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Li Q, Zhang L, Liao X, Zhong Y, Li Z. Predictive Factors of Nonmalignant Pathological Diagnosis and Final Diagnosis of Ultrasound-Guided Cutting Biopsy for Peripheral Pulmonary Diseases. Can Respir J 2023; 2023:5815755. [PMID: 37332881 PMCID: PMC10275682 DOI: 10.1155/2023/5815755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/21/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
This study aimed to explore the predictive factors of nonmalignant pathological diagnosis and final diagnosis of ultrasound-guided cutting biopsy for peripheral pulmonary diseases. A total of 470 patients with peripheral lung disease diagnosed as nonmalignant by ultrasound-guided cutting biopsy in the First Affiliated Hospital of Guangxi Medical University from January 2017 to May 2020 were included. Ultrasound biopsy was performed to determine the correctness of pathological diagnosis. Independent risk factors of malignant tumor were predicted by multivariate logistic regression analysis. Pathological biopsy results showed that 162 (34.47%) of the 470 biopsy data were specifically benign, and 308 (65.53%; malignant lesions: 25.3%, benign lesions: 74.7%) were nondiagnostic findings. The final diagnoses were benign in 387 cases and malignant in 83 cases. In the nondiagnostic biopsy malignant risk prediction analysis, lesion size (OR = 1.025, P = 0.005), partial solid lesions (OR = 2.321, P = 0.035), insufficiency (OR = 6.837, P < 0.001), and presence of typical cells (OR = 34.421, P = 0.001) are the final important independent risk factors for malignant tumors. In addition, 30.1% (25/83) of patients with nonmalignant lesions who were finally diagnosed with malignant tumors underwent repeated biopsy, and 92.0% (23/25) were diagnosed during the second repeated biopsy. 59.0% (49/83) received additional invasive examination. Nondiagnostic biopsy predictors of malignant risk include lesion size, partial solid lesions, insufficiency, and presence of atypical cells. When a nonmalignant result is obtained for the first time, the size of the lesion, whether the lesion is subsolid, and the type of pathology obtained should be reviewed.
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Affiliation(s)
- Qing Li
- Department of Diagnostic Ultrasound, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, Guangxi, China
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Li Zhang
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Xinhong Liao
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Yanfen Zhong
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Zhixian Li
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China
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2
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Rai H, Graham E, Ghoshal A, McDill H, Hassan M, Nicholson T, Taylor L, Corcoran J, Howell T, Daneshvar C. Endobronchial Ultrasound-guided Sampling of Centrally Located Intrapulmonary Tumors Provides Suitable Material for Diagnostic and Molecular Testing. J Bronchology Interv Pulmonol 2023; 30:163-168. [PMID: 36094327 DOI: 10.1097/lbr.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Curvilinear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a key diagnostic and staging procedure for patients with suspected lung cancer. However, sampling centrally located intrapulmonary tumors is feasible but less well established. METHODS We retrospectively evaluated the diagnostic utility of EBUS-TBNA in patients who underwent sampling of centrally located intrapulmonary tumors. Diagnostic accuracy, sample suitability for molecular testing, and complications were assessed. RESULTS Between January 2015 and April 2021, 102 EBUS-TBNA procedures sampled centrally located intrapulmonary tumors in 99 patients. The median age was 70 [interquartile range, 63 to 75] years and 51% (51/99) were male. The commonest site was the right upper lobe (n=42/99; 42%). The median tumor size was 29 [interquartile range, 21 to 35] mm. The diagnostic yield was 88/102 (86%) with a false negative rate of 14% (14/102). In addition to intrapulmonary tumor sampling, lymph nodes were sampled in 65/102 procedures and 30/65(46%) were positive for lung cancer. Cancer was diagnosed in 87/99 (88%) cases. When requested, molecular testing was adequate in ≥94% of samples. Complications included minor bleeding in 6/102 (6%) with 2 requiring cold saline instillation, desaturation in 1/102 (1%), and tachycardia in 1/102(1%). One procedure was abandoned due to patient tachycardia. Delayed complications occurred in 1 patient who was hospitalized ≤7 days with pneumonia. CONCLUSION EBUS-TBNA sampling of centrally located intrapulmonary tumors provides similar diagnostic accuracy to lymph node sampling, provides suitable material for molecular testing, and has a low complication rate.
