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D’Agnano V, Perrotta F, Stella GM, Pagliaro R, De Rosa F, Cerqua FS, Schiattarella A, Grella E, Masi U, Panico L, Bianco A, Iadevaia C. Molecular Diagnostic Yield and Safety Profile of Ultrasound-Guided Lung Biopsies: A Cross-Sectional Study. Cancers (Basel) 2024; 16:2860. [PMID: 39199631 PMCID: PMC11352358 DOI: 10.3390/cancers16162860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The recent advances in precision oncology for lung cancer treatment has focused attention on the importance of obtaining appropriate specimens for tissue diagnosis as well as comprehensive molecular profiling. CT scan-guided biopsies and bronchoscopy are currently the main procedures employed for tissue sampling. However, growing evidence suggests that ultrasound-guided biopsies may represent an effective as well as safe approach in this diagnostic area. This study explores the safety and the diagnostic yield for cancer molecular profiling in ultrasound-guided percutaneous lung lesion biopsies (US-PLLB). METHODS One hundred consecutive patients with suspected lung cancer, between January 2021 and May 2024, who had ultrasound-guided lung biopsies have been retrospectively analyzed. Molecular profiling was conducted with next-generation sequencing Genexus using Oncomine precision assay or polymerase chain reaction according to specimen quality. Qualitative immunohistochemical assay of programmed death ligand 1 (PD-L1) expression was evaluated by the Dako PD-L1 immunohistochemistry 22C3 pharmDx assay. The co-primary endpoints were the molecular diagnostic yield and the safety profile of US-guided lung biopsies. RESULTS From January 2021 to May 2024, 100 US-guided lung biopsies were carried out and 95 were considered for inclusion in the study. US-PLLB provided informative tissue for a histological evaluation in 93 of 95 patients with an overall diagnostic accuracy of 96.84% [Sensitivity: 92.63%; Specificity: 96.84%; PPV: 100%; NPV: 100%]. Sixty-Six patients were diagnosed with NSCLC (69.47%) and were considered for molecular diagnostic yield evaluation and PD-L1 testing. Four patients had malignant lymphoid lesions. US-PLLB was not adequate to achieve a final diagnosis in three patients (3.16%). Complete molecular profiling and PD-L1 evaluation were achieved in all patients with adenocarcinoma (molecular diagnostic yield: 100%). PD-L1 evaluation was achieved in 28 of 29 patients (96.55%) with either SCC or NOS lung cancer. The overall complication rate was 9.47% (n = 9). Six patients (6.31%) developed pneumothorax, while three patients (3.16%) suffered mild haemoptysis without desaturation. CONCLUSIONS According to our findings, US-guided lung biopsy is a safe, minimally invasive procedure in patients with suspected lung malignancies, providing an excellent diagnostic yield for both comprehensive molecular profiling and PD-L1 testing. In addition, our results suggest that US-guided biopsy may also be an effective diagnostic approach in patients with suspected lung lymphoma.
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Affiliation(s)
- Vito D’Agnano
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Giulia Maria Stella
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia Medical School, 27100 Pavia, Italy
| | - Raffaella Pagliaro
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Filippo De Rosa
- Unit of Pathology Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.D.R.); (L.P.)
| | - Francesco Saverio Cerqua
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Angela Schiattarella
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Edoardo Grella
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
| | - Umberto Masi
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
| | - Luigi Panico
- Unit of Pathology Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.D.R.); (L.P.)
