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Goetz A, Poschenrieder F, Steer FG, Zeman F, Lange TJ, Thurn S, Greiner B, Stroszczynski C, Uller W, Hamer O, Hammer S. Intravenous Opioid Medication with Piritramide Reduces the Risk of Pneumothorax During CT-Guided Percutaneous Core Biopsy of the Lung. Cardiovasc Intervent Radiol 2024; 47:621-631. [PMID: 38639781 DOI: 10.1007/s00270-024-03717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax. MATERIALS AND METHODS One hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis. RESULTS The overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate. CONCLUSION Procedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung. LEVEL OF EVIDENCE 4: small study cohort.
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Affiliation(s)
- Andrea Goetz
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Florian Poschenrieder
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Frederike Georgine Steer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Sylvia Thurn
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Okka Hamer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Kim D, Han JY, Baek JW, Lee HY, Cho HJ, Heo YJ, Shin GW. Effect of the respiratory motion of pulmonary nodules on CT-guided percutaneous transthoracic needle biopsy. Acta Radiol 2023; 64:2245-2252. [PMID: 36575592 DOI: 10.1177/02841851221144616] [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: 12/29/2022]
Abstract
BACKGROUND Computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) is highly affected by respiratory motion; however, respiratory motion of target nodule during the PTNB and its effect on CT-guided lung biopsy have not been studied. PURPOSE To investigate the effect of the respiratory motion of pulmonary nodules on CT-guided PTNB. MATERIAL AND METHODS We retrospectively reviewed the procedural CT scans of 426 pulmonary nodules that underwent PTNB during quiet breathing. Maximal and average respiratory motions were measured using the difference of table position of the targeted nodule between multiple procedural scans. Diagnostic performance, complications, and technical factors of PTNB in nodules with large motion (maximal motion >1 cm) were compared with those in nodules with small motion (≤1 cm). RESULTS The mean maximal and average respiratory motions between tidal volume breathing were 5.4 ± 4.4 and 2.7 ± 2.6 mm, respectively. Sensitivity and accuracy were 93.1% and 96.1% in nodules with large motion, compared with 94.7% and 95.9% in nodules with small motion, respectively. Respiratory targeting (P < 0.001), needle modulation (P < 0.001), motion artifact of target (P < 0.001), target disappearance from scans (P < 0.001), and number of performed CT scans (P < 0.001) were significantly higher in the large motion group, with no significant difference in radiation dose and complications between the groups. CONCLUSION The respiratory motion of pulmonary nodules during CT-guided PTNB may cause technical difficulties but does not affect diagnostic performance nor complications associated with PTNB.
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Affiliation(s)
- Dasom Kim
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Ji-Yeon Han
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jin Wook Baek
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Ho Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hwa Jin Cho
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Young Jin Heo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Gi Won Shin
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
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Fong KY, Tan ASM, Bin Sulaiman MS, Leong SH, Ng KW, Too CW. Phantom and Animal Study of a Robot-Assisted, CT-Guided Targeting System using Image-Only Navigation for Stereotactic Needle Insertion without Positional Sensors. J Vasc Interv Radiol 2022; 33:1416-1423.e4. [PMID: 35970505 DOI: 10.1016/j.jvir.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/11/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the feasibility and accuracy of a robotic system to integrate and map computed tomography (CT) and robotic coordinates, followed by automatic trajectory execution by a robotic arm. The system was hypothesized to achieve a targeting error of <5 mm without significant influence from variations in angulation or depth. MATERIALS AND METHODS An experimental study was conducted using a robotic system (Automated Needle Targeting device for CT [ANT-C]) for needle insertions into a phantom model on both moving patient table and moving gantry CT scanners. Eight spherical markers were registered as targets for 90 insertions at different trajectories. After a single ANT-C registration, the closed-loop software targeted multiple markers via the insertion of robotically aligned 18-gauge needles. Accuracy (distance from the needle tip to the target) was assessed by postinsertion CT scans. Similar procedures were repeated to guide 10 needle insertions into a porcine lung. A regression analysis was performed to test the effect of needle angulation and insertion depth on the accuracy of insertion. RESULTS In the phantom model, all needle insertions (median trajectory depth, 64.8 mm; range, 46.1-153 mm) were successfully performed in single attempts. The overall accuracy was 1.36 mm ± 0.53, which did not differ between the 2 types of CT scanners (1.39 mm ± 0.54 [moving patient table CT] vs 1.33 mm ± 0.52 [moving gantry CT]; P = .54) and was not significantly affected by the needle angulation and insertion depth. The accuracy for the porcine model was 9.09 mm ± 4.21. CONCLUSIONS Robot-assisted needle insertion using the ANT-C robotic device was feasible and accurate for targeting multiple markers in a phantom model.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alexander Sheng Ming Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | | | | | - Ka Wei Ng
- NDR Medical Technology Pvt Ltd, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore.
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Zhang H, Tian S, Wang S, Liu S, Liao M. CT-Guided Percutaneous Core Needle Biopsy in Typing and Subtyping Lung Cancer: A Comparison to Surgery. Technol Cancer Res Treat 2022; 21:15330338221086411. [PMID: 35313752 PMCID: PMC8943531 DOI: 10.1177/15330338221086411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Lung cancer histologic types and subtypes are closely
associated with treatment selection and prognosis prediction. In this study, we
aim to evaluate the suitability of computed tomography-guided percutaneous core
needle biopsy (CT-guided PCNB) in typing and subtyping lung cancer.
