1
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Zhao Y, You B, Li H. Enhancing surgical precision in early-stage non-small cell lung cancer: A novel approach through temporary pulmonary vascular occlusion. Thorac Cancer 2024; 15:1582-1589. [PMID: 38837623 PMCID: PMC11246783 DOI: 10.1111/1759-7714.15388] [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: 04/03/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND To evaluate a novel intraoperative localization technique utilizing temporary pulmonary arteriovenous occlusion for enhancing the precision of sublobar resections in early-stage NSCLC. METHODS Conducted from January to November 2023, this study involved 140 patients. During the surgery, key pulmonary vessels were identified using preoperative three-dimensional (3D) imaging and temporarily occluded with noninvasive clamps to isolate the target lung segment. Following vascular occlusion, indocyanine green (ICG) was administered intravenously to precisely delineate the resection margins. After visually confirming the marked areas, the clamps were released, and a targeted partial resection was performed on the delineated segment. Surgical data, including operation times, surgical margins, and hospitalization costs, were collected and compared with those from a historical control group of 110 patients who underwent traditional pulmonary wedge resections. RESULTS In the study group, the median surgical margin achieved was 16 mm, which was statistically significant compared to 15 mm in the control group (p < 0.05). Operation times were reduced to an average of 58.43 ± 12.962 min, showing a decrease from the control group's average of 69.50 ± 17.544 min (p < 0.05). Hospitalization costs were also lower, averaging $4772.98 ± 624.339 for the study group versus $5161.34 ± 856.336 for the control group (p < 0.05). Patient safety was maintained with no increase in surgical complications. CONCLUSION The technique, leveraging temporary pulmonary arteriovenous occlusion, offered a significant advancement in the surgical treatment of peripheral early-stage NSCLC. It reduced operation time and lowered overall surgical costs. This method represented a promising alternative to traditional surgical approaches.
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Affiliation(s)
- Yan Zhao
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bin You
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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2
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Ezenagu OC, Gabriel GE, Saha SP. Computed Tomography (CT)-Guided Needle Biopsy of Lung Lesions: A Single Center Experience. Healthcare (Basel) 2024; 12:1260. [PMID: 38998796 PMCID: PMC11240914 DOI: 10.3390/healthcare12131260] [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: 05/30/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Objective: Lung cancer is one of the leading causes of cancer death among men and women across the globe. The accurate and timely diagnosis of lung lesions is of paramount importance for prognosis. This single-center study is the first to assess the diagnostic yield and complication rate of a computed tomography (CT)-guided needle biopsy of pulmonary parenchymal and pleural nodules in an academic training center in the United States. (2) Methods: This is a retrospective study approved by IRB. Patients who underwent CT-guided needle biopsy between 2016 and 2020 were reviewed. A CT-guided needle biopsy involving mediastinal lesions was excluded, focusing only on lung parenchymal and pleural lesions. A CT-guided needle biopsy aborted at any point during the procedure was also excluded from this study. (3) Results: 1063 patients were included in this study; 532 were males, and 531 were females. Lesion size ranged from 0.26 cm to 9.2 cm. 1040 patients received diagnoses, among which 772 had a specific diagnosis, and 268 had nonspecific inflammatory or non-malignant diagnoses. Twenty-three cases were non-diagnostic. Among the patients with specific diagnoses, 691 were malignant, 5 were hamartomas, 30 were fungal infections, 6 were acid-fast-positive organisms, and 40 were unspecified atypical cells. Of the patients that had a malignant diagnosis, 317 were adenocarcinoma, 197 were squamous cell carcinoma, 26 were a neuroendocrine tumor, 45 were non-small cell carcinoma (undifferentiated), 17 were small cell carcinoma, and 89 were other metastatic malignancies to the lung. Various common complications, including pneumothorax (337), hemorrhage (128), and hemoptysis (17), were observed, and 42 of the cases required chest tube intervention; others were treated with observation. Other rare complications observed included hemothorax (4) and oxygen desaturation (2), and there was no death in this series. (4) Conclusions: CT-guided needle biopsy is a reliable diagnostic modality for patients with lung parenchymal and pleural nodules, and it can effectively distinguish between benign and cancerous lesions before invasive procedures such as video-assisted thoracoscopy (VATs) or thoracotomy are planned. Our study showed a higher rate of pneumothorax and pulmonary hemorrhage compared to the rates established in guidelines, attributable to the varying experience level in a busy training academic center.
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Affiliation(s)
| | - Gaby E Gabriel
- College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Sibu P Saha
- College of Medicine, University of Kentucky, Lexington, KY 40506, USA
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3
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Chen X, Bian Y, Li H, Li S, Shi Z, Zhao Y, Li H, Yang Y. Efficacy of autologous blood patch injection for pneumothorax rate after CT-guided percutaneous transthoracic lung biopsy: a systematic review and meta-analysis. J Cardiothorac Surg 2024; 19:332. [PMID: 38877547 PMCID: PMC11177476 DOI: 10.1186/s13019-024-02781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 04/29/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Pneumothorax is the most frequent complication after CT-guided percutaneous transthoracic lung biopsy (CT-PTLB). Many studies reported that injection of autologous blood patch (ABP) during biopsy needle withdrawal could reduce the pneumothorax and chest tube insertion rate after CT-PTLB, but the result is debatable. The aim of this systematic review and meta-analysis is to synthesize evidence regarding the efficacy of ABP procedure in patients receiving CT-PTLB. METHODS Eligible studies were searched in Pubmed, Embase and Web of Science databases. The inclusion criteria were studies that assessed the relationship between ABP and the pneumothorax and/or chest tube insertion rate after CT-PTLB. Subgroup analyses according to study type, emphysema status and ABP technique applied were also conducted. Odds ratio (OR) with 95% confidence interval (CI) were calculated to examine the risk association. RESULTS A total of 10 studies including 3874 patients were qualified for analysis. Our analysis suggested that ABP reduced the pneumothorax (incidence: 20.0% vs. 27.9%, OR = 0.67, 95% CI = 0.48-0.66, P < 0.001) and chest tube insertion rate (incidence: 4.0% vs. 8.0%, OR = 0.47, 95% CI = 0.34-0.65, P < 0.001) after CT-PTLB. Subgroup analysis according to study type (RCT or retrospective study), emphysema status (with or without emphysema), and ABP technique applied (clotted or non-clotted ABP) were also performed and we found ABP reduced the pneumothorax and chest tube insertion rate in all subgroups. CONCLUSIONS Our study indicated that the use of ABP was effective technique in reducing the pneumothorax and chest tube insertion rate after CT-PTLB.
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Affiliation(s)
- Xin Chen
- Department of General Surgery, The People's Hospital of Fengqing, Lincang, 675900, PR China
| | - Yungui Bian
- Department of Thoracic Surgery, The People's Hospital of Fengqing, Lincang, 675900, PR China
| | - Hai Li
- Department of Stomatology, The People's Hospital of Fengqing, Lincang, 675900, PR China
| | - Shurong Li
- Department of Clinical Laboratory, The People's Hospital of Fengqing, Lincang, 675900, PR China
| | - Zhaowen Shi
- Department of General Surgery, The People's Hospital of Fengqing, Lincang, 675900, PR China
| | - Yunping Zhao
- Department of Thoracic Surgery I, The First Affiliated Hospital of Kunming Medical University, No.295 Xichang Road, Wuhua District, Kunming, Yunnan Province, 650032, PR China
| | - Haibin Li
- Department of Thoracic Surgery I, The First Affiliated Hospital of Kunming Medical University, No.295 Xichang Road, Wuhua District, Kunming, Yunnan Province, 650032, PR China
| | - Yanlong Yang
- Department of Thoracic Surgery I, The First Affiliated Hospital of Kunming Medical University, No.295 Xichang Road, Wuhua District, Kunming, Yunnan Province, 650032, PR China.
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4
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Shah R, Sun L, Ridge CA. Image guided lung biopsy. Lung Cancer 2024; 192:107803. [PMID: 38749073 DOI: 10.1016/j.lungcan.2024.107803] [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: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Image guided lung biopsy is vital in the evaluation of pulmonary abnormalities. Various modalities can be used including Ultrasound, Computed Tomography and Navigational Bronchoscopy. In this paper, we review the indications, techniques, diagnostic accuracy and complications of image guided biopsies and the role of novel techniques such as navigational and robot-assisted bronchoscopy.
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Affiliation(s)
- R Shah
- Royal Brompton and Harefield Hospitals, United Kingdom
| | - L Sun
- Royal Brompton and Harefield Hospitals, United Kingdom
| | - C A Ridge
- National Heart and Lung Institute, Imperial College London, United Kingdom
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5
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Yang L, Duan S, Zhang Y, Hao L, Wang S, Zou Z, Hu Y, Chen S, Hu Y, Zhang L. Feasibility and Safety of Percutaneous Puncture Guided by a 5G-Based Telerobotic Ultrasound System: An Experimental Study. Cardiovasc Intervent Radiol 2024; 47:812-819. [PMID: 38592415 DOI: 10.1007/s00270-024-03681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/31/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To evaluate the feasibility and safety of percutaneous puncture guided by a 5th generation mobile communication technology (5G)-based telerobotic ultrasound system in phantom and animal experiments. MATERIALS AND METHODS In the phantom experiment, 10 simulated lesions were punctured, once at each of two angles for each lesion, under the guidance of a telerobotic ultrasound system and ultrasound-guided freehand puncture. Student's t test was used to compare the two methods in terms of puncture accuracy, total operation duration, and puncture duration. In the animal experiment, under the guidance of the telerobotic ultrasound system, an 18G puncture needle was used to puncture 3 target steel beads in the liver, right kidney, and right gluteal muscle, respectively. The animal experiment had no freehand ultrasound-guided control group. After puncture, a CT scan was performed to verify the position of the puncture needle in relation to the target, and the complications and puncture duration, etc., were recorded. RESULTS In the phantom experiment, the mean accuracies of puncture under telerobotic ultrasound guidance and conventional ultrasound guidance were 1.8 ± 0.3 mm and 1.6 ± 0.3 mm (P = 0.09), respectively; therefore, there was no significant difference in the accuracy of the two guide methods. In the animal experiment, the first-attempt puncture success (the needle tip close to the target) rate was 93%. Polypnea occurred during one puncture. No other intraoperative or postoperative complications were observed. CONCLUSION Puncture guided by a 5G-based telerobotic ultrasound system has shown good feasibility and safety in phantom and animal experiments.
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Affiliation(s)
- Lanling Yang
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Shaobo Duan
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
- Department of Ultrasound, Henan Key Laboratory for Ultrasound Molecular Imaging and Artificial Intelligence Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, No.7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Ye Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Liuwei Hao
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Shuaiyang Wang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Zhi Zou
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Yanshan Hu
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Si Chen
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Yiwen Hu
- Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Lianzhong Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China.
- Department of Rehabilitation, Henan Rehabilitation Clinical Medicine Research Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China.
- Department of Ultrasound, Henan Key Laboratory for Ultrasound Molecular Imaging and Artificial Intelligence Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, No.7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.