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Carlo Iadevaia
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
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Jiang X, Chen J, Gu FF, Li ZR, Song YS, Long JJ, Zhang SZ, Xu TT, Tang YJ, Gu JY, Fang XM. Evaluating the efficacy of percutaneous puncture biopsy guided by contrast-enhanced ultrasound for peripheral pulmonary lesions. World J Clin Cases 2024; 12:3791-3799. [PMID: 38994323 PMCID: PMC11235426 DOI: 10.12998/wjcc.v12.i19.3791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The incidence and mortality of lung cancer have increased annually. Accurate diagnosis can help improve therapeutic efficacy of interventions and prognosis. Percutaneous lung biopsy is a reliable method for the clinical diagnosis of lung cancer. Ultrasound-guided percutaneous lung biopsy technology has been widely promoted and applied in recent years. AIM To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS)-guided percutaneous biopsy in peripheral pulmonary lesions. METHODS We retrospectively collected data on 237 patients with peripheral thoracic focal lesions who underwent puncture biopsy at Wuxi People's Hospital. The patients were randomly divided into two groups: The CEUS-guided before lesion puncture group (contrast group) and conventional ultrasound-guided group (control group). Analyze the diagnostic efficacy of the puncture biopsy, impact of tumor size, and number of puncture needles and complications were analyzed and compared between the two groups. RESULTS Accurate pathological results were obtained for 92.83% (220/237) of peripheral lung lesions during the first biopsy, with an accuracy rate of 95.8% (113/118) in the contrast group and 89.9% (107/119) in the control group. The difference in the area under the curve (AUC) between the contrast and the control groups was not statistically significant (0.952 vs 0.902, respectively; P > 0.05). However, when the lesion diameter ≥ 5 cm, the diagnostic AUC of the contrast group was higher than that of the control group (0.952 vs 0.902, respectively; P < 0.05). In addition, the average number of puncture needles in the contrast group was lower than that in the control group (2.58 ± 0.53 vs 2.90 ± 0.56, respectively; P < 0.05). CONCLUSION CEUS guidance can enhance the efficiency of puncture biopsy of peripheral pulmonary lesions, especially for lesions with a diameter ≥ 5 cm. Therefore, CEUS guidance has high clinical diagnostic value in puncture biopsy of peripheral focal lung lesions.
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Affiliation(s)
- Xiao Jiang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
- Department of Ultrasonography, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Jun Chen
- Department of Ultrasonography, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Fang-Fang Gu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Zhong-Rong Li
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Yu-Shan Song
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Jing-Jing Long
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Shu-Zhen Zhang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Ting-Ting Xu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Yong-Jun Tang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Ji-Ying Gu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Xiang-Ming Fang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
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Łyźniak P, Świętoń D, Szurowska E. Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view. Part 2. Pol J Radiol 2024; 89:e211-e224. [PMID: 38783909 PMCID: PMC11112417 DOI: 10.5114/pjr.2024.139286] [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: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 05/25/2024] Open
Abstract
In recent years, lung ultrasound (LUS) has developed rapidly, and it is gaining growing popularity in various scenarios. There are constant attempts to introduce it to new fields. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemics. In the first part of this review we discuss lines, signs and pheno-mena, profiles, some applications, and misconceptions. An aim of the second part of the review is mainly to discuss some advanced applications of LUS, including lung elastography, lung spectroscopy, colour and spectral Doppler, contrast-enhanced ultrasound of lung, speckled tracking of pleura, quantification of pulmonary oedema, predicting success of talc pleurodesis, asthma exacerbations, detecting chest wall invasion by tumours, lung biopsy, estimating pleural effusion volume, and predicting mechanical ventilatory weaning outcome. For this purpose, we reviewed literature concerning LUS.
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Affiliation(s)
- Piotr Łyźniak
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Dominik Świętoń
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Edyta Szurowska
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
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Gonnelli F, Hassan W, Bonifazi M, Pinelli V, Bedawi EO, Porcel JM, Rahman NM, Mei F. Malignant pleural effusion: current understanding and therapeutic approach. Respir Res 2024; 25:47. [PMID: 38243259 PMCID: PMC10797757 DOI: 10.1186/s12931-024-02684-7] [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: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality and elevated costs to healthcare systems. Over the last decades the understanding of pathophysiology mechanisms, diagnostic techniques and optimal treatment intervention in MPE have been greatly advanced by recent high-quality research, leading to an ever less invasive diagnostic approach and more personalized management. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. In the next future, because of a better understanding of underlying tumor biology together with more sensitive molecular diagnostic techniques, it is likely that combined diagnostic and therapeutic procedures allowing near total outpatient management of MPE will become popular. This article provides a review of the current advances, new discoveries and future directions in the pathophysiology, diagnosis and management of MPE.
