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Wang J, Zhang T, Li H, Hu Y, Xu Y, Huang Z, Xie S, Yang M, Sun H. Diagnostic yield and complication rates of percutaneous transthoracic CT-guided coaxial needle biopsy in persistent pulmonary consolidation. Jpn J Radiol 2024:10.1007/s11604-024-01623-2. [PMID: 38937410 DOI: 10.1007/s11604-024-01623-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES To investigate the diagnostic performance and complication rates of percutaneous transthoracic CT-guided coaxial core needle biopsy (PTCNB) in persistent consolidations and evaluate its safety in routine clinical practice. METHODS A total of 685 patients (404 males, 281 females) underwent PTCNB with coaxial core technique for persisted consolidation were reviewed in this study. According to histopathological and microbiological analysis, the results of biopsy specimens were categorized as follows: malignant, specific benign, non-specific benign and non-diagnostic. The final diagnosis was established through surgical resection or clinicoradiological follow-up for at least 12 months following biopsy. Diagnostic yield of PTCNB was defined as the percentage of the true diagnosis from biopsy as malignant and specific benign lesions. RESULTS With respect to the final diagnosis, 54 (54/685; 7.88%) cases were obtained by surgery and the remaining were by follow-up. The total accuracy, sensitivity, specificity of PTCNB for malignancy diagnosis was 94.45%, 84.87%, 100%, respectively. Diagnostic yield of PTCNB was 66.28%. Compared to lesions smaller than 3 cm, higher diagnostic yield (70.89%), lower complication incidence (38.22%) and shorter procedure time (8.78 min) were observed in lesions ≥ 3 cm group. CONCLUSION PTCNB in persistent consolidation is a safe and effective procedure, which provide relatively high diagnostic yield and acceptable complication, especially in size over 3 cm lesions. CRITICAL RELEVANCE STATEMENT CT-guided coaxial needle biopsy for pulmonary consolidation is a safe and effective procedure. The coaxial needle biopsy yielded high diagnostic rates and low complication rates (including pneumothorax and intrapulmonary hemorrhage), especially in larger lesions.
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Affiliation(s)
- Juan Wang
- Department of Radiology, Civil Aviation General Hospital, Beijing, 100123, China
| | - Tongyin Zhang
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
- Graduate School, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100029, China
| | - Haoyu Li
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, China
| | - Yuwan Hu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
- Graduate School, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100029, China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Zhenguo Huang
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Meng Yang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China.
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Bhagavatula SK, Graur A, Fintelmann FJ. Lung Needle Biopsy and Lung Ablation: Indications, Patient Management, and Postprocedure Imaging Findings. Clin Chest Med 2024; 45:307-323. [PMID: 38816090 DOI: 10.1016/j.ccm.2024.02.005] [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: 06/01/2024]
Abstract
The clinical role and use of percutaneous transthoracic needle biopsy (TTNB) and ablation of lung tumors are evolving. Here we discuss important considerations for referring providers, including current and emerging indications supported by guidelines, critical aspects of pre and postprocedure patient management, and expected postprocedure imaging findings.
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Affiliation(s)
- Sharath K Bhagavatula
- Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alexander Graur
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Liang T, Du Y, Guo C, Wang Y, Shang J, Yang J, Niu G. Ultra-low-dose CT-guided lung biopsy in clinic: radiation dose, accuracy, image quality, and complication rate. Acta Radiol 2021; 62:198-205. [PMID: 32460511 DOI: 10.1177/0284185120917622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Computed tomography (CT)-guided percutaneous lung biopsy is usually performed by helical scanning. However, there are no studies on radiation dose, diagnostic accuracy, image quality, and complications based on axial scan mode. PURPOSE To determine radiation dose, accuracy, image quality, and complication rate following an ultra-low-dose (ULD) protocol for CT-guided lung biopsy in clinic. MATERIAL AND METHODS A total of 105 patients were enrolled to receive CT-guided lung biopsy. The use of an ULD protocol (axial scan) for CT-guided biopsy was initiated. Patients were randomly assigned to axial mode (Group A) and conventional helical mode (Group B) CT groups. 64-slice CT was performed for CT-guided pulmonary biopsy with an 18-G coaxial cutting biopsy needle. The radiation dose, accuracy, image quality, and complication rate were measured. RESULTS Ninety-seven patients were selected for the final phase of the study. There was no significant difference between the two groups for pulmonary nodule characteristics (P > 0.05). The mean effective dose in group A (0.077 ± 0.010 mSv) was significantly reduced relative to group B (0.653 ± 0.177 mSv, P < 0.001). There was no significant difference in accuracy, image quality, and complication rate (P > 0.050) between the two modes. CONCLUSION An ULD protocol for CT-guided lung nodule biopsy yields a reduction in the radiation dose without significant change in the accuracy, image quality, and complication rate relative to the conventional helical mode scan.