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6
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Saggiante L, Biondetti P, Lanza C, Carriero S, Ascenti V, Piacentino F, Shehab A, Ierardi AM, Venturini M, Carrafiello G. Computed-Tomography-Guided Lung Biopsy: A Practice-Oriented Document on Techniques and Principles and a Review of the Literature. Diagnostics (Basel) 2024; 14:1089. [PMID: 38893616 PMCID: PMC11171640 DOI: 10.3390/diagnostics14111089] [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: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Computed tomography (CT)-guided lung biopsy is one of the oldest and most widely known minimally invasive percutaneous procedures. Despite being conceptually simple, this procedure needs to be performed rapidly and can be subject to meaningful complications that need to be managed properly. Therefore, knowledge of principles and techniques is required by every general or interventional radiologist who performs the procedure. This review aims to contain all the information that the operator needs to know before performing the procedure. The paper starts with the description of indications, devices, and types of percutaneous CT-guided lung biopsies, along with their reported results in the literature. Then, pre-procedural evaluation and the practical aspects to be considered during procedure (i.e., patient positioning and breathing) are discussed. The subsequent section is dedicated to complications, with their incidence, risk factors, and the evidence-based measures necessary to both prevent or manage them; special attention is given to pneumothorax and hemorrhage. After conventional CT, this review describes other available CT modalities, including CT fluoroscopy and cone-beam CT. At the end, more advanced techniques, which are already used in clinical practice, like fusion imaging, are included.
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Affiliation(s)
- Lorenzo Saggiante
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Velio Ascenti
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Anas Shehab
- Interventional Radiology Fellowship, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
- School of Radiology, Università Degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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7
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Safai Zadeh E, Huber KP, Görg C, Prosch H, Findeisen H. The Value of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Central Lung Cancer with Obstructive Atelectasis. Diagnostics (Basel) 2024; 14:1051. [PMID: 38786349 PMCID: PMC11119496 DOI: 10.3390/diagnostics14101051] [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: 03/24/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose: To assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) alongside contrast-enhanced computed tomography (CECT) in evaluating central lung cancer (CLC). Materials and Methods: From 2006 to 2022, 54 patients with CLC and obstructive atelectasis (OAT) underwent standardized examinations using CEUS in addition to CECT. The ability to differentiate CLC from atelectatic tissue in CECT and CEUS was categorized as distinguishable or indistinguishable. In CEUS, in distinguishable cases, the order of enhancement (time to enhancement) (OE; categorized as either an early pulmonary arterial [PA] pattern or a delayed bronchial arterial [BA] pattern of enhancement), the extent of enhancement (EE; marked or reduced), the homogeneity of enhancement (HE; homogeneous or inhomogeneous), and the decrease in enhancement (DE; rapid washout [<120 s] or late washout [≥120 s]) were evaluated. Results: The additional use of CEUS improved the diagnostic capability of CECT from 75.9% to 92.6% in differentiating a CLC from atelectatic tissue. The majority of CLC cases exhibited a BA pattern of enhancement (89.6%), an isoechoic reduced enhancement (91.7%), and a homogeneous enhancement (91.7%). Rapid DE was observed in 79.2% of cases. Conclusions: In cases of suspected CLC with obstructive atelectasis, the application of CEUS can be helpful in differentiating tumor from atelectatic tissue and in evaluating CLC.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria;
- Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35037 Marburg, Germany
| | - Katharina Paulina Huber
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35037 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria;
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, 28199 Bremen, Germany
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De Silva DL, Luo J. Clinical approach and utilizing liquid biopsies to interrogate suspected acquired resistance to PD-1 blockade. Future Sci OA 2024; 10:FSO937. [PMID: 38817357 PMCID: PMC11137779 DOI: 10.2144/fsoa-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/07/2023] [Indexed: 06/01/2024] Open
Abstract
PD-1 blockade is now routine for nearly all patients with non-small lung cancer. Acquired resistance to PD-1 blockade - defined generally as an initial response followed later by progression [1-3] is a common yet poorly understood concept. A key clinical challenge to insight has been a lack of standard guidance for clinical management of a case of suspected acquired resistance. The infrequency of performing tumor biopsies and the uncertainty of actionability from tissue sampling likely also contribute to limited insight into the biology of acquired resistance [4]. To address this knowledge gap and to highlight the value of tumor and liquid biopsy, we present a representative case of suspected acquired resistance to PD-1 blockade and propose a multi-modal guide for approaching this clinical scenario.
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Affiliation(s)
- Dilanka Lakshan De Silva
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parkville Familial Cancer Centre, Peter MacCallum Centre, Melbourne, Victoria, 3000, Australia
- Peter MacCallum Department of Oncology, University of Melbourne Victoria, 3010, Australia
| | - Jia Luo
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Bourgeais G, Frampas E, Liberge R, Nicolas A, Defrance C, Blanc FX, Coudol S, Morla O. Pneumothorax Incidence with Normal Saline Instillation for Sealing the Needle Track After Computed Tomography-Guided Percutaneous Lung Biopsy. Cardiovasc Intervent Radiol 2024; 47:604-612. [PMID: 38263525 DOI: 10.1007/s00270-023-03648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE To determine whether instillation of normal saline solution for sealing the needle track reduces incidence of pneumothorax and chest tube placement after computed tomography-guided percutaneous lung biopsy. MATERIALS AND METHODS A total of 242 computed tomography-guided percutaneous lung biopsies performed at a single institution were retrospectively reviewed, including 93 biopsies in which the needle track was sealed by instillation of 3-5 ml of normal saline solution during needle withdrawal (water seal group) and 149 biopsies without sealing (control group). Patient and lesion characteristics, procedure-specific variables, pneumothorax and chest tube placement rates were recorded. RESULTS Baseline characteristics were comparable in both groups. There was a statistically significant decrease in the pneumothorax rate (19.4% [18/93] vs. 40.9% [61/149]; p < 0.001) and a numerically lower chest tube placement rate without significant reduction (4.3% [4/93] vs. 10.7% [16/149]; p = 0.126) with using normal saline instillation for sealing the needle track versus not using sealant material. Using a multiple logistic regression analysis, using normal saline instillation to seal the needle track, having a senior radiologist as operator of the procedure and putting patients in prone position were significantly associated with a decreased risk of pneumothorax. The presence of emphysema along the needle track was significantly associated with an increased risk of pneumothorax. No complication was observed due to normal saline injection. CONCLUSION Normal saline solution instillation for sealing the needle track after computed tomography-guided percutaneous lung biopsy is a simple, low-cost and safe technique resulted in significantly decreased pneumothorax occurrence and a numerically lower chest tube placement rate, and might help to reduce both hospitalization risks and costs for the healthcare system. Level of evidence 3 Non-controlled retrospective cohort study.
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Affiliation(s)
- Geoffrey Bourgeais
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France.
| | - Eric Frampas
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Renan Liberge
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Aymeric Nicolas
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Claire Defrance
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - François-Xavier Blanc
- Department of Pneumology, Nantes University Hospital, Boulevard Jacques-Monod, 44093, Saint-Herblain, France
| | - Sandrine Coudol
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire, 11: Santé Publique, Clinique Des Données, INSERM, CIC 1413, 44000, Nantes, France
| | - Olivier Morla
- Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France
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10
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Goetz A, Poschenrieder F, Steer FG, Zeman F, Lange TJ, Thurn S, Greiner B, Stroszczynski C, Uller W, Hamer O, Hammer S. Intravenous Opioid Medication with Piritramide Reduces the Risk of Pneumothorax During CT-Guided Percutaneous Core Biopsy of the Lung. Cardiovasc Intervent Radiol 2024; 47:621-631. [PMID: 38639781 DOI: 10.1007/s00270-024-03717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax. MATERIALS AND METHODS One hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis. RESULTS The overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate. CONCLUSION Procedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung. LEVEL OF EVIDENCE 4: small study cohort.
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Affiliation(s)
- Andrea Goetz
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Florian Poschenrieder
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Frederike Georgine Steer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Sylvia Thurn
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Okka Hamer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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11
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Mull HJ, Foster MV, Higgins MCSS, Sturgeon DJ, Hederstedt K, Bart N, Lamkin RP, Sullivan BA, Ayeni C, Branch-Elliman W, Malloy PC. Development and Validation of an Electronic Adverse Event Model for Patient Safety Surveillance in Interventional Radiology. J Am Coll Radiol 2024; 21:752-766. [PMID: 38157954 PMCID: PMC11257375 DOI: 10.1016/j.jacr.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Comprehensive adverse event (AE) surveillance programs in interventional radiology (IR) are rare. Our aim was to develop and validate a retrospective electronic surveillance model to identify outpatient IR procedures that are likely to have an AE, to support patient safety and quality improvement. METHODS We identified outpatient IR procedures performed in the period from October 2017 to September 2019 from the Veterans Health Administration (n = 135,283) and applied electronic triggers based on posyprocedure care to flag cases with a potential AE. From the trigger-flagged cases, we randomly sampled n = 1,500 for chart review to identify AEs. We also randomly sampled n = 600 from the unflagged cases. Chart-reviewed cases were merged with patient, procedure, and facility factors to estimate a mixed-effects logistic regression model designed to predict whether an AE occurred. Using model fit and criterion validity, we determined the best predicted probability threshold to identify cases with a likely AE. We reviewed a random sample of 200 cases above the threshold and 100 cases from below the threshold from October 2019 to March 2020 (n = 20,849) for model validation. RESULTS In our development sample of mostly trigger-flagged cases, 444 of 2,096 cases (21.8%) had an AE. The optimal predicted probability threshold for a likely AE from our surveillance model was >50%, with positive predictive value of 68.9%, sensitivity of 38.3%, and specificity of 95.3%. In validation, chart-reviewed cases with AE probability >50% had a positive predictive value of 63% (n = 203). For the period from October 2017 to March 2020, the model identified approximately 70 IR cases per month that were likely to have an AE. CONCLUSIONS This electronic trigger-based approach to AE surveillance could be used for patient-safety reporting and quality review.
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Affiliation(s)
- Hillary J Mull
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Marva V Foster
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; VA Boston Healthcare System, Department of Quality Management, Boston, Massachusetts
| | | | - Daniel J Sturgeon
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Kierstin Hederstedt
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Nina Bart
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Rebecca P Lamkin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Brian A Sullivan
- Duke University School of Medicine, Department of Gastroenterology, Durham, North Carolina; Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Christopher Ayeni
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Westyn Branch-Elliman
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Patrick C Malloy
- Director of the VHA National Radiology Program, VA New York Harbor Healthcare System, New York, New York
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12
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Li Y, Chen Z, Tian S, Han X, Wang C, Wang Y, Liu B. Stereotactic ablative brachytherapy versus percutaneous microwave ablation as salvage treatments for lung oligometastasis from colorectal cancer. BMC Cancer 2024; 24:481. [PMID: 38627695 PMCID: PMC11020186 DOI: 10.1186/s12885-024-12163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The treatment for lung oligometastasis from colorectal cancer (CRC) remains challenging. This retrospective study aimed to compare the local tumor control, survival and procedure-related complications in CRC patients undergoing low-dose rate stereotactic ablative brachytherapy (L-SABT) versus percutaneous microwave ablation (MWA) for lung oligometastasis. METHODS Patients between November 2017 and December 2020 were retrospectively analyzed. Local tumor progression-free survival (LTPFS) and overall survival (OS) were analyzed in the entire cohort as well as by stratified analysis based on the minimal ablation margin (MAM) around the tumor. RESULTS The final analysis included 122 patients: 74 and 48 in the brachytherapy and MWA groups, respectively, with a median follow-up of 30.5 and 35.3 months. The 1- and 3-year LTPFS rate was 54.1% and 40.5% in the brachytherapy group versus 58.3% and 41.7% in the MWA group (P = 0.524 and 0.889, respectively). The 1- and 3-year OS rate was 75.7% and 48.6% versus 75.0% and 50.0% (P = 0.775 and 0.918, respectively). Neither LTPFS nor OS differed significantly between the patients with MAM of 5-10 mm versus > 10 mm. Pulmonary complication rate did not differ in the overall analysis, but was significantly higher in the MWA group in the subgroup analysis that only included patients with lesion within 10 mm from the key structures (P = 0.005). The increased complications was primarily bronchopleural fistula. CONCLUSIONS Considering the caveats associated with radioisotope use in L-SABT, MWA is generally preferable. In patients with lesion within 10 mm from the key pulmonary structures, however, L-SABT could be considered as an alternative due to lower risk of bronchopleural fistula.
