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Magnini A, Lorini C, Calistri L, Calcagni F, Giuntoli F, Foxi P, Nardi C, Colagrande S. The Impact of Rapid On-site Evaluation on Diagnostic Performance of Computed Tomography-Guided Core Needle Biopsy in Lung Cancer. J Comput Assist Tomogr 2024:00004728-990000000-00297. [PMID: 38518357 DOI: 10.1097/rct.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
PURPOSE Rapid on-site-evaluation (ROSE) is a technique aimed at improving the diagnostic performance of computed tomography (CT)-guided core needle biopsy (CNB) in lung cancer. The aim of this retrospective study was to investigate the impact of ROSE on the rate of nondiagnostic specimens and on accuracy computed on diagnostic specimens. MATERIALS AND METHODS During a 3-year period, 417 CT-guided CNBs were performed at our center. The biopsies were retrospectively classified into 2 groups: 141 procedures were assisted by ROSE and 276 were not. All of them were reviewed for clinical, procedural, and pathological data. Pathology results were classified as diagnostic (positive or negative for malignancy) or nondiagnostic. The results were compared with the final diagnosis after surgery or clinical follow-up. Nondiagnostic rate, sensitivity/specificity/negative predictive value/positive predictive value for the ROSE and non-ROSE groups were calculated. Finally, procedural complications and the adequacy of the specimens for the molecular analysis were recorded. RESULTS The study evaluated 417 CNBs (mean patients' age 71 years, 278 men). Nondiagnostic rates with and without ROSE were 4% (6/142) and 11% (29/276), respectively (P = 0.028). Sensitivity/specificity/negative predictive value/positive predictive value with and without ROSE did not show statistically significant differences, and no difference in major/minor complication rates was observed between the 2 groups. The adequacy of specimen for subsequent molecular analysis was 100% with (42/42) and 82% without ROSE (51/62). CONCLUSIONS Rapid on-site-evaluation reduced the rate of nondiagnostic specimens by 50% with no change in complication rates or accuracy and increased by 20% the chances of a successful subsequent molecular analysis.
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Affiliation(s)
- Andrea Magnini
- From the Departments of Experimental and Clinical Biomedical Sciences
| | | | - Linda Calistri
- From the Departments of Experimental and Clinical Biomedical Sciences
| | - Francesca Calcagni
- S.O.C. Interventional Radiology, Department of Diagnostic Imaging, Azienda Sanitaria Toscana Centro
| | - Federico Giuntoli
- S.O.C. Interventional Radiology, Department of Diagnostic Imaging, Azienda Sanitaria Toscana Centro
| | - Prassede Foxi
- S.O.C. Anatomical Pathology and Citodiagnostic, Department of Oncology, Azienda Sanitaria Toscana Centro, Florence, Italy
| | - Cosimo Nardi
- From the Departments of Experimental and Clinical Biomedical Sciences
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Alves VM, dos Santos Cardoso J, Gama J. Classification of Pulmonary Nodules in 2-[ 18F]FDG PET/CT Images with a 3D Convolutional Neural Network. Nucl Med Mol Imaging 2024; 58:9-24. [PMID: 38261899 PMCID: PMC10796312 DOI: 10.1007/s13139-023-00821-6] [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: 12/05/2022] [Revised: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 01/25/2024] Open
Abstract
Purpose 2-[18F]FDG PET/CT plays an important role in the management of pulmonary nodules. Convolutional neural networks (CNNs) automatically learn features from images and have the potential to improve the discrimination between malignant and benign pulmonary nodules. The purpose of this study was to develop and validate a CNN model for classification of pulmonary nodules from 2-[18F]FDG PET images. Methods One hundred thirteen participants were retrospectively selected. One nodule per participant. The 2-[18F]FDG PET images were preprocessed and annotated with the reference standard. The deep learning experiment entailed random data splitting in five sets. A test set was held out for evaluation of the final model. Four-fold cross-validation was performed from the remaining sets for training and evaluating a set of candidate models and for selecting the final model. Models of three types of 3D CNNs architectures were trained from random weight initialization (Stacked 3D CNN, VGG-like and Inception-v2-like models) both in original and augmented datasets. Transfer learning, from ImageNet with ResNet-50, was also used. Results The final model (Stacked 3D CNN model) obtained an area under the ROC curve of 0.8385 (95% CI: 0.6455-1.0000) in the test set. The model had a sensibility of 80.00%, a specificity of 69.23% and an accuracy of 73.91%, in the test set, for an optimised decision threshold that assigns a higher cost to false negatives. Conclusion A 3D CNN model was effective at distinguishing benign from malignant pulmonary nodules in 2-[18F]FDG PET images. Supplementary Information The online version contains supplementary material available at 10.1007/s13139-023-00821-6.
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Affiliation(s)
- Victor Manuel Alves
- Faculty of Economics, University of Porto, Rua Dr. Roberto Frias, Porto, 4200-464 Porto, Portugal
- Department of Nuclear Medicine, University Hospital Center of São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Jaime dos Santos Cardoso
- Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - João Gama
- Faculty of Economics, University of Porto, Rua Dr. Roberto Frias, Porto, 4200-464 Porto, Portugal
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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Park B, Lim JK, Shin KM, Hong J, Cha JG, Cho SH, Park SY, Ryeom HK, Kim SH, Seo AN, Cha SI, Lee J, Lee H, Park J. Clinical Role of Upfront F-18 FDG PET/CT in Determining Biopsy Sites for Lung Cancer Diagnosis. Diagnostics (Basel) 2024; 14:153. [PMID: 38248030 PMCID: PMC10813933 DOI: 10.3390/diagnostics14020153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE This study aimed to investigate the impact of FDG PET/CT timing for biopsy site selection in patients with stage IV lung cancer regarding complications and diagnostic yield. METHODS This retrospective analysis was performed on 1297 patients (924 men and 373 women with a mean age of 71.4 ± 10.2 years) who underwent percutaneous needle biopsy (PNB) for stage IV lung cancer diagnosis in two hospitals. Data collected included the patient's characteristics, order date of the biopsy and PET/CT exams, biopsy target site (lung or non-lung), guidance modality, complications, sample adequacy, and diagnostic success. Based on the order date of the PNB and PET/CT exams, patients were categorized into upfront and delayed PET/CT groups. RESULTS PNB for non-lung targets resulted in significantly lower rates of minor (8.1% vs. 16.2%), major (0.2% vs. 3.4%), and overall complications (8.3% vs. 19.6%) compared to PNB for lung targets (p < 0.001 for all types of complications). Compared to the delayed PET/CT group, the upfront PET/CT group exhibited a lower probability of lung target selection of PNB (53.9% vs. 67.1%, p < 0.001), including a reduced incidence of major complications (1.0% vs. 2.9%, p = 0.031). Moreover, there was no significant difference in the occurrence of minor and total complications between the two groups. Upfront PET/CT and delayed PET/CT groups showed no significant difference regarding sample adequacy and diagnostic success. CONCLUSIONS Upfront PET/CT may have an impact on the selection of the biopsy site for patients with advanced lung cancer, which could result in a lower rate of major complications with no change in the diagnostic yield. Upfront PET/CT demonstrates potential clinical implications for enhancing the safety of lung cancer diagnosis in clinical practice.
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Affiliation(s)
- Byunggeon Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Kyung Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seo Young Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hoseok Lee
- Department of Radiology, Semyung Radiology Clinic, Gumi 39254, Gyeongsangbuk-do, Republic of Korea
| | - Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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Kim DH, Gilyard S, Suh R. Special Considerations and Techniques of Interventions in Lung Transplant Recipients. Tech Vasc Interv Radiol 2023; 26:100926. [PMID: 38123291 DOI: 10.1016/j.tvir.2023.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Lung transplant remains an important treatment option for patients with end-stage lung diseases providing improvement in survival rates and quality of life. Specialized considerations should be applied with interventions of lung transplant recipients as they host specific anatomic variations and high risk towards certain complications. In this article, we highlight the role of interventional radiology for lung transplant recipients along with discussion of interventional techniques. Specific emphasis is placed on describing and explaining the techniques pertained to the points of anastomosis, diagnosis and treatment of malignancies, and management of complications in lung transplant recipients.
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Affiliation(s)
- Daniel H Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shenise Gilyard
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Robert Suh
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Kim DY, Sun JS, Kim EY, Park KJ, You S. Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern. Sci Rep 2022; 12:15682. [PMID: 36127437 PMCID: PMC9489867 DOI: 10.1038/s41598-022-20030-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022] Open
Abstract
This study aimed to assess the diagnostic accuracy and safety of CT-guided percutaneous core needle biopsy (PCNB) with a coaxial needle for the diagnosis of lung cancer in patients with an usual interstitial pneumonia (UIP) pattern of interstitial lung disease. This study included 70 patients with UIP and suspected to have lung cancer. CT-guided PCNB was performed using a 20-gauge coaxial cutting needle. The diagnostic accuracy, sensitivity, specificity, and percentage of nondiagnostic results for PCNB were determined in comparison with the final diagnosis. PCNB-related complications were evaluated. Additionally, the risk factors for nondiagnostic results and pneumothorax were analyzed. The overall diagnostic accuracy, sensitivity, and specificity were 85.7%, 85.5%, and 87.5%, respectively. The percentage of nondiagnostic results was 18.6% (13/70). Two or less biopsy sampling was a risk factor for nondiagnostic results (p = 0.003). The overall complication rate was 35.7% (25/70), and pneumothorax developed in 22 patients (31.4%). A long transpulmonary needle path was a risk factor for the development of pneumothorax (p = 0.007). CT-guided PCNB using a coaxial needle is an effective method with reasonable accuracy and an acceptable complication rate for the diagnosis of lung cancer, even in patients with UIP.