Methods: From August 2007 to December 2015, the patients who
underwent CT-guided PCNB and lung lesion resection were retrospectively
collected and analyzed. All pathological sections were reassessed in consensus
by 2 junior pathologists (group A) and 2 senior pathologists (group B),
respectively. All cases were diagnosed on 3 levels: first, malignant and benign
diagnosis; second, histologic types diagnosis; and third, histologic subtypes
diagnosis and compared with surgery results. Pearson chi-square test was used to
compare the differences of diagnostic accuracy between pathologists in group A
and group B. Results: A cohort of 160 patients was included in this
study. On the first level, the diagnostic accuracy was 90.63% (group A) and
94.38% (group B), (P = .20). On the second level, the
diagnostic accuracy for malignant lesions, adenocarcinoma (ADC), and squamous
cell carcinoma (SQC) were, respectively, 72.66%, 84.72%, and 69.05% (group A)
and 76.98%, 90.28%, and 71.43% (group B) (P > .05). On the
third level, the diagnostic accuracy for ADC subtypes were 26.39% (group A) and
55.56% (group B) (P < 0.01); for SQC subtypes were 28.57%
(group A) and 38.10% (group B) (P = 0.36).
Conclusion: Small specimens obtained by CT-guided PCNB were
suitable for the diagnosis of lung cancer histologic types, which may contribute
to the selection of a suitable treatment strategy for the unresectable lung
cancers. While for the diagnosis of subtypes, discussion with experienced
pathologists was recommended.
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Affiliation(s)
- Hanfei Zhang
- 89674Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Sufang Tian
- 89674Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shan Wang
- 89674Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Songmei Liu
- 89674Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meiyan Liao
- 89674Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Lingegowda D, Gupta B, Gehani A, Sen S, Ghosh P. Optimization of the Lung Biopsy Procedure: A Primer. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1740456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractImage-guided lung biopsy plays a very important role in the diagnosis and management of lung lesions. As a diagnostic tool, it demands a high diagnostic yield and a low complication rate. It is imperative to balance the diagnostic yield and patient safety during lung biopsies. The aim of this article is to review the standard practice guidelines of lung biopsy, to describe the techniques used to minimize the complications associated with lung biopsy, and to describe the management of complications.
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Affiliation(s)
| | - Bharat Gupta
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Anisha Gehani
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Priya Ghosh
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
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Abstract
ABSTRACT Percutaneous computed tomography-guided transthoracic lung biopsy is an effective and minimally invasive procedure to achieve tissue diagnosis. Radiologists are key in appropriate referral for further workup, with percutaneous computed tomography-guided transthoracic lung biopsy performed by both thoracic and general interventionalists. Percutaneous computed tomography-guided transthoracic lung biopsy is increasingly performed for both diagnostic and research purposes, including molecular analysis. Multiple patient, lesion, and technique-related variables influence diagnostic accuracy and complication rates. A comprehensive understanding of these factors aids in procedure planning and may serve to maximize diagnostic yield while minimizing complications, even in the most challenging scenarios.
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Portela-Oliveira E, Souza CA, Gupta A, Bayanati H, Inacio J, Rakhra K. Ultrasound-guided percutaneous biopsy of thoracic lesions: high diagnostic yield and low complication rate. Clin Radiol 2021; 76:281-286. [PMID: 33531160 DOI: 10.1016/j.crad.2020.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
AIM To investigate the use of ultrasound (US)-guided biopsy of thoracic lesions aiming to determine diagnostic success and complication rates and to identify factors that may affect sample adequacy and safety. MATERIAL AND METHODS This was a retrospective study of consecutive percutaneous US-guided biopsy over 10-year period, including 147 procedures in 146 patients (66 ± 7 years, 83 men, 63 women) with lesions located in the lung (67/147), chest wall (54/147), mediastinum (14/147) and pleura (12/147). Overall diagnostic success, yield for benign and malignant diagnoses and diagnostic success according to lesion location, biopsy type (fine-need aspiration [FNA] or core-needle biopsy [CNB]) and number of specimens were calculated. Presence of complications and effect of age, lesion location, biopsy type, and number of specimens were measured. RESULTS The overall diagnostic success rate was 90.5% and was similar for malignant (90.6%) and benign (87.5%) diagnoses. Specimen adequacy was similar for FNA and CNB (91.2% and 88.9%, p=0.66); number of specimens did not affect yield. Diagnostic success was highest for mediastinal and chest wall lesions (92.9% and 94.4%) and lowest for pleural lesions (75%), albeit not statistically significant (p=0.45). Complications occurred in 4/147(2.7%) cases, exclusively in lung lesions, and were not associated with any covariates analysed. CONCLUSIONS US-guided biopsy is an effective and safe technique for diagnosis of thoracic lesions, with high diagnostic yield and low complication rate. In the presence of an adequate acoustic window, US guidance can be valuable for diagnosis of peripheral lung and mediastinal lesions. Radiologists performing thoracic biopsy should be encouraged to implement or expand the use of US guidance in their practice.
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Affiliation(s)
- E Portela-Oliveira
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), University of Ottawa, 501 Smyth Road, Box 232, General Campus Room 1466e, Ottawa, ON, K1H 8L6, Canada
| | - C A Souza
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), University of Ottawa, 501 Smyth Road, Box 232, General Campus Room 1466e, Ottawa, ON, K1H 8L6, Canada.
