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Ortmans S, de Oliveira F, Serrand C, Kammoun T, Greffier J, Dabli D, de Forges H, Rieux C, Beregi JP, Frandon J. Proposal for a computed tomography score to predict major complications requiring hospitalization after percutaneous lung biopsy: a single-center retrospective study. Quant Imaging Med Surg 2024; 14:6830-6842. [PMID: 39281132 PMCID: PMC11400643 DOI: 10.21037/qims-23-500] [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: 04/28/2023] [Accepted: 12/12/2023] [Indexed: 09/18/2024]
Abstract
Background Image-guided percutaneous lung biopsy (PLB) may lead to major complications requiring hospitalization. This study aims to evaluate the rate of major PLB complications and determine a predictive computed tomography (CT) score to define patients requiring hospitalization due to these complications. Methods This single-center retrospective study included all PLBs performed from July 2019 to December 2020 in Nimes University Hospital, France. Patients who were undergoing thermo-ablation during the same procedure or for whom PLB procedure data were not available were excluded. All major complications leading to hospitalization were recorded. A Percutaneous Image-guided Lung biopsy In/out Patient score (PILIP) based on variables significantly associated with major complications was calculated by multivariate analysis. Results A total of 240 consecutive patients (160 men, 80 women; mean age: 67.3±10.5 years) were included. The major complication rate was 10.4%. Length of lung parenchyma traversed <20 vs. 20-40 mm [P=0.017, odds ratio (OR) =5.02; 95% confidence interval (CI): 1.33-18.92] and vs. >40 mm (P=0.010, OR =6.15; 95% CI: 1.54-24.53), middle vs. superior lobar location (P=0.011, OR =6.34; 95% CI: 1.53-26.31), emphysema along the needle pathway (P<0.0001, OR =10.96; 95% CI: 3.61-33.28), and pleural/scissural attraction (P=0.023, OR =3.50; 95% CI: 1.19-10.32) were independently associated with major complications. Based on these parameters, the PILIP made it possible to differentiate low-risk patients (PILIP <4) from those at high risk (PILIP ≥4) of major complications with 0.40 sensitivity (95% CI: 0.21-0.59), 0.95 specificity (95% CI: 0.93-0.98), a positive predictive value of 0.50 (95% CI: 0.28-0.72) and a negative predictive value of 0.93 (95% CI: 0.90-0.97). Conclusions PLB showed a major complication rate of 10.4%. The PILIP is an easy-to-use CT score for differentiating patients at a low or high risk of complications requiring hospitalization.
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Affiliation(s)
- Satcha Ortmans
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Fabien de Oliveira
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), Hospital University Center, Nîmes, France
| | - Tarek Kammoun
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Joel Greffier
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Djamel Dabli
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Hélène de Forges
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Cécile Rieux
- Department of Pneumology, Hospital University Center of Nîmes, Hôpital Caremeau, Rue du Pr Debré, Nîmes Cedex, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Julien Frandon
- Department of Medical Imaging, PRIM Platform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
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Yang H, Zhang Y, Gong Y, Zhang J, He L, Zhong J, Tang L. A lung biopsy path planning algorithm based on the double spherical constraint Pareto and indicators' importance-correlation degree. Comput Med Imaging Graph 2024; 117:102426. [PMID: 39288579 DOI: 10.1016/j.compmedimag.2024.102426] [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: 05/26/2024] [Revised: 08/25/2024] [Accepted: 08/25/2024] [Indexed: 09/19/2024]
Abstract
Lung cancer has the highest mortality rate among cancers. The commonly used clinical method for diagnosing lung cancer is the CT-guided percutaneous transthoracic lung biopsy (CT-PTLB), but this method requires a high level of clinical experience from doctors. In this work, an automatic path planning method for CT-PTLB is proposed to provide doctors with auxiliary advice on puncture paths. The proposed method comprises three steps: preprocessing, initial path selection, and path evaluation. During preprocessing, the chest organs required for subsequent path planning are segmented. During the initial path selection, a target point selection method for selecting biopsy samples according to biopsy sampling requirements is proposed, which includes a down-sampling algorithm suitable for different nodule shapes. Entry points are selected according to the selected target points and clinical constraints. During the path evaluation, the clinical needs of lung biopsy surgery are first quantified as path evaluation indicators and then divided according to their evaluation perspective into risk and execution indicators. Then, considering the impact of the correlation between indicators, a path scoring system based on the double spherical constraint Pareto and the importance-correlation degree of the indicators is proposed to evaluate the comprehensive performance of the planned paths. The proposed method is retrospectively tested on 6 CT images and prospectively tested on 25 CT images. The experimental results indicate that the method proposed in this work can be used to plan feasible puncture paths for different cases and can serve as an auxiliary tool for lung biopsy surgery.
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Affiliation(s)
- Hui Yang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China.
| | - Yu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China.
| | - Yuhang Gong
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China.
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China.
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China.
| | - Jianquan Zhong
- Department of Radiology, Zigong First People's Hospital, Zigong 643000, China.
| | - Ling Tang
- Department of Radiology, Zigong First People's Hospital, Zigong 643000, China.