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Affiliation(s)
- Da Young Kim
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Eun Young Kim
- Department of Radiology, Hankook Hospital, Cheongju, Republic of Korea
| | - Kyung Joo Park
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Seulgi You
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Older Age and Abnormal Pulmonary Ventilation Function Do Not Increase the Risk of Pulmonary Hemorrhage Caused by CT-Guided Percutaneous Core Needle Biopsy. Can Respir J 2022; 2022:5238177. [PMID: 36033344 PMCID: PMC9410978 DOI: 10.1155/2022/5238177] [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: 02/24/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to analyze the differences in risk factors for pulmonary hemorrhage in elderly and young patients with percutaneous computed tomography-guided needle biopsies (PCNBs). The correlations between the incidence of pulmonary hemorrhage and pulmonary function indicators before CT-guided PCNB were also discussed. Methods Between January 2018 and December 2019, 1,100 consecutive patients underwent CT-guided PCNBs at Qilu Hospital. Both univariate and multivariate logistic regression analyses identified risk factors for hemorrhage. Results The occurrence of pulmonary hemorrhage was 22.1% in elderly patients and was 22.6% in young patients. In elderly patients, pulmonary hemorrhage was significantly influenced by needle depth to the lesion and dwell time, while in young patients, pulmonary hemorrhage was independently associated with lesion size, needle depth to the lesion, and dwell time. However, pulmonary function parameters, including FVC (% pred), FEV1 (% pred), FEV1/FVC ratio (%), small airway function parameters (FEF50%, FEF75%, and FEF25–75%), and large airway function parameters (MVV, PEF, and FEF25%), were not risk factors for hemorrhage. Furthermore, the incidence of pulmonary hemorrhage was not associated with different types of pulmonary dysfunctions. The risk of pulmonary hemorrhage did not increase with the severity of pulmonary dysfunctions. Conclusions In this study, age is no longer a risk factor in evaluating pulmonary hemorrhage. Longer needle depth to the lesion and longer dwell time were significantly high risk factors of hemorrhage in both elderly patients and young patients. Patients with severe pulmonary dysfunctions did not show increased risks of pulmonary hemorrhage here.
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Huang K, Yang L, Wang Y, Huang L, Zhou X, Zhang W. Identification of non-small-cell lung cancer subtypes by unsupervised clustering of CT image features with distinct prognoses and gene pathway activities. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Tipaldi MA, Ronconi E, Krokidis ME, Zolovkins A, Orgera G, Laurino F, Daffina J, Caruso D, Laghi A, Rossi M. Diagnostic yield of CT-guided lung biopsies: how can we limit negative sampling? Br J Radiol 2021; 95:20210434. [PMID: 34808070 PMCID: PMC8822563 DOI: 10.1259/bjr.20210434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To investigate whether lesion imaging features may condition the outcome of CT-guided lung biopsy (CTLB) and to develop a scoring system of biopsy outcome prediction. METHODS This is a single center retrospective study on 319 CTLBs that were performed in 319 patients (167 males/152 females, mean age 68 ± 12.2). Uni- and multivariate analysis were performed aiming to assess the imaging features that are likely to be correlated to a negative biopsy outcome and patients were stratified in groups accordingly. RESULTS Technical success was 100%. 78% of the biopsies (250/319) led to a concrete histology report (218 malignant/32 benign). The remaining lesions led to concrete histology at a second attempt that occurred on a later time. Multivariate analysis revealed increased risk of inconclusive result for nodules with low fludeoxyglucose uptake [odds ration (OR) = 2.64, 95% confidence interval (CI) 1.4-4.97; p = 0.003], for nodules with diameter smaller than 18 mm (OR = 2.03, 95% CI 1.14-3.62; p = 0.017) and for nodules that are located in one of the lung bases (OR = 1.96, 95% CI 1.06-3.62; p = 0.033). Three different groups of patients were identified accordingly with low (<30%), medium (30-50%) and high (>50%) probability of obtaining an inconclusive biopsy sample. CONCLUSION This study confirms that percutaneous CT-guided biopsy in nodules that are either small in diameter or present low positron emission tomography-fludeoxyglucose uptake or are in one of the lung bases may lead to inconclusive histology. This information should be factored when planning percutaneous biopsies of such nodules in terms of patient informed consent and biopsy strategy. ADVANCES IN KNOWLEDGE Inconclusive histology after lung biopsy may be subject to factors irrelevant to technical success. Lung biopsy histology outcomes may be predicted and avoided after adequate planning.
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Affiliation(s)
- Marcello Andrea Tipaldi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Edoardo Ronconi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Miltiadis E Krokidis
- 1st Department of Radiology, Aretaion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aleksejs Zolovkins
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Gianluigi Orgera
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Florindo Laurino
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Julia Daffina
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Damiano Caruso
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Andrea Laghi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Michele Rossi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
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Kim J, Chee CG, Cho J, Kim Y, Yoon MA. Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis. Br J Radiol 2021; 94:20210065. [PMID: 34662206 DOI: 10.1259/bjr.20210065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. METHODS We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. RESULTS We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85-94%) and 99% (95% CI: 92-100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs 85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs 83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25-62%) and 0.1% (95% CI: 0-0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). CONCLUSION PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. ADVANCES IN KNOWLEDGE This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.
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Affiliation(s)
- Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjune Kim
- Air Force Education and Training Command Base Hospita, Jinju, Korea
| | - Min A Yoon
- Department of Radiology, Asan Medical Center, Seoul, Korea
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Şahan MH, Inal M, Muluk NB, Doğan A, Atasoy P. The Diagnostic Value of CT-guided Percutaneous Co-axial Trans-thoracic Biopsy (PCTTB) and Evaluation of the Pathologic Examination. Curr Med Imaging 2020; 15:479-488. [PMID: 32008555 DOI: 10.2174/1573405614666180704150335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/06/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND We investigated thoracic masses with Computed Tomography (CT)- guided Percutaneous Co-Axial Trans-Thoracic Biopsy (PCTTB). METHODS The retrospective data of 86 patients to whom CT-guided PCTTB had been applied were obtained. Eighty-four cases and their pathologic results were included in the study. Localization and appearance of the lesions, pathologic results, and complications were evaluated. RESULTS Diagnostic sensitivity of CT-guided PCTTB was 97.6%. In 60.7% of the cases, malign lesions and, in 39.3% of the cases, benign lesions were diagnosed. The mass size was on average greater than 2 cm, and one mass was detected as being more than ≥2 masses. Mainly, irregular contours were observed. Most of the malign tumors were primary malign tumors on both sides (91.7% on the right side and 88.9% on the left side). Squamous Cell Carcinoma (SCC) was the most often detected malign tumor on the right side, and adenocarcinoma was the most often detected malign tumor on the left side. In masses localized on the left inferior lobe, metastasis was often detected. When the number of the mass was ≥2 and the mass had the appearance of consolidation, metastasis was usually detected. Small and large masses were mainly localized on right and left upper lobes. In the small mass group, 75.0% of the cases were benign, and, in the large mass group, 64.5% of the cases were malign (p=0.031, χ2=4.666). Pneumothorax was the most commonly occurring complication (23.8%). In masses localized on the right lower lobe, the pneumothorax ratio increased in benign masses compared to malign masses. The hemorrhage detection rate was 13.0%, and hemoptysis occurred in 14.2% of the cases. Hemorrhage was detected during 11.8% of the large mass biopsies. In females, hemorrhage occurred more often than in males (p=0.026, r= 0.244). CONCLUSION CT-guided PCTTB is a safe method to utilize for lung biopsies. Co-axial method increased the diagnostic accuracy of CT-guided percutaneous trans-thoracic biopsies. A single cut also decreased the complication rates.
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Affiliation(s)
- Mehmet Hamdi Şahan
- Department of Radiology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Mikail Inal
- Department of Radiology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Nuray Bayar Muluk
- ENT Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Adil Doğan
- Radiology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Pınar Atasoy
- Pathology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Zhou M, Wang T, Wei D, Zhu Y, Jiang Y, Zuo C, Jiang L, Chen H, Guo S, Yang L. Incidence, severity and tolerability of pneumothorax following low-dose CT-guided lung biopsy in different severities of COPD. CLINICAL RESPIRATORY JOURNAL 2020; 15:84-90. [PMID: 32935471 DOI: 10.1111/crj.13272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The feasibility of pneumothorax following low-dose CT-guided puncture lung biopsy in different severities of COPD has not been reported. METHODS The data of the patients with pulmonary lesion who underwent low-dose CT-guided lung biopsy by one experienced operator in our hospital from January 1st to September 30th in 2019 were retrospectively collected. They were divided into COPD group and non-COPD group. The risk factors, incidence and severity of pneumothorax with the severity of COPD and changes in MMRC score, treatment way and discharge time after pneumothorax were assessed. RESULTS Two hundred and nineteen patients were retrospectively enrolled in this study with 64 in the COPD group and 155 in the non-COPD group. The average age, MMRC score and the incidence of pneumothorax after biopsy were significantly higher in the COPD group (64.7 ± 1.27 years, 1.02 ± 0.13, 31.3%) than in the non-COPD group (58.8 ± 1.16 years, 0.35 ± 0.06, 17.4%, P < 0.05). The incidence of pneumothorax between I-II and III-IV in COPD did not reach the significant difference (P = 0.863). COPD was the only independent risk factor for pneumothorax after biopsy in a multivariable regression (P < 0.05). MMRC score was significantly increased at post-pneumothorax in the two groups (P < 0.001). There was no significant difference in diagnostic rate, severity of pneumothorax, the proportion of delayed pneumothorax, the changes in treatment way and discharge time between the two groups (P > 0.05). CONCLUSION Although the incidence of pneumothorax after low dose CT-guided lung biopsy is increased in COPD, there was no difference in the severity of pneumothorax amongst the different severities of COPD and it is well-tolerated without increasing medical burden.