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Affiliation(s)
- Francesca Gonnelli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | - Wafa Hassan
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | | | - Eihab O Bedawi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - José M Porcel
- Research Group of Cancer Biomarkers, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova, University Hospital, Lleida, Spain
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Unit, Oxford, UK
- Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy.
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Park B, Lim JK, Shin KM, Hong J, Cha JG, Cho SH, Park SY, Ryeom HK, Kim SH, Seo AN, Cha SI, Lee J, Lee H, Park J. Clinical Role of Upfront F-18 FDG PET/CT in Determining Biopsy Sites for Lung Cancer Diagnosis. Diagnostics (Basel) 2024; 14:153. [PMID: 38248030 PMCID: PMC10813933 DOI: 10.3390/diagnostics14020153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE This study aimed to investigate the impact of FDG PET/CT timing for biopsy site selection in patients with stage IV lung cancer regarding complications and diagnostic yield. METHODS This retrospective analysis was performed on 1297 patients (924 men and 373 women with a mean age of 71.4 ± 10.2 years) who underwent percutaneous needle biopsy (PNB) for stage IV lung cancer diagnosis in two hospitals. Data collected included the patient's characteristics, order date of the biopsy and PET/CT exams, biopsy target site (lung or non-lung), guidance modality, complications, sample adequacy, and diagnostic success. Based on the order date of the PNB and PET/CT exams, patients were categorized into upfront and delayed PET/CT groups. RESULTS PNB for non-lung targets resulted in significantly lower rates of minor (8.1% vs. 16.2%), major (0.2% vs. 3.4%), and overall complications (8.3% vs. 19.6%) compared to PNB for lung targets (p < 0.001 for all types of complications). Compared to the delayed PET/CT group, the upfront PET/CT group exhibited a lower probability of lung target selection of PNB (53.9% vs. 67.1%, p < 0.001), including a reduced incidence of major complications (1.0% vs. 2.9%, p = 0.031). Moreover, there was no significant difference in the occurrence of minor and total complications between the two groups. Upfront PET/CT and delayed PET/CT groups showed no significant difference regarding sample adequacy and diagnostic success. CONCLUSIONS Upfront PET/CT may have an impact on the selection of the biopsy site for patients with advanced lung cancer, which could result in a lower rate of major complications with no change in the diagnostic yield. Upfront PET/CT demonstrates potential clinical implications for enhancing the safety of lung cancer diagnosis in clinical practice.
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Affiliation(s)
- Byunggeon Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Kyung Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seo Young Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hoseok Lee
- Department of Radiology, Semyung Radiology Clinic, Gumi 39254, Gyeongsangbuk-do, Republic of Korea
| | - Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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Li X, Kong L. Ultrasound versus computed tomography-guided transthoracic biopsy for pleural and peripheral lung lesions: a systematic review and meta-analysis. Acta Radiol 2023; 64:2999-3008. [PMID: 37822264 DOI: 10.1177/02841851231206349] [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: 10/13/2023]
Abstract
BACKGROUND An accurate diagnosis of peripheral lung and pleural lesions using image-guided transthoracic biopsy procedure becomes a good diagnostic performance protocol. PURPOSE To examine the difference between ultrasonography (USG)-guided versus computed tomography (CT)-guided transthoracic biopsy for pleural and peripheral lung lesions by pooling data from published studies. MATERIAL AND METHODS PubMed, CENTRAL, Scopus, Web of Science, and Embase were searched for comparative studies up to 20 February 2023 irrespective of the language of publication. The outcomes were adequacy of the sample and complications (pneumothorax and hemothorax). RESULTS Two randomized controlled trials (RCTs) and eight non-RCTs were eligible. The total sample size was 1618. Meta-analysis showed that there was no difference in the adequacy of the sample obtained by USG- or CT-guided biopsies; however, an analysis of only non-RCTs indicated better adequacy with USG. On pooled analysis of any pneumothorax, there was a lower risk associated with USG-guided biopsies, but the risk of pneumothorax requiring interventional treatment was not different in the two groups. Similarly, the pooled analysis also demonstrated a reduced risk of hemothorax with USG-guided biopsies. CONCLUSION While there seems to be no difference in the adequacy of the sample obtained with either imaging modality, retrospective data show that USG guidance offers better diagnostic yield compared to CT guidance for peripheral lung and pleural biopsies. The risk of pneumothorax and hemothorax is also significantly lower with USG-guided biopsies. Results should be interpreted with caution owing to selection bias among studies. There is a need for large-scale RCTs to enhance current evidence.