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Affiliation(s)
- Hem Rai
- Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter
| | - Emma Graham
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Avik Ghoshal
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen McDill
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Maged Hassan
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Thomas Nicholson
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Lindsey Taylor
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - John Corcoran
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Timothy Howell
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Cyrus Daneshvar
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
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3
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Ahmadzai S, Koefod Petersen J, Fjaellegaard K, Frost Clementsen P, Bodtger U. Suspected Lung Cancer with Suspicious Liver Lesions: Diagnostic Yield and Safety of Same-Day Bronchoscopy and Liver Biopsy in the Hands of a Pulmonologist. Adv Respir Med 2023; 91:11-17. [PMID: 36825937 PMCID: PMC9951995 DOI: 10.3390/arm91010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Bronchoscopy and endobronchial ultrasound (EBUS) are standard procedures for the diagnosis and staging of patients suspected of lung cancer. If the patient simultaneously presents with suspicious liver lesions, it is tradition to refer the patient to a radiologist for ultrasound-guided percutaneous liver biopsy. OBJECTIVE The aim of this study was to investigate the results and complications when the pulmonologist performs all three procedures in the same setting. METHODS We retrospectively identified patients who during 2018-2020 underwent invasive workup of suspected lung cancer and liver metastases with percutaneous liver lesion biopsy with or without same-day endoscopy (bronchoscopy and EBUS). We compared diagnostic yield and safety of liver lesion biopsy stratified by same-day endoscopy or not. RESULTS In total, 89 patients were included, of whom 28 patients (31%) underwent same-day endoscopy. All liver lesion biopsies were fine-needle aspiration biopsies performed by experienced pulmonologists. No complications were reported, and overall diagnostic yield was 88%. The diagnostic yield was significantly lower in the same-day endoscopy group (71% vs. 95%), and undergoing endoscopy was significantly associated with having fewer liver lesions, higher prevalence of lung cancer, and lower overall prevalence of a malignant diagnosis. CONCLUSION Liver biopsy in the same session as endoscopy during lung cancer workup was feasible and safe. Confounding by indication was present in our study.
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Affiliation(s)
- Sina Ahmadzai
- Institute of Science and Environment, Roskilde University, 4000 Roskilde, Denmark
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Correspondence:
| | - Jesper Koefod Petersen
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Katrine Fjaellegaard
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Paul Frost Clementsen
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), 2100 Copenhagen, Denmark
| | - Uffe Bodtger
- Pulmonary Research Unit Zealand (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 4700 Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
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4
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Livi V, Sotgiu G, Cancellieri A, Paioli D, Leoncini F, Magnini D, Trisolini R. Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial. Cancers (Basel) 2022; 14:cancers14205156. [PMID: 36291940 PMCID: PMC9600579 DOI: 10.3390/cancers14205156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Pulmonologist-performed US-NAB of “superficial” metastatic lesions is safe and has an excellent diagnostic yield for both tissue diagnosis and molecular profiling regardless of the use of rapid on-site evaluation. These findings have important implications for costs, hospital resource allocation, and the globally widespread utilization of US-NAB. Abstract Background and Objective: Studies which evaluated the role of an ultrasound-guided needle aspiration biopsy (US-NAB) of metastases from lung cancer located in “superficial” organs/tissues are scant, and none of them assessed the possible impact of rapid on-site evaluation (ROSE) on diagnostic accuracy and safety outcomes. Methods: Consecutive patients with suspected superficial metastases from lung cancer were randomized 1:1 to US-NAB without (US-NAB group) or with ROSE (ROSE group). The diagnostic yield for a tissue diagnosis was the primary outcome. Secondary outcomes included the diagnostic yield for cancer genotyping, the diagnostic yield for PD-L1 testing, and safety. Results: During the study period, 136 patients were randomized to receive an US-NAB with (n = 68) or without ROSE (n = 68). We found no significant differences between the ROSE group and the US-NAB group in terms of the diagnostic yields for tissue diagnosis (94.1% vs. 97%, respectively; p = 0.68), cancer genotyping (88% vs. 91.8%, respectively; p = 0.56), and PD-L1 testing (93.5% vs. 90.6%, respectively; p = 0.60). Compared to the diagnostic US-NAB procedures, the non-diagnostic procedures were characterized by less common use of a cutting needle (66.6% vs. 96.9%, respectively; p = 0.0004) and less common retrieval of a tissue core (37.5% vs. 98.5%; p = 0.0001). Only one adverse event (vasovagal syncope) was recorded. Conclusion: US-NAB of superficial metastases is safe and has an excellent diagnostic success regardless of the availability of ROSE. These findings provide a strong rationale for using US-NAB as the first-step method for tissue acquisition whenever a suspected superficial metastatic lesion is identified in patients with suspected lung cancer.
