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Zou X, Cui N, Ma Q, Lin Z, Zhang J, Li X. Conventional versus cone-beam computed tomography in lung biopsy: diagnostic performance, risks, and the advantages of tract embolization with gelfoam particle suspension. Quant Imaging Med Surg 2024; 14:6479-6492. [PMID: 39281169 PMCID: PMC11400691 DOI: 10.21037/qims-24-342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/25/2024] [Indexed: 09/18/2024]
Abstract
Background With the widespread adoption of computed tomography (CT) technology, the number of detected pulmonary nodules has gradually increased. CT-guided percutaneous needle biopsy has become the primary method for qualitative diagnosis of pulmonary nodules. Benefiting from its three-dimensional (3D) reconstruction capability, cone-beam CT (CBCT) technology has also been widely adopted. Nevertheless, pneumothorax remains the most common complication of these diagnostic and therapeutic procedures. This study assessed the diagnostic accuracy of conventional CT (CCT)- and CBCT-guided coaxial core needle biopsy (CCNB) and the effectiveness of gelfoam particle suspension in reducing complications through tract embolization. Methods A retrospective analysis was conducted on 320 patients who had undergone CCNB for nodules ≤3 cm from January 2020 to June 2022 at Zhongshan People's Hospital, comprising 325 biopsies (145 CCT-guided and 180 CBCT-guided). Gelfoam tract embolization was specifically used in biopsies of patients identified with a high risk of complications. Comparative statistics involved diagnostic outcomes (sensitivity, specificity, accuracy), procedural lengths, complication occurrences, and radiation doses. Results Diagnostically, both CCT (sensitivity 93.3%, specificity 100%, accuracy 94.1%) and CBCT (sensitivity 92.8%, specificity 100%, accuracy 93.8%) offered a similarly high performance. The CCT technique was preferable in terms of shorter median operational times (19 vs. 24 minutes; P<0.001) and greater radiation exposure (13.9 vs. 10.1 mSv; P<0.001). The complication rates of CBCT and CCT, such as those of pneumothorax (18.9% vs. 20.7%; P=0.69) and hemorrhage (23.9% vs. 18.6%; P=0.25), were comparable. Of note, the comparison of biopsies with and without gelfoam embolization revealed a marked reduction in postoperative pneumothorax incidence (1.24% vs. 7.9%; P=0.004) and the requirement for drainage (0% vs. 4.27%; P=0.02), indicating the effectiveness of this procedure. Conclusions CCT- and CBCT-guided lung biopsies demonstrate equivalent diagnostic capacities, with CCT providing shorter median operational times. Importantly, gelfoam embolization substantially diminishes the risk of postoperative pneumothorax, underscoring its value in high-risk patients.
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Affiliation(s)
- Xugong Zou
- Department of Interventional Medicine, Zhongshan People's Hospital, Zhongshan, China
| | - Ning Cui
- Medical Imaging Center, Taihe Hospital, Shiyan, China
| | - Qiang Ma
- Department of Interventional Medicine, Zhongshan People's Hospital, Zhongshan, China
| | - Zhipeng Lin
- Department of Interventional Medicine, Zhongshan People's Hospital, Zhongshan, China
| | - Jian Zhang
- Department of Interventional Medicine, Zhongshan People's Hospital, Zhongshan, China
| | - Xiaoqun Li
- Department of Interventional Medicine, Zhongshan People's Hospital, Zhongshan, China
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Xu D, Xie F, Zhang J, Chen H, Chen Z, Guan Z, Hou G, Ji C, Li H, Li M, Li W, Li X, Li Y, Lian H, Liao J, Liu D, Luo Z, Ouyang H, Shen Y, Shi Y, Tang C, Wan N, Wang T, Wang H, Wang H, Wang J, Wu X, Xia Y, Xiao K, Xu W, Xu F, Yang H, Yang J, Ye T, Ye X, Yu P, Zhang N, Zhang P, Zhang Q, Zhao Q, Zheng X, Zou J, Chen E, Sun J. Chinese expert consensus on cone-beam CT-guided diagnosis, localization and treatment for pulmonary nodules. Thorac Cancer 2024; 15:582-597. [PMID: 38337087 PMCID: PMC10912555 DOI: 10.1111/1759-7714.15222] [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: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/12/2024] Open
Abstract
Cone-beam computed tomography (CBCT) system can provide real-time 3D images and fluoroscopy images of the region of interest during the operation. Some systems can even offer augmented fluoroscopy and puncture guidance. The use of CBCT for interventional pulmonary procedures has grown significantly in recent years, and numerous clinical studies have confirmed the technology's efficacy and safety in the diagnosis, localization, and treatment of pulmonary nodules. In order to optimize and standardize the technical specifications of CBCT and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Interventional Pulmonology of China Association for Promotion of Health Science and Technology.
