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Li Q, Xiao T, Li J, Niu Y, Zhang G. The diagnosis and management of multiple ground-glass nodules in the lung. Eur J Med Res 2024; 29:305. [PMID: 38824558 PMCID: PMC11143686 DOI: 10.1186/s40001-024-01904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
The prevalence of low-dose CT (LDCT) in lung cancer screening has gradually increased, and more and more lung ground glass nodules (GGNs) have been detected. So far, a consensus has been reached on the treatment of single pulmonary ground glass nodules, and there have been many guidelines that can be widely accepted. However, at present, more than half of the patients have more than one nodule when pulmonary ground glass nodules are found, which means that different treatment methods for nodules may have different effects on the prognosis or quality of life of patients. This article reviews the research progress in the diagnosis and treatment strategies of pulmonary multiple lesions manifested as GGNs.
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Affiliation(s)
- Quanqing Li
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tianjiao Xiao
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jindong Li
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yan Niu
- Jilin University, Changchun, Jilin Province, China
| | - Guangxin Zhang
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Chen Z, Zeng J, Lin Y, Zhang X, Wu X, Yong Y, Tang L, Ke M. Synchronous Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy and Microwave Ablation for Highly Suspicious Malignant Pulmonary Ground-Glass Nodules. Respiration 2024:1-9. [PMID: 38599179 DOI: 10.1159/000538743] [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: 10/28/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION There is no consensus regarding the most appropriate management of suspected malignant pulmonary ground-glass nodules (GGNs). OBJECTIVE We aimed to explore the feasibility and safety of synchronous computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) and microwave ablation (MWA) for patients highly suspicious of having malignant GGNs. METHODS We retrospectively reviewed medical records between July 2020 and April 2023 from our medical center. Eligible patients synchronously underwent PTNB and MWA (either MWA immediately after PTNB [PTNB-first group] or PTNB immediately after MWA [MWA-first group]) at the the physician's discretion. We analyzed the rate of definitive diagnosis and technical success, the length of hospital stay, the postoperative efficacy, and periprocedural complications. RESULTS Of 65 patients who were enrolled, the rate of definitive diagnosis was 86.2%, which did not differ when stratified by the tumor size, the consolidation-to-tumor ratio, or the sequence of the two procedures (all p > 0.05). The diagnostic rate of malignancy was 83.1%. After the median follow-up duration of 18.5 months, the local control rate was 98.2% and the rate of completed ablation was 48.2%. The rate of perioperative minor and major complications was 44.6% and 6.2%, respectively. The most common adverse events included pain, cough, and mild hemorrhage. Mild hemorrhage took place significantly less frequently in the MWA-first group than in the PTNB-first group (16.7% vs. 45.5%, p < 0.05). CONCLUSION Synchronous PTNB and MWA are feasible and well tolerated for patients highly suspicious of having malignant GGNs, providing an alternative option for patients who are ineligible for surgical resection.
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Affiliation(s)
- Zhide Chen
- Department of Respiratory and Critical Care Medicine, West China Xiamen Hospital of Sichuan University, Xiamen, China
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Junli Zeng
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yan Lin
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xiaoling Zhang
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xuemei Wu
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yazhi Yong
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Lihua Tang
- Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Mingyao Ke
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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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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Fernandez-Bussy S, Yu Lee-Mateus A, Reisenauer J, Balasubramanian P, Barrios-Ruiz A, Garza-Salas A, Chandra NC, Koratala A, Nadrous A, Edell ES, Bowman AW, Grage RA, Reisenauer CJ, Kurup AN, Patel NM, Chadha R, Hazelett BN, Abia-Trujillo D. Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules. Respiration 2024; 103:280-288. [PMID: 38471496 DOI: 10.1159/000538132] [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: 08/23/2023] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) are scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN. METHODS A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6 mm from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB. RESULTS A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5 mm (IQR: 4.5, 6). Patients were divided into two groups: 27 in the ssRAB group and 38 in the CTTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p = 0.646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs. 88.5%; p = 0.828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs. 2; p = 0.135). CONCLUSION Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure.