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Leonhardi J, Dahms U, Schnarkowski B, Struck MF, Höhn AK, Krämer S, Ebel S, Prasse G, Frille A, Denecke T, Meyer HJ. Impact of radiomics features, pulmonary emphysema score and muscle mass on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies. Respir Res 2024; 25:320. [PMID: 39174980 PMCID: PMC11340115 DOI: 10.1186/s12931-024-02936-6] [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: 08/01/2024] [Indexed: 08/24/2024] Open
Abstract
Iatrogenic pneumothorax is a relevant complication of computed tomography (CT)-guided percutaneous lung biopsy. The aim of the present study was to analyze the prognostic significance of texture analysis, emphysema score and muscle mass derived from CT-imaging to predict postinterventional pneumothorax after CT-guided lung biopsy. Consecutive patients undergoing CT-guided percutaneous lung biopsy between 2012 and 2021 were analyzed. Multivariate logistic regression analysis included clinical risk factors and CT-imaging features to detect associations with pneumothorax development. Overall, 479 patients (178 females, mean age 65 ± 11.7 years) underwent CT-guided percutaneous lung biopsy of which 180 patients (37.5%) developed pneumothorax including 55 patients (11.5%) requiring chest tube placement. Risk factors associated with pneumothorax were chronic-obstructive pulmonary disease (COPD) (p = 0.03), age (p = 0.02), total lung capacity (p < 0.01) and residual volume (p = 0.01) as well as interventional parameters needle length inside the lung (p < 0.001), target lesion attached to pleura (p = 0.04), and intervention duration (p < 0.001). The combined model demonstrated a prediction accuracy of the occurrence of pneumothorax with an AUC of 0.78 [95%CI: 0.70-0.86] with a resulting sensitivity 0.80 and a specificity of 0.66. In conclusion, radiomics features of the target lesion and the lung lobe CT-emphysema score are predictive for the occurrence of pneumothorax and need for chest insertion after CT-guided lung biopsy.
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Affiliation(s)
- Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Ulrike Dahms
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Benedikt Schnarkowski
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Sebastian Krämer
- Department of Thoracic Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Gordian Prasse
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Armin Frille
- Department of Respiratory Medicine, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany.
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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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Tsai SCS, Wu TC, Lin FCF. Optimizing Precision: A Trajectory Tract Reference Approach to Minimize Complications in CT-Guided Transthoracic Core Biopsy. Diagnostics (Basel) 2024; 14:796. [PMID: 38667442 PMCID: PMC11048995 DOI: 10.3390/diagnostics14080796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The advent of computed tomography (CT)-guided transthoracic needle biopsy has significantly advanced the diagnosis of lung lesions, offering a minimally invasive approach to obtaining tissue samples. However, the technique is not without risks, including pneumothorax and hemorrhage, and it demands high precision to ensure diagnostic accuracy while minimizing complications. This study introduces the Laser Angle Guide Assembly (LAGA), a novel device designed to enhance the accuracy and safety of CT-guided lung biopsies. We retrospectively analyzed 322 CT-guided lung biopsy cases performed with LAGA at a single center over seven years, aiming to evaluate its effectiveness in improving diagnostic yield and reducing procedural risks. The study achieved a diagnostic success rate of 94.3%, with a significant reduction in the need for multiple needle passes, demonstrating a majority of biopsies successfully completed with a single pass. The incidence of pneumothorax stood at 11.1%, which is markedly lower than the reported averages, and only 0.3% of cases necessitated chest tube placement, underscoring the safety benefits of the LAGA system. These findings underscore the potential of LAGA to revolutionize CT-guided lung biopsies by enhancing procedural precision and safety, making it a valuable addition to the diagnostic arsenal against pulmonary lesions.
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Affiliation(s)
- Stella Chin-Shaw Tsai
- Superintendent Office, Taichung MetroHarbor Hospital, Taichung 43503, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Tzu-Chin Wu
- Department of Pulmonary Medicine, Chung Shan University Hospital, Taichung 40201, Taiwan;
| | - Frank Cheau-Feng Lin
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Koratala A, Chandra NC, Balasubramanian P, Yu Lee-Mateus A, Barrios-Ruiz A, Garza-Salas A, Bowman A, Grage R, Fernandez-Bussy S, Abia-Trujillo D. Diagnostic Accuracy of a Computed Tomography-Guided Transthoracic Needle Biopsy for Ground-Glass Opacities and Subsolid Pulmonary Nodules. Cureus 2024; 16:e57414. [PMID: 38694634 PMCID: PMC11061815 DOI: 10.7759/cureus.57414] [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: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Purpose The increasing use of computed tomography (CT) imaging has led to the detection of more ground-glass nodules (GGNs) and subsolid nodules (SSNs), which may be malignant and require a biopsy for proper diagnosis. Approximately 75% of persistent GGNs can be attributed to adenocarcinoma in situ or minimally invasive adenocarcinoma. A CT-guided biopsy has been proven to be a reliable procedure with high diagnostic performance. However, the diagnostic accuracy and safety of a CT-guided biopsy for GGNs and SSNs with solid components ≤6 mm are still uncertain. The aim of this study is to assess the diagnostic accuracy of a CT-guided core needle biopsy (CNB) for GGN and SSNs with solid components ≤6 mm. Methods This is a retrospective study of patients who underwent CT-guided CNB for the evaluation of GGNs and SSNs with solid components ≤6 mm between February 2020 and January 2023. Biopsy findings were compared to the final diagnosis determined by definite histopathologic examination and clinical course. Results A total of 22 patients were enrolled, with a median age of 74 years (IQR: 68-81). A total of 22 nodules were assessed, comprising 15 (68.2%) SSNs with a solid component measuring ≤6 mm and seven (31.8%) pure GGNs. The histopathological examination revealed that 12 (54.5%) were diagnosed as malignant, nine (40.9%) as benign, and one (4.5%) as non-diagnostic. The overall diagnostic accuracy and sensitivity for malignancy were 86.36% and 85.7%, respectively. Conclusion A CT-guided CNB for GGNs and SSNs with solid components measuring ≤6 mm appears to have a high diagnostic accuracy.