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Affiliation(s)
- Dongyang Xu
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Jisong Zhang
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory DiseaseSir Run Run Shaw Hospital of Zhejiang UniversityHangzhouChina
| | - Hong Chen
- Department of Pulmonary and Critical Care MedicineSecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zhongbo Chen
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Zhenbiao Guan
- Department of Respiration, Changhai HospitalNaval Medical UniversityShanghaiChina
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, China‐Japan Friendship HospitalBeijingChina
| | - Cheng Ji
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Haitao Li
- Department of Respiratory and Critical Care MedicineThe Second Hospital of Hebei Medical UniversityShijiazhuangHebeiChina
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Wei Li
- Department of Respiratory DiseaseThe First Affiliated Hospital of Bengbu Medical CollegeBengbuChina
| | - Xuan Li
- Department of Respiratory Medicine, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Yishi Li
- Dept of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Hairong Lian
- Department of Respiratory MedicineAffiliated Hospital of Jiangnan UniversityWuxiChina
| | - Jiangrong Liao
- Department of Respiratory MedicineGuizhou Aerospace HospitalZunyiChina
| | - Dan Liu
- Department of Respiratory and Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Zhuang Luo
- Department of Respiratory and Critical Care MedicineFirst Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Haifeng Ouyang
- Department of Respiratory DiseasesXi'an International Medical CenterXi'anChina
| | - Yongchun Shen
- Department of Respiratory and Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Yiwei Shi
- Department of Respiratory and Critical Care MedicineShanxi Medical University Affiliated First HospitalTaiyuanChina
| | - Chunli Tang
- China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Nansheng Wan
- Department of Respiratory and Critical Care MedicineTianjin Medical University General HospitalTianjinChina
| | - Tao Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hong Wang
- Department of Respiratory MedicineLanzhou University Second HospitalLanzhouChina
| | - Huaqi Wang
- Department of Respiratory MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xuemei Wu
- Department of Respiratory CentreThe Second Affiliated Hospital of Xiamen Medical CollegeXiamenChina
| | - Yang Xia
- Department of Respiratory and Critical Care MedicineSecond Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Kui Xiao
- Department of Respiratory Medicine, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Wujian Xu
- Department of Respiratory and Critical Care Medicine, Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Fei Xu
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Huizhen Yang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou UniversityZhengzhouChina
| | - Junyong Yang
- Department of Respiratory MedicineXinjiang Chest HospitalWulumuqiChina
| | - Taosheng Ye
- Department of TuberculosisThe Third People's Hospital of ShenzhenShenzhenChina
| | - Xianwei Ye
- Department of Pulmonary and Critical Care MedicineGuizhou Provincial People's HospitalGuiyangChina
| | - Pengfei Yu
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding HospitalAffiliated with the Medical College of QingdaoYantaiChina
| | - Nan Zhang
- Department of Respiratory Medicine, Emergency General HospitalBeijingChina
| | - Peng Zhang
- Pulmonary Intervention DepartmentAnhui Chest HospitalHefeiChina
| | - Quncheng Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou UniversityZhengzhouChina
| | - Qi Zhao
- Department of Respiratory Medicine, Nanjing Drum Tower HospitalNanjing University Medical SchoolNanjingChina
| | - Xiaoxuan Zheng
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Jun Zou
- Department of Respiratory and Critical Care Medicine, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Enguo Chen
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory DiseaseSir Run Run Shaw Hospital of Zhejiang UniversityHangzhouChina