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Affiliation(s)
| | | | - Janani Reisenauer
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alanna Barrios-Ruiz
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ana Garza-Salas
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Nikitha C Chandra
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Anoop Koratala
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Anthony Nadrous
- 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
| | - Andrew W Bowman
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Rolf A Grage
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Anil N Kurup
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Neal M Patel
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, 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
| | - David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Omindo WW. Management of screening-detected ground glass nodules: a narrative review. Indian J Thorac Cardiovasc Surg 2024; 40:205-212. [PMID: 38389756 PMCID: PMC10879480 DOI: 10.1007/s12055-023-01595-4] [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: 03/22/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 02/24/2024] Open
Abstract
Wide-scale application of low-dose computed tomography (LDCT) in lung cancer screening has led to an increased detection of ground glass nodule (GGN) lesions. However, there is still no clear management plan for these lesions after detection. Clinicians are usually faced with a dilemma in choosing the best initial management approach that not only limits overtreatment but also avoids the possibility of lesions growing into invasive carcinoma. Most current and past guidelines favor surveillance with computed tomography (CT) as the initial management approach based on the notion that the majority of GGN lesions are indolent tumors. Immediate surgery is generally considered overtreatment and is usually only recommended when the lesion grows in size, persists, or increases its solid component during follow-up CT surveillance. However, due to evolution of surgery to minimal invasive procedures, such as uniportal video-assisted thoracic surgery, and the development of enhanced recovery after thoracic surgery protocols, modern surgery is now safer and associated with less postoperative mortality. Additionally, intraoperative frozen sections can be used to guide resection, making initial management via surgery more attractive than before. Based on these developments, this review recommends that immediate surgery should be considered at the same level as follow-up CT surveillance when making multidisciplinary team decisions for screening-detected GGNs, as it provides both a diagnostic and treatment role.
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Affiliation(s)
- Willis Wasonga Omindo
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030 Hubei China
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Abdelghani R, Omballi M, Abia-Trujillo D, Casillas E, Villalobos R, Badar F, Bansal S, Kheir F. Imaging modalities during navigational bronchoscopy. Expert Rev Respir Med 2024; 18:175-188. [PMID: 38794918 DOI: 10.1080/17476348.2024.2359601] [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: 10/21/2023] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Lung nodules are commonly encountered in clinical practice. Technological advances in navigational bronchoscopy and imaging modalities have led to paradigm shift from nodule screening or follow-up to early lung cancer detection. This is due to improved nodule localization and biopsy confirmation with combined modalities of navigational platforms and imaging tools. To conduct this article, relevant literature was reviewed via PubMed from January 2014 until January 2024. AREAS COVERED This article highlights the literature on different imaging modalities combined with commonly used navigational platforms for diagnosis of peripheral lung nodules. Current limitations and future perspectives of imaging modalities will be discussed. EXPERT OPINION The development of navigational platforms improved localization of targets. However, published diagnostic yield remains lower compared to percutaneous-guided biopsy. The discordance between the actual location of lung nodule during the procedure and preprocedural CT chest is the main factor impacting accurate biopsies. The utilization of advanced imaging tools with navigation-based bronchoscopy has been shown to assist with localizing targets in real-time and improving biopsy success. However, it is important for interventional bronchoscopists to understand the strengths and limitations of these advanced imaging technologies.
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Affiliation(s)
- Ramsy Abdelghani
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Mohamed Omballi
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH, USA
| | - David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ernesto Casillas
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Regina Villalobos
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Faraz Badar
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH, USA
| | - Sandeep Bansal
- The Lung Center, Penn Highlands Healthcare, DuBois, PA, USA
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Wang B, Zhong F, An W, Liao M. The diagnostic value of CT-guided percutaneous puncture biopsy of pulmonary ground-glass nodules: a meta-analysis. Acta Radiol 2022; 64:1431-1438. [PMID: 36380521 DOI: 10.1177/02841851221137693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background More and more pulmonary ground-glass nodules (GGNs) are screened with the extensive usage of low-dose computed tomography (CT). The need of CT-guided percutaneous puncture biopsy of GGN remains controversial. Purpose To explore the diagnostic accuracy of CT-guided percutaneous puncture biopsy of GGNs. Material and Methods We searched PubMed, EMBASE, the Cochrane Library, and CNKI. Included studies reported the puncture biopsy results of pulmonary GGNs, including the number of true positive (TP), false positive (FP), true negative (TN), and false negative (FN) cases. After evaluating the studies, statistical analysis, and quality assessment, the pooled diagnostic sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR) were calculated. The summary receiver operating characteristic (SROC) curve was constructed and the area under the curve (AUC) was calculated. Subgroup analysis was performed according to whether spiral CT or fluoroscopy-guided CT was used in the study. Results This meta-analysis included 14 studies with a total of 759 patients (702 samples). The pooled SEN, SPE, and DOR of CT-guided puncture biopsy of pulmonary GGNs were 0.91 (95% confidence interval [CI] = 0.89–0.94), 0.99 (95% CI = 0.95–1.00), and 138.72 (95% CI = 57.98–331.89), respectively. The AUC was 0.97. Conclusion Our results indicated that CT-guided puncture biopsy of GGNs has high SEN, SPE, and DOR, which proved that CT-guided puncture biopsy was a good way to determine the pathological nature of GGN.