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Affiliation(s)
- Anoop Koratala
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | - Nikitha C Chandra
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | | | | | | | - Ana Garza-Salas
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Rolf Grage
- Radiology, Mayo Clinic, Jacksonville, USA
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WANG X, ZHANG H, ZHANG X. [Analysis of Influencing Factors of Complications for CT-guided
Percutaneous Lung Biopsy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:179-186. [PMID: 38590192 PMCID: PMC11002188 DOI: 10.3779/j.issn.1009-3419.2024.101.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Computed tomography guided percutaneous lung biopsy (CT-PLB) is a widely used method for the diagnosis of lung lesions. However, it is invasive, and the most common complications are pneumothorax and pulmonary hemorrhage, which can be life-threatening in severe cases. Therefore, the aim of this study is to analyze the independent risk factors affecting the occurrence of different complications of CT-PLB, so as to reduce the incidence of complications. METHODS The 605 patients with complete clinical data who underwent CT-PLB in our hospital from May 2018 to December 2019 were retrospectively analyzed. According to the location of the lesions, they were divided into subpleural group and non-subpleural group. The patients were divided into pneumothorax group, pulmonary hemorrhage group, pneumothorax with pulmonary hemorrhage group and non-pneumothorax/pulmonary hemorrhage group according to the complications. The risk factors affecting the incidence of different complications and the independent risk factors of each complication were analyzed. RESULTS The incidence of pneumothorax was 34.1%, the incidence of pulmonary hemorrhage was 28.1%, and the incidence of pneumothorax complicated with pulmonary hemorrhage was 10.8% (63 cases). The independent risk factor affecting the incidence of subpleural pneumothorax was lesion size (P=0.002). The independent risk factors affecting the occurrence of pneumothorax in the non-subpleural group were plain scan CT value (P=0.035), length of needle through lung tissue (P=0.003), and thickness of needle through chest wall (P=0.020). Independent risk factors affecting the occurrence of pulmonary hemorrhage in the non-subpleural group were length of needle through lung tissue (P<0.001), △CT value of needle travel area (P=0.001), lesion size (P=0.034) and body position (P=0.014). The independent risk factors affecting the co-occurrence of pneumothorax and pulmonary hemorrhage were the length of needle through lung tissue (P<0.001) and the △CT value of needle travel area (P<0.001). CONCLUSIONS CT-PLB is a safe and effective diagnostic method, which of high diagnostic value for lung lesions. Selecting the appropriate puncture program can reduce complications such as pneumothorax and pulmonary hemorrhage, and improve diagnosis and treatment efficiency.
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Grange R, Di Bisceglie M, Habert P, Resseguier N, Sarkissian R, Ferre M, Dassa M, Grange S, Izaaryene J, Piana G. Evaluation of preventive tract embolization with standardized gelatin sponge slurry on chest tube placement rate after CT-guided lung biopsy: a propensity score analysis. Insights Imaging 2023; 14:212. [PMID: 38015340 PMCID: PMC10684456 DOI: 10.1186/s13244-023-01566-8] [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: 06/14/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND To evaluate the effect of tract embolization (TE) with gelatin sponge slurries during a percutaneous lung biopsy on chest tube placement and to evaluate the predictive factors of chest tube placement. METHODS Percutaneous CT-guided lung biopsies performed with (TE) or without (non-TE) tract embolization or between June 2012 and December 2021 at three referral tertiary centers were retrospectively analyzed. The exclusion criteria were mediastinal biopsies, pleural tumors, and tumors adjacent to the pleura without pleural crossing. Variables related to patients, tumors, and procedures were collected. Univariable and multivariable analyses were performed to determine risk factors for chest tube placement. Furthermore, the propensity score matching analysis was adopted to yield a matched cohort. RESULTS A total of 1157 procedures in 1157 patients were analyzed, among which 560 (48.4%) were with TE (mean age 66.5 ± 9.2, 584 men). The rates of pneumothorax (44.9% vs. 26.1%, respectively; p < 0.001) and chest tube placement (4.8% vs. 2.3%, respectively; p < 0.001) were significantly higher in the non-TE group than in the TE group. No non-targeted embolization or systemic air embolism occurred. In the whole population, two protective factors for chest tube placement were found in univariate analysis: TE (OR 0.465 [0.239-0.904], p < 0.05) and prone position (OR 0.212 [0.094-0.482], p < 0.001). These data were confirmed in multivariate analysis (p < 0.001 and p < 0.0001 respectively). In the propensity matched cohort, TE reduces significatively the risk of chest tube insertion (OR = 0.44 [0.21-0.87], p < 0.05). CONCLUSIONS The TE technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy. CRITICAL RELEVANCE STATEMENT The tract embolization technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy. KEY POINTS 1. Use of tract embolization with gelatine sponge slurry during percutaneous lung biopsy is safe. 2. Use of tract embolization significantly reduces the risk of chest tube insertion. 3. This is the first multicenter study to show the protective effect of tract embolization on chest tube insertion.
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Affiliation(s)
- Rémi Grange
- Department of Interventional Radiology, University Hospital of Saint-Etienne, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Mathieu Di Bisceglie
- Department of Interventional Radiology, Institut Paoli Calmettes, Marseille, France
| | - Paul Habert
- Department of Imaging, Hospital Nord, Marseille, APHM, Aix Marseille University, Marseille, France
- Aix Marseille Univ, LIIE, Marseille, France
| | - Noémie Resseguier
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- CEReSS- Health Services and Quality of Research, Aix Marseille University, Marseille, France
| | - Robin Sarkissian
- Department of Interventional Radiology, University Hospital of Saint-Etienne, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Marjorie Ferre
- Department of Interventional Radiology, Institut Paoli Calmettes, Marseille, France
| | - Michael Dassa
- Department of Interventional Radiology, Institut Paoli Calmettes, Marseille, France
| | - Sylvain Grange
- Department of Interventional Radiology, University Hospital of Saint-Etienne, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Jean Izaaryene
- Department of Interventional Radiology, Institut Paoli Calmettes, Marseille, France
| | - Gilles Piana
- Department of Interventional Radiology, Institut Paoli Calmettes, Marseille, France
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Yu Lee-Mateus A, Abia-Trujillo D, Edell ES, Chadha R, Hazelett BN, Fernandez-Bussy S. Shape-Sensing Robotic Bronchoscopy Live Images of Advanced Emphysema and Pulmonary Nodule. Respiration 2023; 102:632-634. [PMID: 37423210 DOI: 10.1159/000531298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
| | - David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Britney N Hazelett
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Polat G, Özdemir Ö, Serçe Unat D, Karadeniz G, Ayrancı A, Unat ÖS, Büyükşirin M, Maviş A, Yazgan S. Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients. Tuberk Toraks 2023; 71:67-74. [PMID: 36912411 PMCID: PMC10795232 DOI: 10.5578/tt.20239909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Introduction The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB). Materials and Methods Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumothorax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was placed, and when patients who did not require chest tube placement were discharged. Result CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 ± 5.57). Conclusions This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours.