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Affiliation(s)
- Xuemei Li
- Department of Ultrasound, Dianjiang County People's Hospital of Chongqing, Chongqing, PR China
| | - Lan Kong
- Department of Ultrasound, Dianjiang County People's Hospital of Chongqing, Chongqing, PR China
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Li S, Yu LL, Li L, Tang XM, He P, Gu P. Ultrasound-guided core-needle biopsy for peripheral pulmonary lesions: a systematic review and meta-analysis. Clin Radiol 2023; 78:755-762. [PMID: 37558538 DOI: 10.1016/j.crad.2023.07.005] [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: 10/04/2022] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023]
Abstract
AIM To evaluate the diagnostic value and safety of ultrasound-guided core-needle biopsy for peripheral pulmonary lesions (PPLs). MATERIALS AND METHODS PubMed, EMBASE, and the Cochrane Library for relevant were searched for studies published up to June 2022. The diagnostic accuracy of US-guided percutaneous transthoracic needle biopsy (PTNB) for the diagnosis of PPLs was evaluated using pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios (PLR and NLR), and the area under the summary receiver operating characteristic curves value (SROC). RESULTS The search included 12 original studies (3,830 procedures). For US-guided PTNB, the pooled sensitivity and specificity for the diagnosis of PPLs were 0.93 (95% confidence interval [CI]: 0.91-0.94) and 0.99 (95% CI: 0.96-1.00), respectively. The pooled estimates of the PLR, NLR, and DOR were 134.88 (95% CI: 24.88-731.74), 0.07 (95% CI: 0.06-0.09), and 1,814.95 (95% CI: 333.62-9,873.76), respectively. The area under the SROC curve was 0.95 (95% CI: 0.93-0.97). The overall complication rate was 3.6% (136 of 3,830), including self-limited haemoptysis and asymptomatic pneumothorax, and only six cases of pneumothorax requiring chest tube drainage and one case of severe bleeding were reported. CONCLUSIONS US-guided core-needle biopsy is an excellent diagnostic tool for PPLs, with high accuracy and excellent technical performance and safety.
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Affiliation(s)
- S Li
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China
| | - L-L Yu
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China
| | - L Li
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China
| | - X-M Tang
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China
| | - P He
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China
| | - P Gu
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China.
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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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Tao T, Bao X, Wang Y, Tang N. The Diagnostic Value of Medical Thoracoscopy Pleural Biopsy, Ultrasound-guided Pleural Biopsy, and Closed Pleural Biopsy in Tuberculous Pleurisy: A propensity score matching analysis.. [DOI: 10.21203/rs.3.rs-2099835/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Abstract
Background and objective
For diagnosis of exudative pleural effusion in tuberculous pleurisy, medical thoracoscopic pleural biopsy (MTPB) enables direct vision and is most widely applied, although ultrasound-guided pleural biopsy (USPB) and closed pleural biopsy (CPB) are also viable. This retrospective study compared the diagnostic efficiencies and safety of USPB, CPB, and MTPB.