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
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Yang Y, Ma J, Peng Z, Zhou X, Du N, Zhang W, Yan Z. Pneumothorax and pulmonary hemorrhage after C-arm cone-beam computed tomography-guided percutaneous transthoracic lung biopsy: incidence, clinical significance, and correlation. BMC Pulm Med 2024; 24:33. [PMID: 38218792 PMCID: PMC10787482 DOI: 10.1186/s12890-023-02822-9] [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: 06/25/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE This study aimed to assess the incidence and clinical significance of pneumothorax (PTX) and pulmonary hemorrhage (PH) after percutaneous transthoracic lung biopsy (PTLB) guided by C-arm cone-beam computed tomography (CBCT). Furthermore, this study aimed to examine the relationships between PTX and PH with demographics, clinical characteristics, imaging, and PTLB parameters. METHODS A retrospective analysis was conducted on 192 patients who underwent PTLB at our hospital between January 2019 and October 2022. Incidences of PTX and PH were recorded. PTX was considered clinically significant if treated with chest tube insertion (CTI), and PH if treated with bronchoscopes or endovascular treatments. The various factors on PTX and PH were analyzed using the Chi-squared test and Student t-test. Logistic regression analyses were then used to determine these factors on the correlation to develop PTX and PH. RESULTS PTX occurred in 67/192 cases (34.9%); CTI was required in 5/67 (7.5%). PH occurred in 63/192 cases (32.8%) and none of these cases required bronchoscopes or endovascular treatments. Lesion diameter (ORPTX = 0.822; ORPH = 0.785), presence of pulmonary emphysema (ORPH = 2.148), the number of samples (ORPH = 1.834), the use of gelfoam (ORPTX = 0.474; ORPH = 0.341) and ablation (ORPTX = 2.351; ORPH = 3.443) showed statistically significant correlation to PTX and PH. CONCLUSIONS CBCT-guided PTLB is a safe and effective method for performing lung biopsies. The use of gelfoam has been shown to reduce the occurrence of PTX and PH. However, caution should be exercised when combining radiofrequency ablation with PTLB, as it may increase the risk of PTX and PH.
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Affiliation(s)
- Yanjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhijie Peng
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Nan Du
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
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Hong T, Ji G, Sun T, Gui X, Ma T, Zhang H. CT-guided percutaneous transthoracic needle biopsy (PTNB): A thoracic surgeon's learning curve and experience summary. Thorac Cancer 2023; 14:673-682. [PMID: 36647903 PMCID: PMC9981308 DOI: 10.1111/1759-7714.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Few studies have investigated the learning process of percutaneous transthoracic needle biopsy (PTNB). Here, we aimed to evaluate the number of cases required to achieve proficiency by plotting the learning curve of PTNB. METHODS Data were collected from 94 consecutive patients who underwent computed tomography-guided PTNB by a thoracic surgeon at the Affiliated Hospital of Xuzhou Medical University between May 2021 and February 2022. The data collected included patient information, relevant examination results, intraoperative parameters, postoperative complications, and diagnostic results. RESULTS The inflection points of the cumulative sum curve were around cases 13 and 24, according to which three phases were identified, including phase I, phase II, and phase III. A significant downtrend was observed regarding operative time (phase I, 26.53 ± 9.13 min vs. phase III, 18.42 ± 4.29 min, p < 0.05), rate of false-negative (phase I, 15.4% vs. phase III, 5.7%; p < 0.05), rate of pneumothorax (phase I, 30.8% vs. phase III, 12.9%; p < 0.05), and rate of hemoptysis (phase I, 15.4% vs. phase III, 2.9%; p < 0.05). CONCLUSIONS Thirteen cases were accumulated to lay the technical foundation, and 24 cases were required to achieve proficiency. In this study we summarize our own experience and provide specific guidance for young doctors with no experience in biopsy.