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Affiliation(s)
- Vanina Livi
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Alessandra Cancellieri
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Paioli
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Fausto Leoncini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniele Magnini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Correspondence:
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5
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Gershman E, Vaynshteyn I, Freidkin L, Pertzov B, Rosengarten D, Kramer MR. Marked safety and high diagnostic yield of freehand ultrasound-guided core-needle biopsies performed by pulmonologists. Thorac Cancer 2022; 13:1577-1582. [PMID: 35474608 PMCID: PMC9161330 DOI: 10.1111/1759-7714.14413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Adequate tissue sampling is fundamental for establishing a definitive diagnosis, assessing prognosis and tailoring therapy. Each of the methods for obtaining tissue (e.g., endoscopic, image guidance and surgical biopsies) results in a different diagnostic yield and complication rate profile. Objectives Present feasibility, and assess safety and efficacy of freehand transthoracic ultrasound‐guided core‐needle biopsies (USGNB) of thoracic lesions performed by pulmonologist. Methods A retrospective analysis study of ultrasound‐guided core‐needle biopsies of thoracic lesions performed at the Pulmonary Institute of Rabin Medical Center was conducted from September 2020 to October 2021. All core‐needle biopsies were performed under local anesthesia with guidance of Mindray TE7 2019 US system. Procedural variables including complications and pathological diagnostic yield were the primary end point. IRB 0671‐21‐RMC. Results In total 91 biopsy procedures were analyzed in38 females and 53 males, average age 71.1 years. Twenty‐three (25.3%) cases were lung lesions, 7 (7.7%) – mediastinal, 13 (14.3%) – chest wall, 27 (29.7%) – pleural, and 21 (23.1%) supraclavicular lesions. Average lesion size was 51.6 mm, the largest in the mediastinum and the smallest in supraclavicular locations (97.7mm and 28.0 mm, respectively). Overall pathological diagnostic yield was 90%, highest success in chest wall (100%) and lowest in mediastinal biopsies (71.4%). We had only one complication –hemothorax resolved by chest tube drainage‐ accounting for only 1.1% complication rate. Conclusion Safety and efficacy were demonstrated in freehand US‐guided core‐needle biopsy of thoracic lesions performed by pulmonologists. We suggest thoracic ultrasound and USG‐CNB be part of training and clinical practice in interventional pulmonology.
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Affiliation(s)
- Evgeni Gershman
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Vaynshteyn
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Lev Freidkin
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Reuven Kramer
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Corcoran JP, Taylor LM, Nicholson TW, McDill H, Hassan M, Daneshvar CJ. Outcomes From a Physician-led Ultrasound-guided Transthoracic Biopsy Service: Supporting a Rapid Diagnostic Pathway in Suspected Lung Cancer. J Bronchology Interv Pulmonol 2022; 29:86-90. [PMID: 34935670 DOI: 10.1097/lbr.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- John P Corcoran
- Interventional Pulmonology Service, Chest Clinic, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Lindsey M Taylor
- Interventional Pulmonology Service, Chest Clinic, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Thomas W Nicholson
- Interventional Pulmonology Service, Chest Clinic, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Helen McDill
- Interventional Pulmonology Service, Chest Clinic, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Maged Hassan
- Interventional Pulmonology Service, Chest Clinic, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Cyrus J Daneshvar
- Interventional Pulmonology Service, Chest Clinic, University Hospitals Plymouth NHS Trust, Plymouth, UK
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7
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Milojevic I, Lemma K, Khosla R. Ultrasound use in the ICU for interventional pulmonology procedures. J Thorac Dis 2021; 13:5343-5361. [PMID: 34527370 PMCID: PMC8411174 DOI: 10.21037/jtd-19-3564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
Critical care ultrasound has shifted the paradigm of thoracic imaging by enabling the treating physician to acquire and interpret images essential for clinical decision-making, at the bedside, in real-time. Once considered impossible, lung ultrasound based on interpretation of artifacts along with true images, has gained momentum during the last decade, as an integral part of rapid evaluation algorithms for acute respiratory failure, shock and cardiac arrest. Procedural ultrasound image guidance is a standard of care for both common bedside procedures, and advanced procedures within interventional pulmonologist’s (IP’s) scope of practice. From IP’s perspective, the lung, pleural, and chest wall ultrasound expertise is a prerequisite for mastery in pleural drainage techniques and transthoracic biopsies. Another ultrasound application of interest to the IP in the intensive care unit (ICU) setting is during percutaneous dilatational tracheostomy (PDT). As ICU demographics shift towards older and sicker patients, the indications for closed pleural drainage procedures, bedside transthoracic biopsies, and percutaneous dilatational tracheostomies have dramatically increased. Although ultrasound expertise is considered an essential IP operator skill there is no validated curriculum developed to address this component. Further, there is a need for developing an educational tool that matches up with the curriculum and could be integrated real-time with ultrasound-guided procedures.