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Affiliation(s)
- Gülru Polat
- Department of Thoracic Diseases, Health Sciences University Faculty of Medicine, İzmir, Türkiye
| | - Özer Özdemir
- Clinic of Thoracic Diseases, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Türkiye
| | - Damla Serçe Unat
- Clinic of Thoracic Diseases, İzmir Kemalpaşa State Hospital, İzmir, Türkiye
| | - Gülistan Karadeniz
- Department of Thoracic Diseases, Health Sciences University Faculty of Medicine, İzmir, Türkiye
| | - Aysu Ayrancı
- Clinic of Thoracic Diseases, Çiğli Training and Research Hospital, University of İzmir Bakırçay, İzmir, Türkiye
| | - Ömer Selim Unat
- Department of Thoracic Diseases, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Melih Büyükşirin
- Clinic of Thoracic Diseases, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Türkiye
| | - Ahmet Maviş
- Clinic of Radiology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Türkiye
| | - Serkan Yazgan
- Clinic of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Türkiye
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11
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Fall D, Smith T, Prazak AM, Cizman Z, Iravani A. Acute decompensation of patient following an outpatient CT-guided needle biopsy: A case report. Radiol Case Rep 2023; 18:1261-1263. [PMID: 36691413 PMCID: PMC9860268 DOI: 10.1016/j.radcr.2022.12.052] [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: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023] Open
Abstract
A 74-year-old female with history of type 2 diabetes, hypertension, and uterine adenocarcinoma presented for CT-guided lung biopsy that was ultimately complicated by an arterial air embolus requiring intensive care. Systemic air embolism is a very rare event but can be devastating. Prompt recognition can be difficult due to an often-vague presentation but is essential and should be considered upon rapid deterioration of a patient's status following high risk procedures. Hyperbaric oxygen therapy is preferred; however, if this is unavailable, additional treatments are predominately supportive care with 100% supplemental oxygen, rapid volume expansion, and ionotropic medications as needed.
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Affiliation(s)
- Danielle Fall
- Department of Internal Medicine, Devision of Pulmonology and Critical Care Medicine, University of Utah School of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Tyler Smith
- Department of Interventional Radiology, University of Utah School of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132, USA,Corresponding author.
| | - Ann Marie Prazak
- Department of Pharmacy Services, University of Utah Health, University of Utah School of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Ziga Cizman
- Department of Interventional Radiology, University of Utah School of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Aidin Iravani
- Department of Internal Medicine, Devision of Pulmonology and Critical Care Medicine, University of Utah School of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132, USA
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12
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Efficacy and Safety Analysis of Multislice Spiral CT-Guided Transthoracic Lung Biopsy in the Diagnosis of Pulmonary Nodules of Different Sizes. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8192832. [PMID: 36060660 PMCID: PMC9436531 DOI: 10.1155/2022/8192832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
Objective This study is aimed at investigating the efficacy and safety of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different sizes. Methods Data of 78 patients with pulmonary nodules who underwent CT-guided transthoracic lung biopsy in our hospital from January 2020 to December 2021 were retrospectively analyzed, and they were divided into the small nodules group (n = 12), medium nodules group (n = 35), and large nodules group (n = 31) according to the diameter of pulmonary nodules. The results of puncture biopsy and final diagnosis of pulmonary nodules of different sizes were compared. The incidence of complications in patients with pulmonary nodules of different sizes was compared. Univariate analysis was used to compare the incidence of complications in 78 patients. Logistic multiple regression analysis was used to analyze the independent risk factors of pneumothorax in patients with pulmonary nodule puncture. Logistic multiple regression analysis was used to analyze the independent risk factors of pulmonary hemorrhage in patients with pulmonary nodule puncture. Results The diagnostic accuracy, sensitivity, and specificity were 83.33%, 100.00%, and 77.78% in small nodules group. The diagnostic accuracy, sensitivity, and specificity of medium nodules group were 85.71%, 100.00%, and 73.68%, respectively. The diagnostic accuracy, sensitivity, and specificity of large nodules group were 93.55%, 100.00%, and 33.33%, respectively. There was no significant difference in the incidence of pneumothorax among the three groups (P > 0.05). The incidence of pulmonary hemorrhage in small nodule group was higher than that in the medium nodule group and large nodule group, and the difference was statistically significant (P < 0.05). There was no significant difference in the incidence of total complications among the three groups (P > 0.05). There were statistically significant differences in clinical data such as the needle tract length, the puncture position, and the distance of the puncture needle passing through the lung tissue in patients with or without pneumothorax (P < 0.05). There were statistically significant differences in needle tract length, distance of puncture needle passing through lung tissue, and size of pulmonary nodules in patients with or without pulmonary hemorrhage (P > 0.05). Logistic multivariate analysis showed that needle tract length ≤ 50 mm, lateral decubitus position, and the distance of puncture needle passing through lung tissue ≥ 14 mm were independent risk factors for pneumothorax after puncture in patients with pulmonary nodules (P < 0.05). The needle tract length > 50 mm, the distance of puncture needle passing through lung tissue ≥ 14 mm, and small nodules (pulmonary nodules diameter ≤ 10 mm) were independent risk factors for pulmonary hemorrhage after puncture in patients with pulmonary nodules (P < 0.05). Conclusion Multislice spiral CT-guided transthoracic lung biopsy is effective in diagnosing pulmonary nodules of different sizes.
