Massive intrathoracic haemorrhage after CT-guided lung biopsy

Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy

Biopsy has been used to diagnose thoracic diseases for more than a century. Percutaneous needle biopsy plays a crucial role in the diagnosis, staging, and treatment planning for tumors in the lungs, thoracic wall, hilum, and mediastinum. With the continuous improvement in imaging techniques, the range of clinical applications for percutaneous needle biopsy is also expanding. It has become important to improve Chinese professionals’ and technicians’ understanding of percutaneous transthoracic needle biopsy (PTNB) in order to standardize operating procedures and to strengthen perioperative management. However, there is currently no Chinese expert consensus that provides systematic standardization and guidance for PTNB in clinical practice. The Committee of Chinese Society of Interventional Oncology (CSIO) of the Chinese Anti‐Cancer Association (CACA) initiated a Chinese multidisciplinary expert consensus on PTNB. The consensus includes image‐guided methods, indications, contraindications, multidisciplinary team recommendations, biopsy procedures, daytime/outpatient biopsy, complications, pathological examination, and management of negative results.

Extrapleural locating method in computed tomography-guided needle biopsies of 1,106 lung lesions

Transthoracic needle biopsy is considered to be safe and effective for the diagnosis of focal lung lesions. The aim of the present study was to evaluate factors affecting the accuracy and safety of automated cutting needle lung biopsy (ACNB) using a new extrapleural locating (EPL) method. Computed tomography (CT)-guided needle biopsies were performed on 1,065 patients between March 2005 and May 2012 using the EPL method. The locating needle remained in the chest following extrapleural positioning, while the radiologist confirmed the puncture angle and distance between the locating needle and lesion. The biopsy instrument was advanced into the lung, and the core needle was subsequently fired into the lesion based on the direction indicated by the locating needle. Univariate and multivariate regression analyses were used to evaluate the diagnostic accuracy and safety of the procedure. The sensitivity, specificity, positive predictive value and negative predictive value of the extrapleural method were 91.9, 100, 100 and 82.9%, respectively, and the overall diagnostic accuracy was 94.2%. Significant risk factors affecting accuracy were younger age, atelectasis, hemoptysis and lesion depth (P<0.03). Multivariate logistic regression analysis revealed that the risk of malignant lesions receiving a false-negative diagnosis decreased for each additional year of subject age [odds ratio (OR), 0.97; P=0.027] and increased with each millimeter increase in lesion depth (OR, 1.03; P=0.008). Among the 1,106 lesions biopsied, 207 were associated with pneumothorax, 251 with hemorrhage and 58 with hemoptysis. Multivariate analysis revealed that lesion size and emphysema affected pneumothorax incidence, while age, lesion location and depth and emphysema significantly affected hemorrhage incidence (P<0.05). In conclusion, low-dose, CT-guided ACNB with the EPL method provides a safe and accurate diagnosis.

Precision of coaxial needle placement in computed tomography-guided transthoracic needle biopsy

In the present study, a set of self-designed measurement protocols for the precision of coaxial needle placement (PCNP) was proposed and applied in a computed tomography (CT)-guided transthoracic needle biopsy (TNB) audit of an interventional radiologist to determine if the PCNP was commensurate with the experience of the operator. A total of 102 patients (98 with lung lesions and four with mediastinum lesions) consented to be subjected to CT-guided TNB performed by staff interventional radiologists. The patients were divided into two groups based on appointment date. Group A consisted of the first 51 patients and group B comprised of the latter 51 patients. A set of self-designed measurement protocols for PCNP was proposed, and the PCNP was classified into four grades, from grade 1 (most accurate) to grade 4 (least accurate). PCNPs were independently measured by three staff radiologists who were blind to the grouping. The anatomical features of the lesions were also analyzed between the two groups. A significant difference in the PCNP gained after the first needle placement was identified between the two groups (P=0.003, two-tailed). The number of patients in group B with grade I PCNP (51.0%) was significantly higher than that in group A (21.6%) (P<0.05). The number of patients in group B with grade III PCNP (11.8%) was significantly lower than that in group A (29.4%, P<0.05). The PCNP was observed to be commensurate with the experience of the operator and should be considered as a routine audit index in CT-guided TNB.