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Affiliation(s)
- Mi Zhou
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongshan Wei
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Zhu
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yudan Jiang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cui Zuo
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Yang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tongbai T, McDermott S, Kiranantawat N, Muse VV, Wu CCC, Shepard JAO, Gilman MD. Non-Diagnostic CT-Guided Percutaneous Needle Biopsy of the Lung: Predictive Factors and Final Diagnoses. Korean J Radiol 2020; 20:1515-1526. [PMID: 31606956 PMCID: PMC6791813 DOI: 10.3348/kjr.2019.0014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/17/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To investigate the predictive factors for a non-diagnostic result and the final diagnosis of pulmonary lesions with an initial non-diagnostic result on CT-guided percutaneous transthoracic needle biopsy. MATERIALS AND METHODS All percutaneous transthoracic needle biopsies performed over a 4-year period were retrospectively reviewed. The initial pathological results were classified into three categories-malignant, benign, and non-diagnostic. A non-diagnostic result was defined when no malignant cells were seen and a specific benign diagnosis could not be made. The demographic data of patients, lesions' characteristics, technique, complications, initial pathological results, and final diagnosis were reviewed. Statistical analysis was performed using binary logistic regression. RESULTS Of 894 biopsies in 861 patients (male:female, 398:463; mean age 67, range 18-92 years), 690 (77.2%) were positive for malignancy, 55 (6.2%) were specific benign, and 149 (16.7%) were non-diagnostic. Of the 149 non-diagnostic biopsies, excluding 27 cases in which the final diagnosis could not be confirmed, 36% revealed malignant lesions and 64% revealed benign lesions. Predictive factors for a non-diagnostic biopsy included the size ≤ 15 mm, needle tract traversing emphysematous lung parenchyma, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Non-diagnostic biopsies with a history of malignancy or atypical cells on pathology were more likely to be malignant (p = 0.043 and p = 0.001). CONCLUSION The predictive factors for a non-diagnostic biopsy were lesion size ≤ 15 mm, needle tract traversing emphysema, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Thirty-six percent of the non-diagnostic biopsies yielded a malignant diagnosis. In cases with a history of malignancy or the presence of atypical cells in the biopsy sample, a repeat biopsy or surgical intervention should be considered.
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Affiliation(s)
- Thanisa Tongbai
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Nantaka Kiranantawat
- Department of Radiology, Songklanagarind Hospital, Prince of Songkhla University, Hat Yai, Thailand
| | | | - Carol Chia Chia Wu
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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13
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Doğan C, Fidan A, Cömert SŞ, Kıral N, Salepçi B, Parmaksıza ET, Çağlayan B. Can PET-CT predict diagnostic success in ultrasonography-guided transthoracic fine needle aspiration biopsies in lung cancers? Pulmonology 2020; 26:275-282. [PMID: 32044295 DOI: 10.1016/j.pulmoe.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To examine any correlations between tumor maximum standard uptake values (SUVmax) in positron emission tomography-computed tomography (PET-CT) and homogeneous/heterogeneous tumor FDG uptake in PET-CT, and the diagnostic success of the procedure in thoracic ultrasonography (US)-guided transthoracic fine needle aspiration biopsy (TFNAB). METHODS The files of patients who underwent thoracic US-guided TFNAB between 2013 and 2018 were examined. Patients who underwent thoracic US-guided TFNAB and were diagnosed as having primary lung cancer were considered as the US-TFNAB diagnostic group. Patients whose disease was diagnosed as primary lung cancer using a different diagnostic method (e.g. CT-guided biopsies, fiberoptic bronchoscopy) due to a lack of diagnosis despite undergoing thoracic US-guided TFNAB were allocated to the US-TFNAB non-diagnostic group. The clinical and radiologic characteristics and PET-CT parameters of the two groups were compared. RESULTS A total of 104 patients were included in the study; 79 (76%) patients whose disease was diagnosed using US-guided TFNAB, and 25 (24%) patients whose primary lung cancer could not be diagnosed with US-guided TFNAB. The mean SUVmax value of the US-TFNAB diagnostic group was 19.5 ± 10.1, whereas it was 15.1 ± 8.9 in the US-TFNAB non-diagnostic group (p = 0.016). Whether a lesion showed homogeneous or heterogeneous FDG uptake did not effect diagnostic success (p = 0.289). SUVmax value was the only effective independent factor in the diagnostic success of the procedure (p = 0.035). CONCLUSIONS High SUVmax values in PET-CT in lung cancers may increase the diagnostic success of US guided-TFNAB procedures.
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Affiliation(s)
- C Doğan
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - A Fidan
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - S Ş Cömert
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - N Kıral
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - B Salepçi
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - E T Parmaksıza
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - B Çağlayan
- Departmentof Chest Diseases, Koç University, Istanbul, Turkey
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14
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Gray ME, Sullivan P, Marland JRK, Greenhalgh SN, Meehan J, Gregson R, Clutton RE, Cousens C, Griffiths DJ, Murray A, Argyle D. A Novel Translational Ovine Pulmonary Adenocarcinoma Model for Human Lung Cancer. Front Oncol 2019; 9:534. [PMID: 31316911 PMCID: PMC6611418 DOI: 10.3389/fonc.2019.00534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/03/2019] [Indexed: 11/13/2022] Open
Abstract
In vitro cell line and in vivo murine models have historically dominated pre-clinical cancer research. These models can be expensive and time consuming and lead to only a small percentage of anti-cancer drugs gaining a license for human use. Large animal models that reflect human disease have high translational value; these can be used to overcome current pre-clinical research limitations through the integration of drug development techniques with surgical procedures and anesthetic protocols, along with emerging fields such as implantable medical devices. Ovine pulmonary adenocarcinoma (OPA) is a naturally-occurring lung cancer that is caused by the jaagsiekte sheep retrovirus. The disease has similar histological classification and oncogenic pathway activation to that of human lung adenocarcinomas making it a valuable model for studying human lung cancer. Developing OPA models to include techniques used in the treatment of human lung cancer would enhance its translational potential, making it an excellent research tool in assessing cancer therapeutics. In this study we developed a novel OPA model to validate the ability of miniaturized implantable O2 and pH sensors to monitor the tumor microenvironment. Naturally-occurring pre-clinical OPA cases were obtained through an on-farm ultrasound screening programme. Sensors were implanted into OPA tumors of anesthetized sheep using a CT-guided trans-thoracic percutaneous implantation procedure. This study reports the findings from 9 sheep that received sensor implantations. Time taken from initial CT scans to the placement of a single sensor into an OPA tumor was 45 ± 5 min, with all implantations resulting in the successful delivery of sensors into tumors. Immediate post-implantation mild pneumothoraces occurred in 4 sheep, which was successfully managed in all cases. This is, to the best of our knowledge, the first description of the use of naturally-occurring OPA cases as a pre-clinical surgical model. Through the integration of techniques used in the treatment of human lung cancer patients, including ultrasound, general anesthesia, CT and surgery into the OPA model, we have demonstrated its translational potential. Although our research was tailored specifically for the implantation of sensors into lung tumors, we believe the model could also be developed for other pre-clinical applications.
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Affiliation(s)
- Mark E Gray
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, United Kingdom.,Cancer Research UK Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Sullivan
- School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Jamie R K Marland
- School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Stephen N Greenhalgh
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, United Kingdom
| | - James Meehan
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.,Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
| | - Rachael Gregson
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, United Kingdom
| | - R Eddie Clutton
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, United Kingdom
| | - Chris Cousens
- Moredun Research Institute, Pentlands Science Park, Midlothian, United Kingdom
| | - David J Griffiths
- Moredun Research Institute, Pentlands Science Park, Midlothian, United Kingdom
| | - Alan Murray
- School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - David Argyle
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, United Kingdom
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15
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Percutaneous Lung Tumor Biopsy Under CBCT Guidance with PET-CT Fusion Imaging: Preliminary Experience. Cardiovasc Intervent Radiol 2019; 42:1644-1648. [DOI: 10.1007/s00270-019-02270-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022]
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16
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Chen CK, Chang HT, Chen YC, Chiang SC, Chou HP, Chen TJ. Utilization and Safety of Percutaneous Lung Biopsy: A 10-Year Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081316. [PMID: 31013710 PMCID: PMC6517953 DOI: 10.3390/ijerph16081316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Percutaneous lung biopsy is a technique used for sampling peripherally located lung masses and has been gaining in popularity. However, its exact utilization is unknown, and its safety has not been well studied. The current study aimed to assess the trend of utilization and study the safety of this procedure. Using the National Health Insurance Research Database, we retrospectively determined the total number of procedures that were performed on subjects older than 20 years between 2001 and 2010. We also estimated the rates of major complications, such as pneumothorax, requiring intercostal drainage. A total of 630 percutaneous biopsies were performed in 2001, while 3814 were performed in 2010, representing a 6.1-fold increase. The compound annual growth rate was 22.1%. The number of hospitals that performed the procedure increased from 55 to 99. Pneumothorax requiring drainage occurred in 1.5% of the procedures. The factors associated with a higher complication rate included male gender, chronic obstructive pulmonary disease, rural hospital, and low-volume hospital. Percutaneous lung biopsies are a relatively safe procedure, and their performance has been rapidly increasing. The number of procedures performed by a hospital was associated with the complication rate.
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Affiliation(s)
- Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Radiology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Yu-Chun Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Shu-Chiung Chiang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Hsiao-Ping Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Radiology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Division of Radiology, Yonghe Cardinal Tien Hospital, New Taipei City 23445, Taiwan.