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Affiliation(s)
- Binchen Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Feiyang Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Wenting An
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Meiyan Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, PR China
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Kim DY, Sun JS, Kim EY, Park KJ, You S. Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern. Sci Rep 2022; 12:15682. [PMID: 36127437 PMCID: PMC9489867 DOI: 10.1038/s41598-022-20030-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022] Open
Abstract
This study aimed to assess the diagnostic accuracy and safety of CT-guided percutaneous core needle biopsy (PCNB) with a coaxial needle for the diagnosis of lung cancer in patients with an usual interstitial pneumonia (UIP) pattern of interstitial lung disease. This study included 70 patients with UIP and suspected to have lung cancer. CT-guided PCNB was performed using a 20-gauge coaxial cutting needle. The diagnostic accuracy, sensitivity, specificity, and percentage of nondiagnostic results for PCNB were determined in comparison with the final diagnosis. PCNB-related complications were evaluated. Additionally, the risk factors for nondiagnostic results and pneumothorax were analyzed. The overall diagnostic accuracy, sensitivity, and specificity were 85.7%, 85.5%, and 87.5%, respectively. The percentage of nondiagnostic results was 18.6% (13/70). Two or less biopsy sampling was a risk factor for nondiagnostic results (p = 0.003). The overall complication rate was 35.7% (25/70), and pneumothorax developed in 22 patients (31.4%). A long transpulmonary needle path was a risk factor for the development of pneumothorax (p = 0.007). CT-guided PCNB using a coaxial needle is an effective method with reasonable accuracy and an acceptable complication rate for the diagnosis of lung cancer, even in patients with UIP.
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Affiliation(s)
- Da Young Kim
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Eun Young Kim
- Department of Radiology, Hankook Hospital, Cheongju, Republic of Korea
| | - Kyung Joo Park
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Seulgi You
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Li Y, Yang CF, Peng J, Li B, Zhang C, Yu JH. Small (≤ 20 mm) ground-glass opacity pulmonary lesions: which factors influence the diagnostic accuracy of CT-guided percutaneous core needle biopsy? BMC Pulm Med 2022; 22:265. [PMID: 35799223 PMCID: PMC9264544 DOI: 10.1186/s12890-022-02058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background The diagnostic accuracy of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤ 20 mm) ground-glass opacity (GGO) lesions has not been reported in detail. Objectives To evaluate factors that affect the diagnostic accuracy of CT-guided percutaneous CNB for small (≤ 20 mm) GGO pulmonary lesions. Methods From January 2014 to February 2018, 156 patients with a small (≤ 20 mm) GGO pulmonary lesion who underwent CT-guided CNB were enrolled in this study. Factors affecting diagnostic accuracy were evaluated by analyzing patient and lesion characteristics and technical factors. Significant factors were identified by multivariate logistic regression. Results The diagnostic accuracy of CT-guided percutaneous CNB was 90.4% for small (≤ 20 mm) GGO pulmonary lesions. The diagnostic accuracy was higher for larger lesions (72.5% for lesions ≤ 10 mm, 96.6% for lesions between 11 and 20 mm [P < 0.001]). The diagnostic accuracy of CT-guided percutaneous CNB was 74.5% for lesions with > 90% GGO components and 97.2% for lesions with 50–90% GGO components (P < 0.001). In multivariate analysis, the significant factors influencing diagnostic accuracy were lesion size (P = 0.022; odds ratio [OR] for a lesion between 11 and 20 mm in size was approximately 5 times higher than that for a lesion ≤ 10 mm; 95% confidence interval [CI], 1.3 to 18.5), and GGO component (P = 0.015; OR for a lesion with 50–90% GGO components was approximately 6 times higher than that for a lesion with > 90% GGO components; 95% CI: 1.4 to 25.7). Conclusions Lesion size and GGO component are factors affecting diagnostic accuracy. The diagnostic accuracy was higher for larger lesions and lesions with 50–90% GGO components.
