy guidance for lung ground-glass opacity (GGO).
METHODS: We searched for English- and Chinese-language studies in PubMed, EMBASE, EBSCO, OVID, and CNKI (China National Knowledge Infrastructure) database. Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software. From the pooled data, we calculated sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) curves were constructed and incidence of complications was recorded.
RESULTS: Four documents included in this present meta-analysis met the criteria for analysis. The pooled Sen, Spe, +LR, -LR and DOR with 95%CI were 0.91 (0.86-0.95), 1.0 (0.91-1.0), 18.64 (4.83-71.93), 0.11 (0.05-0.26) and 153.17 (30.78-762.33), respectively. The area under the SROC curve was 0.98. The incidence of pneumothorax and hemoptysis was 17.86%-51.80% and 10.50%-19.40%, respectively.
CONCLUSION: CT fluoroscopy-guided PTNB, which has an acceptable incidence of complications, can be used as a primary examination method for lung GGO, with moderate sensitivity and specificity.
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Abstract
BACKGROUND Image guided transthoracic needle aspiration (TTNA) is a valuable tool used for the diagnosis of countless thoracic diseases. Computed tomography (CT) is the most common imaging modality used for guidance followed by ultrasound (US) for lesions abutting the pleural surface. Novel approaches using virtual CT guidance have recently been introduced. The objective of this review is to examine the current literature for TTNA biopsy of the lung focusing on diagnostic accuracy and safety. METHODS MEDLINE was searched from inception to October 2015 for all case series examining image guided TTNA. Articles focusing on fluoroscopic guidance as well as influence of rapid on-site evaluation (ROSE) on yield were excluded. The diagnostic accuracy, defined as the number of true positives divided by the number of biopsies done, as well as the complication rate [pneumothorax (PTX), bleeding] was examined for CT guided TTNA, US guided TTNA as well as CT guided electromagnetic navigational-TTNA (E-TTNA). Of the 490 articles recovered 75 were included in our analysis. RESULTS The overall pooled diagnostic accuracy for CT guided TTNA using 48 articles that met the inclusion and exclusion criteria was 92.1% (9,567/10,383). A similar yield was obtained examining ten articles using US guided TTNA of 88.7% (446/503). E-TTNA, being a new modality, only had one pilot study citing a diagnostic accuracy of 83% (19/23). Pooled PTX and hemorrhage rates were 20.5% and 2.8% respectively for CT guided TTNA. The PTX rate was lower in US guided TTNA at a pooled rate of 4.4%. E-TTNA showed a similar rate of PTX at 20% with no incidence of bleeding in a single pilot study available. CONCLUSIONS Image guided TTNA is a safe and accurate modality for the biopsy of lung pathology. This study found similar yield and safety profiles with the three imaging modalities examined.
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Affiliation(s)
- David M DiBardino
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lonny B Yarmus
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Roy W Semaan
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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How should pulmonary nodules be optimally investigated and managed? Lung Cancer 2016; 91:48-55. [DOI: 10.1016/j.lungcan.2015.10.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/12/2015] [Indexed: 12/21/2022]
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Witt BL, Cohen MB, Chadwick BE, Stephenson PD, Abasolo P, Schmidt RL. Cytomorphology is often insufficient to categorize non-small-cell lung carcinoma on FNA specimens. Diagn Cytopathol 2015; 44:73-9. [PMID: 26592713 DOI: 10.1002/dc.23387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/12/2015] [Accepted: 11/02/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine the accuracy and reproducibility of differentiating between squamous cell carcinoma (SCC) and adenocarcinoma (ADC) on fine-needle aspiration (FNA) specimens. METHODS Fifty cases of NSCLC diagnosed by FNA having either concurrent core biopsies or resection as a diagnostic reference standard were selected. FNA slides were reviewed independently by five blinded observers. Two rounds of review were performed. Cases were initially categorized as SCC, favor SCC, NSCLC (type indeterminate), favor ADC, or ADC; while the indeterminate category was eliminated in the second round of review. RESULTS The interobserver agreement was 0.22 and 0.1 with and without the indeterminate category, respectively. The overall accuracy for differentiating between SCC and ADC of the lung was 65% with the indeterminate category and 66% without. CONCLUSION Overall, the low interobserver agreement in our study indicates that accurate subclassification between the NSCLCs often cannot be made by cytomorphology alone.