Methods
Patients enrolled from 2014 through 2020 underwent USPB, CPB, or MTPB (n = 69, 69, and 110, respectively). Propensity score matching (PSM) analysis was used to compare the diagnostic sensitivities of CPB, MTPB, and USPB. The secondary outcomes were postoperative complications and hospitalization stay.
Results
PSM analysis resulted in 40 (USPB vs. CPB), 47 (USPB vs. MTPB), and 52 (CPB vs. MTPB) matched pairs. The diagnostic sensitivities of the USPB and CPB groups were 72.5% and 55.0% (P = 0.162); that of USPB and MTPB were 70.2% and 80.9% (P = 0.337); the CPB and MTPB groups were comparable(P = 0.152). The rates of associated pain and subcutaneous emphysema of the MTPB group were higher than that of the USPB or CPB (P = 0.000, both).Hospitalization time of the MTPB group was longest, and significantly longer than that of the USPB (P = 0.029).
Conclusions
While the three techniques were similarly effective in diagnosing tuberculous pleurisy, USPB and CPB showed fewer associated complications and shorter hospital stays compared with MTPB. The image guidance offered by USPB benefited reduction in postoperative complications.
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Affiliation(s)
- Tao Tao
- Chongqing University Fuling Hospital
| | | | | | - Nan Tang
- Chongqing University Fuling Hospital
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10
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Som A, Rosenboom JG, Chandler A, Sheth RA, Wehrenberg-Klee E. Image-guided intratumoral immunotherapy: Developing a clinically practical technology. Adv Drug Deliv Rev 2022; 189:114505. [PMID: 36007674 PMCID: PMC10456124 DOI: 10.1016/j.addr.2022.114505] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/14/2022] [Accepted: 08/17/2022] [Indexed: 02/07/2023]
Abstract
Immunotherapy has revolutionized the contemporary oncology landscape, with durable responses possible across a range of cancer types. However, the majority of cancer patients do not respond to immunotherapy due to numerous immunosuppressive barriers. Efforts to overcome these barriers and increase systemic immunotherapy efficacy have sparked interest in the local intratumoral delivery of immune stimulants to activate the local immune response and subsequently drive systemic tumor immunity. While clinical evaluation of many therapeutic candidates is ongoing, development is hindered by a lack of imaging confirmation of local delivery, insufficient intratumoral drug distribution, and a need for repeated injections. The use of polymeric drug delivery systems, which have been widely used as platforms for both image guidance and controlled drug release, holds promise for delivery of intratumoral immunoadjuvants and the development of an in situ cancer vaccine for patients with metastatic cancer. In this review, we explore the current state of the field for intratumoral delivery and methods for optimizing controlled drug release, as well as practical considerations for drug delivery design to be optimized for clinical image guided delivery particularly by CT and ultrasound.
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Affiliation(s)
- Avik Som
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, United States
| | - Jan-Georg Rosenboom
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, United States; Department of Gastroenterology, Brigham and Women's Hospital, United States
| | - Alana Chandler
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, United States; Department of Gastroenterology, Brigham and Women's Hospital, United States
| | - Rahul A Sheth
- Department of Interventional Radiology, M.D. Anderson Cancer Center, United States
| | - Eric Wehrenberg-Klee
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States.
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11
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Nguyen ET, Bayanati H, Hurrell C, Aitken M, Cheung EM, Gupta A, Harris S, Sedlic T, Taylor JL, Gahide G, Dennie C. Canadian Association of Radiologists/Canadian Association of Interventional Radiologists/Canadian Society of Thoracic Radiology Guidelines on Thoracic Interventions. Can Assoc Radiol J 2022; 74:272-287. [PMID: 36154303 DOI: 10.1177/08465371221122807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thoracic interventions are frequently performed by radiologists, but guidelines on appropriateness criteria and technical considerations to ensure patient safety regarding such interventions is lacking. These guidelines, developed by the Canadian Association of Radiologists, Canadian Association of Interventional Radiologists and Canadian Society of Thoracic Radiology focus on the interventions commonly performed by thoracic radiologists. They provide evidence-based recommendations and expert consensus informed best practices for patient preparation; biopsies of the lung, mediastinum, pleura and chest wall; thoracentesis; pre-operative lung nodule localization; and potential complications and their management.