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Affiliation(s)
- Ivana Milojevic
- Department of Pulmonary, Critical Care and Sleep Medicine, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Kewakebt Lemma
- Department of Pulmonary, Critical Care and Sleep Medicine, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Rahul Khosla
- Department of Pulmonary and Critical Care Medicine, US Department of Veterans Affairs, Washington, DC, USA
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8
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López González FJ, García Alfonso L, Cascón Hernández J, Ariza Prota M, Herrero Huertas J, Hermida Valverde T, Ruíz Álvarez I, Torres Rivas HE, Fernández Fernández LM, Enríquez Rodríguez AI, García Clemente MM, Gallo González V. Biopsy of Intrapulmonary Lesions in Lungs with Atelectasis and Pleural Effusion. Arch Bronconeumol 2021; 57:438-439. [PMID: 34088403 DOI: 10.1016/j.arbr.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lucía García Alfonso
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan Cascón Hernández
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Miguel Ariza Prota
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Julia Herrero Huertas
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Tamara Hermida Valverde
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Inés Ruíz Álvarez
- Sección de Neumología, Hospital Alvarez-Buylla, Mieres, Asturias, Spain
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9
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Laursen CB, Clive A, Hallifax R, Pietersen PI, Asciak R, Davidsen JR, Bhatnagar R, Bedawi EO, Jacobsen N, Coleman C, Edey A, Via G, Volpicelli G, Massard G, Raimondi F, Evison M, Konge L, Annema J, Rahman NM, Maskell N. European Respiratory Society statement on thoracic ultrasound. Eur Respir J 2021; 57:13993003.01519-2020. [PMID: 33033148 DOI: 10.1183/13993003.01519-2020] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
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Affiliation(s)
- Christian B Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amelia Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jesper Rømhild Davidsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Niels Jacobsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | | | - Anthony Edey
- Dept of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg, Grand-Duchy of Luxembourg
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Dept of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Matthew Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Centre for HR, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Joint last authors
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Joint last authors
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10
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Knox D, Halligan K. Case series of trans-thoracic nodule aspirate performed by interventional pulmonologists. Respir Med Case Rep 2021; 32:101362. [PMID: 33665077 PMCID: PMC7897983 DOI: 10.1016/j.rmcr.2021.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/25/2022] Open
Abstract
Percutaneous interventional tissue sampling of pulmonary masses and lymphadenopathy is a means for diagnosis of thoracic malignancy. The user base that can perform this skill with ultrasound guidance is expanding. A retrospective cohort of fine needle aspiration and percutaneous core biopsies was identified to evaluate their safety and efficacy. 47 distinct procedures were performed by a university medical center's Interventional Pulmonary service between 2012 and 2018.39 consecutive procedures were diagnostically successful by percutaneous means, with 34 of the successful diagnoses based on fine needle aspiration alone. In our cohort by percutaneous biopsy the most common diagnosis was Non-Small Cell Lung Cancer with 28 samples, followed by Small Cell Lung Cancer with 7 samples as well as additional solitary diagnoses of suspected infection, Hepatocellular Cancer, Hodgkin Lymphoma and Malignant Melanoma. 4 procedures had complications, two of which resolved post procedure with observation and two pneumothoracies which resolved with chest tube placement and hospital observation. A wide variety of diagnoses were obtained with percutaneous biopsies with 83% of percutaneous biopsies performed by Interventional Pulmonologists achieving diagnostic success.