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Affiliation(s)
- Benjamin L Witt
- Department of Pathology/ARUP Laboratories, University of Utah School of Medicine, Utah
| | - Michael B Cohen
- Department of Pathology/ARUP Laboratories, University of Utah School of Medicine, Utah
| | - Barbara E Chadwick
- Department of Pathology/ARUP Laboratories, University of Utah School of Medicine, Utah
| | - Philip D Stephenson
- Department of Pathology/ARUP Laboratories, University of Utah School of Medicine, Utah
| | - Peter Abasolo
- Department of Pathology/ARUP Laboratories, University of Utah School of Medicine, Utah
| | - Robert L Schmidt
- Department of Pathology/ARUP Laboratories, University of Utah School of Medicine, Utah
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De Filippo M, Saba L, Silva M, Zagaria R, Concari G, Nizzoli R, Bozzetti C, Tiseo M, Ardizzoni A, Lipia S, Paladini I, Macarini L, Carrafiello G, Brunese L, Rotondo A, Rossi C. CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage? Diagn Interv Radiol 2015; 20:421-5. [PMID: 25163758 DOI: 10.5152/dir.2014.14019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the correlation between pulmonary hemorrhage and pneumothorax in computed tomography (CT)-guided transthoracic fine needle aspiration (TTFNA), particularly its possible value as protection against the development of pneumotorax. MATERIALS AND METHODS We reviewed the CT images of 538 patients (364 males and 174 females, mean age 70 years, range 36-90 years) who underwent CT-guided TTFNA of pulmonary nodules between January 2008 and September 2013. The following CT findings were assessed: pulmonary hemorrhage (type 1, along the needle track; type 2, perilesional; low-grade, ≤6 mm; high-grade, >6 mm), pneumothorax, distance between the target nodule and the pleural surface, and emphysema. RESULTS Pneumothorax occurred in 154 cases (28.6%) and pulmonary hemorrhage occurred in 144 cases (26.8%). The incidence of pneumothorax was lower in patients showing type 1 and high-grade pulmonary hemorrhage pattern. The incidence of pneumothorax in biopsies ≥30 mm from pleural surface was 26% (12/46) in cases showing this pattern, while it was 71.4% (30/42) when this pattern was not seen. Similarly, the incidence of pneumothorax in biopsies <30 mm from the pleural surface was 0% (0/28) in cases showing this hemorrhage pattern, while it was 19% (76/394) when this pattern was not seen. CONCLUSION Pulmonary hemorrhage during TTFNA is a frequent event that protects against pneumothorax. A bleeding greater than 6 mm along the needle track is associated with lower incidence of pneumothorax, especially in biopsies deeper than 3 cm.
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Affiliation(s)
- Massimo De Filippo
- Department of Surgical Sciences, Section of Diagnostic Imaging, University Hospital of Parma, Parma, Italy.
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 570] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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Curved Needles in CT-Guided Fine Needle Biopsies of Abdominal and Retroperitoneal Small Lesions. Cardiovasc Intervent Radiol 2015; 38:1611-6. [DOI: 10.1007/s00270-015-1107-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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Abstract
The development of widespread lung cancer screening programs has the potential to dramatically increase the number of thoracic computed tomography (CT) examinations performed annually in the United States, resulting in a greater number of newly detected, indeterminate solitary pulmonary nodules (SPNs). Additional imaging studies, such as fluorodeoxyglucose F 18 (FDG)-positron emission tomography (PET), have been shown to provide valuable information in the assessment of indeterminate SPNs. Newer technologies, such as contrast-enhanced dual-energy chest CT and FDG-PET/CT, also have the potential to facilitate diagnosis of potentially malignant SPNs.
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Aparici CM, Aslam R, Win AZ. Initial Experience of Utilizing Real-Time Intra-Procedural PET/CT Biopsy. J Clin Imaging Sci 2014; 4:54. [PMID: 25337440 PMCID: PMC4204304 DOI: 10.4103/2156-7514.141941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/24/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Nonreal-time Positron Emission Tomography/Computed Tomography (PET/CT) biopsies that use the image co-registration of a prior PET with an intra-procedural CT have been reported. The aim of this study was to report the initial experience of performing real-time intra-procedural PET/CT-guided biopsies. MATERIALS AND METHODS All patients (n = 4) had a prior PET/CT examination of the concerning lesion and no significant CT correlate. On the day of the biopsy, 5 mCi of 18F-fluorodeoxyglucose (FDG) or NaF18 was intravenously injected. After 60 min of biodistribution of the molecular probe, PET/CT images were obtained in a limited one bed position over the region of the concerning lesion to be biopsied. RESULTS One patient had a mesenteric mass and the other three had bone lesions, one located in the rib and two in the iliac bone. The pathology report revealed that two lesions (50%) were malignant and two lesions (50%) were benign. The results of the biopsy changed management in all cases. There was 0% complication rate. CONCLUSIONS No additional software or hardware is required to perform real-time intra-procedural PET/CT-guided biopsies. It can optimize the yield, especially in cases where there are no anatomical abnormalities. Real-time intra-procedural PET/CT biopsy may have benefits over conventional biopsy techniques in terms of accuracy.
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Affiliation(s)
- Carina Mari Aparici
- Department of Radiology, University California San Francisco, California, USA
| | - Rizwan Aslam
- Department of Radiology, University California San Francisco, California, USA
| | - Aung Zaw Win
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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