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Affiliation(s)
- Tao Hong
- Thoracic Surgery LaboratoryXuzhou Medical UniversityXuzhouChina,Department of Thoracic SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Guijuan Ji
- Department of Respiratory and Critical Care MedicineAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Teng Sun
- Thoracic Surgery LaboratoryXuzhou Medical UniversityXuzhouChina,Department of Thoracic SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Xin Gui
- Department of Thoracic SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Tianyue Ma
- Thoracic Surgery LaboratoryXuzhou Medical UniversityXuzhouChina,Department of Thoracic SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Hao Zhang
- Thoracic Surgery LaboratoryXuzhou Medical UniversityXuzhouChina,Department of Thoracic SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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Duarte A, Corbett M, Melton H, Harden M, Palmer S, Soares M, Simmonds M. EarlyCDT Lung blood test for risk classification of solid pulmonary nodules: systematic review and economic evaluation. Health Technol Assess 2022; 26:1-184. [PMID: 36534989 PMCID: PMC9791464 DOI: 10.3310/ijfm4802] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND EarlyCDT Lung (Oncimmune Holdings plc, Nottingham, UK) is a blood test to assess malignancy risk in people with solid pulmonary nodules. It measures the presence of seven lung cancer-associated autoantibodies. Elevated levels of these autoantibodies may indicate malignant disease. The results of the test might be used to modify the risk of malignancy estimated by existing risk calculators, including the Brock and Herder models. OBJECTIVES The objectives were to determine the diagnostic accuracy, clinical effectiveness and cost-effectiveness of EarlyCDT Lung; and to develop a conceptual model and identify evidence requirements for a robust cost-effectiveness analysis. DATA SOURCES MEDLINE (including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE), EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, EconLit, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, NHS Economic Evaluation Database ( NHS EED ) and the international Health Technology Assessment database were searched on 8 March 2021. REVIEW METHODS A systematic review was performed of evidence on EarlyCDT Lung, including diagnostic accuracy, clinical effectiveness and cost-effectiveness. Study quality was assessed with the quality assessment of diagnostic accuracy studies-2 tool. Evidence on other components of the pulmonary nodule diagnostic pathway (computerised tomography surveillance, Brock risk, Herder risk, positron emission tomography-computerised tomography and biopsy) was also reviewed. When feasible, bivariate meta-analyses of diagnostic accuracy were performed. Clinical outcomes were synthesised narratively. A simulation study investigated the clinical impact of using EarlyCDT Lung. Additional reviews of cost-effectiveness studies evaluated (1) other diagnostic strategies for lung cancer and (2) screening approaches for lung cancer. A conceptual model was developed. RESULTS A total of 47 clinical publications on EarlyCDT Lung were identified, but only five cohorts (695 patients) reported diagnostic accuracy data on patients with pulmonary nodules. All cohorts were small or at high risk of bias. EarlyCDT Lung on its own was found to have poor diagnostic accuracy, with a summary sensitivity of 20.2% (95% confidence interval 10.5% to 35.5%) and specificity of 92.2% (95% confidence interval 86.2% to 95.8%). This sensitivity was substantially lower than that estimated by the manufacturer (41.3%). No evidence on the clinical impact of EarlyCDT Lung was identified. The simulation study suggested that EarlyCDT Lung might potentially have some benefit when considering intermediate risk nodules (10-70% risk) after Herder risk analysis. Two cost-effectiveness studies on EarlyCDT Lung for pulmonary nodules were identified; none was considered suitable to inform the current decision problem. The conceptualisation process identified three core components for a future cost-effectiveness assessment of EarlyCDT Lung: (1) the features of the subpopulations and relevant heterogeneity, (2) the way EarlyCDT Lung test results affect subsequent clinical management decisions and (3) how changes in these decisions can affect outcomes. All reviewed studies linked earlier diagnosis to stage progression and stage shift to final outcomes, but evidence on these components was sparse. LIMITATIONS The evidence on EarlyCDT Lung among patients with pulmonary nodules was very limited, preventing meta-analyses and economic analyses. CONCLUSIONS The evidence on EarlyCDT Lung among patients with pulmonary nodules is insufficient to draw any firm conclusions as to its diagnostic accuracy or clinical or economic value. FUTURE WORK Prospective cohort studies, in which EarlyCDT Lung is used among patients with identified pulmonary nodules, are required to support a future assessment of the clinical and economic value of this test. Studies should investigate the diagnostic accuracy and clinical impact of EarlyCDT Lung in combination with Brock and Herder risk assessments. A well-designed cost-effectiveness study is also required, integrating emerging relevant evidence with the recommendations in this report. STUDY REGISTRATION This study is registered as PROSPERO CRD42021242248. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ana Duarte