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Affiliation(s)
- Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
- Department of Biomedical Engineering the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology of Xi’an Jiaotong University, Xi’an, PR China
| | - Yonghao Du
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Chenguang Guo
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Yuan Wang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
- Department of Biomedical Engineering the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology of Xi’an Jiaotong University, Xi’an, PR China
| | - Gang Niu
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
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Brioulet J, David A, Sagan C, Cellerin L, Frampas E, Morla O. Percutaneous CT-guided lung biopsy for the diagnosis of persistent pulmonary consolidation. Diagn Interv Imaging 2020; 101:727-732. [PMID: 32811758 DOI: 10.1016/j.diii.2020.07.007] [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: 06/14/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The primary objective of this study was to determine the diagnostic accuracy of percutaneous computed tomography (CT)-guided biopsy of persistent pulmonary consolidations. The secondary objective was to determine the complication rate and identify factors affecting diagnostic yield. MATERIALS AND METHODS Two radiologists retrospectively reviewed 98 percutaneous CT-guided biopsies performed in 93 patients (60 men, 33 women; mean age, 62±14.0 (SD) years; range: 18-88 years) with persistent pulmonary consolidations. Final diagnoses were based on surgical outcomes or 12 months clinical follow-up findings. Biopsy results were compared to the final diagnosis to estimate diagnostic yield. RESULTS A final diagnosis was obtained for all patients: 51/93 (54.8%) had malignant lesions, 12/93 (12.9%) specific definite benign lesions (including 9 infections, two pneumoconiosis and one lipoid pneumonia) and 30/93 (32.3%) non-specific benign lesions. CT-guided biopsy had an overall diagnostic yield of 60% (59/98) with a correct diagnosis for 50/51 malignant lesions (diagnostic yield of 98% for malignancy) and for 9/47 benign lesions (diagnostic yield of 19% for benign conditions). Major complications occurred in 4/98 (4%) of lung biopsies (four pneumothoraxes requiring chest tube placement). CONCLUSION Percutaneous CT-guided biopsy is an alternative to endoscopic or surgical biopsy for the diagnosis of persistent consolidation with a low risk of severe complication.
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Affiliation(s)
- J Brioulet
- Department of Radiology, Centre Hospitalier Universitaire de Nantes, Hôtel Dieu, 44093 Nantes Cedex 1, France.
| | - A David
- Department of Radiology, Centre Hospitalier Universitaire de Nantes, Hôtel Dieu, 44093 Nantes Cedex 1, France
| | - C Sagan
- Department of Pathology, Centre Hospitalier Universitaire de Nantes, Hôpital Laënnec, Saint-Herblain, 44000 Nantes, France
| | - L Cellerin
- Department of Pneumology, Centre Hospitalier Universitaire de Nantes, Hôpital Laënnec, Saint-Herblain, 44000 Nantes, France
| | - E Frampas
- Department of Radiology, Centre Hospitalier Universitaire de Nantes, Hôtel Dieu, 44093 Nantes Cedex 1, France; CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, 44000 Nantes, France
| | - O Morla
- Department of Radiology, Centre Hospitalier Universitaire de Nantes, Hôtel Dieu, 44093 Nantes Cedex 1, France
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Nath A, Neyaz Z, Hashim Z, Agrawal V, Richa M. Role of Percutaneous Computed Tomography-guided Lung Biopsy in Non-resolving Consolidation and Identification of Clinical and High-resolution Computed Tomography Characteristics Predicting Outcome. J Clin Imaging Sci 2019; 9:48. [PMID: 31819825 PMCID: PMC6884987 DOI: 10.25259/jcis_126_2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/14/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Non-resolving consolidation (NRC) with inconclusive sputum, bronchoscopy, and bronchoalveolar lavage results poses a diagnostic dilemma. This retrospective analytical study was conducted to evaluate diagnostic yield and complications of percutaneous computed tomography (CT)-guided lung biopsy (PCLB) in NRC. Assessment of clinical features and high-resolution CT (HRCT) characteristics was also done which may predict outcome. Materials and Methods: Data of PCLB performed for lung consolidation from January 2010 to January 2019 were retrospectively evaluated. For the determination of diagnostic yield, a positive result from any one specimen obtained by PCLB (tissue core, aspiration cytology, or microbiology) was sufficient to considered procedure diagnostic if it was concordant with clinical features, imaging findings, response to treatment, and subsequent follow-up. Student’s t-test and Fisher’s exact test were used for statistical analysis. Results: Out of total 56 patients, final diagnosis was achieved in 48 (19 malignant and 29 benign). Diagnostic yield was 69.6%. Complications were noted in 10 patients including mild hemoptysis and pneumothorax, which were managed conservatively. No clinical feature was having statistically significant association with final diagnosis. HRCT findings significantly associated with malignant outcome were larger size of consolidation, multiple contiguous lobe involvement, multiple air-filled cysts inside consolidation, and associated ground-glass areas or multiple ground-glass nodules. The absence of air bronchogram was more common in benign cases. Conclusion: PCLB is a safe and useful method for obtaining specimen in NRC. Differentiation of benign from malignant outcome is not possible based on clinical findings; however, certain HRCT findings raise suspicion of malignancy.