| | - A Gupta
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), University of Ottawa, 501 Smyth Road, Box 232, General Campus Room 1466e, Ottawa, ON, K1H 8L6, Canada
| | - H Bayanati
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), University of Ottawa, 501 Smyth Road, Box 232, General Campus Room 1466e, Ottawa, ON, K1H 8L6, Canada
| | - J Inacio
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), University of Ottawa, 501 Smyth Road, Box 232, General Campus Room 1466e, Ottawa, ON, K1H 8L6, Canada
| | - K Rakhra
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), University of Ottawa, 501 Smyth Road, Box 232, General Campus Room 1466e, Ottawa, ON, K1H 8L6, Canada
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8
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Lee JW, Park CH, Lee SM, Jeong M, Hur J. Planting Seeds into the Lung: Image-Guided Percutaneous Localization to Guide Minimally Invasive Thoracic Surgery. Korean J Radiol 2020; 20:1498-1514. [PMID: 31606955 PMCID: PMC6791818 DOI: 10.3348/kjr.2019.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
Image-guided localization materials are constantly evolving, providing options for the localization of small pulmonary nodules to guide minimally invasive thoracic surgery. Several preoperative methods have been developed to localize small pulmonary lesions prior to video-assisted thoracic surgery. These localization techniques can be categorized into 4 groups according to the materials used: localization with metallic materials (hook-wire, microcoil, or spiral coil), localization with dye (methylene blue or indigo carmine), localization with contrast agents (lipiodol, barium, or iodine contrast agents), and radiotracers (technetium-99m). However, the optimal localization method has not yet been established. In this review article, we discuss the various localization techniques and the advantages and disadvantages of localization techniques as well as the available safety and efficacy data on these techniques.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miri Jeong
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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9
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Frimpong GAA, Aboagye E, Amankwah P, Coleman NE, Abaidoo NK. Short-duration post CT-guided thoracic biopsy monitoring- clinical experience with 440 patients. J Med Radiat Sci 2019; 66:91-95. [PMID: 30859701 PMCID: PMC6545478 DOI: 10.1002/jmrs.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/09/2019] [Accepted: 02/19/2019] [Indexed: 01/31/2023] Open
Abstract
Purpose With several studies recording a higher percentage of complications in the first hour of post‐biopsy, this study sought to evaluate the safety in the reduction in post‐biopsy patient monitoring time after computed tomography (CT)‐guided thoracic biopsies, providing a basis for further research. Materials and Methods This was a retrospective study involving patients who were referred to our centre for CT‐guided thoracic biopsies from January 2010 to December 2017. Patients who presented with no complications immediately after the post‐biopsy CT scan were given 30 min of post‐biopsy care after which they were discharged, and given a hot line to call in case of any complication. There was also a follow‐up call by a nurse after 24 h to inquire about any complication and general condition of the patients. Results A total of 440 core needle thoracic biopsies were performed within the period of the study. The most common thoracic region indicated for biopsy was mediastinal (n = 240, 54.5%), followed by lung (n = 185, 42.0%). Complications were recorded at a rate of 6.4% (n = 28), with 4.1% (n = 18) been pneumothorax and pulmonary haemorrhage and haemoptysis accounting for 2.3% (n = 10). No relevant complications were recorded in patients who presented with no complications immediately after the post‐biopsy CT scan (n = 374, 85%). Conclusions Findings from this initial study have shown that thirty minutes of post‐biopsy care could be sufficient for patients present with no complications immediately after a post‐procedural scan in CT‐guided thoracic biopsies; providing a basis for similar algorithms to be explored in a randomised control study to substantiate the observation.
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Affiliation(s)
- George Asafu Adjaye Frimpong
- Department of Radiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Spectra Health Imaging and Interventional Radiology, Kumasi, Ghana
| | - Evans Aboagye
- Spectra Health Imaging and Interventional Radiology, Kumasi, Ghana.,Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pierre Amankwah
- Spectra Health Imaging and Interventional Radiology, Kumasi, Ghana.,Department of Radiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Nana E Coleman
- Spectra Health Imaging and Interventional Radiology, Kumasi, Ghana
| | - Nakao K Abaidoo
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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10
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Jun C, Lim S, Petrisor D, Chirikjian G, Kim JS, Stoianovici D. A simple insertion technique to reduce the bending of thinbevel-point needles. MINIM INVASIV THER 2019; 28:199-205. [PMID: 30822190 DOI: 10.1080/13645706.2018.1505758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Needle insertion is a common component of most diagnostic and therapeutic interventions. Needles with asymmetrically sharpened points such as the bevel point are ubiquitous. Their insertion path is typically curved due to the rudder effect at the point. However, the common planned path is straight, leading to targeting errors. We present a simple technique that may substantially reduce these errors. The method was inspired by practical experience, conceived mathematically, and refined experimentally. Methods: Targeting errors are reduced by flipping the bevel on the opposite side (rotating the needle 180° about its axis), at a certain depth during insertion. The ratio of the flip depth to the full depth of insertion is defined as the flip depth ratio (FDR). Based on a model, FDR is constant 0.3. Results: Experimentally, the ratio depends on the needle diameter, 0.35 for 20Ga and 0.45 for 18Ga needles. Thinner needles should be flipped a little shallower, but never less than 0.3. Conclusion: Practically, a physician may expect to reduce ∼80% of needle deflection errors by simply flipping the needle. The technique may be used by hand or with guidance devices.