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Affiliation(s)
- Yuliang Li
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
| | - Zitong Chen
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
| | - Shuhui Tian
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
| | - Xujian Han
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
- Department of Radiology, Shandong Provincial Hospital, Jinan, PR of China
| | - Changjun Wang
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
- Department of Radiology, People's Hospital of Jiyang County, Jinan, PR of China
| | - Yongzheng Wang
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
| | - Bin Liu
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China.
- Interventional Oncology Institute, Shandong University, Jinan, PR of China.
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13
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Zhang J, Zhang J, Han P, Chen XZ, Zhang Y, Li W, Qin J, He L. Path planning algorithm for percutaneous puncture lung mass biopsy procedure based on the multi-objective constraints and fuzzy optimization. Phys Med Biol 2024; 69:095006. [PMID: 38394681 DOI: 10.1088/1361-6560/ad2c9f] [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: 05/18/2023] [Accepted: 02/23/2024] [Indexed: 02/25/2024]
Abstract
Objective. The percutaneous puncture lung mass biopsy procedure, which relies on preoperative CT (Computed Tomography) images, is considered the gold standard for determining the benign or malignant nature of lung masses. However, the traditional lung puncture procedure has several issues, including long operation times, a high probability of complications, and high exposure to CT radiation for the patient, as it relies heavily on the surgeon's clinical experience.Approach.To address these problems, a multi-constrained objective optimization model based on clinical criteria for the percutaneous puncture lung mass biopsy procedure has been proposed. Additionally, based on fuzzy optimization, a multidimensional spatial Pareto front algorithm has been developed for optimal path selection. The algorithm finds optimal paths, which are displayed on 3D images, and provides reference points for clinicians' surgical path planning.Main results.To evaluate the algorithm's performance, 25 data sets collected from the Second People's Hospital of Zigong were used for prospective and retrospective experiments. The results demonstrate that 92% of the optimal paths generated by the algorithm meet the clinicians' surgical needs.Significance.The algorithm proposed in this paper is innovative in the selection of mass target point, the integration of constraints based on clinical standards, and the utilization of multi-objective optimization algorithm. Comparison experiments have validated the better performance of the proposed algorithm. From a clinical standpoint, the algorithm proposed in this paper has a higher clinical feasibility of the proposed pathway than related studies, which reduces the dependency of the physician's expertise and clinical experience on pathway planning during the percutaneous puncture lung mass biopsy procedure.
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Affiliation(s)
- Jiayu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Ping Han
- Urologic Surgery, Sichuan University West China Hospital, Chengdu, People's Republic of China
- Urologic Surgery, Peoples Hospital Yibin City 2, Chengdu, People's Republic of China
| | - Xin-Zu Chen
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Ya'an Cancer Prevention and Control Center, People's Hospital of Ya'an City, Ya'an, People's Republic of China
| | - Yu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Wen Li
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Jing Qin
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hung Hom, People's Republic of China
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
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14
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Tipaldi MA, Ronconi E, Ubaldi N, Bozzi F, Siciliano F, Zolovkins A, Orgera G, Krokidis M, Quarta Colosso G, Rossi M. Histology profiling of lung tumors: tru-cut versus full-core system for CT-guided biopsies. LA RADIOLOGIA MEDICA 2024; 129:566-574. [PMID: 38512617 PMCID: PMC11021310 DOI: 10.1007/s11547-024-01772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/03/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE We aimed to compare the diagnostic yield and procedure-related complications of two different types of systems for percutaneous CT-guided lung biopsy. MATERIAL AND METHODS All patients with a lung lesion who underwent a CT-guided lung biopsy at our institution, between January 2019 and 2021, were retrospectively analyzed. The inclusion criteria were: (a) Procedures performed using either a fully automated tru-cut or a semi-automated full-core biopsy needle, (b) CT images demonstrating the position of the needles within the lesion, (c) histopathological result of the biopsy and (d) clinical follow-up for at least 12 months and\or surgical histopathological results. A total of 400 biopsy fulfilling the inclusion criteria were selected and enrolled in the study. RESULTS Overall technical success was 100% and diagnostic accuracy was 84%. Tru-cut needles showed a significantly higher diagnostic accuracy when compared to full-core needles (91% vs. 77%, p = 0.0004) and a lower rate of pneumothorax (31% vs. 41%, p = 0.047). Due to the statistically significant different of nodules size between the two groups, we reiterated the statistical analysis splitting our population around the 20 mm cut-off for nodule size. We still observed a significant difference in diagnostic accuracy between tru-cut and full-core needles favoring the former for both smaller and larger lesions (81% vs. 71%, p = 0.025; and 92% vs. 81%; p = 0.01, respectively). CONCLUSION Our results demonstrated that the use of automated tru-cut needles is associated with higher histopathological diagnostic accuracy compared to semi-automated full-core needles for CTLB.
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Affiliation(s)
- Marcello Andrea Tipaldi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy.
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy.
| | - Edoardo Ronconi
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Nicolò Ubaldi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Fernando Bozzi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Francesco Siciliano
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Aleksejs Zolovkins
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Gianluigi Orgera
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Miltiadis Krokidis
- School of Medicine, National and Kapodistrian University of Athens Areteion Hospital 76, Vas. Sophias Ave, 11528, Athens, Greece
| | - Giulio Quarta Colosso
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Michele Rossi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" - University of Rome, Rome, Italy
- Department of Interventional Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
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15
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Tammemägi MC, Darling GE, Schmidt H, Walker MJ, Langer D, Leung YW, Nguyen K, Miller B, Llovet D, Evans WK, Buchanan DN, Espino-Hernandez G, Aslam U, Sheppard A, Lofters A, McInnis M, Dobranowski J, Habbous S, Finley C, Luettschwager M, Cameron E, Bravo C, Banaszewska A, Creighton-Taylor K, Fernandes B, Gao J, Lee A, Lee V, Pylypenko B, Yu M, Svara E, Kaushal S, MacNiven L, McGarry C, Della Mora L, Koen L, Moffatt J, Rey M, Yurcan M, Bourne L, Bromfield G, Coulson M, Truscott R, Rabeneck L. Risk-based lung cancer screening performance in a universal healthcare setting. Nat Med 2024; 30:1054-1064. [PMID: 38641742 DOI: 10.1038/s41591-024-02904-z] [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: 08/04/2023] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening. Adoption of lung screening outside the United States has, until recently, been slow. Between June 2017 and May 2019, the Ontario Lung Cancer Screening Pilot successfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained and provided with high-quality follow-up, including appropriate treatment. In the Ontario Lung Cancer Screening Pilot, the lung cancer detection rate and the proportion of early-stage cancers were 2.4% and 79.2%, respectively; serious harms were infrequent; and sensitivity to detect lung cancers was 95.3% or more. With abnormal scans defined as ones leading to diagnostic investigation, specificity was 95.5% (positive predictive value, 35.1%), and adherence to annual recall and early surveillance scans and clinical investigations were high (>85%). The Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.
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Affiliation(s)
- Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.
- Brock University, St. Catharines, ON, Canada.
| | - Gail E Darling
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Heidi Schmidt
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Deanna Langer
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Yvonne W Leung
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Kathy Nguyen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Beth Miller
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Diego Llovet
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Aisha Lofters
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Erin Cameron
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Caroline Bravo
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Alex Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Van Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Monica Yu
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Erin Svara
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Lynda MacNiven
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Liz Koen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Marta Yurcan
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Laurie Bourne
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
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16
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Leng L, Li AT, Lokken RP, Kohn M, Wu X, Sohn JH. Effect of Rapid Rollover on Pneumothorax Rate after Percutaneous CT-Guided Lung Biopsy: A Multicenter, Randomized Controlled Trial. J Vasc Interv Radiol 2024; 35:618-620. [PMID: 38184169 DOI: 10.1016/j.jvir.2023.12.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024] Open
Affiliation(s)
- Lynn Leng
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California; School of Medicine, University of California, San Francisco, California
| | - Andrew Tong Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California; School of Medicine, University of California, San Francisco, California
| | - R Peter Lokken
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Michael Kohn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
| | - Jae Ho Sohn
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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17
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Mwesigwa NW, Tentzeris V, Gooseman M, Qadri S, Maxine R, Cowen M. Electromagnetic Navigational Bronchoscopy Learning Curve Regarding Pneumothorax Rate and Diagnostic Yield. Cureus 2024; 16:e58289. [PMID: 38752107 PMCID: PMC11094565 DOI: 10.7759/cureus.58289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/18/2024] Open
Abstract
Electromagnetic navigational bronchoscopy (ENB) has emerged as an innovative technique for diagnosing peripheral and central nodules, offering an improved diagnostic yield compared to conventional bronchoscopy with fewer complications. That being said, pneumothorax remains a frequent complication. This retrospective study conducted at Castle Hill Hospital, UK, analysed ENB procedures over four years to assess the diagnostic yield and pneumothorax rates, exploring learning curves and procedural improvements specifically focusing on the diagnostic yield and pneumothorax rate as markers of change. A total of 246 patients underwent 358 peripheral lung biopsies, revealing an overall diagnostic yield of 61.3%. The diagnostic yield increased from 58.2% in 2020-2021 to 66.0% in 2022-2023 while the pneumothorax rate decreased significantly from 9.8% to 3.4% (p = 0.021*). The majority of pneumothorax cases occurred following upper lobe procedures. The study depicts the importance of procedural experience in improving outcomes, suggesting a learning curve effect. Additionally, it emphasizes the potential for technological advancements, such as robotic assistance, to mitigate operator-dependent variability and improve reproducibility in ENB procedures. These findings contribute to optimizing diagnostic pathways for lung lesions and improving patient safety in ENB interventions.