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Affiliation(s)
- Alok Nath
- Departments of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Departments of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zia Hashim
- Departments of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vinita Agrawal
- Departments of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mishra Richa
- Departments of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kiranantawat N, McDermott S, Fintelmann FJ, Montesi SB, Price MC, Digumarthy SR, Sharma A. Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation. Respir Res 2019; 20:23. [PMID: 30704502 PMCID: PMC6357395 DOI: 10.1186/s12931-019-0982-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/08/2019] [Indexed: 01/18/2023] Open
Abstract
Background To determine the clinical role, safety, and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation. Methods A retrospective review of all computed tomography (CT)-guided percutaneous transthoracic needle biopsies (PTNB) at a tertiary care hospital over a 4-year period was performed to identify all cases of PTNB performed for pulmonary consolidation. For each case, CT Chest images were reviewed by two thoracic radiologists. Histopathologic and microbiologic results were obtained and clinical follow-up was performed. Results Thirty of 1090 (M:F 17:30, mean age 67 years) patients underwent PTNB for pulmonary consolidation (2.8% of all biopsies). A final diagnosis was confirmed in 29 patients through surgical resection, microbiology, or clinicoradiologic follow-up for at least 18 months after biopsy. PTNB had an overall diagnostic accuracy of 83%. A final diagnosis of malignancy was made in 20/29 patients, of which 19 were correctly diagnosed by PTNB, resulting in a sensitivity of 95% and specificity of 100% for malignancy. In all cases of primary lung cancer, adequate tissue for molecular testing was obtained. A benign final diagnosis was made in 9 patients, infection in 5 cases and non-infectious benign etiology in 4 cases. PTNB correctly diagnosed all cases of infection. Minor complications occurred in 13% (4/30) of patients. Conclusions Pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy. Diagnostic yield is high, especially for malignancy. PTNB of pulmonary consolidation should be considered following non-diagnostic bronchoscopy.
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Affiliation(s)
- Nantaka Kiranantawat
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Radiology, Songklanagarind Hospital, Prince of Songkhla University Hat Yai, Songkhla, 90110, Thailand
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Sydney B Montesi
- Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa C Price
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Abstract
Image-guided percutaneous transthoracic needle biopsy (PTNB) is a well-established and minimally invasive technique for evaluating pulmonary nodules. Implementation of a national lung screening program and increased use of chest computed tomography have contributed to the frequent identification of indeterminate pulmonary nodules that may require tissue sampling. The advent of biomarker-driven lung cancer therapy has led to increased use of repeat PTNB after diagnosis. Percutaneous insertion of markers for preoperative localization of small nodules can aid in minimally invasive surgery and radiation treatment planning. This article discusses PTNB, patient selection, and biopsy technique, including minimizing and managing complications.
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Affiliation(s)
- Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 202, Boston, MA 02114, USA.
| | - Jo-Anne O Shepard
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 202, Boston, MA 02114, USA
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Abers MS, Sandvall BP, Sampath R, Zuno C, Uy N, Yu VL, Stager CE, Musher DM. Postobstructive Pneumonia: An Underdescribed Syndrome. Clin Infect Dis 2016; 62:957-61. [PMID: 26908806 PMCID: PMC4803103 DOI: 10.1093/cid/civ1212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Postobstructive community-acquired pneumonia (PO-CAP) is relatively common in clinical practice. The clinical syndrome is poorly defined, and the role of infection as a cause of the infiltrate is uncertain. We prospectively studied patients with PO-CAP and compared them to a cohort of patients with bacterial community-acquired pneumonia (B-CAP). Methods. We prospectively studied patients hospitalized for CAP; 5.4% had PO-CAP, defined as a pulmonary infiltrate occurring distal to an obstructed bronchus. Sputum and blood cultures, viral polymerase chain reaction, urinary antigen tests, and serum procalcitonin (PCT) were done in nearly all cases. Clinical and laboratory characteristics of patients with PO-CAP were compared to those of patients with B-CAP. Results. In a 2-year period, we identified 30 patients with PO-CAP. Compared to patients with B-CAP, patients with PO-CAP had longer duration of symptoms (median, 14 vs 5 days; P < .001). Weight loss and cavitary lesions were more common (P < .01 for both comparisons) and leukocytosis was less common (P < .01) in patients with PO-CAP. A bacterial pathogen was implicated in only 3 (10%) PO-CAP cases. PCT was <0.25 ng/mL in 19 (63.3%) patients. Although no differences were observed in disease severity or rates of intensive care unit admissions, 30-day mortality was significantly higher in PO-CAP vs B-CAP (40.0% vs 11.7%; P < .01). Conclusions. Although there is substantial overlap, PO-CAP is a clinical entity distinct from B-CAP; a bacterial cause was identified in only 10% of patients. Our study has important implications for the clinical recognition of patients with PO-CAP, the role of microorganisms as etiologic agents, and the use of antibiotic therapy.