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
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17
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Zehentmayr F, Sprenger M, Rettenbacher L, Wass R, Porsch P, Fastner G, Pirich C, Studnicka M, Sedlmayer F. Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation. Thorac Cancer 2019; 10:321-329. [PMID: 30618120 PMCID: PMC6360228 DOI: 10.1111/1759-7714.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Approximately 15% of lung cancer patients are diagnosed in early stages. Microscopic proof of disease cannot always be obtained because of comorbidity or reluctance to undergo invasive diagnostic procedures. In the current study, survival data of patients with and without pathology are compared. METHODS One hundred and sixty three patients with NSCLC I-IIb (T3 N0) treated between 2002 and 2016 were eligible: 123 (75%) had pathological confirmation of disease, whereas 40 (25%) did not. In accordance with international guidelines, both groups received radiotherapy. Comorbidity was assessed with the Charlson Comorbidity Index (CCI). RESULTS The median follow-up was 28.6 months (range: 0.3-162): 66 (40%) patients are still alive, while 97 (59%) patients died: 48 (29%) cancer-related deaths and 49 (30%) from causes other than cancer. Median overall survival (OS) in patients without pathological confirmation was 58.6 months (range: 0.5-162), which did not differ from those with microscopic proof of disease (39.4 months, range: 0.3-147.5; logrank P = 0.481). Median cancer-specific survival (CSS) also did not differ at 113.4 months (range: 0.5-162) in the non-confirmation group (logrank P = 0.763) versus 51.5 months (range: 3.7-129.5) in patients with pathology. In Cox regression, a CCI of ≥ 3 was associated with poor OS (hazard ratio 2.0; range 1.2-3.4; P = 0.010) and CSS (hazard ratio 2.0; 1.0-4.0; P = 0.043). CONCLUSION OS and CSS in early lung cancer patients depend on comorbidity rather than on pathological confirmation of disease.
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Affiliation(s)
- Franz Zehentmayr
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.,radART, Paracelsus Medical University, Salzburg, Austria
| | - Martin Sprenger
- Postgraduate Public Health Program, Medical University of Graz, Graz, Austria
| | - Lukas Rettenbacher
- Department of Nuclear Medicine, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Romana Wass
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Peter Porsch
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Gerd Fastner
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Christian Pirich
- Department of Nuclear Medicine, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Michael Studnicka
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.,radART, Paracelsus Medical University, Salzburg, Austria
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18
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Jang H, Rho JY, Suh YJ, Jeong YJ. Asymptomatic systemic air embolism after CT-guided percutaneous transthoracic needle biopsy. Clin Imaging 2019; 53:49-57. [DOI: 10.1016/j.clinimag.2018.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 12/28/2022]
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19
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Guo Z, Shi H, Li W, Lin D, Wang C, Liu C, Yuan M, Wu X, Xiong B, He X, Duan F, Han J, Yang X, Yu H, Si T, Xu L, Xing W, Jinhua H, Wang Y, Xie H, Cui L, Gao W, He D, Liu C, Liu Z, Ma C, Pan J, Shao H, Tu Q, Yong L, Xu Y, Weihao Z, Qiang Z, Wang S. Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy. Thorac Cancer 2018; 9:1530-1543. [PMID: 30221455 PMCID: PMC6209790 DOI: 10.1111/1759-7714.12849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
Biopsy has been used to diagnose thoracic diseases for more than a century. Percutaneous needle biopsy plays a crucial role in the diagnosis, staging, and treatment planning for tumors in the lungs, thoracic wall, hilum, and mediastinum. With the continuous improvement in imaging techniques, the range of clinical applications for percutaneous needle biopsy is also expanding. It has become important to improve Chinese professionals’ and technicians’ understanding of percutaneous transthoracic needle biopsy (PTNB) in order to standardize operating procedures and to strengthen perioperative management. However, there is currently no Chinese expert consensus that provides systematic standardization and guidance for PTNB in clinical practice. The Committee of Chinese Society of Interventional Oncology (CSIO) of the Chinese Anti‐Cancer Association (CACA) initiated a Chinese multidisciplinary expert consensus on PTNB. The consensus includes image‐guided methods, indications, contraindications, multidisciplinary team recommendations, biopsy procedures, daytime/outpatient biopsy, complications, pathological examination, and management of negative results.
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Affiliation(s)
- Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Committee of Chinese Society of Interventional Oncology, China Anti-Cancer Association, Tianjin, China
| | - Hong Shi
- Chinese Medical Association Publishing House, Beijing, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital, Beijing, China
| | - Changli Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chen Liu
- Department of Pathology, Peking University Cancer Hospital, Beijing, China
| | - Min Yuan
- Department of Interventional Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Xia Wu
- Department of Interventional Radiology, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Xiong
- Department of Interventional Radiology, Huazhong University of Science and Technology Affiliated with Union Hospital of Tongji Medical College, Wuhan, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Feng Duan
- Department of Interventional Therapy, The General Hospital of People's Liberation Army, Beijing, China
| | - Jianjun Han
- Department of Interventional Therapy, Shandong Cancer Hospital, Jinan, China
| | - Xueling Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haipeng Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Tongguo Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Linfeng Xu
- Department of Interventional Therapy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenge Xing
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Huang Jinhua
- Department of Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yingjuan Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hui Xie
- Department of Interventional Therapy, 302 Military Hospital of China, Beijing, China
| | - Li Cui
- Department of Interventional Therapy, The General Hospital of People's Liberation Army, Beijing, China
| | - Wei Gao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dongfeng He
- The Affiliated Cancer Hospital of Harbin Medical University, Harbin, China
| | - Changfu Liu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhou Liu
- Department of Interventional Therapy, Shenzhen Cancer Hospital, Shenzhen, China
| | - Chunhua Ma
- Department of Interventional Therapy, Tianjin Huanhu Hospital, Tianjin, China
| | - Jie Pan
- Department of Interventional Therapy, Peking Union Medical College Hospital, Beijing, China
| | - Haibo Shao
- Department of Interventional Therapy, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qiang Tu
- Department of Interventional Therapy, Jiangxi Cancer Hospital, Nanchang, China
| | - Li Yong
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yan Xu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhang Weihao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zou Qiang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Sen Wang
- Department of Interventional Therapy, Tianjin Third Central Hospital, Tianjin, China
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20
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Chassagnon G, Gregory J, Al Ahmar M, Magdeleinat P, Legmann P, Coste J, Revel MP. Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures. Diagn Interv Radiol 2018; 23:347-353. [PMID: 28762333 DOI: 10.5152/dir.2017.160338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy. METHODS All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable. RESULTS A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16-0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049). CONCLUSION The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy.
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Affiliation(s)
- Guillaume Chassagnon
- Department of Radiology, Paris Descartes University, Sorbonne Paris Cité Groupe Hospitalier Cochin-Hotel Dieu, Paris, France.
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21
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Jazieh AR, Al Kattan K, Bamousa A, Al Olayan A, Abdelwarith A, Ansari J, Al Twairqi A, Al Fayea T, Al Saleh K, Al Husaini H, Abdelhafiez N, Mahrous M, Faris M, Al Omair A, Hebshi A, Al Shehri S, Al Dayel F, Bamefleh H, Khalbuss W, Al Ghanem S, Loutfi S, Khankan A, Al Rujaib M, Al Ghamdi M, Ibrahim N, Swied A, Al Kayait M, Datario M. Saudi lung cancer management guidelines 2017. Ann Thorac Med 2017; 12:221-246. [PMID: 29118855 PMCID: PMC5656941 DOI: 10.4103/atm.atm_92_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lung cancer management is getting more complex due to the rapid advances in all aspects of diagnostic and therapeutic options. Developing guidelines is critical to help practitioners provide standard of care. METHODS The Saudi Lung Cancer Guidelines Committee (SLCGC) multidisciplinary members from different specialties and from various regions and healthcare sectors of the country reviewed and updated all lung cancer guidelines with appropriate labeling of level of evidence. Supporting documents to help healthcare professionals were developed. RESULTS Detailed lung cancer management guidelines were finalized with appropriate resources for systemic therapy and short reviews highlighting important issues. Stage based disease management recommendation were included. A summary explanation for complex topics were included in addition to tables of approved systemic therapy. CONCLUSION A multidisciplinary lung cancer guidelines was developed and will be disseminated across the country.
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Affiliation(s)
| | - Abdul Rahman Jazieh
- Department of Medical Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khaled Al Kattan
- Department of Surgery, Al Faisal University, Riyadh, Saudi Arabia
| | - Ahmed Bamousa
- Department of Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ashwaq Al Olayan
- Department of Medical Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmed Abdelwarith
- Department of Medical Oncology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Jawaher Ansari
- Department of Medical Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Twairqi
- Department of Medical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Turki Al Fayea
- Department of Medical Oncology, Princess Noorah Oncology Center, Riyadh, Saudi Arabia
| | - Khalid Al Saleh
- Department of Medical Oncology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Hamed Al Husaini
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nafisa Abdelhafiez
- Department of Medical Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mervat Mahrous
- Department of Medical Oncology, King Fahad Hospital, Madinah, Saudi Arabia
| | - Medhat Faris
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ameen Al Omair
- Department of Radiation Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Adnan Hebshi
- Department of Radiation Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Salem Al Shehri
- Department of Radiation Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Foad Al Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hanaa Bamefleh
- Department of Pathology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Walid Khalbuss
- Department of Pathology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sarah Al Ghanem
- Department of Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Shukri Loutfi
- Department of Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Azzam Khankan
- Department of Interventional Radiology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Meshael Al Rujaib
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Majed Al Ghamdi
- Department of Pulmonary, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nagwa Ibrahim
- Department of Pharmacy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulmonem Swied
- Department of Gastroenterology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammad Al Kayait
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Marie Datario
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Anzidei M, Porfiri A, Andrani F, Di Martino M, Saba L, Catalano C, Bezzi M. Imaging-guided chest biopsies: techniques and clinical results. Insights Imaging 2017. [PMID: 28639114 PMCID: PMC5519500 DOI: 10.1007/s13244-017-0561-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. Methods Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive. Results Although a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy. Conclusion Percutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications. Teaching points • Imaging-guided biopsy is one of the main methods to obtain lung nodule specimens. • CT has the highest accuracy for diagnosis as an imaging guide. • Compared to FNAB, CNB has a higher accuracy for diagnosis. • Pneumothorax and parenchymal pulmonary haemorrhage care the most frequent complications. • Several clinical and technical variables can affect diagnostic accuracy and patient safety.