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Affiliation(s)
| | | | | | - Suhail Qadri
- Thoracic Surgery, Hull University Teaching Hospitals, Hull, GBR
| | - Read Maxine
- Cardiothoracic Surgery, Hull University Teaching Hospitals, Hull, GBR
| | - Michael Cowen
- Thoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Hull, GBR
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18
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Aguinagalde B, Lizarbe IA, Rumbero JC, Lorenzo M, Sanchez L, Sanchez L, Fernández-Monge A, Lopez I. Is histological confirmation necessary to avoid futile resections? Comparative of 4 university hospitals. Eur J Cardiothorac Surg 2024; 65:ezae136. [PMID: 38632054 DOI: 10.1093/ejcts/ezae136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES There is no consensus in the literature on preoperative histological analysis for lung cancer. The objective of this study was to assess 4 diagnostic models used in different hospitals with differing practices regarding preoperative histological diagnosis and the consequences in terms of unnecessary surgery and futile major resection. METHODS We carried out a retrospective observational study collected from 4 university hospitals in Spain over 3 years (January 2019 to December 2021). We included all patients with a confirmed diagnosis of primary lung cancer and any patients with suspected primary lung cancer who had undergone surgery. All patients underwent computed tomography and positron emission tomography/computed tomography scans. Each multidisciplinary committee was free to choose whether to perform flexible bronchoscopic or transthoracic lung biopsy. Decisions concerning whether to perform intraoperative sample analysis, the surgical approach and the type of resection were left to the surgical team. RESULTS We included a total of 1642 patients. The use of flexible endoscopy and its diagnostic performance varied substantially between hospitals (range: 23.8-79.3% and 25-60.7%, respectively); and the same was observed for transthoracic biopsy and its performance (range: 16.9-82.3% and 64.6-97%, respectively). Regarding major resection surgery (lobectomy or more extensive resection), the lowest rate was observed in hospital C (1%) and the highest in hospital B (2.8%), with between-hospital differences not reaching significance (P = 0.173). CONCLUSIONS The rate of histological sampling before lung cancer surgery still varies between hospitals. In spite of very diverse multidisciplinary management, the rate of futile lobectomy is not significantly higher in hospitals with lower rates of preoperative histological analysis.
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Affiliation(s)
- Borja Aguinagalde
- Department of Thoracic Surgery, Osakidetza Basque Health Service, Donostia University Hospital, Donostia, Spain
- Department of Surgery, UPV/EHU, Leioa, Spain
- Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - Ion Ander Lizarbe
- Department of Thoracic Surgery, Osakidetza Basque Health Service, Donostia University Hospital, Donostia, Spain
- Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - Juan Carlos Rumbero
- Department of Thoracic Surgery, Osakidetza Basque Health Service, Cruces University Hospital, Barakaldo, Spain
| | - Mónica Lorenzo
- Department of Thoracic Surgery, Osakidetza Basque Health Service, Cruces University Hospital, Barakaldo, Spain
| | - Leire Sanchez
- Department of Thoracic Surgery, Catalan Health Institute, Vall d'Hebron Universtity Hospital, Barcelona, Spain
| | - Laura Sanchez
- Department of Thoracic Surgery, Cantabrian Health Service, Hospital Marqués de Valdecilla University Hospital, Santander, Spain
| | - Arantza Fernández-Monge
- Department of Thoracic Surgery, Osakidetza Basque Health Service, Donostia University Hospital, Donostia, Spain
- Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - Iker Lopez
- Department of Thoracic Surgery, Osakidetza Basque Health Service, Donostia University Hospital, Donostia, Spain
- Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
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19
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Chopra A, Judson MA, Rahman NM, Doelken P. The lung is not a balloon: the self-sealing property of the lung. THE LANCET. RESPIRATORY MEDICINE 2024; 12:190-192. [PMID: 38423702 DOI: 10.1016/s2213-2600(24)00030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA.
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Peter Doelken
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA
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20
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Ko RB, Abelson JA, Fleischmann D, Louie JD, Hwang GL, Sze DY, Schüler E, Kielar KN, Maxim PG, Le QT, Hara WH, Diehn M, Kothary N, Loo BW. Pulmonary interstitial lymphography: A prospective trial with potential impact on stereotactic ablative radiotherapy planning for early-stage lung cancer. Radiother Oncol 2024; 191:110079. [PMID: 38163486 DOI: 10.1016/j.radonc.2023.110079] [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: 11/27/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024]
Abstract
This prospective feasibility trial investigated pulmonary interstitial lymphography to identify thoracic primary nodal drainage (PND). A post-hoc analysis of nodal recurrences was compared with PND for patients with early-stage lung cancer; larger studies are needed to establish correlation. Exploratory PND-inclusive stereotactic ablative radiotherapy plans were assessed for dosimetric feasibility.
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Affiliation(s)
- Ryan B Ko
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA.
| | - Jonathan A Abelson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Coastal Radiation Oncology, San Luis Obispo, CA, USA.
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - John D Louie
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gloria L Hwang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel Y Sze
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Emil Schüler
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kayla N Kielar
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Varian Medical Systems, Stanford, CA, USA
| | - Peter G Maxim
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiation Oncology, University of California, Irvine, CA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy H Hara
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Nishita Kothary
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
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21
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Stefanidis K, Bellos I, Konstantelou E, Yusuf G, Hardavella G, Jacob T, Goldman A, Senbanjo T, Vlahos I. 18F-FDG PET/CT anatomic and metabolic guidance in CT-guided lung biopsies. Eur J Radiol 2024; 171:111315. [PMID: 38237515 DOI: 10.1016/j.ejrad.2024.111315] [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: 04/20/2023] [Revised: 08/21/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To evaluate the role of Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT as a metabolic guide in increasing the accuracy, diagnostic yield and safety of CT-guided percutaneous needle lung biopsy (PNB). METHODS AND MATERIALS Retrospective analysis of 340 consecutive patients with suspicious lung nodules, masses or extensive disease that underwent lung biopsy over a 3-year period. Patients were divided into three groups; those that had PET/CT prior to the biopsy, those that had PET-CT following the biopsy and those who did not undergo PET-CT. Correlation was made with the histopathological result. RESULTS 353 PNBs were performed (median lesion size 30 mm, 7-120 mm) with overall diagnostic rate of 83.9 % (95.8 % malignant). Biopsy success rate was 88.8 % with PET-CT pre-PNB, versus 78.9 % of 175 PNB without PET-CT upfront (p < 0.01 Fisher exact test). Correct targeting to PET-CT-maximum activity area (MAA) was present in 87.1 %. Biopsy success rate was 88.8 % for PNBs targeting the PET-CT-MAA region and only 52.8 % for PNBs not targeting the PET-CT-MAA (p < 0.0001). PET-CT pre-PNB had higher rates of PET-CT-MAA targeting compared to PET-CT post PNB (91.0 % v 80.0 %, p = 0.01). The availability of PET-CT before the PNB lead to significantly increased biopsy success rates in patients with a mass (OR:7.01p = 0.004), compared to a nodule (p = 0.498) or multiple nodules (p = 0.163). Patients with a PET-CT pre-PNB underwent fewer PNB passes (mean 2.6 v 3.1, p < 0.0001 Mann Whitney U). Serious complications were less common in PET-CT pre-PNB group (4.5 % v 10.9 %, p < 0.05). Pre-PNB PET-CT performance improvement applied to all 3 radiologists and was greatest for masses and infiltrative abnormalities. CONCLUSION Metabolic information provided by 18F-FDG PET/CT and PNB localisation to the PET-CT maximum activity region is associated with higher diagnostic biopsy rates especially in masses and appears to account for improved performance, less needle passes and complications when available pre-biopsy.
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Affiliation(s)
| | - Ioannis Bellos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Gibran Yusuf
- Radiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Georgia Hardavella
- 9(th) Department of Respiratory Medicine, "Sotiria" Athens Chest Diseases Hospital, Athens, Greece
| | - Teresa Jacob
- Radiology Department, St George's Hospital, NHS Foundation Trust, London, UK
| | - Anouscka Goldman
- Radiology Department, St George's Hospital, NHS Foundation Trust, London, UK
| | - Taiwo Senbanjo
- Radiology Department, Epsom and St Helier, NHS Foundation Trust, London, UK
| | - Ioannis Vlahos
- Department of Thoracic Radiology, Division of Diagnostic Imaging. University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Ierardi AM, Ascenti V, Lanza C, Carriero S, Amato G, Pellegrino G, Giurazza F, Torcia P, Carrafiello G. Is it a complication or a consequence - a new perspective on adverse outcomes in Interventional Radiology. CVIR Endovasc 2024; 7:6. [PMID: 38180623 PMCID: PMC10769947 DOI: 10.1186/s42155-023-00417-3] [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: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
The aim of the article is to introduce a new term in post-procedural events related to the procedure itself. All the Societies and Councils report these events as complications and they are divided in mild, moderate and severe or immediate and delayed.On the other hand the term error is known as the application of a wrong plan, or strategy to achieve a goal.For the first time, we are trying to introduce the term "consequence"; assuming that the procedure is the only available and the best fit to clinical indication, a consequence should be seen as an expected and unavoidable occurrence of an "adverse event" despite correct technical execution.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Serena Carriero
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Gaetano Amato
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | | | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Pierluca Torcia
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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23
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Duffy MJ. Circulating tumor DNA (ctDNA) as a biomarker for lung cancer: Early detection, monitoring and therapy prediction. Tumour Biol 2024; 46:S283-S295. [PMID: 37270828 DOI: 10.3233/tub-220044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Circulating tumor DNA (ctDNA), i.e., DNA shed from tumor cells into the bloodstream, is emerging as one of the most useful plasma biomarkers in patients with multiple types of cancer, including patients with non-small cell lung cancer (NSCLC). Indeed, NSCLC was the first malignancy in which measurement of ctDNA was approved for clinical use, i.e., mutational testing of EGFR for predicting response to EGFR tyrosine kinase inhibitors in patients with advanced disease. Although historically the gold standard method for EGFR mutational analysis required tumor tissue, the use of ctDNA is more convenient and safer for patients, results in a faster turn-around-time for return of results, provides a more complete representation of genetic alteration in heterogeneous tumors and is less costly to perform. Emerging uses of ctDNA in patients with lung or suspected lung cancer include screening for early disease, surveillance following initial treatment and monitoring response to therapy in metastatic disease. For evaluating therapy response, ctDNA appears to be especially useful in patients receiving targeted therapies against driver oncogenes or immunotherapy. Further work should not only validate these emerging findings but also aim to optimize and standardize ctDNA assays.
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Affiliation(s)
- Michael J Duffy
- UCD Clinical Research Centre, St. Vincent's University Hospital, Dublin and UCD School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
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24
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Graham J, Basist M, Frye L, Agrawal A, Nasim F. Advances in navigating to the nodule and targeting. Curr Opin Pulm Med 2024; 30:9-16. [PMID: 37930633 DOI: 10.1097/mcp.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE OF REVIEW The multitude of available platforms and imaging modalities for navigational bronchoscopy, in combination with the various sampling tools that can be used intra-procedurally, is complex. This review seeks to describe the recent developments in peripheral bronchoscopy in regards to navigation, imaging, and sampling target lesions in the pulmonary parenchyma. RECENT FINDINGS Robotic assisted bronchoscopy has improved navigation to the peripheral airways for sampling of peripheral parenchymal lesions. These navigational platforms use innovative technology utilizing electromagnetic navigation and shape-sensing technology for guidance. The greatest improvement has been the stabilization of the robotic scope in the periphery to allow for accurate sampling. Despite improvements in these platforms, limitations of CT to body divergence continue to impact navigation to the lesion and therefore diagnostic yield of the procedure. Advanced intraprocedural imaging with cone beam CT or augmented fluoroscopy has been a recent focus to improve this area. Further, the adoption of newer sampling tools, such as cryobiopsy, offers the possibility of increased diagnostic yield. SUMMARY The developments in advanced bronchoscopy will impact the role of biopsy in the diagnosis of peripheral pulmonary parenchymal lesions.