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Wang N, Xu J, Wang G, Xue G, Li Z, Cao P, Hu Y, Cai H, Wei Z, Ye X. Safety and efficacy of microwave ablation for lung cancer adjacent to the interlobar fissure. Thorac Cancer 2022; 13:2557-2565. [PMID: 35909365 PMCID: PMC9475226 DOI: 10.1111/1759-7714.14589] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background This retrospective study aimed to assess the safety and efficacy of microwave ablation for lung tumors adjacent to the interlobar fissures. Methods From May 2020 to April 2021, 59 patients with 66 lung tumors (mean diameter, 16.9 ± 7.7 mm; range, 6–30 mm) adjacent to the interlobar fissures who underwent microwave ablation at our institution were identified and included in this study. Based on the relationship between the tumor and the interlobar fissure, tumors can be categorized into close to the fissure, causing the fissure, and involving the fissure. The complete ablation rate, local progression‐free survival, complications, and associated factors were analyzed. Results All 66 histologically proven tumors were treated using computed tomography‐guided microwave ablation. The complete ablation rate was 95.5%. Local progression‐free survival at 3, 6, 9, and 12 months were 89.4%, 83.3%, 74.2%, and 63.6%, respectively. The complications included pneumothorax (34.8%), pleural effusion (24.2%), cavity (18.2%), and pulmonary infection (7.6%). There were statistical differences in the incidence of pneumothorax, cavity, and delayed complications between the groups with and without antenna punctures through the fissure. Conclusions Microwave ablation is a safe and effective treatment for lung tumor adjacent to the interlobar fissure. Antenna puncturing though the interlobar fissure may be a potential risk factor for pneumothorax, cavity, and delayed complications.
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Affiliation(s)
- Nan Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Jingwen Xu
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, China
| | - Gang Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Guoliang Xue
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Zhichao Li
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Pikun Cao
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Yanting Hu
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Hongchao Cai
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
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Zhou S, Luo F, Gu M, Lu X, Xu Y, Wu R, Xiong J, Ran X. Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy. Clin Radiol 2022; 77:e673-e679. [PMID: 35788268 DOI: 10.1016/j.crad.2022.05.019] [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: 03/27/2022] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/03/2022]
Abstract
AIM To determine whether the injection of haemocoagulase into the biopsy tract can reduce pneumothorax and pulmonary haemorrhage after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). MATERIALS AND METHODS A retrospective study was performed involving patients with undiagnosed pulmonary lesions scheduled for PTLB between January 2020 and March 2021. Patients were assigned to the haemocoagulase group or the non-haemocoagulase group. After CT-guided biopsies were performed with a 17 G coaxial system, patients in the haemocoagulase group received a haemocoagulase injection (0.2-0.5 units) in the biopsy tract as the sheath was withdrawn. Postoperative image studies were performed to evaluate complications, including pneumothorax and pulmonary haemorrhage. Factors, including the patient's position, lesion location, and pathological results, were evaluated to determine their associations with the complications. RESULTS A total of 100 patients were included, with 44 men and a mean age of 53 years old. The overall incidences of pneumothorax and pulmonary haemorrhage were 15% and 13%, respectively. The incidences of pneumothorax and pulmonary haemorrhage were statistically significantly lower in the haemocoagulase group (8% and 6%, respectively) than in the non-haemocoagulase group (22% and 20%, respectively; p=0.04 and 0.03, respectively). There was no statistically significant difference in haemoptysis between the haemocoagulase (6%) and non-haemocoagulase (2%) groups (p=0.23). There were also no statistically significant associations of pneumothorax or pulmonary haemorrhage with the patients' positions, lesion location, or pathological results. CONCLUSION Biopsy tract haemocoagulase injection reduced the incidences of postoperative pneumothorax and pulmonary haemorrhage after PTLB.
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Affiliation(s)
- S Zhou
- Department of Radiology, Chongqing General Hospital, Chongqing 400014, China
| | - F Luo
- Department of Gastroenterology, The Chongqing Traditional Chinese Medicine Hospital, Chongqing Academy of Traditional Chinese Medicine, Chongqing 400021, China
| | - M Gu
- Department of Radiology, Chongqing General Hospital, Chongqing 400014, China
| | - X Lu
- Department of Radiology, Chongqing General Hospital, Chongqing 400014, China
| | - Y Xu
- Department of Radiology, Chongqing General Hospital, Chongqing 400014, China
| | - R Wu
- Department of Radiology, Chongqing General Hospital, Chongqing 400014, China
| | - J Xiong
- Institute of Higher Education, Chongqing Medical and Pharmaceutical College, Chongqing 401334, China
| | - X Ran
- Department of Radiology, Chongqing General Hospital, Chongqing 400014, China.
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Roson N, Antolin A, Mast R, Sanchéz-Tirado C, Griñón J, Andreu J, Perez Lafuente M, Tomasello A, Escobar M. Experience and results after the implementation of a radiology day unit in a reference hospital. Insights Imaging 2022; 13:109. [PMID: 35767122 PMCID: PMC9243205 DOI: 10.1186/s13244-022-01251-2] [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: 04/17/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Interventional radiological procedures have significantly increased in recent years. Most of them are minimally invasive and require a short hospitalization, mainly done in other non-radiological units nowadays. Limited bed availability and high occupancy rates in these units create longer waiting lists and cancellations. The aim of this retrospective study is to assess the creation and functioning of a Radiology Day Unit (RDU) and evaluating its outcomes. For this purpose, data about interventional procedures and its complications, incidents, patient safety, quality and satisfaction rates were collected from May 2018 to December 2020, and posteriorly analyzed to evaluate its implementation. Results During the assessed period, 3841 patients were admitted into the RDU, with a net increase of 13% and 26% in the second and third year, respectively. Procedures performed by the Abdominal Radiology section were the most frequent (76–85%) followed by Interventional Vascular Radiology and Thoracic Radiology. Complication rates were low (1.5%) and most of them were self-limited and managed in the own department. Waiting lists were significantly reduced, from 2 months to 1 week in case of procedures performed by the Abdominal Radiology section. Patient satisfaction was higher than 80% in all the items evaluated with a global satisfaction of 93%. Conclusion The RDU in our hospital has become a vital section for the management and post-procedure caring of patients undergoing interventional procedures in the Radiology Service with low complication rates and overall high levels of quality and patient safety, allowing the reduction of waiting lists and occupancy rates.