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Affiliation(s)
- Daniel Knox
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kyle Halligan
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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11
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López González FJ, García Alfonso L, Cascón Hernández J, Ariza Prota M, Herrero Huertas J, Hermida Valverde T, Ruíz Álvarez I, Torres Rivas HE, Fernández Fernández LM, Enríquez Rodríguez AI, García Clemente MM, Gallo González V. Biopsy of Intrapulmonary Lesions in Lungs with Atelectasis. Arch Bronconeumol 2020. [PMID: 33127202 DOI: 10.1016/j.arbres.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Lucía García Alfonso
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Juan Cascón Hernández
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Miguel Ariza Prota
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Julia Herrero Huertas
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Tamara Hermida Valverde
- Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Inés Ruíz Álvarez
- Sección de Neumología, Hospital Alvarez-Buylla, Mieres, Asturias, España
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12
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Frank MS, Bødtger U, Høegholm A, Stamp IM, Gehl J. Re-biopsy after first line treatment in advanced NSCLC can reveal changes in PD-L1 expression. Lung Cancer 2020; 149:23-32. [PMID: 32949828 DOI: 10.1016/j.lungcan.2020.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Re-biopsy in progressive advanced Non-Small-Cell Lung Cancer (NSCLC) after first line treatment may reveal information about evolving tumor biology during treatment. Our study aims to investigate the feasibility, risk of complications, and clinical relevance of performing re-biopsy systematically. MATERIALS AND METHODS NSCLC patients with advanced, non-targetable disease, receiving first line systemic treatment, were included in a prospective single-centre study (NCT03512847). A diagnostic biopsy was performed at baseline and repeated at time of progression, preferentially from the progressive lesions as determined by CT or PET/CT. The primary endpoint was feasibility, including complication rate to re-biopsy. Secondary endpoints were clinical relevance, defined as a potential of changing treatment or follow-up, due to new histological evidence, specifically a change in PD-L1 Tumor Proportion Score (TPS). RESULTS Fifty-one patients with progressive advanced NSCLC had re-biopsy performed. Median time from patients' acceptance to biopsy was seven days (range: 0-31). Complication rate was 6% (n = 3) represented by pneumothorax, hydro-pneumothorax and pneumonia, respectively. No severe or chronic complications occurred. Sufficient material for PD-L1 analyses was obtained in 46 of 51 patients: the remaining five cases had insufficient tissue for analyses, no malignant cells/only suspected malignant cells, questioning whether progression was real. PD-L1 TPS change was observed in 33% of patients (n = 15) and 17% (n = 8) had potentially clinically relevant changes. A significantly higher chance of PD-L1 TPS change was observed in chemotherapy-treated patients. CONCLUSION Our study showed that re-biopsy is feasible, with low risk of complications, and can be clinically relevant in patients with suspected progression in advanced NSCLC.
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Affiliation(s)
- Malene Støchkel Frank
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Uffe Bødtger
- Department of Respiratory Medicine, Zealand University Hospital Næstved, Denmark; Institute for Regional Health Research, University of Southern Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Zealand University Hospital Næstved, Denmark
| | | | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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13
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d'Hooghe J, Alvarez Martinez H, Pietersen PI, Laursen CB, Hersch N, Tárnoki ÁD, Walsh S, Annema J, Gompelmann D. ERS International Congress, Madrid, 2019: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly. ERJ Open Res 2020; 6:00116-2020. [PMID: 32714969 PMCID: PMC7369474 DOI: 10.1183/23120541.00116-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/30/2020] [Indexed: 12/29/2022] Open
Abstract
This manuscript summarises the highlights from Assembly 14, "Clinical techniques, imaging and endoscopy", which were presented at the 2019 European Respiratory Society (ERS) International Congress in Madrid, Spain. Novel diagnostic approaches and innovative therapeutic strategies in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases are discussed. The authors from the different Assembly 14 subgroups focus on the key take-home messages given new study results, and place them in the context of current knowledge in these areas. At the 2019 ERS International Congress, encouraging results of numerous trials in the field of interventional pulmonology, imaging and ultrasound were presented. Key topics included novel diagnostic and therapeutic approaches in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases.