- Centre for Health Economics, University of York, York UK
| | - Mark Corbett
- Centre for Reviews and Dissemination, University of York, York UK
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York UK
| | - Marta Soares
- Centre for Health Economics, University of York, York UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York UK
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Yang L, Liang T, Du Y, Guo C, Shang J, Pokharel S, Wang R, Niu G. Nomogram model to predict pneumothorax after computed tomography-guided coaxial core needle lung biopsy. Eur J Radiol 2021; 140:109749. [PMID: 34000599 DOI: 10.1016/j.ejrad.2021.109749] [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: 08/24/2020] [Revised: 03/25/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To develop a predictive model to determine risk factors of pneumothorax in patients undergoing the computed tomography (CT)1-guided coaxial core needle lung biopsy (CCNB). METHODS A total of 489 patients who underwent CCNBs with an 18-gauge coaxial core needle were retrospectively included. Patient characteristics, primary pulmonary disease, target lesion image characteristics and biopsy-related variables were evaluated as potential risk factors of pneumothorax which was determined on the chest X-ray and CT scans. Univariate and multivariate logistic regressions were used to identify the independent risk factors of pneumothorax and establish the predictive model, which was presented in the form of a nomogram. The discrimination and calibration of the model were evaluated as well. RESULTS The incidence of pneumothorax was 32.91 % and 31.42 % in the development and validation groups, respectively. Age, emphysema, pleural thickening, lesion location, lobulation sign, and size grade were identified independent risk factors of pneumothorax at the multivariate logistic regression model. The forming model produced an area under the curve of 0.718 (95 % CI = 0.660-0.776) and 0.722 (95 % CI = 0.638-0.805) in development and validation group, respectively. The calibration curve showed good agreement between predicted and actual probability. CONCLUSIONS The predictive model for pneumothorax after CCNBs had good discrimination and calibration, which could help in clinical practice.
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Affiliation(s)
- Linyun Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Yonghao Du
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Chenguang Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Saugat Pokharel
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Rong Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China.
| | - Gang Niu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, China.
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Endobronchial Navigation Guided by Cone-Beam CT–Based Augmented Fluoroscopy without a Bronchoscope: Feasibility Study in Phantom and Swine. J Vasc Interv Radiol 2020; 31:2122-2131. [DOI: 10.1016/j.jvir.2020.04.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
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Fontana F, Piacentino F, Ierardi AM, Carrafiello G, Coppola A, Muollo A, Beneventi A, Floridi C, Imperatori AS, Carcano G, Venturini M. Comparison Between CBCT and Fusion PET/CT-CBCT Guidance for Lung Biopsies. Cardiovasc Intervent Radiol 2020; 44:73-79. [PMID: 32895781 DOI: 10.1007/s00270-020-02613-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To establish the feasibility of performing percutaneous biopsy of lung lesions guided by fusion PET/CT-CBCT and to evaluate whether the metabolic information provided by a prior PET/CT scan add incremental benefits for diagnosis. METHODS We retrospectively reviewed data from 180 patients who underwent CBCT-guided lung biopsy (group 1-90 cases) or PET/CT-CBCT fusion-guided lung biopsy (group 2-90 cases). Technical and clinical success was calculated. We also evaluated the agreement between biopsy and definitive histology and the possibility to carrying out immunehistochemical and molecular biology analyses. RESULTS Technical success was achieved in 84/90 (93.3%) cases for group 1 and 89/90 (98.9%) for group 2 cases (p 0.054). Clinical success was achieved in 80/94 (95.2%) cases for group 1 and 88/89 (98.9%) cases for group 2. Sensitivity, specificity, positive and negative predictive values and accuracy rate were, respectively, 94.5%, 100.0%, 100.0%, 73.3% and 95.2% for group 1 and 98.6%, 100.0%, 100.0%, 94.4% and 98.9% for group 2 (p 0.167). Agreement between biopsy and definitive histology was reached in 85.7% for group 1 and in 96.2% for group 2 (p 0.211). Immunohistochemical and molecular biology investigations were possible in 66.7% for group 1 and in 77.0% for group 2 (p 0.297). No major complication occurred. CONCLUSIONS PET/CT-CBCT-guided lung biopsy is a feasible technique. In our retrospective case series, we found a higher clinical success rate, but no statistical difference was found.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Via Guicciardini, 9, 21100, Varese, Italy
- Università degli Studi dell'Insubria, Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Via Guicciardini, 9, 21100, Varese, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Via Guicciardini, 9, 21100, Varese, Italy.