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Affiliation(s)
- Jeffrey Graham
- Interventional Pulmonology, Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah Health, Salt Lake City, Utah
| | - Madeleine Basist
- Interventional Pulmonology, Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Laura Frye
- Interventional Pulmonology, Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah Health, Salt Lake City, Utah
| | - Abhinav Agrawal
- Interventional Pulmonology, Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Faria Nasim
- Interventional Pulmonology, Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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25
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Del Valle JB, Alonso Serena M, Ducrey G, Savluk JL, Borensztein MA. [Ultrasound guided biopsy of lung tumors: evaluation of efficacy and complications]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:439-455. [PMID: 38150205 PMCID: PMC10851407 DOI: 10.31053/1853.0605.v80.n4.40922] [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: 04/12/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction The diagnosis of lung cancer, as well as that of lung nodules, is increasing. Percutaneous biopsy has become a transcendental tool for its diagnosis. Traditionally, computed tomography is used for these procedures because of its ability to clearly demonstrate bone and aerated lung. However, in selected cases it can be performed with ultrasound. Methods Retrospective study conducted between January 2020 and December 2021, during the SARS-CoV-2 pandemic. All patients had pleural-based lung lesions or pleural lesions, some with a known history of cancer. Results Thirty-six procedures were performed, in 32 (88.9%) the sample obtained presented diagnostic yield and the most used additional test was Immunohistochemistry in 23 (63.9%). Complications were reported in 5 patients (13.9%): 2 with mild pneumothorax, 2 with hemothorax (1 mild and 1 moderate) and 1 patient reported pain. Conclusion Ultrasound is a valid method to be used as a guide for biopsies of pleural and peripheral pulmonary lesions. The complications and diagnostic rate has been shown to be in line with the experience of other authors and international guidelines.
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26
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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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27
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Kim DH, Gilyard S, Suh R. Special Considerations and Techniques of Interventions in Lung Transplant Recipients. Tech Vasc Interv Radiol 2023; 26:100926. [PMID: 38123291 DOI: 10.1016/j.tvir.2023.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Lung transplant remains an important treatment option for patients with end-stage lung diseases providing improvement in survival rates and quality of life. Specialized considerations should be applied with interventions of lung transplant recipients as they host specific anatomic variations and high risk towards certain complications. In this article, we highlight the role of interventional radiology for lung transplant recipients along with discussion of interventional techniques. Specific emphasis is placed on describing and explaining the techniques pertained to the points of anastomosis, diagnosis and treatment of malignancies, and management of complications in lung transplant recipients.
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Affiliation(s)
- Daniel H Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shenise Gilyard
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Robert Suh
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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28
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Zhou SQ, Luo F, Li K, Ran X, Lv FR. Association between needle track bleeding and postoperative immediate pneumothorax in CT-guided percutaneous transthoracic lung biopsies: a cross-sectional study. Sci Rep 2023; 13:18811. [PMID: 37914714 PMCID: PMC10620196 DOI: 10.1038/s41598-023-44560-2] [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: 07/03/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023] Open
Abstract
The relationship between Needle Track Bleeding (NTB) and the occurrence of postoperative immediate pneumothorax remains unclear. In our cross-sectional study, we conducted a retrospective collected of data from 674 consecutive patients who underwent CT-guided percutaneous transthoracic lung biopsies between 2019 and 2022. A logistic regression model was employed to explore the association between NTB and postoperative immediate pneumothorax, and restricted cubic spline curves was used to investigate the link and its explicit curve shape. A sensitivity analysis was performed by transforming the continuous NTB into categorical variable and calculated an E-value. A total of 453 participants (47.90% male) were included in our analysis. The postoperative immediate pneumothorax rate was 41.05% (186/453). We found a negative correlation between NTB and postoperative immediate pneumothorax (OR = 0.91, 95%CI 0.88-0.95) after adjusting for confounding factors. This relationship was nonlinear, with a key inflection point at NTB of 8 mm. No significant link was noted for NTB > 8 mm (OR = 0.98, 95%CI 0.95-1.02), while a protective association was observed for NTB ≤ 8 mm (OR = 0.74, 95%CI 0.66-0.81). NTB showed a nonlinear, protective correlation with postoperative immediate pneumothorax. However, when NTB exceeded 8 mm, the protective association was not observed.
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Affiliation(s)
- Shao-Quan Zhou
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
- Chongqing General Hospital, Chongqing, China
| | - Fang Luo
- The Chongqing Traditional Chinese Medicine Hospital, Chongqing Academy of Traditional Chinese Medicine, Chongqing, China
| | - Kang Li
- Chongqing General Hospital, Chongqing, China
| | - Xiong Ran
- Chongqing General Hospital, Chongqing, China
| | - Fu-Rong Lv
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
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29
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Tian Y, An J, Zou Z, Dong Y, Wu J, Chen Z, Niu H. Computed Tomography-Guided Microcoil Localization of Pulmonary Nodules: Effects of Multiple Punctures. Thorac Cardiovasc Surg 2023; 71:566-572. [PMID: 34963179 DOI: 10.1055/s-0041-1736244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of the study is to analyze the effect of multiple punctures in computed tomography (CT)-guided microcoil localization of pulmonary nodules with other risk factors for common complications. METHODS Consecutive patients who underwent CT-guided microcoil localization and subsequent video-assisted thoracoscopic surgery (VATS) between January 2020 and February 2021 were enrolled. Nodules successfully located after only one puncture were defined as the single puncture group, and nodules requiring two or more punctures were defined as the multiple puncture group. Binary logistic regression analysis was performed to assess the relationship between the number of punctures and pneumothorax and intrapulmonary hemorrhage. RESULTS A total of 121 patients were included. There were 98 (68.1%) pulmonary nodules in the single puncture group compared with 46 (31.9%) nodules in the multiple puncture group. The frequencies of pneumothorax and intrapulmonary hemorrhage were higher in the multiple puncture group than in the single puncture group (p = 0.019 and <0.001, respectively). Binary logistic regression demonstrated that independent risk factors for developing pneumothorax included lateral positioning of the patient (p < .001) and prone positioning (p = 0.014), as well as multiple punctures (p = 0.013). Independent risk factors for intrapulmonary hemorrhage included the distance between the distal end of the coil and the surface of the pleura (p = 0.033), multiple punctures (p = 0.003), and passage through the pulmonary vasculature (p < 0.001). CONCLUSION Multiple punctures resulted in an increased incidence of pneumothorax and intrapulmonary hemorrhage compared with single puncture during CT-guided microcoil localization of pulmonary nodules and were independently associated with both pneumothorax and intrapulmonary hemorrhage.
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Affiliation(s)
- Ye Tian
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Jianli An
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Zibo Zou
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Yanchao Dong
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Jingpeng Wu
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Zhuo Chen
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Hongtao Niu
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
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30
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Esmail A, Dheda K. The cool new kid on the block: Lung cryobiopsy. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i3.1494. [PMID: 37970575 PMCID: PMC10642397 DOI: 10.7196/ajtccm.2023.v29i3.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Affiliation(s)
- A Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology,
Department of Medicine and UCT Lung Institute, University of Cape Town;
South African MRC/UCT Centre for the Study of Antimicrobial Resistance,
University of Cape Town, South Africa
| | - K Dheda
- Head: Division of Pulmonology, Department of Medicine, University of Cape Town,
South Africa; Professor of Mycobacteriology and Global Health, London School
of Hygiene and Tropical Medicine, United Kingdom; Director: Centre for Lung
Infection and Immunity, University of Cape Town Lung Institute, South Africa
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31
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Ortiz-Jaimes G, Reisenauer J. Real-World Impact of Robotic-Assisted Bronchoscopy on the Staging and Diagnosis of Lung Cancer: The Shape of Current and Potential Opportunities. Pragmat Obs Res 2023; 14:75-94. [PMID: 37694262 PMCID: PMC10492559 DOI: 10.2147/por.s395806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
The approach to peripheral pulmonary lesions (PPL) has been evolving continuously. Advanced bronchoscopic navigational techniques have improved the airway-based approaches to these lesions. Robotic Assisted Bronchoscopy (RAB) can be considered the current pinnacle of this evolution; allowing for a safer approach to sampling lesions previously considered outside of bronchoscopic reach. We present a comprehensive review of the changing epidemiology of lung cancer and the importance of early tissue sampling, the evolution of sampling and navigational bronchoscopic techniques, technical considerations and evidence pertaining to the use of RAB, and adjunct techniques in the diagnosis of lung cancer. Complications and future applications of RAB are also discussed.
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Affiliation(s)
- Gabriel Ortiz-Jaimes
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Janani Reisenauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
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32
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Lamfichekh Y, Lafay V, Hamam J, Guillien A, Puyraveau M, Behr J, Manzoni P, Calame P, Dalphin JC, Eberst G, Grillet F, Westeel V. Score to Predict the Occurrence of Pneumothorax After Computed Tomography-guided Percutaneous Transthoracic Lung Biopsy. J Thorac Imaging 2023; 38:315-324. [PMID: 37603106 DOI: 10.1097/rti.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
PURPOSE The main objective of this study was to identify risk factors for post-percutaneous transthoracic lung biopsy (PTLB) pneumothorax and to establish and validate a predictive score for pneumothorax occurrence to identify patients eligible for outpatient care. MATERIAL AND METHODS Patients who underwent PTLB between November 1, 2012 and March 1, 2017 were retrospectively evaluated for clinical and radiologic factors potentially related to pneumothorax occurrence. Multivariate logistic regression was used to identify risk factors, and the model coefficient for each factor was used to compute a score. Then, a validation cohort was prospectively evaluated from March 2018 to October 2019. RESULTS Among the 498 eligible patients in the study cohort, pneumothorax occurred in 124 patients (24.9%) and required drainage in 34 patients (6.8%). Pneumothorax risk factors were chronic obstructive pulmonary disease (OR 95% CI 2.28[1.18-4.43]), several passages through the pleura (OR 95% CI 7.71[1.95-30.48]), an anterior biopsy approach (OR 95% CI 6.36 3.82-10.58]), skin-to-pleura distance ≤30 mm (OR 95% CI 2.25[1.09-6.65]), and aerial effusion >10 mm (OR 95% CI 9.27 [5.16-16.65]). Among the 236 patients in the prospective validation cohort, pneumothorax occurred in 18% and 8% were drained. A negative score (<73 points) predicted a probability of pneumothorax occurrence of 7.4% and late evacuation of 2.5% (OR 95% CI respectively 0.18[0.08-0.39] and 0.15[0.04-0.55]) and suggested a reduced length of hospital stay (P=0.009). CONCLUSION This predictive score for pneumothorax secondary to PTLB has high prognostic performance and accuracy to direct patients toward outpatient management. CLINICAL TRIALS NCT03488043.