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Affiliation(s)
- Michele Anzidei
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Andrea Porfiri
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Fabrizio Andrani
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Michele Di Martino
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Bezzi
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
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Abstract
PURPOSE This study aimed to assess the current practice patterns of radiologists performing percutaneous lung biopsies. MATERIALS AND METHODS This cross-sectional study used a web-based survey sent to the Society of Thoracic Radiology membership from August to October 2015. Responses were collected anonymously, and results were tallied. RESULTS A total of 244 Society of Thoracic Radiology members responded to the survey. One hundred thirty-seven radiologists regularly perform percutaneous lung biopsies, of whom 102 (74%) practice at an academic teaching hospital. Computed tomography (CT) and CT fluoroscopy were the modalities of choice for image guidance, preferred by 82 (60%) and 48 (35%) respondents, respectively. Twenty (15%) respondents preferred fine-needle aspiration (FNA) alone, 57 (42%) preferred core needle biopsy (CNB) alone, and 59 (43%) preferred both FNA and CNB in the same setting. On-site cytology was routinely requested by 70 (71%) respondents with access to such services. In cases of suspected lung cancer, 79 (60%) respondents estimated sending tissue for molecular analysis >25% of the time. Forty-three (32%) respondents reported using intraprocedural preventive measures to minimize risk of pneumothorax. CONCLUSIONS Among surveyed radiologists who perform percutaneous lung biopsies, most utilize CT guidance with either CNB alone or in conjunction with FNA. A small minority routinely performs FNA alone, which may negatively impact diagnostic accuracy and provide insufficient tissue for molecular profiling. Education of all radiologists regarding the importance of routinely acquiring and sending greater amounts of tissue for molecular/genomic assessment of suspected lung cancer is needed.
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Diagnostic Yield for Cancer and Diagnostic Accuracy of Computed Tomography-guided Core Needle Biopsy of Subsolid Pulmonary Lesions. J Thorac Imaging 2016; 32:50-56. [PMID: 27870823 DOI: 10.1097/rti.0000000000000245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to determine the diagnostic yield for cancer and diagnostic accuracy of computed tomography-guided core needle biopsy (CTNB) in subsolid pulmonary lesions. MATERIALS AND METHODS Fifty-two biopsies of 52 subsolid lesions in 51 patients were identified from a database of 912 lung biopsies and analyzed for the diagnostic yield for cancer and diagnostic accuracy of core CTNB diagnosis as well as complication rates. RESULTS When indeterminate biopsy results were included in the analysis, the diagnostic yield for cancer was 80.8% and the diagnostic accuracy of core needle biopsy was 84.6% (n=52). It was 85.7% and 91.7%, respectively, when indeterminate results were excluded (n=48) and 82.4% and 82.4%, respectively, for biopsies with surgical confirmation (n=17). Attenuation was statistically significant for diagnostic yield for cancer (P=0.028) and diagnostic accuracy of core needle biopsy (P=0.001) when the indeterminate results were excluded (n=48). Attenuation and size were not statistically significant for diagnostic yield for cancer and diagnostic accuracy of needle biopsy (n=52), and size was not statistically significant for either when the indeterminate results were excluded. These results were achieved without any major complications as per the Society of Interventional Radiology Standards of Practice. CONCLUSIONS CTNB offers a high yield in establishing a histopathologic diagnosis of subsolid pulmonary lesions, with both ground-glass and solid-predominance. The pure ground-glass category of lesions requires further research to determine the true diagnostic yield and diagnostic accuracy of core needle biopsies.
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Chami H, Faraj W, Yehia Z, Badour S, Sawan P, Rebeiz K, Safa R, Saade C, Ghandour B, Shamseddine A, Mukherji D, Haydar A. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT. Clin Radiol 2015; 70:1382-7. [DOI: 10.1016/j.crad.2015.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/28/2015] [Accepted: 08/04/2015] [Indexed: 11/30/2022]
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26
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Fontaine-Delaruelle C, Souquet PJ, Gamondes D, Pradat E, De Leusse A, Ferretti GR, Couraud S. Negative Predictive Value of Transthoracic Core-Needle Biopsy. Chest 2015; 148:472-480. [DOI: 10.1378/chest.14-1907] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Olgun DC, Samanci C, Ergin AS, Akman C. Life-threatening complication of percutaneous transthoracic fine-needle aspiration biopsy: systemic arterial air embolism. Eurasian J Med 2014; 47:72-4. [PMID: 25745350 DOI: 10.5152/eajm.2014.51] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 10/03/2013] [Indexed: 01/05/2023] Open
Abstract
Computed tomography-guided percutaneous transthoracic fine-needle aspiration biopsy of lung lesions is a well known diagnostic technique. Nevertheless, it has some complications; such as pneumothorax, intraparenchymal hemorrhage and hemoptysis, which are not rare. Air embolism is one of the rare but potentially fetal complications of this procedure. Herein, we report the case of a 69-year-old male, in which case of systemic air embolism developed after the performance of lung biopsy. Early diagnosis and prompt oxygen therapy is crucial for patient's survival so careful reviewing of the obtained computed tomography images during the biopsy may prevent a missing systemic air embolism and provide an adequate therapy.
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Affiliation(s)
- Deniz Cebi Olgun
- Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Cesur Samanci
- Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ayse Seda Ergin
- Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Canan Akman
- Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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28
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Wang Y, Li W, He X, Li G, Xu L. Computed tomography-guided core needle biopsy of lung lesions: Diagnostic yield and correlation between factors and complications. Oncol Lett 2013; 7:288-294. [PMID: 24348866 PMCID: PMC3861590 DOI: 10.3892/ol.2013.1680] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 11/01/2013] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to determine the diagnostic accuracy of computed tomography (CT)-guided core needle biopsy (CNB) and to retrospectively analyze the correlation between the factors and complications of the procedure. Between January 2009 and June 2010, CNB was performed on 345 lung lesions in 343 patients. These patients were then followed up for at least two years. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the CNB diagnoses were calculated. The correlation between factors, such as smoking, positoin and maximal diameter, and the complications of pneumothorax and hemorrhage was analyzed by χ2 test. The sensitivity, specificity, accuracy, PPV and NPV of the CNB diagnoses were 97.3, 100, 97.7, 100 and 87.7%, respectively. A statistically significant correlation was found between pneumothorax and the factors of smoking (P=0.015) and position (P<0.01) and length of the needle in the normal parenchyma (P=0.011), as well as between hemorrhage and the maximal diameter (P=0.005) and length of the needle in the normal parenchyma (P<0.01) and the frequency of needle adjustments (P<0.01). A CT-guided core needle biopsy of the lung lesions provides a high diagnostic yield. Smoking, the decubitus position and a longer length of the needle in the normal parenchyma were found to represent risk factors for a pneumothorax. In addition, a small diameter and longer length of the needle in the normal parenchyma and a more frequent adjustment of the needle were poor predictive factors of hemorrhage.
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Affiliation(s)
- Ying Wang
- Department of Radiology, Fudan University Cancer Hospital, Shanghai 200032, P.R. China
| | - Wentao Li
- Department of Radiology, Fudan University Cancer Hospital, Shanghai 200032, P.R. China
| | - Xinhong He
- Department of Radiology, Fudan University Cancer Hospital, Shanghai 200032, P.R. China
| | - Guodong Li
- Department of Radiology, Fudan University Cancer Hospital, Shanghai 200032, P.R. China
| | - Lichao Xu
- Department of Radiology, Fudan University Cancer Hospital, Shanghai 200032, P.R. China
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Mattonen SA, Palma DA, Haasbeek CJA, Senan S, Ward AD. Distinguishing radiation fibrosis from tumour recurrence after stereotactic ablative radiotherapy (SABR) for lung cancer: a quantitative analysis of CT density changes. Acta Oncol 2013; 52:910-8. [PMID: 23106174 DOI: 10.3109/0284186x.2012.731525] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND For patients treated with stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer, benign computed tomography (CT) changes due to radiation-induced lung injury (RILI) can be difficult to differentiate from recurrence. We measured the utility of CT image feature analysis in differentiating RILI from recurrence, compared to Response Evaluation Criteria In Solid Tumours (RECIST). MATERIALS AND METHODS Twenty-two patients with 24 lesions treated with SABR were selected (11 with recurrence, 13 with substantial RILI). On each follow-up CT, consolidative changes and ground glass opacities (GGO) were contoured. For each lesion, contoured regions were analysed for mean and variation in Hounsfield units (HU), 3D volume, and RECIST size during follow-up. RESULTS One hundred and thirty-six CT scans were reviewed, with a median imaging follow-up of 26 months. The 3D volume and RECIST measures of consolidative changes could significantly distinguish recurrence from RILI, but not until 15 months post-SABR; mean volume at 15 months [all values ± 95% confidence interval (CI)] of 30.1 ± 19.3 cm(3) vs. 5.1 ± 3.6 cm(3) (p = 0.030) and mean RECIST size at 15 months of 4.34 ± 1.13 cm vs. 2.63 ± 0.84 cm (p = 0.028) respectively for recurrence vs. RILI. At nine months post-SABR, patients with recurrence had significantly higher-density consolidative changes (mean at nine months of -96.4 ± 32.7 HU vs. -143.2 ± 28.4 HU for RILI; p = 0.046). They also had increased variability of HU, an image texture metric, measured as the standard deviation (SD) of HU, in the GGO areas (SD at nine months of 210.6 ± 14.5 HU vs. 175.1 ± 18.7 HU for RILI; p = 0.0078). CONCLUSIONS Quantitative changes in mean HU and GGO textural analysis have the potential to distinguish RILI from recurrence as early as nine months post-SABR, compared to 15 months with RECIST and 3D volume. If validated, this approach could allow for earlier detection and salvage of recurrence, and result in fewer unnecessary investigations of benign RILI.