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Affiliation(s)
- Changhan Jun
- a Robotics Laboratory, Urology Department , Johns Hopkins University , Baltimore , MD , USA.,b Mechanical Engineering Department , Johns Hopkins University , Baltimore , MD , USA
| | - Sunghwan Lim
- a Robotics Laboratory, Urology Department , Johns Hopkins University , Baltimore , MD , USA.,b Mechanical Engineering Department , Johns Hopkins University , Baltimore , MD , USA
| | - Doru Petrisor
- a Robotics Laboratory, Urology Department , Johns Hopkins University , Baltimore , MD , USA
| | - Gregory Chirikjian
- b Mechanical Engineering Department , Johns Hopkins University , Baltimore , MD , USA
| | - Jin Seob Kim
- b Mechanical Engineering Department , Johns Hopkins University , Baltimore , MD , USA
| | - Dan Stoianovici
- a Robotics Laboratory, Urology Department , Johns Hopkins University , Baltimore , MD , USA.,b Mechanical Engineering Department , Johns Hopkins University , Baltimore , MD , USA
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11
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Shahriari N, Georgiadis JR, Oudkerk M, Misra S. Hybrid control algorithm for flexible needle steering: Demonstration in phantom and human cadaver. PLoS One 2018; 13:e0210052. [PMID: 30596801 PMCID: PMC6312316 DOI: 10.1371/journal.pone.0210052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/17/2018] [Indexed: 01/05/2023] Open
Abstract
Needles are commonly used in the clinic for percutaneous procedures. The outcome of such procedures heavily depends on accurate placement of the needle. There are two main challenges to achieve high accuracy: First, aligning the needle with the targeted lesion, and second, compensating for the deflection of the needle in the tissue. In order to address these challenges, scientists have developed several robotic setups for needle steering. However, the subject is still under research and reliable implementations which can be used in clinical practice are not yet available. In this paper, we have taken some steps in order to bring needle steering closer to practice. A new hybrid control algorithm is developed, which enables us to control a flexible needle by combing base-manipulation and beveled-tip steering methods. A pre-operative path planner is developed which considers the clinical requirements. The proposed method is tested in the lung of a fresh-frozen human cadaver. The work-flow of the experiments are similar to the current clinical practice. Three experimental cases are used to evaluate the proposed steering algorithm. Experimental Case I shows that using the proposed steering algorithm controllability of the needle is increased. In Case II and Case III, the needle is steered in a gelatin phantom and a human cadaver, respectively. The targeting accuracy of 1.35±0.49mm in gelatin phantom and 1.97±0.89mm in cadave is achieved. A feasibility study is performed, in which a fine needle aspiration (FNA) needle is steered in the lungs of a human cadaver under computed tomography guidance. The targeting error for the feasibility study is 2.89±0.22mm. The results suggest that such a robotic system can be beneficial for clinical use and the patient receives less x-ray radiation.
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Affiliation(s)
- Navid Shahriari
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
- Surgical Robotics Laboratory, Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - Janniko R. Georgiadis
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Sarthak Misra
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
- Surgical Robotics Laboratory, Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of Biomedical Engineering, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Chevrie J, Shahriari N, Babel M, Krupa A, Misra S. Flexible Needle Steering in Moving Biological Tissue With Motion Compensation Using Ultrasound and Force Feedback. IEEE Robot Autom Lett 2018. [DOI: 10.1109/lra.2018.2809484] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Interventional Pulmonology and Solitary Pulmonary Nodule. Arch Bronconeumol 2018; 54:497-498. [PMID: 29580566 DOI: 10.1016/j.arbres.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
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14
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Zhang HF, Liao MY, Zhu DY, Chen J, Wang YF. Lung radiodensity along the needle passage is a quantitative predictor of pneumothorax after CT-guided percutaneous core needle biopsy. Clin Radiol 2017; 73:319.e1-319.e7. [PMID: 29150082 DOI: 10.1016/j.crad.2017.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
AIM To analyse whether the lowest value of lung radiodensity along the passage of the biopsy needle is a quantitative predictor of pneumothorax. MATERIALS AND METHODS CT-guided percutaneous core needle biopsy (PCNB) procedures performed at Zhongnan Hospital were analysed retrospectively. Age, gender, lesion size, lesion depth, lesion location, patient position, number of passages, needle pleural angle, pulmonary bleeding, and lung radiodensity along the needle passage were collected and classified by the extent of pneumothorax. Univariate analysis and multiple logistic regression analysis were assessed to explore the independent risk factors for pneumothorax. RESULTS Six hundred and seventy-seven cases were included in the study, including 456 males and 221 females. Pneumothorax occurred in 40.18% of cases, of which 82.4% were mild, 14% were moderate, and 3.7% were severe. Univariate and multivariate analysis showed that lesion size ≤2 cm (p=0.002), two or more passages (p=0.033), and lung radiodensity of -850 HU or less (p≤0.001) were independent risk factors for pneumothorax; bleeding (p<0.001) was a protective factor for pneumothorax. CONCLUSIONS The lowest value of lung radiodensity along the needle passage was a quantitative predictor of pneumothorax. A value of -850 HU or less was an independent risk factor for pneumothorax. As the value decreased, there was a higher risk of occurrence of more severe pneumothorax.
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Affiliation(s)
- H F Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
| | - M Y Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, China.
| | - D Y Zhu
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
| | - J Chen
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
| | - Y F Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
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15
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Shahriari N, Heerink W, van Katwijk T, Hekman E, Oudkerk M, Misra S. Computed tomography (CT)-compatible remote center of motion needle steering robot: Fusing CT images and electromagnetic sensor data. Med Eng Phys 2017; 45:71-77. [PMID: 28512000 DOI: 10.1016/j.medengphy.2017.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/22/2017] [Accepted: 04/23/2017] [Indexed: 12/29/2022]
Abstract
Lung cancer is the most common cause of cancer-related death, and early detection can reduce the mortality rate. Patients with lung nodules greater than 10 mm usually undergo a computed tomography (CT)-guided biopsy. However, aligning the needle with the target is difficult and the needle tends to deflect from a straight path. In this work, we present a CT-compatible robotic system, which can both position the needle at the puncture point and also insert and rotate the needle. The robot has a remote-center-of-motion arm which is achieved through a parallel mechanism. A new needle steering scheme is also developed where CT images are fused with electromagnetic (EM) sensor data using an unscented Kalman filter. The data fusion allows us to steer the needle using the real-time EM tracker data. The robot design and the steering scheme are validated using three experimental cases. Experimental Case I and II evaluate the accuracy and CT-compatibility of the robot arm, respectively. In experimental Case III, the needle is steered towards 5 real targets embedded in an anthropomorphic gelatin phantom of the thorax. The mean targeting error for the 5 experiments is 1.78 ± 0.70 mm. The proposed robotic system is shown to be CT-compatible with low targeting error. Small nodule size and large needle diameter are two risk factors that can lead to complications in lung biopsy. Our results suggest that nodules larger than 5 mm in diameter can be targeted using our method which may result in lower complication rate.