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Affiliation(s)
| | - Valentin Lafay
- Department of Chest Disease, University Hospital of Besançon, Besançon
| | - Joffrey Hamam
- Department of Intensive Care Medicine, Hospital of Libourne, Libourne
| | - Alicia Guillien
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, IAB, Grenoble Alpes University, Inserm, CNRS, Grenoble
| | | | | | | | | | | | - Guillaume Eberst
- Department of Chest Disease, University Hospital of Besançon, Besançon
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon
- UMR: 1098, University of Franche-Comté, Besançon
| | - Franck Grillet
- Department of Radiology
- Department of Radiology, Centre Léon Berard, Lyon, France
| | - Virginie Westeel
- Department of Chest Disease, University Hospital of Besançon, Besançon
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon
- UMR: 1098, University of Franche-Comté, Besançon
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Touchet TJ, Brinson B, Jones M, Byju A, Fletcher G, Hasan SM, Nash LD, Maitland DJ. Development of Biopsy Tract Sealants Based on Shape Memory Polymer Foams. BIOMEDICAL MATERIALS & DEVICES (NEW YORK, N.Y.) 2023; 1:853-860. [PMID: 38130883 PMCID: PMC10732340 DOI: 10.1007/s44174-023-00064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 12/23/2023]
Abstract
Lung biopsies are often used to aid in the diagnosis of cancers. However, the procedure carries the dual risk of air (pneumothorax) or blood (hemothorax) filling the pleural cavity, increasing the risk of a collapsed lung and chest intubation. This work demonstrates the effectiveness of a polyurethane-based shape memory polymer foam as a biopsy tract sealant. The impact of diameter, length, pore size, and shape memory effect was evaluated to determine the ideal device design for tract sealing. Characterization in an in vitro benchtop lung model identified that diameter had the largest influence on sealing efficacy, while the length of the device had little to no impact. Finally, evaluation of deployment force demonstrated that devices fabricated from the shape memory polymer foams were easier to deploy than elastic foams. Following characterization, down-selected device designs were combined with radiopaque markers for use in image-guided based procedures. Furthermore, the introduction of the markers or sterilization did not impact the ability of the devices to seal the biopsy tract and led to a decrease in the deployment force. Overall, these results demonstrate the potential for polyurethane-based shape memory foam devices to serve as biopsy tract sealant devices that aim to reduce complications, such as pneumothorax, from occurring.
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Affiliation(s)
- Tyler J. Touchet
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Braeden Brinson
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - McKenzie Jones
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Achu Byju
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Grace Fletcher
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | | | | | - Duncan J. Maitland
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
- Shape Memory Medical, Inc., Santa Clara, CA 95054, USA
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Chopra A, Doelken P, Hu K, Huggins JT, Judson MA. Pressure-Dependent Pneumothorax and Air Leak: Physiology and Clinical Implications. Chest 2023; 164:796-805. [PMID: 37187435 DOI: 10.1016/j.chest.2023.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection, or lobar atelectasis from bronchoscopic lung volume reduction or an endobronchial obstruction. This type of pneumothorax and air leak is clinically inconsequential. Failure to appreciate the benign nature of such air leaks may result in unnecessary pleural procedures or prolonged hospital stay. This review suggests that identification of pressure-dependent pneumothorax is clinically important because the air leak that results is not related to a lung injury that requires repair but rather to a physiological consequence of a pressure gradient. A pressure-dependent pneumothorax occurs during pleural drainage in patients with lung-thoracic cavity shape/size mismatch. It is caused by an air leak related to a pressure gradient between the subpleural lung parenchyma and the pleural space. Pressure-dependent pneumothorax and air leak do not need any further pleural interventions.
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Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
| | - Peter Doelken
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Kurt Hu
- Department of Medicine, Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - John T Huggins
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
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Kodama H, Takaki H, Taniguchi J, Ogasawara A, Kako Y, Kobayashi K, Yamakado K. Efficacy of Percutaneous Direct Puncture Biopsy of Malignant Lung Tumors Contacting to the Pleura. In Vivo 2023; 37:2237-2243. [PMID: 37652495 PMCID: PMC10500516 DOI: 10.21873/invivo.13325] [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: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM This is a retrospective evaluation of whether percutaneous direct puncture biopsy of lung lesions contacting to the pleura is justified. PATIENTS AND METHODS Between August 2016 and July 2021, 163 consecutive patients (100 males, 63 females with a median age of 73 years) who had malignant lung tumors measuring 0.6-12.4 cm (median, 2.9 cm) that contacted to the pleura and underwent percutaneous lung biopsy under computed tomography fluoroscopic guidance using an 18-gauge end-cut needle were examined. The trajectory was direct puncture in 80 patients (49.1%, 80/163), and trans-lung in 83 patients (50.9%, 83/163). Diagnostic yield and major adverse event rates of direct and trans-lung puncture biopsies were compared. RESULTS No difference was found in diagnostic yield between direct puncture and trans-lung biopsies (93.8% vs. 98.8%, p=0.11). Major adverse events were major pneumothorax (n=13/163, 8.0%), pleural dissemination (n=18/163, 11.0%), and hemothorax requiring arterial embolization (n=1/163, 1.0%). Direct puncture caused major pneumothorax significantly less than trans-lung puncture did (0%, 0/80 vs. 15.7%, 13/83, p<0.001). No significant difference was found between the two biopsy methods regarding the incidence of pleural dissemination (11.0%, 11/80 vs. 8.4%, 7/83, p=0.32). CONCLUSION Direct puncture biopsy of malignant lung tumors contacting to the pleura is justified.
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Affiliation(s)
- Hiroshi Kodama
- Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Haruyuki Takaki
- Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Junichi Taniguchi
- Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Atsushi Ogasawara
- Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Yasukazu Kako
- Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Kaoru Kobayashi
- Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
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Wang DX, Wang YG, Ding GX, Li B, Liu RN, Ai ZW, Wang Y. The effectiveness of the puncture channel plugging for reduction of complications after CT-guided percutaneous transthoracic needle biopsy. Sci Rep 2023; 13:12318. [PMID: 37516777 PMCID: PMC10387056 DOI: 10.1038/s41598-023-38915-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/17/2023] [Indexed: 07/31/2023] Open
Abstract
The effect of plugging the puncture channel with a mixture of hemocoagulase injection on the complications of CT-guided percutaneous transthoracic need biopsy (PTNB) was discussed. The medical records of PTNB were retrospectively studied from June 2017 to May 2022. In the study, the puncture channel of 626 patients were blocked, while remain 681 patients' were not. The Mantel Haenszel method performed layered analysis and evaluated the correlation of adjusted confounding factors. The Odds Ratio and its 95% confidence interval were calculated using the Woof method. The incidence of high-level pulmonary hemorrhage was significantly reduced in patients with lesions ≤ 2 cm and different needle lengths. Patients with different pleural-needle tip angle and perineedle emphysema were blocked, and the incidence of pneumothorax and thoracic implants was significantly reduced. Through puncture channel plugging, the incidence of pulmonary hemorrhage, pneumothorax and thoracic catheterization of PTNB under CT guidance was reduced.
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Affiliation(s)
- Dong-Xu Wang
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China.
| | - Yu-Guang Wang
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Guo-Xu Ding
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Bo Li
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Rui-Nan Liu
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Zhong-Wei Ai
- Department of Pathology, Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Yang Wang
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
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Green H, Taylor A, Khoo V. Beyond the Knife in Renal Cell Carcinoma: A Systematic Review-To Ablate or Not to Ablate? Cancers (Basel) 2023; 15:3455. [PMID: 37444565 DOI: 10.3390/cancers15133455] [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: 06/01/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Intensified systemic therapy in metastatic renal cell carcinoma (mRCC) has led to improved patient outcomes. Patients commonly require local control of one or a few metastases. The aim was to evaluate metastasis-directed ablative therapies in extracranial mRCC. Two databases and one registry were searched, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, for all prospective and matched-pair case-control mRCC studies of radiofrequency ablation (RFA), cryotherapy, microwave ablation (MWA), and stereotactic body radiotherapy (SBRT). Eighteen studies were identified. Fourteen investigated SBRT in 424 patients. Four thermal ablation studies were identified: two cryotherapy (56 patients) and two RFA studies (90 patients). The median participant number was 30 (range 12-69). The combined median follow-up was 17.3 months (range 8-52). Four SBRT studies reported local control (LC) at 12 months, median 84.4% (range 82.5-93). Seven studies (six SBRT and one cryotherapy) reported an LC rate of median 87% (79-100%). Median overall survival (OS) was reported in eight studies (five SBRT, two cryotherapy, and one RFA) with a median of 22.7 months (range 6.7-not reached). Median progression-free survival was reported in seven studies (five SBRT, one cryotherapy, and one RFA); the median was 9.3 months (range 3.0-22.7 months). Grade ≥ 3 toxicity ranged from 1.7% to 10%. SBRT has excellent local control outcomes and acceptable toxicity. Only four eligible thermal ablative studies were identified and could not be compared with SBRT. Translationally rich definitive studies are warranted.
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Affiliation(s)
- Harshani Green
- Royal Marsden Hospitals NHS Foundation Trust, London SW3 6JJ, UK
- Institute of Cancer Research, London SW7 3RP, UK
| | - Alexandra Taylor
- Royal Marsden Hospitals NHS Foundation Trust, London SW3 6JJ, UK
- Institute of Cancer Research, London SW7 3RP, UK
| | - Vincent Khoo
- Royal Marsden Hospitals NHS Foundation Trust, London SW3 6JJ, UK
- Institute of Cancer Research, London SW7 3RP, UK
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, VIC 3800, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
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Chan MV, Afraz Z, Huo YR, Kandel S, Rogalla P. Manual aspiration of a pneumothorax after CT-guided lung biopsy: outcomes and risk factors. Br J Radiol 2023:20220366. [PMID: 37393532 PMCID: PMC10392636 DOI: 10.1259/bjr.20220366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVE Quantify the outcomes following pneumothorax aspiration and influence upon chest drain insertion. METHODS This was a retrospective cohort study of patients who underwent aspiration for the treatment of a pneumothorax following a CT percutaneous transthoracic lung biopsy (CT-PTLB) from January 1, 2010 to October 1, 2020 at a tertiary center. Patient, lesion and procedural factors associated with chest drain insertion were assessed with univariate and multivariate analyses. RESULTS A total of 102 patients underwent aspiration for a pneumothorax following CT-PTLB. Overall, 81 patients (79.4%) had a successful pneumothorax aspiration and were discharged home on the same day. In 21 patients (20.6%), the pneumothorax continued to increase post-aspiration and required chest drain insertion with hospital admission. Significant risk factors requiring chest drain insertion included upper/middle lobe biopsy location [odds ratio (OR) 6.46; 95% CI 1.77-23.65, p = 0.003], supine biopsy position (OR 7.06; 95% CI 2.24-22.21, p < 0.001), emphysema (OR 3.13; 95% CI 1.10-8.87, p = 0.028), greater needle depth ≥2 cm (OR 4.00; 95% CI 1.44-11.07, p = 0.005) and a larger pneumothorax (axial depth ≥3 cm) (OR 16.00; 95% CI 4.76-53.83, p < 0.001). On multivariate analysis, larger pneumothorax size and supine position during biopsy remained significant for chest drain insertion. Aspiration of a larger pneumothorax (radial depths ≥3 cm and ≥4 cm) had a 50% rate of success. Aspiration of a smaller pneumothorax (radial depth 2-3 cm and <2 cm) had an 82.6% and 100% rate of success, respectively. CONCLUSION Aspiration of pneumothorax after CT-PTLB can help reduce chest drain insertion in approximately 50% of patients with larger pneumothoraces and even more so with smaller pneumothoraces (>80%). ADVANCES IN KNOWLEDGE Aspiration of pneumothoraces up to 3 cm was often associated with avoiding chest drain insertion and allowing for earlier discharge.