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Affiliation(s)
- Yang Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong City, 637000, Sichuan Province, China.,Department of Radiology, The People's Hospital of Yuechi County, 22 East Jianshe Road, Yuechi County, 638350, Sichuan Province, China
| | - Chao Feng Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong City, 637000, Sichuan Province, China
| | - Jun Peng
- Department of Radiology, The People's Hospital of Yuechi County, 22 East Jianshe Road, Yuechi County, 638350, Sichuan Province, China
| | - Bing Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong City, 637000, Sichuan Province, China
| | - Chuan Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong City, 637000, Sichuan Province, China
| | - Jin Hong Yu
- Sichuan Key Laboratory of Medical Imaging, Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong City, 637000, Sichuan Province, China. .,Department of Ultrasound, The People's Hospital of Yuechi County, 22 East Jianshe Road, Yuechi County, 638350, Sichuan Province, China.
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Nakamura K, Matsumoto K, Inoue C, Matsusue E, Fujii S. Computed Tomography-guided Lung Biopsy: A Review of Techniques for Reducing the Incidence of Complications. INTERVENTIONAL RADIOLOGY 2021; 6:83-92. [PMID: 35912280 PMCID: PMC9327413 DOI: 10.22575/interventionalradiology.2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
Computed tomography-guided lung biopsy is a well-established method for the histological diagnosis of pulmonary lesions. There is abundant literature regarding the diagnostic yield of and complications associated with computed tomography-guided lung biopsy. Many studies have investigated the risk factors influencing pneumothorax. Conversely, there are a limited number of reports detailing techniques for reducing the incidence of pneumothorax or other complications. This study reviews the indications, diagnostic accuracy, and complications of computed tomography-guided lung biopsy. In addition, techniques for reducing the incidence of these complications were reviewed.
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Affiliation(s)
| | | | - Chie Inoue
- Department of Radiology, Tottori Prefectural Central Hospital
| | - Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital
| | - Shinya Fujii
- Department of Radiology, Tottori University School of Medicine
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Kim J, Chee CG, Cho J, Kim Y, Yoon MA. Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis. Br J Radiol 2021; 94:20210065. [PMID: 34662206 DOI: 10.1259/bjr.20210065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. METHODS We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. RESULTS We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85-94%) and 99% (95% CI: 92-100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs 85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs 83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25-62%) and 0.1% (95% CI: 0-0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). CONCLUSION PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. ADVANCES IN KNOWLEDGE This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.
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Affiliation(s)
- Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjune Kim
- Air Force Education and Training Command Base Hospita, Jinju, Korea
| | - Min A Yoon
- Department of Radiology, Asan Medical Center, Seoul, Korea
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Abstract
ABSTRACT Percutaneous computed tomography-guided transthoracic lung biopsy is an effective and minimally invasive procedure to achieve tissue diagnosis. Radiologists are key in appropriate referral for further workup, with percutaneous computed tomography-guided transthoracic lung biopsy performed by both thoracic and general interventionalists. Percutaneous computed tomography-guided transthoracic lung biopsy is increasingly performed for both diagnostic and research purposes, including molecular analysis. Multiple patient, lesion, and technique-related variables influence diagnostic accuracy and complication rates. A comprehensive understanding of these factors aids in procedure planning and may serve to maximize diagnostic yield while minimizing complications, even in the most challenging scenarios.
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Abstract
The increasing use of low-dose CT for screening for lung cancer will inevitably identify many small, asymptomatic lung nodules and ground-glass opacities (GGOs). Current guidelines for the management of screening-detected lesions tend to advise a conservative approach based on serial imaging and intervention only if ‘suspicious’ features emerge. However, more recent developments in thoracic surgery and in the understanding of the screening-detected lesions themselves prompt some pertinent questions over this conservatism. Is CT surveillance sufficiently reliable to exclude malignancy? Is it really necessary to hold back on operative biopsy and resection given modern surgical safety and efficacy? Is the option for early surgical therapy a viable one—especially with the availability of sublobar resection today? Modern data suggests that the risk of inaction for some screening-detected lesions may be higher than expected, whereas the potential harm of surgical intervention may be substantially reduced by sublobar resection and the latest minimally invasive surgical techniques. A more pro-active approach towards offering surgery for screening-detected lesions should now be considered.