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Affiliation(s)
- Navid Shahriari
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, The Netherlands; Department of Biomechanical Engineering, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Horstring (HR) Z-140, Drienerlolaan 5, Enschede 7522NB, The Netherlands.
| | - Wout Heerink
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Tim van Katwijk
- Department of Biomechanical Engineering, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Horstring (HR) Z-140, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - Edsko Hekman
- Department of Biomechanical Engineering, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Horstring (HR) Z-140, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sarthak Misra
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, The Netherlands; Department of Biomechanical Engineering, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Horstring (HR) Z-140, Drienerlolaan 5, Enschede 7522NB, The Netherlands; Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, The Netherlands
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16
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Görgülü FF, Öksüzler FY, Arslan SA, Arslan M, Özsoy İE, Görgülü O. Computed tomography-guided transthoracic biopsy: Factors influencing diagnostic and complication rates. J Int Med Res 2017; 45:808-815. [PMID: 28415930 PMCID: PMC5536670 DOI: 10.1177/0300060517698064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to assess the complication and diagnostic rates of computed tomography (CT)-guided transthoracic needle biopsy of pulmonary parenchymal and mediastinal lesions. Methods Patients who were suspected to have a malignancy based on chest imaging and CT and could not be otherwise diagnosed were evaluated. Results Sixty-five patients were included; 48 (73.8%) were male and 17 (26.2%) were female. Their average age was 58 years. The lesion size ranged from 11 to 105 mm. The most common specific histologic subtype was adenocarcinoma, and the least common was lymphoma. The diagnostic rate was 90.8%. The mean complication rate was 15.4%. Statistically significant associations were found between the complication rate and needle size and between the needle path length and lesion size. Conclusion CT-guided needle biopsy is an effective diagnostic method for patients with mediastinal and parenchymal lesions before thoracotomy. This method can also reliably differentiate benign and malignant tumors.
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Affiliation(s)
- Feride Fatma Görgülü
- 1 Radiology Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
| | - Fatma Yasemin Öksüzler
- 1 Radiology Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
| | | | - Muhammet Arslan
- 1 Radiology Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
| | - İbrahim Ethem Özsoy
- 3 Chest Surgery Department, University of Health Sciences, Kayseri Research and Training Hospital, Kayseri, Turkey
| | - Orhan Görgülü
- 4 ENT Department, University of Health Sciences, Adana Numune Research and Training Hospital, Adana, Turkey
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17
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Aktaş AR, Gözlek E, Yılmaz Ö, Kayan M, Ünlü N, Demirtaş H, Değirmenci B, Kara M. CT-guided transthoracic biopsy: histopathologic results and complication rates. Diagn Interv Radiol 2016; 21:67-70. [PMID: 25430528 DOI: 10.5152/dir.2014.140140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate the effectiveness and complications of transthoracic CT-guided biopsy techniques. METHODS A total of 94 CT-guided percutaneous transthoracic biopsy procedures performed in 85 patients were retrospectively evaluated. Core biopsy technique was used in 87 procedures and transthoracic fine-needle aspiration biopsy was used in seven procedures. RESULTS Diagnostic results were achieved in 79 of 94 biopsy procedures. Pathology results were malignant in 54 patients, suspicious for malignancy in three patients, benign in five patients, and benign nonspecific in 17 patients. Specific diagnoses were obtained in 59 patients (62.8%) using core biopsy, but no specific diagnosis could be reached with transthoracic fine-needle aspiration biopsy. Complications included pneumothorax in 27 patients (28.7%) and parenchymal hemorrhage during and after the procedure in eight patients (8.5%). CONCLUSIONS CT-guided percutaneous transthoracic needle biopsy is a highly accurate procedure for histopathological diagnosis of thoracic masses. In addition, percutaneous transthoracic biopsy has an acceptably low complication rate and it reduces the need for more invasive surgical procedures.
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Affiliation(s)
- Aykut Recep Aktaş
- Radiology Department, Suleyman Demirel University School of Medicine, Isparta, Turkey.
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18
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de Margerie-Mellon C, de Bazelaire C, de Kerviler E. Image-guided biopsy in primary lung cancer: Why, when and how. Diagn Interv Imaging 2016; 97:965-972. [DOI: 10.1016/j.diii.2016.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
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19
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Zhang HF, Zeng XT, Xing F, Fan N, Liao MY. The diagnostic accuracy of CT-guided percutaneous core needle biopsy and fine needle aspiration in pulmonary lesions: a meta-analysis. Clin Radiol 2015; 71:e1-10. [PMID: 26545460 DOI: 10.1016/j.crad.2015.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 08/17/2015] [Accepted: 09/22/2015] [Indexed: 01/23/2023]
Abstract
AIM To determine and compare the diagnostic value of computed tomography (CT)-guided percutaneous core needle biopsy (PCNB) and percutaneous fine-needle aspiration biopsy (PNAB) in pulmonary lesions. MATERIALS AND METHODS PubMed, EMBASE, and the Web of Science were systematically searched for relevant studies that investigated the diagnostic accuracy of CT-guided PCNB and/or PNAB for pulmonary lesions up to December 2014. After study selection, data extraction, and quality assessment, the sensitivity (SEN), specificity (SPE), diagnostic odds rate (DOR), positive likelihood ratios (PLR), negative likelihood ratios (NLR), and summary receiver operating characteristic (SROC) curves were calculated using the Meta-Disc 1.4 software. RESULTS Nineteen publications, including 21 independent studies, met the inclusion criteria. Of them, 15 studies were included in the PCNB group and six studies in the PNAB group. The pooled SEN, SPE, DOR, PLR, NLR, and SROC were 0.95, 0.99, 54.72, 0.06, 821.90, and 0.98 in the PCNB group and 0.90, 0.99, 24.71, 0.14, 210.72, and 0.98 in the PNAB group, respectively. CONCLUSION Based on current evidence, both PCNB and PNAB can be used as diagnostic methods to distinguish benign and malignant pulmonary lesions; the difference between PCNB and PNAB regarding diagnostic accuracy of benign or malignant pulmonary lesions is not obvious.