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Affiliation(s)
- Michael Vinchill Chan
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
- Department of Radiology, Concord Repatriation General Hospital, NSW, Concord, NSW, Australia
- Concord Hospital Clinical School, University of Sydney, NSW, Concord, Australia
| | - Zahra Afraz
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Ya Ruth Huo
- Department of Radiology, Concord Repatriation General Hospital, NSW, Concord, NSW, Australia
- Concord Hospital Clinical School, University of Sydney, NSW, Concord, Australia
| | - Sonja Kandel
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Patrik Rogalla
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
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Yang S, Lou L, Wang W, Li J, Jin X, Wang S, Cai J, Kuang F, Liu L, Hadjouni M, Elmannai H, Cai C. Pneumothorax prediction using a foraging and hunting based ant colony optimizer assisted support vector machine. Comput Biol Med 2023; 161:106948. [PMID: 37207406 DOI: 10.1016/j.compbiomed.2023.106948] [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: 02/16/2023] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/21/2023]
Abstract
Although PNLB is generally considered safe, it is still invasive and risky. Pneumothorax, the most common complication of lung puncture, can cause shortness of breath, chest pain, and even life-threatening. Therefore, the auxiliary diagnosis for pneumothorax is of great clinical interest. This paper proposes an ant colony optimizer with slime mould foraging behavior and collaborative hunting, called SCACO, in which slime mould foraging behavior is combined to improve the convergence accuracy and solution quality of ACOR. Then the ability of ACO to jump out of the local optimum is optimized by an adaptive collaborative hunting strategy when trapped in the local optimum. As a first step toward Pneumothorax diagnostic prediction, we suggested an SVM classifier based on bSCACO (bSCACO-SVM), which uses the proposed SCACO's binary version as the basis for its feature selection algorithms. To demonstrate the SCACO performance, we first used the slime mould foraging behavior and adaptive cooperative hunting strategy, then compared SCACO with nine basic algorithms and nine variants, respectively. Finally, we verified bSCACO-SVM on various widely used public datasets and applied it to the Pneumothorax prediction issue, showing that it has robust classification prediction capacity and can be successfully employed for tuberculous pleural effusion diagnostic prediction.
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Affiliation(s)
- Song Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Lejing Lou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Wangjia Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Jie Li
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Xiao Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Shijia Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Jihao Cai
- Wenzhou Medical University Renji College, Wenzhou, China.
| | - Fangjun Kuang
- School of Information Engineering, Wenzhou Business College, Wenzhou, 325035, China.
| | - Lei Liu
- College of Computer Science, Sichuan University, Chengdu, Sichuan, 610065, China.
| | - Myriam Hadjouni
- Department of Computer Sciences, College of Computer and Information Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Hela Elmannai
- Department of Information Technology, College of Computer and Information Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Chang Cai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
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40
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Duke JD, Reisenauer J. Robotic bronchoscopy: potential in diagnosing and treating lung cancer. Expert Rev Respir Med 2023; 17:213-221. [PMID: 36939545 DOI: 10.1080/17476348.2023.2192929] [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: 03/21/2023]
Abstract
INTRODUCTION Lung cancer remains the deadliest form of cancer in the world. Screening through low-dose CT scans has shown improved detection of pulmonary nodules; however, with the introduction of robotic bronchoscopy, accessing and biopsying peripheral pulmonary nodules from the airway has expanded. Improved diagnostic yield through enhanced navigation has made robotic bronchoscopy an ideal diagnostic technology for many proceduralists. Studies have demonstrated that robotic bronchoscopes can reach further with improved maneuverability into the distal airways compared to conventional bronchoscopes. AREAS COVERED This review paper highlights the literature on the technological advancements associated with robotic bronchoscopy and the future directions the field of interventional pulmonary may utilize this modality for in the treatment of lung cancer. Referenced articles were included at the discretion of the authors after a database search of the particular technology discussed. EXPERT OPINION As the localization of target lesions continues to improve, robotic platforms that provide reach, stability, and accuracy paves the way for future research in endoluminal treatment for lung cancer. Future studies with intratumoral injection of chemotherapy and immunotherapy and ablation modalities are likely to come in the coming years.
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Affiliation(s)
- Jennifer D Duke
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Janani Reisenauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
- Division of Thoracic Surgery, Mayo Clinic Rochester, Rochester, MN, USA
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Hiddinga BI, Slebos DJ, David Koster T, Hijmering-Kappelle LBM, Hiltermann TJN, Kievit H, van der Wekken AJ, de Jonge G, Vliegenthart R, Van De Wauwer C, Timens W, Bensch F. The additional diagnostic value of virtual bronchoscopy navigation in patients with pulmonary nodules - The NAVIGATOR study. Lung Cancer 2023; 177:37-43. [PMID: 36708592 DOI: 10.1016/j.lungcan.2023.01.012] [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: 11/14/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The number of solitary pulmonary nodules to be evaluated is expected to increase and therefore we need to improve diagnostic and therapeutic tools to approach these nodules. To prevent patients from futile invasive procedures and receiving treatment without histological confirmation of cancer, we evaluated the value of virtual bronchoscopy navigation to obtain a diagnosis of the solitary pulmonary nodule in a real-world clinical setting. METHODS In the NAVIGATOR single center, prospective, observational cohort study patients underwent a virtual bronchoscopy navigation procedure with or without guide sheet tunnelling to assess a solitary pulmonary nodule. Nodules were considered not accessible if a diagnosis could not be obtained by either by CT-guided transthoracic biopsy or conventional bronchoscopy. RESULTS Between February 2021 and January 2022 35 patients underwent the virtual bronchoscopy navigation procedure. The overall diagnostic yield was 77% and was dependent on size of the nodule and chosen path, with highest yield in lesions with an airway path. Adverse events were few and manageable. CONCLUSION Virtual bronchoscopy navigation with or without sheet tunnelling is a new technique with a good diagnostic yield, also in patients in whom previously performed procedures failed to establish a diagnosis and/or alternative procedures are considered not feasible based on expected yield and/or safety. Preventing futile or more invasive procedures like surgery or transthoracic punctures with a higher complication rate is beneficial for patients, and allowed treatment adaptation in two-third of the analyzed patient population.
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Affiliation(s)
- Birgitta I Hiddinga
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - Dirk-Jan Slebos
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands
| | - T David Koster
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Lucie B M Hijmering-Kappelle
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands
| | - T Jeroen N Hiltermann
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Hanneke Kievit
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Anthonie J van der Wekken
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Gonda de Jonge
- Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Caroline Van De Wauwer
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Frederike Bensch
- Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands
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Peng B, Deng Z, Wang Y, Xu S, Luo D, Du Z, Liu L, Hu Y, Ren Y. The risk of immediate pneumothorax after CT-guided lung needle biopsy: pleural tail sign as a novel factor. Quant Imaging Med Surg 2023; 13:707-719. [PMID: 36819288 PMCID: PMC9929422 DOI: 10.21037/qims-22-474] [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: 05/22/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Background Pneumothorax is the most frequent complication in computed tomography-guided lung needle biopsy (CT-LNB) and generally appears immediately or within an hour after CT-LNB. Preventing pneumothorax after CT-LNB requires a preoperative evaluation of risk factors. This study investigated risk factors for the occurrence of immediate pneumothorax after CT-LNB. Methods A total of 311 CT-LNB procedures were conducted for 290 patients (217 males and 73 females) with persistent solid or part-solid pulmonary lesions in this case-control study. We retrospectively evaluated immediate postbiopsy pneumothorax complications and associated risk factors. The possible risk factors for immediate pneumothorax were analyzed, including 12 parameters in demographics, radiological features, and procedural factors. Univariate and multivariate logistic regression analyses were used to investigate independent risk factors for the occurrence of immediate pneumothorax after CT-LNB. Results All CT-LNB procedures (100%) were technically successful. Immediate pneumothorax after CT-LNB occurred in 115 out of the 311 procedures (36.9%). Chest tube placement was required for 12.2% (14/115) of the pneumothoraces (14/311, 4.5% of the total number of CT-LNB procedures). The other pneumothoraces were treated conservatively. Independent risk factors of immediate pneumothorax included a lesion with pleural tail sign [PTS; odds ratio (OR) =3.021, 95% confidence interval (CI): 1.703-5.359; P<0.001], smaller lesion size (OR =0.827, 95% CI: 0.705-0.969; P=0.019), a lesion in the middle or lower lobe (OR =2.237, 95% CI: 1.267-3.951; P=0.006), a higher number of pleural punctures (OR =2.710, 95% CI: 1.399-5.248; P=0.003), and a deep-seated lesion (OR =1.622, 95% CI: 1.261-2.088; P<0.001). Conclusion PTS is a novel risk factor for immediate pneumothorax and may increase the immediate pneumothorax rate after CT-LNB. Practitioners should be vigilant of the risk of immediate pneumothorax after CT-LNB in lung lesions with PTS.
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Affiliation(s)
- Bo Peng
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Zhenglong Deng
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Yuxi Wang
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Shuhao Xu
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Dong Luo
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Zedong Du
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Le Liu
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Ying Hu
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Yi Ren
- Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China
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43
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He L, Meng Y, Zhong J, Tang L, Chui C, Zhang J. Preoperative path planning algorithm for lung puncture biopsy based on path constraint and multidimensional space distance optimization. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chen X, Yan Y, Li A, Wang T, Wang Y. Robot-Assisted Needle Insertion for CT-Guided Puncture: Experimental Study with a Phantom and Animals. Cardiovasc Intervent Radiol 2023; 46:128-135. [PMID: 36380153 DOI: 10.1007/s00270-022-03301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate the accuracy and safety of robotic CT-guided needle insertion in phantom and animal experiments. MATERIALS AND METHODS A robotic system was developed for CT-guided needle insertion. For the phantom experiment, a specially made phantom containing multiple spherical was used. 15 robotic and manual insertions were conducted, and the accuracy, time, number of needle insertions, and radiation dose were compared between the robotic and manual insertion using Student's t-test. For the animal experiment, 20 robotic needle insertions were attempted toward simulated pulmonary nodules in the swine lung. The accuracy and safety of robotic CT-guided needle insertions were evaluated. RESULTS In the phantom experiment, the mean accuracies of manual and robotic insertion were 1.8 ± 0.3 mm and 1.9 ± 0.2 mm. The accuracy of robotic needle insertion had no significant difference with manual needle insertion, but the number of needle insertions and radiation dose of the robotic needle placement significantly decreased compared to manual needle placement. In the animal experiment, the mean accuracy of the robotic needle insertion was 3.8 ± 1.3 mm. The time for the whole needle insertion was 14.4 ± 4.8 min. The whole robotic needle insertions were safe and only one mild pneumothorax occurred. CONCLUSION CT-guided robotic needle insertion showed accuracy comparable to manual needle insertion, but the number of needle insertions, confirmatory scans, and radiation exposure had been reduced significantly. In future, we will further apply the robotic system to clinical experiments.