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Affiliation(s)
- Nuria Roson
- Department of Radiology, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Andreu Antolin
- Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Richard Mast
- Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Cristina Sanchéz-Tirado
- Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jesús Griñón
- Department of Radiology, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jordi Andreu
- Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Mercedes Perez Lafuente
- Department of Radiology, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Radiology, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Manuel Escobar
- Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Grange R, Sarkissian R, Bayle-Bleuez S, Tissot C, Tiffet O, Barral FG, Flaus A, Grange S. Preventive tract embolization with gelatin sponge slurry is safe and considerably reduces pneumothorax after CT-guided lung biopsy with use of large 16-18 coaxial needles. Br J Radiol 2022; 95:20210869. [PMID: 34986006 PMCID: PMC10993978 DOI: 10.1259/bjr.20210869] [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: 07/20/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy. METHODS We retrospectively compared coaxial needle CT-guided lung biopsies performed without embolization (100 patients) and with the tract embolization technique using a mixture of iodine and gelatin sponge slurry (105 patients) between June 2012 and July 2020. Uni- and multivariate analyses were performed between groups to determine risk factors of pneumothorax. RESULTS Patients with gelatin sponge slurry tract embolization had statistically lower rates of pneumothorax ((17.1% vs 39%, p < 0.001). In univariate analysis, tract embolization (OR = 0.32, CI = 0.17-0.61 p<0.001) and nodule size >2 cm (OR = 0.33 CI = 0.14-0.8 p = 0.013) had a protective effect on pneumothorax. The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax (OR = 3.35 IC = 1.44-8.21 p = 0.006 and OR = 4.36 CI = 1.98-10.29 p<0.001, respectively). In multivariate regression analysis, tract embolization had a protective effect of pneumothorax (OR = 0.25, CI = 0.12-0.51, p < 0.001). The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax (p = 0.030 and p = 0.002, respectively). CONCLUSIONS The tract embolization technique using iodinated gelatin sponge slurry is safe and considerably reduces pneumothorax after percutaneous CT-guided lung biopsy. Our results suggest that it could be use in clinical routine. ADVANCES IN KNOWLEDGE The systemic use of gelatin sponge slurry is safe and reduces considerably the rate of pneumothorax upon needle removal when CT-guided core biopsies are performed using large 16-18G coaxial needles.
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Affiliation(s)
- Rémi Grange
- Department of Radiology, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Robin Sarkissian
- Department of Radiology, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Sophie Bayle-Bleuez
- Department of Pneumology, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Claire Tissot
- Department of Pneumology, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Olivier Tiffet
- Department of Thoracic Surgery, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Fabrice-Guy Barral
- Department of Radiology, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Anthime Flaus
- Department of Nuclear Medicine, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Sylvain Grange
- Department of Radiology, University Hospital of
Saint-Etienne, Saint-Etienne,
France
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An W, Zhang H, Wang B, Zhong F, Wang S, Liao M. Comparison of CT-Guided Core Needle Biopsy in Pulmonary Ground-Glass and Solid Nodules Based on Propensity Score Matching Analysis. Technol Cancer Res Treat 2022; 21:15330338221085357. [PMID: 35297696 PMCID: PMC8935414 DOI: 10.1177/15330338221085357] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: To compare the diagnostic accuracy and safety of computed tomography (CT)-guided core needle biopsy (CNB) between pulmonary ground-glass and solid nodules using propensity score matching (PSM) method and determine the relevant risk factors. Methods: This was a single-center retrospective cohort study using data from 665 patients who underwent CT-guided CNB of pulmonary nodules in our hospital between May 2019 and May 2021, including 39 ground-glass nodules (GGNs) and 626 solid nodules. We used a 1:4 PSM analysis to compared the diagnostic yields and complications rates of CT-guided CNB between 2 groups. Results: After PSM, 170 cases involved in the comparison (34 GGNs vs 136 solid nodules) were randomly matched (1:4) by patient demographics, clinical history, lesion characteristics, and procedure-related factors. There was no statistically significant difference in the diagnostic yields and complications rates between 2 groups. Significant pneumothorax incidence increase was noted at small lesion size, deep lesion location, and traversing interlobar fissure (P < .05). Post-biopsy hemorrhage was a protective factor for pneumothorax (P < .05). The size/proportion of consolidation of GGN did not influence the diagnostic accuracy and complication incidence (P > .05). Conclusions: The accuracy and safety of CT-guided CNB were comparable for ground-glass and solid nodules and the size/proportion of consolidation of GGN may be not a relevant risk factor. The biopsy should avoid traversing interlobar fissure as far as possible. Smaller lesion size and deeper lesion location may lead to higher pneumothorax rate and post-biopsy hemorrhage may be a protective factor for pneumothorax.
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Affiliation(s)
- Wenting An
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hanfei Zhang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binchen Wang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feiyang Zhong
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shan Wang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meiyan Liao
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
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Smith TA, Gage D, Quencer KB. Narrative review of vascular iatrogenic trauma and endovascular treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1199. [PMID: 34430640 PMCID: PMC8350708 DOI: 10.21037/atm-20-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.