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Affiliation(s)
- Michael S Abers
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts
| | - Barcleigh P Sandvall
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California
| | - Rahul Sampath
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Carlo Zuno
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Natalie Uy
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Victor L Yu
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Charles E Stager
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Daniel M Musher
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
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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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Abumossalam A, Shebl A. The right get with the proper git: Precision of diagnosing pulmonary tuberculous cavities by means of various biopsies. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Chaudhuri AD, Mukherjee S, Nandi S, Bhuniya S, Tapadar SR, Saha M. A study on non-resolving pneumonia with special reference to role of fiberoptic bronchoscopy. Lung India 2013; 30:27-32. [PMID: 23661913 PMCID: PMC3644829 DOI: 10.4103/0970-2113.106130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Context: Non-resolving pneumonia is often an area of concern for pulmonologists. Fiber optic bronchoscopy (FOB) may have a special role in etiologic evaluation of non-resolving pneumonias. There is paucity of recent studies in this field. Aims: This study aimed to assess the patients of non-resolving or slowly resolving pneumonia with special emphasis on efficacy of FOB and computed tomography (CT)-guided fine needle aspiration cytology (FNAC) in diagnosis. Settings and Design: Prospective, observational study conducted in a tertiary care institute over a period of one year. Materials and Methods: After fulfilling the definition of non-resolving pneumonia by clinical and radiological parameters, patients were evaluated by FOB with relevant microbiological, cytological, histopathological investigations and CT scan of thorax. CT-guided FNAC was done in selected cases where FOB was inconclusive. Results: Sixty patients were enrolled in the study. Mean age was 51.33 ± 1.71 years with male to female ratio 2:1. Right lung was more commonly involved (65%), and right upper lobe was the commonest site (25%). Pyogenic infection was the commonest etiology (53.3%), bronchogenic carcinoma and tuberculosis accounted for 26.7% and 16.7% cases, respectively. Both, FOB (85.7%) and CT-guided FNAC (91.67%) were very useful for etiological diagnosis of non-resolving pneumonia. Both the procedures were safe, and no major complication was observed. Conclusions: Because of the high yield of FOB, it is very useful and safe diagnostic tool for evaluation of non-resolving pneumonia. CT-guided FNAC also gives good yield when cases are properly selected.
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Affiliation(s)
- Arunabha D Chaudhuri
- Department of Respiratory Medicine, R.G. Kar Medical College and Hospital, Kolkata, India
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Hadda V, Khilnani GC, Bhalla AS, Mathur S. Lipoid pneumonia presenting as non resolving community acquired pneumonia: a case report. CASES JOURNAL 2009; 2:9332. [PMID: 20062592 PMCID: PMC2803992 DOI: 10.1186/1757-1626-2-9332] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/16/2009] [Indexed: 11/13/2022]
Abstract
Introduction Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances like, petroleum jelly, mineral oils, few laxatives etc. It usually presents as insidious onset chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, specially, when exposure to fatty substance is acute and/or massive. Radiologically, it may mimic carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Diagnosis of LP requires demonstration of lipid laden macrophages in sputum, bronchoalveolar lavage fluid or fine needle aspiration cytology/biopsy from lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy and corticosteroids. Case presentation A 20-year old Indian farmer was referred to us with a diagnosis of non resolving community acquired pneumonia. Respiratory examination revealed signs of consolidation. Chest radiograph revealed findings suggestive of bilateral consolidation. Sputum and blood culture were sterile. He was treated with prolonged course of various antibiotics without any significant response. For evaluation of non resolving pneumonia fibreoptic bronchoscopy was done. Bronchoalveolar lavage fluid and biopsy from lung lesion showed lipid laden macrophages. Hence diagnosis of lipoid pneumonia was made. Patient was treated with course of corticosteroids with good response. Literature on this rare entity is discussed. Conclusion Lipoid pneumonia is a rare form of pneumonia which rarely present acutely resembling community acquired pneumonia and requires high degree of suspicion for diagnosis. Its treatment is difficult and poorly defined. However, prolonged corticosteroids may be effective.
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Affiliation(s)
- Vijay Hadda
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
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