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Affiliation(s)
- Sarah A Mattonen
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
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30
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Khankan AA, Al-Muaikeel M. Image-guided percutaneous transthoracic biopsy in lung cancer – Emphasis on CT-guided technique. J Infect Public Health 2012; 5 Suppl 1:S22-30. [DOI: 10.1016/j.jiph.2012.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Outcomes of stereotactic ablative radiotherapy following a clinical diagnosis of stage I NSCLC: comparison with a contemporaneous cohort with pathologically proven disease. Radiother Oncol 2011; 101:250-4. [PMID: 22056535 DOI: 10.1016/j.radonc.2011.09.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 12/23/2022]
Abstract
INTRODUCTION As a finding of benign disease is uncommon in Dutch patients undergoing surgery after a clinical diagnosis of stage I NSCLC, patients are also accepted for stereotactic ablative radiotherapy (SABR) without pathology. We studied outcomes in patients who underwent SABR after either a pathological (n=209) or clinical diagnosis (N=382). MATERIALS AND METHODS Five hundred and ninety-one patients with a single pulmonary lesion underwent SABR after either a pathological- or a clinical diagnosis of stage I NSCLC based on a (18)FDG-PET positive lesion with CT features of malignancy. SABR was delivered to a total dose of 60Gy in 3, 5 or 8 fractions, and outcomes were compared between groups with and without pathological diagnosis. RESULTS Patients with pathology had significantly larger tumor diameters (p<.001) and higher predicted FEV1% values (p=.025). No significant differences were observed between both groups in overall survival (p=.99) or local control (p=.98). Regional and distant recurrence rates were also similar. CONCLUSIONS In a population with a low incidence of benign (18)FDG-PET positive lung nodules, clinical SABR outcomes were similar in large groups of patients with or without pathology. The survival benefits reported after the introduction of SABR are unlikely to be biased by inclusion of benign lesions.
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32
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Wallace AB, Suh RD. Percutaneous transthoracic needle biopsy: special considerations and techniques used in lung transplant recipients. Semin Intervent Radiol 2011; 21:247-58. [PMID: 21331136 DOI: 10.1055/s-2004-861559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lung transplant recipients are among the patients most likely eventually to undergo diagnostic lung biopsy. Unfortunately, these patients are at particularly high risk for experiencing intra- and periprocedural complications. Percutaneous transthoracic needle biopsy (TNB) has over time emerged as an increasingly safe and reliable method of obtaining lung tissue for diagnosis. This article gives an overview of TNB including its indications, the imaging modalities currently used for guidance, and the special techniques utilized in performing the procedure and minimizing complications with an emphasis placed upon the special case of TNB performed in lung transplant recipients.
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Affiliation(s)
- Amanda B Wallace
- Department of Radiological Sciences, UCLA Medical Center, Los Angeles, California
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Kim YD, Jeong YJ, Hoseok I, Cho JS, Lee JW, Kim HJ, Lee SH, Kim DH. Localization of pulmonary nodules with lipiodol prior to thoracoscopic surgery. Acta Radiol 2011; 52:64-9. [PMID: 21498328 DOI: 10.1258/ar.2010.100307] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preoperative localization with lipiodol for identifying small or deeply seated pulmonary nodules is simple and useful for thoracoscopic surgery. Although several studies about performance and complication rates of lipiodol localization have been reported, there has been no report about the performance and complication rates of lipiodol localization with regard to the CT appearance of pulmonary nodules. PURPOSE To evaluate the performance and complication rates of localization of pulmonary nodules with lipiodol prior to video-assisted thoracoscopic surgery with regard to the CT appearance of nodules. MATERIAL AND METHODS After institutional review board approval and informed consent were obtained, lipiodol marking was performed in 67 patients (33 men and 34 women; mean age 58 years) with 68 nodules. All nodules were marked with 0.4-0.5 mL lipiodol under CT guidance on the day of surgery. The size of the targeted nodule and the shortest distance to the accessible pleural surface were measured. Lipiodol accumulation of a targeted nodule was scored by use of a four-point scale (0: none, 1: within 1 cm around a nodule, 2: partial accumulation within a nodule, 3: total accumulation within a nodule). Any complications after localization of nodules were noted. We analyzed the score of lipiodol accumulation and the presence of complications for the CT appearance of pulmonary nodules using the Mann Whitney U test, Fisher's exact test and the Kruskall Walis test. RESULTS The average nodule size was 11.4 mm (range 3.0-28.3 mm) and the average distance to the pleural surface was 13.7 mm (range 0-51.4 mm). Lipiodol accumulation scores of nodules were as follows: score 3 (n=19, 28%), score 2 (n=37, 54%), score 1 (n=11, 16%), and score 0 (n=1, 2%). Lipiodol accumulation scores of nodules were different according to the size of nodules (Kruskal Wallis test, p=0.023). Pneumothorax after localization occurred in 20 (29%) patients and the incidence was higher in nodules located in the subpleural area (Mann Whitney U test, p=0.048). Pulmonary hemorrhage along the needle tract occurred in five (7%) patients and was more frequent in patients with deep nodules as compared to shallow nodules (Mann Whitney U test, p < 0.001). CONCLUSION Lipiodol marking under CT guidance is a useful and safe procedure for the intraoperative localization of pulmonary nodules. Of variable CT findings, lesion size is important to determine the degree of lipiodol accumulation and the lesion depth is the most important feature for the development of postprocedural complications.
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Affiliation(s)
| | | | - I Hoseok
- Department of Thoracic and Cardiovascular Surgery
| | - Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery
| | | | | | | | - Dong Hyun Kim
- Department of Biomedical Engineering Lab, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan 602-739, Korea
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Bhatia S. Systemic Air Embolism following CT-guided Lung Biopsy. J Vasc Interv Radiol 2009; 20:709-11. [DOI: 10.1016/j.jvir.2009.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 02/24/2009] [Accepted: 03/02/2009] [Indexed: 02/07/2023] Open
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Um SJ, Lee SK, Yang DK, Son C, Kim KN, Lee KN, Kim YS. Four cases of a cerebral air embolism complicating a percutaneous transthoracic needle biopsy. Korean J Radiol 2009; 10:81-4. [PMID: 19182507 PMCID: PMC2647167 DOI: 10.3348/kjr.2009.10.1.81] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A percutaneous transthoracic needle biopsy is a common procedure in the practice of pulmonology. An air embolism is a rare but potentially fatal complication of a percutaneous transthoracic needle biopsy. We report four cases of a cerebral air embolism that developed after a percutaneous transthoracic needle biopsy. Early diagnosis and the rapid application of hyperbaric oxygen therapy is the mainstay of therapy for an embolism. Prevention is the best course and it is essential that possible risk factors be avoided.
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Affiliation(s)
- Soo Jung Um
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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36
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Laspas F, Roussakis A, Efthimiadou R, Papaioannou D, Papadopoulos S, Andreou J. Percutaneous CT-guided fine-needle aspiration of pulmonary lesions: Results and complications in 409 patients. J Med Imaging Radiat Oncol 2008; 52:458-62. [DOI: 10.1111/j.1440-1673.2008.01990.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Felip E, Rojo F, Reck M, Heller A, Klughammer B, Sala G, Cedres S, Peralta S, Maacke H, Foernzler D, Parera M, Möcks J, Saura C, Gatzemeier U, Baselga J. A phase II pharmacodynamic study of erlotinib in patients with advanced non-small cell lung cancer previously treated with platinum-based chemotherapy. Clin Cancer Res 2008; 14:3867-74. [PMID: 18559607 DOI: 10.1158/1078-0432.ccr-07-5186] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine potential markers of clinical benefit and the effects of erlotinib on the epidermal growth factor receptor (EGFR) signaling pathway in advanced non-small cell lung cancer patients refractory to platinum-based chemotherapy. EXPERIMENTAL DESIGN Patients were given erlotinib (150 mg/d). Tumor biopsies were done immediately before treatment and in a subgroup of patients after 6 weeks' treatment. RESULTS Of 73 evaluable patients, 7 (10%) had partial response and 28 (38%) had stable disease. In 53 patients with baseline tumor samples, no relationship was observed between pretreatment levels of EGFR, phosphorylated (p)-EGFR, p-AKT, p-mitogen-activated protein kinase (MAPK), or p27 and clinical benefit (i.e., response, or stable disease >/=12 weeks). Tumors from 15 of 57 patients had high EGFR gene copy number, assessed using fluorescence in situ hybridization (FISH positive), 10 of whom had clinical benefit, compared with 5 of 42 FISH-negative patients. FISH-positive patients had longer median progression-free [137 versus 43 days, P = 0.002; hazard ratio (HR), 0.37] and overall (226 versus 106 days, P = 0.267; HR, 0.70) survival than FISH-negative patients. In paired biopsy samples from 14 patients, p-EGFR (P = 0.002), p-MAPK (P = 0.001), and Ki-67 (P = 0.025) levels were significantly reduced after 6 weeks' treatment. Apoptosis was significantly increased in patients with clinical benefit (P = 0.029), and may be a marker of clinical benefit. CONCLUSION In this study, EGFR FISH-positive status was associated with improved outcome after erlotinib therapy. Erlotinib led to reduced levels of p-EGFR, p-MAPK, and Ki-67, and stimulated apoptosis in tumor samples from patients with clinical benefit.