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Affiliation(s)
- Xiangqian Chen
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yadong Yan
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ailing Li
- Beijing TrueHealth Medical Technology Co., Ltd., Beijing, China
| | - Tianmiao Wang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
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45
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Zhao Y, Bao D, Wu W, Tang W, Xing G, Zhao X. Development and validation of a prediction model of pneumothorax after CT-guided coaxial core needle lung biopsy. Quant Imaging Med Surg 2022; 12:5404-5419. [PMID: 36465829 PMCID: PMC9703113 DOI: 10.21037/qims-22-176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/08/2022] [Indexed: 08/22/2023]
Abstract
BACKGROUND Pneumothorax is the most common complication of computed tomography-guided coaxial core needle biopsy (CCNB) and may be life-threatening. We aimed to evaluate the risk factors and develop a model for predicting pneumothorax in patients undergoing computed tomography-guided CCNB, and to further determine its clinical utility. METHODS Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for pneumothorax from 18 variables. A predictive model was established using multivariable logistic regression and presented as a nomogram based on a training cohort of 690 patients who underwent computed tomography-guided CCNB. The model was validated in 253 consecutive patients in the validation cohort and 250 patients in the test cohort. The area under the curve was used to determine the predictive accuracy of the proposed model. RESULTS The risk factors associated with pneumothorax after computed tomography-guided CCNB were sex, patient position, lung field, lesion contact with the pleura, lesion size, distance from the pleura to the lesion, presence of emphysema adjacent to the biopsy tract, and crossing fissures. The predictive model that incorporated these predictors showed good predictive performance in the training cohort [area under the curve, 0.71 (95% confidence interval: 0.67-0.75)], validation cohort [0.71 (0.64-0.78)], and internal test cohort [0.68 (0.60-0.75)]. The nomogram also provided excellent calibration and discrimination, and decision curve analysis (DCA) demonstrated its clinical utility. CONCLUSIONS The predictive model showed good performance for pneumothorax after computed tomography-guided CCNB and may help improve individualized preoperative prediction.
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Affiliation(s)
- Yanfeng Zhao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Bao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenli Wu
- Medical Imaging Center, Liaocheng Tumor Hospital, Liaocheng, China
| | - Wei Tang
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gusheng Xing
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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46
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Shape-Sensing Robotic-Assisted Bronchoscopy with Concurrent use of Radial Endobronchial Ultrasound and Cone Beam Computed Tomography in the Evaluation of Pulmonary Lesions. Lung 2022; 200:755-761. [PMID: 36369295 DOI: 10.1007/s00408-022-00590-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Lung nodules are a common radiographic finding. Non-surgical biopsy is recommended in patients with moderate or high pretest probability for malignancy. Shape-sensing robotic-assisted bronchoscopy (ssRAB) combined with radial endobronchial ultrasound (r-EBUS) and cone beam computed tomography (CBCT) is a new approach to sample pulmonary lesions. Limited data are available regarding the diagnostic accuracy of combined ssRAB with r-EBUS and CBCT. METHODS We conducted a retrospective analysis of the first 200 biopsy procedures of 209 lung lesions using ssRAB, r-EBUS, and CBCT at UT Southwestern Medical Center in Dallas, Texas. Outcomes were based on pathology interpretations of samples taken during ssRAB, clinical and radiographic follow-up, and/or additional sampling. RESULTS The mean largest lesion dimension was 22.6 ± 13.3 mm with a median of 19 mm (range 7 to 73 mm). The prevalence of malignancy in our data was 64.1%. The diagnostic accuracy of ssRAB combined with advanced imaging was 91.4% (CI 86.7-94.8%). Sensitivity was 87.3% (CI 80.5-92.4%) with a specificity of 98.7% (CI 92.8-100%). The negative and positive predictive values were 81.3% and 99.2%. The rate of non-diagnostic sampling was 11% (23/209 samples). The only complication was pneumothorax in 1% (2/200 procedures), with 0.5% requiring a chest tube. CONCLUSION Our results of the combined use of ssRAB with r-EBUS and CBCT to sample pulmonary lesions suggest a high diagnostic accuracy for malignant lesions with reasonably high sensitivity and negative predictive values. The procedure is safe with a low rate of complications.
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Leung JH, Ng B, Lim WW. Interleukin-11: A Potential Biomarker and Molecular Therapeutic Target in Non-Small Cell Lung Cancer. Cells 2022; 11:cells11142257. [PMID: 35883698 PMCID: PMC9318853 DOI: 10.3390/cells11142257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer and is a fast progressive disease when left untreated. Identification of potential biomarkers in NSCLC is an ongoing area of research that aims to detect, diagnose, and prognosticate patients early to optimize treatment. We review the role of interleukin-11 (IL11), a stromal-cell derived pleiotropic cytokine with profibrotic and cellular remodeling properties, as a potential biomarker in NSCLC. This review identifies the need for biomarkers in NSCLC, the potential sources of IL11, and summarizes the available information leveraging upon published literature, publicly available datasets, and online tools. We identify accumulating evidence suggesting IL11 to be a potential biomarker in NSCLC patients. Further in-depth studies into the pathophysiological effects of IL11 on stromal-tumor interaction in NSCLC are warranted and current available literature highlights the potential value of IL11 detection as a diagnostic and prognostic biomarker in NSCLC.
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Affiliation(s)
- Jason Hongting Leung
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore 169609, Singapore
- Correspondence:
| | - Benjamin Ng
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore 169609, Singapore; (B.N.); (W.-W.L.)
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169609, Singapore
| | - Wei-Wen Lim
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore 169609, Singapore; (B.N.); (W.-W.L.)
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169609, Singapore
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Ball M, Babu S, Wallis A, Asciak R. Promising role for pleural vent in pneumothorax following CT-guided biopsy of lung lesions. Br J Radiol 2022; 95:20210965. [PMID: 35604638 PMCID: PMC10996322 DOI: 10.1259/bjr.20210965] [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: 08/19/2021] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the safety, effectiveness and cost-benefit of ambulatory pleural vent compared to conventional chest drain for pneumothorax following CT-guided biopsy of lung lesions (CTGB). METHODS We retrospectively analysed electronic hospital records of patients requiring intervention for pneumothorax following CTGB. All patients treated with pleural vent over a 2-year period (August 2017-July 2019) were included and compared to a control group of all patients treated with chest drain over a previous 2-year period (August 2014-July 2016). RESULTS Patients managed with a pleural vent had a shorter length of hospital stay compared to the chest drain group (median 0 days vs 4.5 days, p < 0.01). The mean cost of follow-up in the pleural vent group was £530.36 per patient compared to a mean of £2699.38 per patient in the chest drain group (p-value < 0.01). CONCLUSION Pleural vent can be a safe and effective alternative to conventional chest drain for the management of CTGB-related pneumothorax which allows patients to be managed on an outpatient basis with reduced hospital stays and lower associated healthcare costs. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first study demonstrating the safety and effectiveness of pleural vent for CTGB-related pneumothorax.
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Affiliation(s)
- Michael Ball
- Department of Respiratory Medicine, Portsmouth Hospitals
University NHS Trust, Portsmouth,
United Kingdom
| | - Suresh Babu
- Department of Respiratory Medicine, Portsmouth Hospitals
University NHS Trust, Portsmouth,
United Kingdom
| | - Adam Wallis
- Department of Radiology, Portsmouth Hospitals University NHS
Trust, Portsmouth, United
Kingdom
| | - Rachelle Asciak
- Department of Respiratory Medicine, Portsmouth Hospitals
University NHS Trust, Portsmouth,
United Kingdom
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Abrishami Kashani M, Campbell-Washburn AE, Murphy MC, Catalano OA, McDermott S, Fintelmann FJ. Magnetic Resonance Imaging for Guidance and Follow-up of Thoracic Needle Biopsies and Thermal Ablations. J Thorac Imaging 2022; 37:201-216. [PMID: 35426857 PMCID: PMC10441002 DOI: 10.1097/rti.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI) is used for the guidance and follow-up of percutaneous minimally invasive interventions in many body parts. In the thorax, computed tomography (CT) is currently the most used imaging modality for the guidance and follow-up of needle biopsies and thermal ablations. Compared with CT, MRI provides excellent soft tissue contrast, lacks ionizing radiation, and allows functional imaging. The role of MRI is limited in the thorax due to the low hydrogen proton density and many air-tissue interfaces of the lung, as well as respiratory and cardiac motion. Here, we review the current experience of MR-guided thoracic needle biopsies and of MR-guided thermal ablations targeting lesions in the lung, mediastinum, and the chest wall. We provide an overview of MR-compatible biopsy needles and ablation devices. We detail relevant MRI sequences and their relative advantages and disadvantages for procedural guidance, assessment of complications, and long-term follow-up. We compare the advantages and disadvantages of CT and MR for thoracic interventions and identify areas in need of improvement and additional research.
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Affiliation(s)
| | - Adrienne E Campbell-Washburn
- Division of Intramural Research, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mark C Murphy
- Division of Thoracic Imaging and Intervention, Department of Radiology
| | - Onofrio A Catalano
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Sargent T, Kolderman N, Nair GB, Jankowski M, Al-Katib S. Risk Factors for Pneumothorax Development Following CT-Guided Core Lung Nodule Biopsy. J Bronchology Interv Pulmonol 2022; 29:198-205. [PMID: 34654044 DOI: 10.1097/lbr.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aims to correlate nodule, patient, and technical risk factors less commonly investigated in the literature with pneumothorax development during computed tomography-guided core needle lung nodule biopsy. PATIENTS AND METHODS Retrospective data on 671 computed tomography-guided percutaneous core needle lung biopsies from 671 patients at a tertiary care center between March 2014 and August 2016. Univariate and multivariable logistic regression analyses were used to identify pneumothorax risk factors. RESULTS The overall incidence of pneumothorax was 26.7% (n=179). Risk factors identified on univariate analysis include anterior [odds ratio (OR)=1.98; P<0.001] and lateral (OR=2.17; P=0.002) pleural surface puncture relative to posterior puncture, traversing more than one pleural surface with the biopsy needle (OR=2.35; P=0.06), patient positioning in supine (OR=2.01; P<0.001) and decubitus nodule side up (OR=2.54; P=0.001) orientation relative to decubitus nodule side down positioning, and presence of emphysema in the path of the biopsy needle (OR=3.32; P<0.001). In the multivariable analysis, the presence of emphysematous parenchyma in the path of the biopsy needle was correlated most strongly with increased odds of pneumothorax development (OR=3.03; P=0.0004). Increased body mass index (OR=0.95; P=0.001) and larger nodule width (cm; OR=0.74; P=0.02) were protective factors most strongly correlated with decreased odds of pneumothorax development. CONCLUSION Emphysema in the needle biopsy path is most strongly associated with pneumothorax development. Increases in patient body mass index and width of the target lung nodule are most strongly associated with decreased odds of pneumothorax.
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Affiliation(s)
- Tyler Sargent
- Oakland University William Beaumont School of Medicine, Rochester
| | | | - Girish B Nair
- Division of Pulmonary Critical Care, Beaumont Health System, Royal Oak, MI
| | | | - Sayf Al-Katib
- Department of Diagnostic Radiology and Molecular Imaging
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