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Affiliation(s)
- Julia d'Hooghe
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Haizea Alvarez Martinez
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark
| | - Christian B. Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Nicole Hersch
- Dept of Respiratory Medicine, St George Hospital, Sydney, Australia
| | - Ádám Domonkos Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Dept of Radiology, Oncologic Imaging Diagnostic Center, National Institute of Oncology, Budapest, Hungary
| | - Simon Walsh
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jouke Annema
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Gompelmann
- Dept of Pneumology and Critical Care Medicine, Thoraxklink University Heidelberg, Heidelberg, Germany
- Dept of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
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14
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Sidhu JS, Salte G, Christiansen IS, Naur TMH, Høegholm A, Clementsen PF, Bodtger U. Fluoroscopy guided percutaneous biopsy in combination with bronchoscopy and endobronchial ultrasound in the diagnosis of suspicious lung lesions - the triple approach. Eur Clin Respir J 2020; 7:1723303. [PMID: 32128079 PMCID: PMC7034437 DOI: 10.1080/20018525.2020.1723303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/21/2020] [Indexed: 11/04/2022] Open
Abstract
Flexible bronchoscopy and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) are the pulmonologists´ basic procedures for the biopsy of suspicious lung lesions. If inconclusive, other guiding-modalities for tissue sampling are needed, computed tomography performed by a radiologist, or – if available – radial EBUS or electromagnetic navigation biopsy. We wanted to investigate if same-day X-ray fluoroscopy-guided transthoracic fine-needle aspiration biopsy (F-TTNAB) performed by the pulmonologist immediately after bronchoscopy and EBUS is a feasible alternative. We retrospectively identified consecutive patients in whom F-TTNAB followed a bronchoscopy and EBUS in the same séance. Patients in whom the suspicion of malignancy was invalidated after complete work up were followed for six months to identify false-negative cases. In total 125 patients underwent triple approach (bronchoscopy, EBUS and F-TTNAB) during the same séance. Malignancy was diagnosed in 86 (69%), and 77 of these (90%) were primary lung cancers. The diagnostic yield of F-TTNAB for malignancy was 77%, and sensitivity was 90%. Pneumothorax occurred in 35 (28%) patients, and was administered with pleural drainage in 22 (18% of all patients). No cases of prolonged haemoptysis were observed. The risk of pneumothorax differed insignificantly with lesion size ≤2.0 cm (27%) versus >2.0 cm (29%). We conclude that it is feasible for pulmonologist to perform F-TTNAB immediately after endoscopy as a combined triple approach in a fast-track workup of suspected lung cancer.
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Affiliation(s)
| | - Geir Salte
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Ida Skovgaard Christiansen
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Therese Marie Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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15
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Yuan Z, Li H, Sun Y, Qiu J, Xu H, Liu J, Zhou M, Chen A, Ye X, Wang Z, Zhao Q. Pericardial fluid levels of growth differentiation factor 15 in patients with or without coronary artery disease: a prospective study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:113. [PMID: 32175406 PMCID: PMC7048982 DOI: 10.21037/jtd.2019.12.92] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/06/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Growth differentiation factor 15 (GDF15) has already been reported as a novel efficient biomarker in patients with coronary artery diseases (CAD). However, very little is demonstrated about the potential impact of pericardial fluid GDF-15 accumulation on CAD. The aim of this study was to evaluate pericardial fluid and plasma GDF15 levels in patients with ischemic heart disease. METHODS In this study, 42 consecutive patients (21 patients with significant CAD; 21 patients without CAD) undergoing open heart surgery were recruited in this study. Pericardial fluid were obtained at the time of surgery, and GDF15 levels in the samples were measured by enzyme-linked immunosorbent assay. Plasma glucose, creatinine, CK-MB, cTnI and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements were performed. RESULTS The plasma GDF15 levels were markedly higher than the pericardial fluid levels both in the CAD group and non-CAD group (1,174.0±148.7 vs. 677.8±77.2 pg/mL, P<0.01; 925.8±127.4 vs. 617.4±76.2 pg/mL, P<0.01). The levels of pericardial fluid GDF15, was not statistically different between the CAD and non-CAD groups (P>0.05). An obvious correlation was observed between plasma and pericardial fluid GDF15 concentration both in the CAD group and non-CAD group (R=0.53, P<0.01; R=0.54, P<0.01). An obvious positive correlation was found between pericardial fluid GDF15 and plasma creatinine levels in CAD patients but not in non-CAD patients (R=0.65, P<0.01). In the CAD group, an obvious correlation was also observed between pericardial fluid GDF15 levels and NT-ProBNP (R=0.63, P<0.01), while no relationship was found in non-CAD group. There was a positive correlation between pericardial fluid GDF15 and LVEF in non-CAD group but not in CAD group patients (R=-0.44, P<0.05). CONCLUSIONS Our study first revealed an association between pericardial fluid GDF15 and baseline characteristics. Pericardial fluid GDF15 levels are associated with cardiac and kidney function in patients with coronary artery disease and may be a valuable marker for assessing CAD severity and predicting its complications.