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Affiliation(s)
- Enriqueta Felip
- Medical Oncology Service and Pathology Service, Vall d'Hebron University Hospital, Barcelona, Spain
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Ferretti G, Jankowski A, Calizzano A, Moro-Sibilot D, Vuillez J. [Imaging and PET/CT of lung cancer]. ACTA ACUST UNITED AC 2008; 89:387-400; quiz 301-2. [PMID: 18408640 DOI: 10.1016/s0221-0363(08)89016-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Lung cancer is one of the most frequently occurring cancer in the world. Imaging plays a critical role for screening, diagnosing, staging, and following patients. Although morphologic imaging such as chest X-ray and CT are still useful for these purpose, major limitations occur in the proper evaluation of diagnosing and staging. Metabolic imaging using PET significantly increases the accuracy of staging. This paper will review the role of imaging in patients suspected or diagnosed with lung cancer.
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Affiliation(s)
- G Ferretti
- Clinique Universitaire de Radiologie et Imagerie Médicale, Pôle d'imagerie, CHU Grenoble, Université J Fourier, Grenoble.
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Li L, Liu LZ, Wu QL, Mo YX, Liu XW, Cui CY, Wan DS. CT-guided core needle biopsy in the diagnosis of pancreatic diseases with an automated biopsy gun. J Vasc Interv Radiol 2008; 19:89-94. [PMID: 18192472 DOI: 10.1016/j.jvir.2007.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the safety and diagnostic accuracy of computed tomographic (CT)-guided core needle biopsy (CNB) in the diagnosis of pancreatic diseases by using an automated biopsy gun with a cutting-type needle. MATERIALS AND METHODS From January 2000 to January 2006, CT-guided CNB was performed in 80 patients suspected of having pancreatic diseases in the absence of liver metastasis. Biopsies were performed with an 18-20-gauge cutting needle driven by a spring-loaded biopsy gun. Histologic reports and medical records of all patients were retrospectively reviewed. An institutional review board exemption was obtained to perform this retrospective study. RESULTS All patients tolerated the biopsies well, with no serious complications. Three patients had mild abdominal pain after the procedure, and a limited abdominal CT scan did not reveal any marked abnormality. Two patients had an elevated serum amylase level, which returned to normal within 2 weeks. A definitive diagnosis and accurate histologic diagnosis were obtained for 69 patients, for a successful diagnosis rate of 86%. Surgical sampling was performed in 11 patients with neoplasms and nondiagnostic core-needle biopsies. Only 50% of patients with well-differentiated adenocarcinomas were definitely diagnosed with CT-guided CNB. CONCLUSIONS CT-guided CNB with an automated biopsy gun is a safe and effective method for obtaining tissue for the histologic evaluation of pancreatic diseases. However, CT-guided CNB requires further development for the accurate diagnosis of well-differentiated adenocarcinomas.
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Affiliation(s)
- Li Li
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
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Gillams AR, Lees WR. Analysis of the factors associated with radiofrequency ablation-induced pneumothorax. Clin Radiol 2007; 62:639-44. [PMID: 17556032 DOI: 10.1016/j.crad.2007.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 02/04/2007] [Accepted: 02/15/2007] [Indexed: 11/19/2022]
Abstract
AIM To define the characteristics most likely to result in radiofrequency ablation (RFA)-induced pneumothorax. METHODS AND MATERIALS CT-guided RFA was performed in 79 tumours in 55 lungs in 37 patients, 16 were women, mean age 62 years (range 34-83). Three had primary lung cancer, 34 had metastases. The number, size, and location of tumours, electrode type, treatment parameters, length of electrode trajectory through aerated lung, background emphysema, prior interventions, and use of positive-pressure ventilation were analysed. The size, timing of any pneumothoraces, and intervention were recorded. RESULTS Pneumothorax occurred in 21 of the 25 lungs treated (38%), 18 immediate and three delayed. Seventeen of the 21 (81%) occupied less than 30% of the hemithorax, whereas in four cases >31% was involved. Eight of the 55 (15%) pneumothoraces required aspiration. The length of the electrode trajectory through aerated lung in those who developed a pneumothorax was 5.4+/-4.7cm versus 1.9+/-2.7 in those who did not (p=0.001). The mean number of tumours ablated was higher in the pneumothorax group, 1.7+/-1 versus 1.3+/-0.6 (p=0.03), as was the number of electrode positions, 6+/-3.9 versus 3.6+/-2.2 (p=0.01). On multivariate analysis only the needle trajectory through aerated lung was significant (p=0.04). CONCLUSIONS The number of tumours, electrode positions, and the anticipated electrode trajectory through aerated lung impacts on the likelihood of a pneumothorax. These considerations should be factored into patient selection, the choice of approach, and trajectory used in RFA.
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Affiliation(s)
- A R Gillams
- UCLH and UCL Medical School, Special Xray, Podium 2, University College Hospital, 235 Euston Road, London NW1 2BU, UK.
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Melloni G, Cremona G, Bandiera A, Arrigoni G, Rizzo N, Varagona R, Muriana G, Carretta A, Ciriaco P, Canneto B, Zannini P. Localized Organizing Pneumonia: Report of 21 Cases. Ann Thorac Surg 2007; 83:1946-51. [PMID: 17532376 DOI: 10.1016/j.athoracsur.2007.01.062] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 01/26/2007] [Accepted: 01/29/2007] [Indexed: 01/15/2023]
Abstract
BACKGROUND Thoracic surgeons have limited experience with treating localized organizing pneumonia owing to its rare occurrence in routine clinical practice. METHODS We retrospectively investigated the clinicopathologic features of 21 patients with localized organizing pneumonia observed between 2001 and 2004. RESULTS There were 15 men and 6 women. Mean age was 63 years. Eight patients (38%) were symptomatic. Computed tomographic scan showed a single lesion in 17 patients (12 nodules and 5 masses) and bilateral lesions in 4. Wedge resection was performed in 16 patients and lobectomy in 5. There was no operative mortality. Follow-up was complete in all patients (range, 2 to 46 months; median, 20 months). Surgery was curative in 15 of 17 patients with a single lesion, and no recurrence was observed (p < 0.005). The remaining 2 patients with a single lesion (2 masses) had a local relapse with the appearance of nodular lesions in the residual parenchyma. Both these patients received steroids with resolution of the lesions. All 4 patients with bilateral lesions who underwent surgery for diagnostic purposes received steroids with improvement of the radiologic aspect in 3 and stabilization of the lesions in 1. CONCLUSIONS Clinical and radiologic findings of localized organizing pneumonia are nonspecific, and this unusual entity is difficult to differentiate from a primary or metastatic tumor. Surgical resection allows both diagnosis and cure. However, considering the benignity of the lesion and the efficacy of steroids, major pulmonary resections should be avoided.
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Affiliation(s)
- Giulio Melloni
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy.
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Yasufuku K, Nakajima T, Motoori K, Sekine Y, Shibuya K, Hiroshima K, Fujisawa T. Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest 2006; 130:710-8. [PMID: 16963667 DOI: 10.1378/chest.130.3.710] [Citation(s) in RCA: 354] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY OBJECTIVES To perform a prospective comparison of direct real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), positron emission tomography (PET), and thoracic CT for detection of mediastinal and hilar lymph node metastasis in patients with lung cancer considered for surgical resection. DESIGN Prospective patient enrollment. SETTING University teaching hospital. PATIENTS One hundred two potentially operable patients with proven (n = 96) or radiologically suspected (n = 6) lung cancer were included in the study. INTERVENTIONS CT, PET, and EBUS-TBNA were performed prior to surgery for the evaluation of mediastinal and hilar lymph node metastasis. The convex probe EBUS, which is integrated with a convex scanning probe on its tip, was used for EBUS-TBNA. Surgical histology was used as the "gold standard" to confirm lymph node metastasis unless patients were found inoperable for N3 or extensive N2 disease proven by EBUS-TBNA. MAIN RESULTS EBUS-TBNA was successfully performed in all 102 patients (mean age, 67.8 years) from 147 mediastinal and 53 hilar lymph nodes. EBUS-TBNA proved malignancy in 37 lymph node stations in 24 patients. CT identified 92 positive lymph nodes, and PET identified 89 positive lymph nodes (4 supraclavicular, 63 mediastinal, 22 hilar). The sensitivities of CT, PET, and EBUS-TBNA for the correct diagnosis of mediastinal and hilar lymph node staging were 76.9%, 80.0%, and 92.3%, respectively; specificities were 55.3%, 70.1%, and 100%, and diagnostic accuracies were 60.8%, 72.5%, and 98.0%. EBUS-TBNA was uneventful, and there were no complications. CONCLUSION Compared to CT and PET, EBUS-TBNA has a high sensitivity as well as specificity for mediastinal and hilar lymph node staging in patients with lung cancer. EBUS-TBNA should be considered for evaluation of the mediastinum early in the staging process of lung cancer.