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Affiliation(s)
- Tyler Andrew Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT, USA
| | - David Gage
- Department of Medicine, Intermountain Healthcare, Murray, UT, USA
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CT-Guided Transthoracic Biopsy of Lung Lesions Using a Non-Coaxial Biopsy Needle Technique: CT Characteristics Predictive for Diagnostic Accuracy and Pneumothorax. J Belg Soc Radiol 2021; 105:39. [PMID: 34250437 PMCID: PMC8252971 DOI: 10.5334/jbsr.2429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/15/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To analyze computed tomography (CT) characteristics predictive for diagnostic accuracy and pneumothorax in CT fluoroscopy-guided transthoracic biopsy (CTF-TTB) of lung lesions using non-coaxial biopsy needle technique. Methods Retrospectively 274 lung lesion biopsies with confirmed histology were included in our study. CTF-TTB was done using an 18-gauge non-coaxial cutting needle. Diagnostic accuracy rates were calculated per lesion size and CT and procedural characteristics were evaluated for their predictive value regarding diagnostic accuracy and development of pneumothorax (maximal nodule diameter, distance to pleura, location per lung segment, nodule composition, benign versus malignant histology, and number of specimens). Results Overall diagnostic accuracy of CTF-TTB was high (93%). Diagnostic accuracy for lesions ≤10 mm was 81%. Maximal nodule diameter was the only predictive CT characteristic for diagnostic success (p = 0.03). Pneumothorax occurred in 27%. Distance of lesion to pleura was the only risk factor for pneumothorax (p < 0.00001). Pneumothorax rates were significantly lower in subpleural lesions (14%) compared to those located 1-10 mm (47%), 10-20 mm (33%), and >20 mm from pleura (29%). Conclusions High diagnostic accuracy rates were achieved with CTF-TTB using non-coaxial biopsy technique, even for lesions ≤10 mm. Pneumothorax rates were comparable with other studies. Lesion size was the only predictive CT characteristic for diagnostic accuracy. Distance to pleura was the only risk factor for pneumothorax.
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Lin CY, Chang CC, Chu CY, Huang LT, Chung TJ, Liu YS, Yen YT. Computed Tomography-Guided Transthoracic Needle Biopsy: Predictors for Diagnostic Failure and Tissue Adequacy for Molecular Testing. Front Med (Lausanne) 2021; 8:650381. [PMID: 34095167 PMCID: PMC8169979 DOI: 10.3389/fmed.2021.650381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/20/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Adequate and representative tissue from lung tumor is important in the era of precision medicine. The aim of this study is to identify detailed procedure-related variables and factors influencing diagnostic success and tissue adequacy for molecular testing in CT-guided TTNB. Methods: Consecutive patients undergoing CT-guided TTNB were retrospectively enrolled between January 2013 and May 2020. Multivariate analysis was performed for predictors for diagnostic accuracy and tissue adequacy for molecular testing. Logistic regression was used to identify risk factors for procedure-related complications. Results: A total of 2,556 patients undergoing CT-guided TTNB were enrolled and overall success rate was 91.5% (2,338/2,556). For lung nodules ≤3 cm, predictors for diagnostic success included coaxial needle use [OR = 0.34 (0.16–0.71), p = 0.004], CT scan slice thickness of 2.5 mm [OR = 0.42 (0.15–0.82), p = 0.011] and additional prefire imaging [OR = 0.31 (0.14–0.68), p = 0.004]. For lung tumor >3 cm, ground glass opacity part more than 50% [OR = 7.53 (2.81–20.23), p < 0.001] or presence of obstructive pneumonitis [OR = 2.31 (1.53–3.48), p < 0.001] had higher risk of diagnostic failure. For tissue adequacy, tissue submitted in two cassettes (98.9 vs. 94.9%, p = 0.027) was a positive predictor; while male (5.7 vs. 2.5%, p = 0.032), younger age (56.61 ± 11.64 vs. 65.82 ± 11.98, p < 0.001), and screening for clinical trial (18.5 vs. 0.7%, p < 0.001) were negative predictors. Conclusions: Using a coaxial needle, with thin CT slice thickness (2.5 mm), and obtaining additional prefire imaging improved diagnostic success, while obtaining more than two tissue cores and submitting in two cassettes improved tissue adequacy for molecular testing.
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Affiliation(s)
- Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Yao Chu
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Li-Ting Huang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Jung Chung
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan.,Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
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Yucel S, Sayit AT, Tomak L, Celenk C. Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies. Ann Saudi Med 2021; 41:78-85. [PMID: 33818143 PMCID: PMC8020651 DOI: 10.5144/0256-4947.2021.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them. OBJECTIVES Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB). DESIGN Prospective evaluation of complications. SETTING Single center in Turkey. PATIENTS AND METHODS For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology. MAIN OUTCOME MEASURES The complications and risk factors for complications were evaluated. SAMPLE SIZE 123 adult patients. RESULTS The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema (P=.022), non-peripheral location of the lesion (P<.001), increased needle pathway (P<.001), fissure penetration (P=.011), increased number of pleura penetrations (P=.024), prolonged needle time across pleura (P=.037), and decreased lesion size (P=.033). The pneumothorax rate increased with non-peripheral location of the lesion (P<.007), fissure penetration (P=.021), prolonged needle time across the pleura (P=.013), and decreased lesion size (P=.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion (P<.001, OR=14.7, 95% CI=3.9-55.4 for alveolar hemorrhage) and (P=.001, OR=156.2, 95% CI =7.34-3324.7 for pneumothorax). CONCLUSION Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications. LIMITATIONS Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding. CONFLICT OF INTEREST None.