| | - Alessandra Muollo
- Radiology Department, Ospedale di Legnano, ASST Ovest Milanese, Legnano, MI, Italy
| | - Alessandro Beneventi
- Diagnostic and Interventional Radiology Department, Ospedale Sant'Anna, ASST Lariana, Como, Italy
| | | | - Andrea Selenito Imperatori
- Università degli Studi dell'Insubria, Varese, Italy
- Thoracic Surgery Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | - Giulio Carcano
- Università degli Studi dell'Insubria, Varese, Italy
- Surgery Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Via Guicciardini, 9, 21100, Varese, Italy
- Università degli Studi dell'Insubria, Varese, Italy
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Mychajlowycz M, Alabousi A, Mironov O. Ultrasound- Versus CT-Guided Subpleural Lung and Pleural Biopsy: An Analysis of Wait Times, Procedure Time, Safety, and Diagnostic Adequacy. Can Assoc Radiol J 2020; 72:883-889. [PMID: 32673070 DOI: 10.1177/0846537120939073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To compare the wait times, safety, and diagnostic adequacy of computed tomography (CT)-guided percutaneous lung biopsies with ultrasound (US) guidance for subpleural lung and pleural lesions. METHODS Consecutive CT- and US-guided biopsies performed at our institution between January 2018 and January 2019 were retrospectively reviewed. Biopsy wait times, lesion size, degree of pleural contact, procedure duration, number of needle passes, complications, and pathologic diagnosis were recorded and compared. RESULTS A total of 158 biopsies of subpleural or pleural-based lesions were reviewed. Forty-three cases utilized US guidance, while 115 cases used CT, 41 with conventional CT (CCT), and 74 with cone-beam CT guidance (CBCT). Overall, the mean lesion maximum axial diameter and length of pleural contact for US-guided biopsies was greater than for CT (4.8 ± 2.6 cm vs 3.2 ± 1.9 cm and 4.0 ± 2.5 cm vs 2.6 ± 1.7 cm, respectively, P < .001). Wait times for US-guided biopsies were significantly shorter than CCT by 10.9 days on average while being equivalent to CBCT. Procedure time was shorter for lesions localized with US than CT (29.5 ± 16.4 minutes vs 37.6 ± 19.5 minutes, P = .007) despite CT using less needle passes per lesion (3.5 ± 1.1 vs 3.1 ± 0.8, P = .034). Sample adequacy was equivalent for both modalities (88% for US and 92% for CT). The frequency of pneumothoraces was similar between US (12%) and CT (15%). CONCLUSION Ultrasound and CT guidance have similar safety and diagnostic adequacy for subpleural lung and pleural biopsies. Ultrasound guidance has shorter wait and procedure times.
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Affiliation(s)
- Mirek Mychajlowycz
- Department of Radiology, 3710McMaster University, Hamilton, Ontario, Canada
| | - Abdullah Alabousi
- Department of Radiology, 3710McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Oleg Mironov
- Department of Radiology, 3710McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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10
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Percutaneous Lung Tumor Biopsy Under CBCT Guidance with PET-CT Fusion Imaging: Preliminary Experience. Cardiovasc Intervent Radiol 2019; 42:1644-1648. [DOI: 10.1007/s00270-019-02270-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022]
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11
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Sakai H, Takeda M. Percutaneous transthoracic needle biopsy of the lung in the era of precision medicine. J Thorac Dis 2019; 11:S1213-S1215. [PMID: 31245089 DOI: 10.21037/jtd.2019.03.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Hitomi Sakai
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
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12
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Ahn SY, Park CM, Yoon SH, Kim H, Goo JM. Learning Curve of C-Arm Cone-beam Computed Tomography Virtual Navigation-Guided Percutaneous Transthoracic Needle Biopsy. Korean J Radiol 2019; 20:844-853. [PMID: 30993935 PMCID: PMC6470078 DOI: 10.3348/kjr.2018.0555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/11/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the learning curve for C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous transthoracic needle biopsy (PTNB) and to determine the amount of experience needed to develop appropriate skills for this procedure using cumulative summation (CUSUM). Materials and Methods We retrospectively reviewed 2042 CBCT virtual navigation-guided PTNBs performed by 7 novice operators between March 2011 and December 2014. Learning curves for CBCT virtual navigation-guided PTNB with respect to its diagnostic performance and the occurrence of biopsy-related pneumothorax were analyzed using standard and risk-adjusted CUSUM (RA-CUSUM). Acceptable failure rates were determined as 0.06 for diagnostic failure and 0.25 for PTNB-related pneumothorax. Results Standard CUSUM indicated that 6 of the 7 operators achieved an acceptable diagnostic failure rate after a median of 105 PTNB procedures (95% confidence interval [CI], 14–240), and 6 of the operators achieved acceptable pneumothorax occurrence rate after a median of 79 PTNB procedures (95% CI, 27–155). RA-CUSUM showed that 93 (95% CI, 39–142) and 80 (95% CI, 38–127) PTNB procedures were required to achieve acceptable diagnostic performance and pneumothorax occurrence, respectively. Conclusion The novice operators' skills in performing CBCT virtual navigation-guided PTNBs improved with increasing experience over a wide range of learning periods.
