Biópsia transtorácica de nódulos e massas pulmonares dirigida por tomografia computadorizada

Intermittent CT fluoroscopic guided lung biopsy - Retrospective analysis of success rate, radiation exposure, complications and duration of procedure

OBJECTIVE

Intermittent CT fluoroscopic biopsy is a new technology, but has not been studied widely. This study aims to investigate correlation between the radiation dose and fluoroscopic CT exposure factors to establish the low dose parameters for performing percutaneous lung biopsies, as well as the relationship of the mean diameter and depth of lesions with radiation dose, procedure time, success and complication rates.

MATERIALS AND METHODS

This is a retrospective study to analyse lung biopsies performed using intermittent CT fluoroscopic technique with 18 G semi-automated coaxial gun on 256 slice scanner. A total of 50 patients were included in the study. Biopsy was done in three mAs and KVp settings (30 and 70, 10 and 120, 30 and 120, respectively). The statistical data analysis was performed using SPSS Statistics software.

RESULTS

Pneumothorax occurred in 22 % of cases. Sampling rate was 98% but histopathological diagnosis was made in 94% cases. Mean procedure time was 30.5±11.1 minutes. Low dose protocol (30 mAs and 70 KVp) had least radiation exposure during biopsy procedure (p < 0.001) with similar success rate, complications and procedure time (p > 0.05) in comparison with high dose protocol (10 and 120, 30 and 120 mAs and KVp, respectively). Mean diameter of lesions didn't correlate with radiation dose, success rate, complications and duration of procedure (p > 0.05) while significant association was found when depth was correlated with radiation exposure during fluoroscopic biopsy, duration of procedure and complication rates (p < 0.05) while no association was found with success rates.

CONCLUSION

On third generation dual energy source CT scanner, reducing mAs and KVp to 30 and 70 during fluoroscopy biopsy can produce images whose complications and success rates are comparable to high dose CT. In general, intermittent CT fluoroscopy guided lung biopsy has good success rates with acceptable complications, while utilising less radiation dose and procedure time.

Lung biopsy with guillotine cutting needle and biopsy forceps though transdiaphragmatic thoracoscopy in dogs with pulmonary alterations

ABSTRACT: Lung diseases are common in small animal clinical routine. Diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides a precise diagnosis. Thus thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared with thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy with a the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of Universidade Federal do Rio Grande do Sul (UFRGS), were assessed. Inclusion criteria were presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of FAVET/UFRGS. Surgical time was recorded from first incision to wound closure and surgical complications were reported. The dogs were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedure in any patient. Thoracoscopic assisted biopsy using guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.