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Affiliation(s)
- Serap Yucel
- From the Radiology Section, Mus State Hospital, Mus, Turkey
| | - Asli Tanrivermis Sayit
- From the Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Leman Tomak
- From the Department of Biostatistics and Medical Informatics, Ondokuz Mayis University, Samsun, Turkey
| | - Cetin Celenk
- From the Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Li CL, Yan XC, Liu M, Li PP, Guo XT, Xu YJ, He XM. Magnetic resonance-guided repeat biopsy of suspicious malignant lung lesions after an initial negative computed tomography-guided Biopsy. J Cancer Res Ther 2021; 17:1689-1695. [DOI: 10.4103/jcrt.jcrt_1655_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bae K, Ha JY, Jeon KN. Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence. PLoS One 2020; 15:e0238107. [PMID: 32834016 PMCID: PMC7446785 DOI: 10.1371/journal.pone.0238107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background In CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known. Objectives To compare the risk factors for immediate and delayed pneumothorax after CTLB and to know their clinical significance. Methods Images and medical records of 536 consecutive patients who underwent CTLB were reviewed. All biopsies were performed as inpatient procedures. Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. Risk factors for immediate and delayed pneumothorax were assessed based on patient-, lesion-, and procedure-related variables. Rates of chest tube insertion were also compared. Results Pneumothorax developed in 161 patients (30.0%) including 135 (25.2%) immediate and 26 (4.9%) delayed cases. Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717–0.922 and OR = 0.610; CI = 0.441–0.844, respectively). While emphysema, lower lobe location, and long intrapulmonary biopsy track were risk factors (OR = 1.981; CI = 1.172–3.344, OR = 3.505; CI = 2.718–5.650, and OR = 1.330; CI = 1.132–1.563, respectively) for immediate pneumothorax, upper lobe location and increased number of pleural punctures were independent risk factors (OR = 5.756; CI = 1.634–20.274 and OR = 3.738; CI = 1.860–7.511, respectively) for delayed pneumothorax. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax. Conclusion Pneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage.
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Affiliation(s)
- Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Ji Young Ha
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
- * E-mail:
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Li J, Zhang L, Sun Z, Ge Y, Zhou J, Xie Q. Iodine-125 seed implantation treatment of lung metastases < 2.5 cm using 5-ml syringe as a guide. J Contemp Brachytherapy 2020; 12:335-342. [PMID: 33293972 PMCID: PMC7690223 DOI: 10.5114/jcb.2020.98112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Small lung metastases change their location with respiration, making difficult to localize, therefore, increasing the number of punctures. Accurate puncture can reduce trauma to lung tissue and accelerate patient's recovery. The aim of the study was to present our experience with the technique of using local anesthesia 5-ml syringe as a guide for computerized tomography-guided iodine-125 seed implantation (CT-ISI). MATERIAL AND METHODS This was a retrospective study, including patients with small metastatic tumors in the lung, treated with CT-ISI between December 2013 and March 2018 at the Affiliated Hospital of the University. The patients were divided according to whether a 5-ml syringe was used as a guide during CT-ISI or not. The final follow-up was on March 31st, 2018. Implantation success and complications were examined. RESULTS Nineteen patients were included. A total of 840 seeds were used, with 44.2 ±33.6 (range, 10-160) seeds per patient. The mean D90 for CT-ISI was 134.5 ±7.5 Gy. Treatment intervention for eleven patients was performed using a 5-ml syringe as a guide during CT-ISI. There were no differences in total dose and number of implanted seeds between the two groups, but the number of punctures per lesion was lower in the syringe group than in the no-syringe group (1.9 ±0.5 vs. 2.9 ±0.6, p < 0.001), suggesting a higher puncture accuracy. The total number of SMTIL was 50 (median, 2; range, 1-10), and the median size was 1.9 cm (range, 0.8-2.4 cm). All SMTIL were well-controlled at 6-months follow-up (response rate [RR] = 100%). One patient in the no-syringe group experienced grade 2 chest tightness, chest pain, intraoperative needle tract bleeding, and post-operative blood in sputum. CONCLUSIONS Puncture with a 5-ml syringe as a guide during CT-ISI seems to be a more accurate option for patients with small (< 2.5 cm) lung metastasis.
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Affiliation(s)
- Jie Li
- Department of Intervention, Affiliated Hospital of Jiangnan University (Wuxi Fourth People’s Hospital), China
| | - Lijuan Zhang
- Department of Radiology, Wuxi People’s Hospital, Nanjing Medical University, China
| | - Zongqiong Sun
- Department of Radiology, Affiliated Hospital of Jiangnan University (Wuxi Fourth People’s Hospital), China
| | - Yuxi Ge
- Department of Radiology, Affiliated Hospital of Jiangnan University (Wuxi Fourth People’s Hospital), China
| | - Jialiang Zhou
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University (Wuxi Fourth People’s Hospital), China
| | - Qigen Xie
- Department of Intervention, Affiliated Hospital of Jiangnan University (Wuxi Fourth People’s Hospital), China
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Impact of quantitative pulmonary emphysema score on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies. Sci Rep 2020; 10:10978. [PMID: 32620852 PMCID: PMC7335035 DOI: 10.1038/s41598-020-67348-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the risk of pneumothorax and need for chest tube insertion in CT-guided lung biopsies and identify predictors focusing on pulmonary emphysema determined with quantitative computed tomography. To that end, we retrospectively analysed the incidence of pneumothorax and chest tube insertion in 371 CT-guided lung biopsies with respect to the quantitative emphysema score determined with the density mask technique. Other possible impact factors considered were lesion diameter, length of biopsy pathway within the lung parenchyma, lung lobe, needle size, puncture technique, patient positioning and interventionalist's level of experience. Quantitative emphysema scores of the lung were significantly higher in patients who developed instant pneumothorax (27%, p < 0.0001), overall pneumothorax (38%, p = 0.001) and had chest tube insertion (9%, p = 0.006) compared to those who did not when analysed with the Mann-Whitney U-test. In logistic regression analysis with inclusion of the other possible impact factors, the quantitative emphysema score remained a statistically significant predictor for all three output parameters. This was confirmed with least absolute shrinkage and selection operator (Lasso) regression analysis. In conclusion, quantitatively determined pulmonary emphysema is a positive predictor of the pneumothorax rate in CT-guided lung biopsy and likelihood of chest tube insertion.
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