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Affiliation(s)
- Su Yeon Ahn
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul, Korea.,Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea.
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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13
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Meram E, Longhurst C, Brace CL, Laeseke PF. Comparison of Conventional and Cone-Beam CT for Monitoring and Assessing Pulmonary Microwave Ablation in a Porcine Model. J Vasc Interv Radiol 2018; 29:1447-1454. [PMID: 30217749 DOI: 10.1016/j.jvir.2018.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare cone-beam computed tomography (CT) with conventional CT for assessing the growth and postprocedural appearance of pulmonary microwave ablation zones. MATERIALS AND METHODS A total of 17 microwave ablations were performed in porcine lung in vivo by applying 65 W for 5 minutes through a single 17-gauge antenna. Either CT (n = 8) or CBCT (n = 9) was used for guidance and ablation zone monitoring at 1-minute intervals. Postprocedural noncontrast images were acquired with both modalities. Three independent readers measured the length, width, cross-sectional area, and circularity of the ablation zones on gross tissue samples and CT and cone-beam CT images. The measurements were compared via linear mixed-effects models for postprocedural appearance and with a polynomial mixed effects model for ablation zone growth curves. RESULTS On postprocedural images, the differences between cone-beam CT and CT in mean length (3.84 vs 3.86 cm; Δ = -0.02; P = .70), width (2.61 vs 2.56 cm; Δ = 0.06; P = .46), area (7.84 vs 7.65 cm2; Δ = 0.19; P = .35), and circularity (0.85 vs 0.85; Δ = 0.01; P = .62) were not statistically significant after accounting for intersubject and interrater variability. Also, there was no significant difference between CT and cone-beam CT growth curves of the ablation zones during monitoring in terms of length (pInt. = 1.00; pLin.Slope = 0.52; pQuad.Slope = 0.69); width (pInt. = 0.83; pLin.Slope = 0.98; pQuad.Slope = 0.79), area (pInt. = 0.47; pLin.Slope = 0.27; pQuad.Slope = 0.57), or circularity (pInt. = 0.54; pLin.Slope = 0.74; pQuad.Slope = 0.80). Both CT and cone-beam CT overestimated gross pathologic observations of ablation length, width, and area (P < .001 for all). CONCLUSIONS Cone-beam CT was similar to conventional CT when assessing the growth, final size, and shape of pulmonary microwave ablation zones and may be useful for monitoring and evaluating microwave ablations in the lung.
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Affiliation(s)
- Ece Meram
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, D4-352, Madison, WI 53792.