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Affiliation(s)
- H-F Zhang
- Department of Radiology, ZhongNan Hospital of WuHan University, No. 169 Donghu Road, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - X-T Zeng
- Department of Evidence-based Medicine Center, ZhongNan Hospital of WuHan University, No. 169 Donghu Road, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - F Xing
- Department of Radiology, ZhongNan Hospital of WuHan University, No. 169 Donghu Road, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - N Fan
- Department of Radiology, ZhongNan Hospital of WuHan University, No. 169 Donghu Road, Wuchang District, Wuhan City, Hubei Province, 430071, China
| | - M-Y Liao
- Department of Radiology, ZhongNan Hospital of WuHan University, No. 169 Donghu Road, Wuchang District, Wuhan City, Hubei Province, 430071, China.
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20
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Abstract
PET/computed tomography (CT) combines the anatomic information from CT with PET metabolic characterization. 18F-fluorodeoxyglucose (FDG) PET is helpful to differentiate malignant lesions from benign ones, that usually show lower or no uptake. However, active inflammation or infectious disease might also present FDG uptake. Studies confirm the great value of PET/CT as the imaging method of choice for guiding biopsy procedures. Novel PET radiopharmaceuticals are also being investigated for guiding biopsies.
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21
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Aktas AR, Gozlek E, Yazkan R, Yilmaz O, Kayan M, Demirtas H, Cetin M, Unlu N, Kara M, Degirmenci B. Transthoracic biopsy of lung masses: Non technical factors affecting complication occurrence. Thorac Cancer 2015; 6:151-8. [PMID: 26273352 PMCID: PMC4448479 DOI: 10.1111/1759-7714.12156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/26/2014] [Indexed: 11/30/2022] Open
Abstract
Background To investigate the transthoracic computed tomography (CT)-guided lung nodule biopsy complications and risk factors associated with the development of these complications. Methods We retrospectively evaluated a total of 41 CT-guided transthoracic biopsy complications. Data was analyzed by chi-square and independent sample t-tests. Results Twenty-seven patients (28.7%) developed pneumothorax and eight patients (8.5%) developed parenchymal hemorrhage, and four patients (4.3%) hemothorax and two (2.1%) patients developed subcutaneous emphysema. A significant correlation was obtained between the development of pneumothorax and lesion size (P = 0.040), and the distance that traversed the parenchyma (P = 0.001). There was a statistically significant difference between the parenchymal hemorrhage and lesion size and the distance from passed parenchyma (P values were 0.021 and 0.008, respectively). An increased incidence of parenchymal hemorrhage and pneumothorax was observed at small size and deep-seated lesions. Conclusion Lesion size and the distance that traversed the parenchyma on the biopsy tract are the most important factors that influence the development of complications in CT-guided transthoracic biopsy.
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Affiliation(s)
| | - Emel Gozlek
- Radiology Department, Suleyman Demirel University Isparta, Turkey
| | - Rasih Yazkan
- Thoracic Surgery Department, Suleyman Demirel University Isparta, Turkey
| | - Omer Yilmaz
- Radiology Department, Suleyman Demirel University Isparta, Turkey
| | - Mustafa Kayan
- Radiology Department, Suleyman Demirel University Isparta, Turkey
| | - Hakan Demirtas
- Radiology Department, Suleyman Demirel University Isparta, Turkey
| | - Meltem Cetin
- Radiology Department, Suleyman Demirel University Isparta, Turkey
| | - Nisa Unlu
- Radiology Department, Suleyman Demirel University Isparta, Turkey
| | - Mustafa Kara
- Radiology Department, Suleyman Demirel University Isparta, Turkey
| | - Bumin Degirmenci
- Radiology Department, Suleyman Demirel University Isparta, Turkey
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22
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Age as a risk factor in the occurrence of pneumothorax after transthoracic fine needle biopsy: our experience. Int J Surg 2014; 12 Suppl 2:S29-S32. [PMID: 25180637 DOI: 10.1016/j.ijsu.2014.08.387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/08/2023]
Abstract
Transthoracic needle biopsy (TTNB) of the lung is a well-established technique for diagnosing many thoracic lesions, and is an important alternative to more invasive surgical procedures. Complications of TTNB include pneumothorax, hemoptysis, hemothorax, infection, and air embolism, with the most common complication as pneumothorax. From June 2011 to June 2014 we performed a prospective study of 188 patients who underwent TTNB with CT guidance at University Hospital of Salerno, Italy. Pneumothorax occurred in 14 of 188 biopsies (7.45%). With the respect of age of patients pneumothorax occurred more frequently in patients aged 60-70 years, while it was less frequent in younger (<60 years) and older patients (>70 years). In conclusion, data of our prospective study documented that CT-guided TTNB is a safe and reliable procedure in elderly patients with suspected chest malignancy and is well tolerated.