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Affiliation(s)
- Kazuhiro Yasufuku
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, Eguchi K, Kuriyama K, Sakai F, Noguchi M, Murata K, Murayama S, Mochizuki T, Mori K, Yamada K. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 2006; 59:60-4. [PMID: 16530369 DOI: 10.1016/j.ejrad.2006.02.001] [Citation(s) in RCA: 324] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 02/04/2006] [Accepted: 02/06/2006] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey. MATERIALS AND METHODS Postal questionnaires regarding CT-guided needle biopsy were sent out to multiple hospitals in Japan. The questions regarded: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates and numbers of pneumothorax, hemothorax, air embolism, tumor seeding, tension pneumothorax and other rare complications. Each severe complication was followed with additional questions. RESULTS Data from 9783 biopsies was collected from 124 centers. Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases. A total of 39 (35%) hospitals reported 74 (0.75%) cases with severe complications. There were six cases (0.061%) with air embolism, six cases (0.061%) with tumor seeding at the site of the biopsy route, 10 cases (0.10%) with tension pneumothorax, six cases (0.061%) with severe pulmonary hemorrhage or hemoptysis, nine cases (0.092%) with hemothorax, and 27 cases (0.26%) with others, including heart arrest, shock, and respiratory arrest. From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela, however one patient (0.01%) recovered with hemiplegia due to cerebral infarction, and the remaining seven patients (0.07%) died. CONCLUSIONS This is the first national study documenting severe complications with respect to CT-guided needle biopsy in Japan. The complication rate in Japan is comparable to internationally published figures. We believe this data will improve both clinicians as well as patients understanding of the risk versus benefit of CT-guided needle biopsy, resulting better decisions.
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Affiliation(s)
- Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduated School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Morello FA, Wright KC, Lembo TM. New suction guide needle designed to reduce the incidence of biopsy-related pneumothorax: experimental evaluation in canine model. Radiology 2005; 235:1045-9. [PMID: 15914484 DOI: 10.1148/radiol.2353040433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In an attempt to remove air that enters the pleural space during computed tomography (CT)-guided coaxial transthoracic needle biopsy, the authors fashioned an 18-gauge experimental suction guide needle and evaluated the incidence of pneumothorax with this needle in comparison to the incidence of pneumothorax with a standard 18-gauge guide needle in a canine model. This experiment had animal care and use committee approval. Ten dogs underwent a biopsy of each lung, for a total of 20 lung biopsies. Half of the biopsies were performed by using the experimental needle (five right lungs, five left lungs), and half were performed by using a standard guide needle. CT revealed pneumothorax during the procedure and was performed to reveal pneumothorax 1 and 3 hours after the procedure. A significant reduction (P < .016) in intraprocedural lung biopsy-associated pneumothorax was found when the experimental guide needle was used.
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Affiliation(s)
- Frank A Morello
- Department of Interventional Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex, USA.
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Oblique approach of computed tomography guided needle biopsy using multiplanar reconstruction image by multidetector-row CT in lung cancer. Eur J Radiol 2005; 52:206-11. [PMID: 15489081 DOI: 10.1016/j.ejrad.2004.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Revised: 01/13/2004] [Accepted: 01/15/2004] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to establish the technique of multiplanar reconstruction (MPR) with multidetector-row (MDR) computed tomography (CT) guided needle biopsy for the diagnosis to access very difficult lesions. The CT guided percutaneous biopsy are well-established methods to obtain cytological and histological material such as the peripheral tumors in lung cancer. Occasionally, the conventional CT cannot permit planning a trajectory to avoid passage through bones, avoidance of bullae, fissures or vessels. In addition, some lesions are situated in less favorable locations such as those in the costophrenic recess or close to the mediastinum. Rarely can we diagnose them. MPR with MDR-CT has recently become widely available with applications for thoracic lesions. MPR images have been used to evaluate the location of small peripheral lung nodules to the relation of bullaes, vessels, and costophrenic recess. To diagnose these lesions, the usefulness of MPR were evaluated for an planning of an oblique approach of CT guided needle biopsy. MPR images were reconstructed as a line from the needle entry point to the target lesion. The first oblique image applied as the direction of posterior-anterior and cranio-caudal axis, and the second oblique image applied as the direction of posterior-anterior and left-right. Eleven out of 151 patients were required MPR technique to allow possible access to target, because of avoidance of bone and fissures in the needle pass or located in the costophrenic recess, between April 2001 and December 2002. The 5/11 patients were at the upper site (segment 1, 2 and 6) behind the scapula and ribs, 3/11 patients were at the lower lobe (segment 10) in the costophrenic recess, and 3/11 were middle lobe or segment 3 covered by the ribs and fissures. All the lesions except one were histologically diagnosed. Five patients were adenocarcinoma, and the other five patients were benign tumors. Pneumothorax occurred in one patient before we obtained the specimens. MPR guided needle biopsy with oblique approach was thought to be useful for diagnosis of very difficult thoracic lesions and would obviate an unnecessary surgical thoracoscopy.
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Taki S, Yamamoto T, Kawai A, Terahata S, Kinuya K, Tonami H. Sonographically guided core biopsy of the salivary gland masses. Clin Imaging 2005; 29:189-94. [PMID: 15855064 DOI: 10.1016/j.clinimag.2004.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2004] [Accepted: 06/20/2004] [Indexed: 11/25/2022]
Abstract
Over an 8-year period, we performed ultrasonography (US)-guided core biopsy of the salivary gland in 37 patients using an 1l-mm-throw 18-gauge automated biopsy system. The biopsy results were retrospectively compared with the findings of surgical pathology (n=18) or more than 6 months of clinical follow-up (n=19). The sensitivity, specificity, and accuracy of US-guided core biopsy for the diagnosis of malignancy were 75.0%, 96.6%, and 91.9%, respectively. No immediate or delayed complications occurred.
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Affiliation(s)
- Suzuka Taki
- Department of Radiology, Kanazawa Medical University, Uchinada-cho, Kahoku 920-0293, Japan.
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Aviram G, Schwartz DS, Meirsdorf S, Rosen G, Greif J, Graif M. Transthoracic needle biopsy of lung masses: a survey of techniques. Clin Radiol 2005; 60:370-4. [PMID: 15710141 DOI: 10.1016/j.crad.2004.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 09/13/2004] [Accepted: 09/14/2004] [Indexed: 11/20/2022]
Abstract
AIM In order to assess the range and everyday use of the various techniques for percutaneous transthoracic needle biopsy of lung masses in the USA and Canada, we surveyed thoracic radiologists in academic and community practice on their standard approach to the procedure. MATERIALS AND METHODS The 300 questionnaires that were mailed to members of the Society of Thoracic Radiology throughout the USA and Canada contained specific questions on their approach to a transthoracic needle biopsy of a routine case of a 3cm lung mass located in the right lower lobe 1cm from the pleural surface. RESULTS A total of 140 (47%) members responded. Of the 139 responders who performed lung biopsies, 103 (74%) were located at a teaching centre affiliated to a university or medical school, and 36 (26%) were community-based radiologists. In total 97 (70%) replied that they would perform the procedure under CT guidance, 31 (22%) under either CT or fluoroscopy guidance, and 11 (8%) only under fluoroscopy. Fine-needle aspiration was the procedure of choice for the given case by 101 (73%) responders, whereas 20 (14%) preferred doing core biopsy, and 18 (13%) chose both techniques. On-site cytology confirmation for obtaining diagnostic material was available to 101 (73%) responders. Before performing the procedure, 107 (77%) verified coagulation tests whereas 32 (23%) did not. Follow-up imaging for pneumothorax assessment was not routinely performed by 15 (11%) responders. CONCLUSION The majority of radiologists performed percutaneous transthoracic needle biopsy of a lung mass under CT guidance, by fine-needle aspiration, using repeated pleural puncture technique, and with a cytologist on site. A significant minority did not obtain coagulation screening before the procedure, and a small minority did not routinely assess for pneumothorax by late chest radiography.
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Affiliation(s)
- G Aviram
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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Welker JA, Alattar M, Gautam S. Repeat needle biopsies combined with clinical observation are safe and accurate in the management of a solitary pulmonary nodule. Cancer 2005; 103:599-607. [PMID: 15630699 DOI: 10.1002/cncr.20814] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sixty percent of removed solitary pulmonary nodules (SPNs) are benign. An approach that reduces the unnecessary excision of benign nodules is consistent with the oncologic objective of organ preservation. METHODS A prospective observational study was performed at a lung cancer referral center in which consecutive patients were evaluated who presented with SPNs measuring < 4 cm on computed tomography (CT) scans. Patients underwent transbronchial biopsy (TBB), percutaneous needle aspiration (PCNA), clinical observation, repeat CT scans, and repeat biopsies. Patients were observed clinically and underwent repeat biopsies in an effort to reduce unnecessary surgical intervention. RESULTS One hundred eighteen patients underwent 194 biopsy sessions, including 137 TBB sessions and 57 PCNA sessions. The mean follow-up was 4 years. The shortest follow-up of a benign lesion was 3 years. The incidence of malignancy was 61%. The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy all were 100%. Five patients had a delayed change in diagnosis from benign to malignant. This delay in diagnosis neither resulted in a change in tumor stage nor had an impact on patient management or survival. CONCLUSIONS Repeat needle biopsies combined with clinical observation and repeat CT scans can classify an SPN as benign versus malignant with 100% accuracy (95% confidence interval, 96.1-100.0%). An SPN diagnostic approach that includes a TBB, then PCNA, clinical observation, repeat CT scans, and repeat biopsies for continued suspicion of malignancy appears to reduce the unnecessary surgical excision of benign nodules from the current rate of 60% to 5% of SPN resections without affecting the survival of patients who have malignant SPNs.
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Affiliation(s)
- James A Welker
- Hospitalist Section, Department of Internal Medicine, Harbor Hospital Center, Baltimore, Maryland, USA.
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