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Affiliation(s)
- Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Hamid Bayanati
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Matthew Aitken
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada,St. Michael's Hospital, University of Toronto, ON, Canada
| | - Edward M Cheung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Ashish Gupta
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Scott Harris
- Health Sciences Centre, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Tony Sedlic
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jana Lyn Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Gerald Gahide
- Service de radiologie interventionelle, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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12
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Curti M, Fontana F, Piacentino F, Ossola C, Coppola A, Carcano G, Venturini M. Dual-layer spectral CT fusion imaging for lung biopsies: more accurate targets, diagnostic samplings, and biomarker information? Eur Radiol Exp 2022; 6:34. [PMID: 35965267 PMCID: PMC9376184 DOI: 10.1186/s41747-022-00290-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
The increasingly widespread use of computed tomography (CT) has increased the number of detected lung lesions, which are then subjected to needle biopsy to obtain histopathological diagnosis. Obtaining high-quality biopsy specimens is fundamental for diagnosis and biomolecular characterisation that guide therapy decision-making. In order to obtain samples with high diagnostic potential, fusion imaging techniques, such as fusion between positron emission tomography and CT, have been introduced to target the biopsy where there more viable neoplastic cells can be sampled. Nowadays, dual-layer spectral CT represents a novel technology enabling an increased tissue characterisation. In particular, Z-effective images, i.e., colour-coded images based on the effective atomic number of tissue components, provide a higher level of discrimination than usual imaged based on x-ray attenuation in Hounsfield units and offer the potential of a better tissue characterisation. Our hypothesis is based on the future use of data provided by spectral CT, in particular by Z-effective images, as a guide for appropriate biopsy sampling for histopathological and biomolecular characterisation in the era of patient tailored-therapy.
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13
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Shah A, Cohen K, Patel B, Dahiya N, Fananapazir G. Optimizing anxiolysis and analgesia for percutaneous intervention by the abdominal radiologist. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2721-2729. [PMID: 35072783 DOI: 10.1007/s00261-022-03417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/18/2023]
Abstract
Abdominal radiologists perform a wide variety of image-guided interventions. Procedures performed by abdominal radiologists can be broadly categorized into paracentesis, thoracentesis, superficial and deep soft tissue biopsy, drain placement, and ablation. As these procedures continue to develop as an alternative to more invasive and potentially morbid interventions, and with continued improvements in minimally invasive technologies, it becomes increasingly important for abdominal radiologists to be familiar with options for peri-procedural analgesia and anxiolysis, as well as when to consult anesthesiology. In this review, we discuss analgesic, anxiolytic, and nonpharmacologic options available to the abdominal radiologist. We focus on practical agents that are relatively safe for general use, special populations, and considerations for post-procedural monitoring.
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Affiliation(s)
- Amar Shah
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Kevin Cohen
- Department of Anesthesia, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Bhavik Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
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14
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Larocque N, Brook OR. Lung, Pleural, and Mediastinal Biopsies: From Preprocedural Assessment to Technique and Management of Complications. Semin Intervent Radiol 2022; 39:218-225. [PMID: 36062222 PMCID: PMC9433161 DOI: 10.1055/s-0042-1751292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Biopsies of the lung, pleura, and mediastinum play a crucial role in the workup of thoracic lesions. Percutaneous image-guided biopsy of thoracic lesions is a relatively safe and noninvasive way to obtain a pathologic diagnosis which is required to direct patient management. This article reviews how to safely perform image-guided biopsies of the lung, pleura, and mediastinum, from the preprocedural assessment to reviewing intraprocedural techniques, and how to avoid and manage complications.
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Affiliation(s)
- Natasha Larocque
- Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Olga R. Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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15
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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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