| | - Colin Longhurst
- Department of Radiology, and Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Chris L Brace
- Tumor Ablation Laboratory, University of Wisconsin, Madison, Wisconsin
| | - Paul F Laeseke
- Section of Interventional Radiology, University of Wisconsin, Madison, Wisconsin
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14
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Su N, Chen XC, Zhang YQ, Liu M, He D. A Formula for Calculating Deviation of Computed Tomography-Guided Puncture Point. Chin Med J (Engl) 2018; 131:2119-2121. [PMID: 30127225 PMCID: PMC6111675 DOI: 10.4103/0366-6999.239303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Na Su
- Department of Radiology, The 117 Hospital of the Chinese People's Liberation Army, Hangzhou, Zhejiang 310013; Major in Imaging and Nuclear Medicine, School of the 1st Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Xing-Can Chen
- Department of Radiology, The 117 Hospital of the Chinese People's Liberation Army, Hangzhou, Zhejiang 310013, China
| | - Yong-Qiang Zhang
- Department of Radiology, The 117 Hospital of the Chinese People's Liberation Army, Hangzhou, Zhejiang 310013, China
| | - Miao Liu
- Department of Radiology, The 117 Hospital of the Chinese People's Liberation Army, Hangzhou, Zhejiang 310013, China
| | - Dong He
- Department of Radiology, The 117 Hospital of the Chinese People's Liberation Army, Hangzhou, Zhejiang 310013, China
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15
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Zhou Q, Dong J, He J, Liu D, Tian DH, Gao S, Li S, Liu L, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Tan L, Li D, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Casal RF, Pompeo E, Carretta A, Riquet M, Rena O, Falcoz PE, Saji H, Khan AZ, Danguilan JL, Gonzalez-Rivas D, Guibert N, Zhu C, Shen J. The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer. J Thorac Dis 2018; 10:5538-5544. [PMID: 30416804 DOI: 10.21037/jtd.2018.09.28] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingsi Dong
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming 650100, China
| | - Shidong Xu
- Department of Thoracic surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450000, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marc Riquet
- Georges Pompidou European Hospital, General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Ottavio Rena
- Thoracic Surgery Unit, University of Eastern Piedmont, AOU Maggiore della Carità, Vercelli, Italy
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ali Zamir Khan
- Department of Minimally Invasive Thoracic Surgery, Medanta The Medicity, Gurgaon, India
| | - Jose Luis Danguilan
- Lung Center of the Philippines, Quezon City, Philippines, USA.,University of the Philippines College of Medicine, Manila, Philippines, USA
| | | | - Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Chengchu Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
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16
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Jeon MC, Kim JO, Jung SS, Park HS, Lee JE, Moon JY, Chung CU, Kang DH, Park DI. CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy. Tuberc Respir Dis (Seoul) 2018; 81:330-338. [PMID: 29926547 PMCID: PMC6148095 DOI: 10.4046/trd.2017.0123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/16/2018] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system. METHODS We retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016. RESULTS There were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively. CONCLUSION The additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.
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Affiliation(s)
- Min Cheol Jeon
- Department of Radiology, Daejeon Health Institute of Technology, Daejeon, Korea
| | - Ju Ock Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sung Soo Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hee Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jeong Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Chae Uk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dong Il Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
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17
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Fang HY, Chao YK, Hsieh MJ, Wen CT, Ho PH, Tang WJ, Liu YH. Image-guided video-assisted thoracoscopic surgery for small ground glass opacities: a case series. J Vis Surg 2017; 3:142. [PMID: 29302418 DOI: 10.21037/jovs.2017.09.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
Background This case series demonstrated the feasibility of the image-guided video-assisted thoracoscopic surgery (iVATS) for localization and removal of ground glass opacities (GGOs). The procedure was performed in a hybrid operating room (OR) using C-arm cone-beam computed tomography (CBCT) equipped with a laser-guided navigation system. Methods Between October 1st 2016 to July 31st 2017, 14 consecutive patients presenting with GGOs underwent iVATS procedure. The efficacy and safety of the procedure were assessed through a retrospective chart review. Results The median GGOs size was 7 mm [interquartile range (IQR): 4-10 mm] with a median depth-to-size (D-S) ratio of 1.16 (IQR: 0-2.3). All of the lesions were visible on intraoperative CBCT images and localizations were successful in all patients with a median localization time of 22 min (IQR: 16-44 min). No patient required a conversion to thoracotomy. There was no operative mortality and the median length of postoperative stay was 4 days (IQR: 3-6 days). The final pathological diagnoses were as follows: primary lung cancer (n=6), lung metastases (n=2), and benign lung lesions (n=6). Conclusions Our study suggests the iVATS could be a helpful tool for single-stage detection and removal of GGOs.
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Affiliation(s)
- Hsin-Yueh Fang
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Tsung Wen
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Hsuan Ho
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Jiun Tang
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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