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23
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Boskovic T, Stanic J, Pena-Karan S, Zarogoulidis P, Drevelegas K, Katsikogiannis N, Machairiotis N, Mpakas A, Tsakiridis K, Kesisis G, Tsiouda T, Kougioumtzi I, Arikas S, Zarogoulidis K. Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J Thorac Dis 2014; 6 Suppl 1:S99-S107. [PMID: 24672704 DOI: 10.3978/j.issn.2072-1439.2013.12.08] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022]
Abstract
Transthoracic needle biopsy (TTNB) is done with imaging guidance and most frequently by a radiologist, for the aim is to diagnose a defined mass. It is integral in the diagnosis and treatment of many thoracic diseases, and is an important alternative to more invasive surgical procedures. FNAC is a method of aspiration cytopathology, which with transthoracic biopsy ("core biopsy") is a group of percutaneous minimally invasive diagnostic procedures for exploration of lung lesions. Needle choice depends mostly upon lesion characteristics and location. A recent innovation in biopsy needles has been the introduction of automatic core biopsy needle devices that yield large specimens and improve the diagnostic accuracy of needle biopsy. Both computed tomography and ultrasound may be used as imaging guidance for TTNB, with CT being more commonly utilized. Common complications of TTNB include pneumothorax and hemoptysis. The incidence of pneumothorax in patients undergoing TTNB has been reported to be from 9-54%, according to reports published in the past ten years, with an average of around 20%. Which factors statistically correlate with the frequency of pneumothorax remain controversial, but most reports have suggested that lesion size, depth and the presence of emphysema are the main factors influencing the incidence of pneumothorax after CT-guided needle biopsy. On the contrary, gender, age, and the number of pleural passes have not been shown to correlate with the incidence of pneumothorax. The problem most responsible for complicating outpatient management, after needle biopsy was performed, is not the presence of the pneumothorax per se, but an increase in the size of the pneumothorax that requires chest tube placement and patient hospitalization. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.
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Affiliation(s)
- Tatjana Boskovic
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Jelena Stanic
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Slobodanka Pena-Karan
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Kostas Drevelegas
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Andreas Mpakas
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Georgios Kesisis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Stamatis Arikas
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Institute for pulmonary diseases of Vojvodina, Center for Radiology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica,Vojvodina, Serbia; 2 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Radiology Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece ; 4 Surgery Deparment (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Obstetric-Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 6 Cardiothoracic Surgery Department, 7 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Internal Medicine Department, "Thiagenio" Cancer Hospital, Thessaloniki, Greece
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Pua BB, Li D, Sullivan BW, Madoff DC. Virtually no thoracic lesion inaccessible: a pictorial case review. Semin Intervent Radiol 2014; 30:206-14. [PMID: 24436538 DOI: 10.1055/s-0033-1342963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Access route considerations in percutaneous intrathoracic biopsy or ablation offers its own unique set of challenges, with special consideration toward reducing the rate of pneumothorax. This review highlights several novel and atypical methods to improve access to intrathoracic lesions through a series of representative cases. These methods include patient positioning, curved needles, hydrodissection, induced/artificial pneumothorax, and use of specialized equipment functions. No intrathoracic lesion should be considered "inaccessible" either for biopsy or treatment by percutaneous approaches without consideration of performing these adjunctive techniques.
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Affiliation(s)
- Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David Li
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Brian W Sullivan
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
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25
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Stevenson M, Christensen J, Shoemaker D, Foster T, Barry WT, Tong BC, Wahidi M, Shofer S, Datto M, Ginsburg G, Crawford J, D'Amico T, Ready N. Tumor acquisition for biomarker research in lung cancer. Cancer Invest 2014; 32:291-8. [PMID: 24810245 DOI: 10.3109/07357907.2014.911880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The biopsy collection data from two lung cancer trials that required fresh tumor samples be obtained for microarray analysis were reviewed. In the trial for advanced disease, microarray data were obtained on 50 patient samples, giving an overall success rate of 60.2%. The majority of the specimens were obtained through CT-guided lung biopsies (N = 30). In the trial for early-stage patients, 28 tissue specimens were collected from excess tumor after surgical resection with a success rate of 85.7%. This tissue procurement program documents the feasibility in obtaining fresh tumor specimens prospectively that could be used for molecular testing.
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Loh SEK, Wu DDF, Venkatesh SK, Ong CK, Liu E, Seto KY, Gopinathan A, Tan LKA. CT-Guided Thoracic Biopsy: Evaluating Diagnostic Yield and Complications. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n6p285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: This study retrospectively evaluated CT-guided thoracic biopsies for diagnostic yield, accuracy and complications. Materials and Methods: A retrospective analysis of 384 patients (mean age 62.7 years; male/female = 251/133) who underwent 399 CT-guided thoracic biopsies were performed for evaluating diagnostic yield, accuracy and complications. Correlations between patients age, procedure factors (biopsy-needle size, number of passes, lesion-size, lesion-depth and traversed lung-length) and complications such as pneumothorax, haemothorax and haemoptysis were evaluated. A comparison between fine needle aspiration (FNA) group and core ± FNA group for diagnostic yield and complications was also performed. Results: FNA was performed in 349 patients and core ± FNA in 50 patients. The biopsy samples were adequate in 91.9% and the diagnostic accuracy for malignant lesions was 96.8% with 95.7% sensitivity and 100% specificity. Pneumothorax (detected on CT) occurred in 139 cases (34.8%) and only 12 (3.0%) required insertion of an intercostal drain. Mild haemoptysis occurred in 13 patients (3.2%) and small haemothoraces in 2 patients. Pneumothorax occurrence was significantly associated with the traversed lung-length (>3mm), lesion-size (≤33 mm) and lesion-depth (≥60mm) (P <0.05). Haemoptysis occurrence was also significantly associated with traversed lung-length (>3mm) and lesion-size (≤33 mm) (P <0.05). There was no significant difference between diagnostic yield and complication rate between FNA and core ± FNA groups. Conclusion: CT-guided thoracic biopsy is a safe procedure with high diagnostic yield and low risk of significant complications. Traversed lung-length and smaller lesion size are associated with occurrence of pneumothorax and haemoptysis.