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Affiliation(s)
- Zhize Yuan
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Haiqing Li
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Yanjun Sun
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jiapei Qiu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Hong Xu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jun Liu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Mi Zhou
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Anqing Chen
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Xiaofeng Ye
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Zhe Wang
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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16
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Initial Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Lesions Performed by a Pulmonologist. J Clin Med 2019; 8:jcm8060821. [PMID: 31181794 PMCID: PMC6616495 DOI: 10.3390/jcm8060821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/29/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
In the diagnosis of lung lesions, computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) has a high diagnostic yield and a low complication rate. The procedure is usually performed by interventional radiologists, but the diagnostic yield and safety of CT-guided PTNB when performed by pulmonologists have not been evaluated. A retrospective study of 239 patients who underwent CT-guided PTNB at Yeungnam University Hospital between March 2017 and April 2018 was conducted. A pulmonologist performed the procedure using a co-axial technique with a 20-gauge needle. Then diagnostic yield and safety were assessed. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of malignancy were 96.1% (171/178), 100% (46/46), 100% (171/171), and 86.8% (46/53), respectively. The diagnostic accuracy was 96.9% (217/224) and the overall complication rate was 33.1% (82/248). Pneumothorax, hemoptysis, and hemothorax occurred in 27.0% (67/248), 5.2% (13/248), and 0.8% (2/248) of the patients, respectively. Univariate analyses revealed that pneumothorax requiring chest tube insertion was a significant risk factor (odds ratio, 25.0; p < 0.001) for diagnostic failure. CT-guided PTNB is a safe procedure with a high diagnostic accuracy, even when performed by an inexperienced pulmonologist. The results were similar to those achieved by interventional radiologists as reported in previously published studies.
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17
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Christiansen IS, Clementsen PF, Bodtger U, Naur TMH, Pietersen PI, Laursen CB. Transthoracic ultrasound-guided biopsy in the hands of chest physicians - a stepwise approach. Eur Clin Respir J 2019; 6:1579632. [PMID: 30815241 PMCID: PMC6383606 DOI: 10.1080/20018525.2019.1579632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background: The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will be met by increasing demands with regard to biopsy techniques including ultrasound-guided transthoracic needle biopsy (US-TTNB).Objective: The aim of this paper is to present the pulmonologist to a systematic step-by-step guide for performing US-TTNB and to assess the evidence for this approach. Method/results: Indications, contraindications and a step-by-step guide for the techniques used when performing US-TTNB are presented, and major complications and handling of these are described. Conclusion: US-TTNB performed by pulmonologists is a safe and feasible procedure.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
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18
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Offin M, Chabon JJ, Razavi P, Isbell JM, Rudin CM, Diehn M, Li BT. Capturing Genomic Evolution of Lung Cancers through Liquid Biopsy for Circulating Tumor DNA. JOURNAL OF ONCOLOGY 2017; 2017:4517834. [PMID: 28392802 PMCID: PMC5368362 DOI: 10.1155/2017/4517834] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/28/2017] [Indexed: 01/06/2023]
Abstract
Genetic sequencing of malignancies has become increasingly important to uncover therapeutic targets and capture the tumor's dynamic changes to drug sensitivity and resistance through genomic evolution. In lung cancers, the current standard of tissue biopsy at the time of diagnosis and progression is not always feasible or practical and may underestimate intratumoral heterogeneity. Technological advances in genetic sequencing have enabled the use of circulating tumor DNA (ctDNA) analysis to obtain information on both targetable mutations and capturing real-time Darwinian evolution of tumor clones and drug resistance mechanisms under selective therapeutic pressure. The ability to analyze ctDNA from plasma, CSF, or urine enables a comprehensive view of cancers as systemic diseases and captures intratumoral heterogeneity. Here, we describe these recent advances in the setting of lung cancers and advocate for further research and the incorporation of ctDNA analysis in clinical trials of targeted therapies. By capturing genomic evolution in a noninvasive manner, liquid biopsy for ctDNA analysis could accelerate therapeutic discovery and deliver the next leap forward in precision medicine for patients with lung cancers and other solid tumors.
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Affiliation(s)
- Michael Offin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Jacob J. Chabon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Pedram Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - James M. Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Charles M. Rudin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Maximilian Diehn
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Bob T. Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
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