Key words: Accuracy, Complications, Diagnostic yield, Haemoptysis, Pneumothorax
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Does Antiplatelet Therapy Increase the Risk of Hemoptysis During Percutaneous Transthoracic Needle Biopsy of a Pulmonary Lesion? AJR Am J Roentgenol 2013; 200:1014-9. [DOI: 10.2214/ajr.12.8931] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Henschke CI, Yankelevitz DF, Reeves AP, Cham MD. Image analysis of small pulmonary nodules identified by computed tomography. ACTA ACUST UNITED AC 2012; 78:882-93. [PMID: 22069212 DOI: 10.1002/msj.20300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Detection of small pulmonary nodules has markedly increased as computed tomography (CT) technology has advanced and interpretation evolved from viewing small CT images on film to magnified images on large, high-resolution computer monitors. Despite these advances, determining the etiology of a lung nodule short of major surgery remains problematic. Initial nodule size is a major criterion in evaluating the risk for malignancy, and the majority of CT detected nodules are <10 mm in diameter. Also, the likelihood that the nodule is a lung cancer increases with increasing age and smoking history, and such clinical information needs to be integrated into algorithms that guide the workup of such nodules. Baseline and annual repeat screening results are also very helpful in developing and assessing the usefulness of such algorithms. Based on CT morphology, subtypes of nodules have been identified; today nodules are routinely classified as being solid, part-solid, or nonsolid. It has been shown that part-solid nodules have a higher frequency of being malignant than solid or nonsolid ones. Other nodule characteristics such as spiculation are useful, although granulomas and fibrosis also have such features, so these characteristics have not been as useful as nodule-growth assessment. Depending on the aggressiveness of the lung cancer and the size of the nodule when it is initially seen, a follow-up CT scan 1-3 months after the first CT scan can identify those nodules with growth at a malignant rate. Software has been developed by all CT scanner manufacturers for such growth assessment, but the inherent variability of such assessments needs further development. Nodule-growth assessment based on 2-dimensional approaches is limited; therefore, software has been developed for the 3-dimensional assessment of growth. Different approaches for such growth assessment have been developed, either using automated computer segmentation techniques or hybrid methods that allow the radiologist to adjust such segmentation. There are, however, inherent reasons for variability in such measurements that need to be carefully considered, and this, together with continued technologic advances and integration of the relevant clinical information, will allow for individualization of the algorithms for the workup of small pulmonary nodules.
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Affiliation(s)
- Claudia I Henschke
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA.
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Lal H, Neyaz Z, Nath A, Borah S. CT-guided percutaneous biopsy of intrathoracic lesions. Korean J Radiol 2012; 13:210-26. [PMID: 22438689 PMCID: PMC3303905 DOI: 10.3348/kjr.2012.13.2.210] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/04/2011] [Indexed: 01/05/2023] Open
Abstract
Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications.
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Affiliation(s)
- Hira Lal
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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30
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Braak SJ, Herder GJM, van Heesewijk JPM, van Strijen MJL. Pulmonary masses: initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy. Cardiovasc Intervent Radiol 2011; 35:1414-21. [PMID: 22146973 DOI: 10.1007/s00270-011-0302-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 10/13/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the outcome of percutaneous lung biopsy (PLB) findings using cone-beam computed tomographic (CT) guidance (CBCT guidance) and compared to conventional biopsy guidance techniques. METHODS CBCT guidance is a stereotactic technique for needle interventions, combining 3D soft-tissue cone-beam CT, needle planning software, and real-time fluoroscopy. Between March 2007 and August 2010, we performed 84 Tru-Cut PLBs, where bronchoscopy did not provide histopathologic diagnosis. Mean patient age was 64.6 (range 24-85) years; 57 patients were men, and 25 were women. Records were prospectively collected for calculating sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. We also registered fluoroscopy time, room time, interventional time, dose-area product (DAP), and complications. Procedures were divided into subgroups (e.g., location, size, operator). RESULTS Mean lesion diameter was 32.5 (range 3.0-93.0) mm, and the mean number of samples per biopsy procedure was 3.2 (range 1-7). Mean fluoroscopy time was 161 (range 104-551) s, room time was 34 (range 15-79) min, mean DAP value was 25.9 (range 3.9-80.5) Gy·cm(-2), and interventional time was 18 (range 5-65) min. Of 84 lesions, 70 were malignant (83.3%) and 14 were benign (16.7%). Seven (8.3%) of the biopsy samples were nondiagnostic. All nondiagnostic biopsied lesions proved to be malignant during surgical resection. The outcome for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 90% (95% confidence interval [CI] 86-96), 100% (95% CI 82-100), 100% (95% CI 96-100), 66.7% (95% CI 55-83), and 91.7% (95% CI 86-96), respectively. Sixteen patients (19%) had minor and 2 (2.4%) had major complications. CONCLUSION CBCT guidance is an effective method for PLB, with results comparable to CT/CT fluoroscopy guidance.
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Affiliation(s)
- Sicco J Braak
- Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430, EM, EM Nieuwegein, The Netherlands.
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Almolla J, Balconi G. Interventional ultrasonography of the chest: Techniques and indications. J Ultrasound 2011; 14:28-36. [PMID: 23396954 DOI: 10.1016/j.jus.2011.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Thoracic ultrasonography can be used for diagnostic purposes as well as a guide for diagnostic and therapeutic interventions.When the lesion or fluid collection has been located and the patient properly positioned, the angle of the needle is identified with respect to the transducer. The insertion tract should transgress the smallest possible area of aerated parenchyma. The needle can be introduced with a free-hand technique or with the aid of a needle guide. Correct planning of the procedure reduces intervention time and decreases the risk of complications.The main indications are superficial masses that require biopsy, pleural and parenchymal lesions formerly biopsied with CT or fluoroscopic guidance, and fluid collections that need to be drained.Ultrasound, thanks to its widespread use, simple execution, and low costs, represents a safe, manageable guide for thoracic interventions.
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Affiliation(s)
- J Almolla
- San Matteo Medical Center, Institute of Radiology, University of Pavia, Italy
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Abstract
When choosing the best method to undertake a biopsy of a lesion in the lung or mediastinum, it is important to consider the entire range of possible options, such as surgical, bronchoscopic/endoscopic, and radiologic techniques. Features to be considered include the anatomic location of the lesion, the amount of tissue needed, cost, availability of specific techniques, safety and risks, and expected diagnostic yield/accuracy.
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Affiliation(s)
- L E Quint
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109, USA
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