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Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong, China.,International Medical Centre, Hong Kong, China
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14
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Li X, Xu K, Cen R, Deng J, Hao Z, Liu J, Takizawa H, Ng CSH, Marulli G, Kim MP, Cui F, He J. Preoperative computer tomography-guided indocyanine green injection is associated with successful localization of small pulmonary nodules. Transl Lung Cancer Res 2021; 10:2229-2236. [PMID: 34164272 PMCID: PMC8182704 DOI: 10.21037/tlcr-21-425] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Localization of small pulmonary nodules (SPNs) is challenging in minimally invasive pulmonary resection, and it is unknown whether computer tomography (CT) guided by indocyanine green (ICG) can provide accurate localization with minimal complications. Methods We performed a retrospective study of patients who underwent thoracoscopic resection of pulmonary nodules after CT-guided preoperative localization with ICG from May 2019 to May 2020. Demographics, procedural data, postoperative complications, and pathologic information, were collected, and an analysis of the accuracy and complications after surgery was conducted. Results In 471 patients, there was a total of 512 peripheral pulmonary nodules that were ≤2 cm in size. The average time for CT-guided percutaneous ICG injection for localization was 18 minutes, and 98.4% (504/512) of the nodules were successfully localized. The average size of the nodules was 9.1 mm, and the average depth from the pleural surface was 8.9 mm. Overall, 5.9% (28/471) of the patients had asymptomatic pneumothorax after localization, but none needed a tube thoracostomy. All the nodules were resected using video-assisted thoracoscopy technique. Conclusions Preoperative CT-guided transthoracic ICG injection is safe and feasible for localization of small lung nodules for minimally invasive pulmonary resection. This technique should be considered for preoperative CT-guided localization of small lung nodules.
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Affiliation(s)
- Xukai Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Department of Cardiothoracic Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ke Xu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Renli Cen
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinghui Deng
- Department of Clinical Medicine, the Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Zhexue Hao
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hiromitsu Takizawa
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital of Bari, Bari, Italy
| | - Min P Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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15
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Kheir F, Thakore SR, Uribe Becerra JP, Tahboub M, Kamat R, Abdelghani R, Fernandez-Bussy S, Kaphle UR, Majid A. Cone-Beam Computed Tomography-Guided Electromagnetic Navigation for Peripheral Lung Nodules. Respiration 2021; 100:44-51. [PMID: 33401270 DOI: 10.1159/000510763] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Electromagnetic navigation bronchoscopy (ENB) is a minimally invasive technology for the diagnosis of peripheral pulmonary nodules. However, ENB is limited by the lack of real-time confirmation of various biopsy devices. Cone-beam computed tomography (CBCT) could increase diagnostic yield by allowing real-time confirmation to overcome the inherent divergence of nodule location. OBJECTIVES The aim of this study was to assess the diagnostic yield of ENB plus CBCT as compared with ENB alone for biopsy of peripheral lung nodules. METHOD We conducted a retrospective study of patients undergoing ENB before and after the implementation of CBCT. Data from 62 consecutive patients with lung nodules located in the outer two-thirds of the lung who underwent ENB and combined ENB-CBCT were collected. Radial endobronchial ultrasound was used during all procedures as well. Diagnostic yield was defined as the presence of malignancy or benign histological findings that lead to a specific diagnosis. RESULTS Thirty-one patients had ENB-CBCT, and 31 patients had only ENB for peripheral lung lesions. The median size of the lesion for the ENB-CBCT group was 16 (interquartile range (IQR) 12.6-25.5) mm as compared to 21.5 (IQR 16-27) mm in the ENB group (p = 0.2). In the univariate analysis, the diagnostic yield of ENB-CBCT was 74.2% and ENB 51.6% (p = 0.05). Following multivariate regression analysis adjusting for the size of the lesion, distance from the pleura, and presence of bronchus sign, the odds ratio for the diagnostic yield was 3.4 (95% CI 1.03-11.26, p = 0.04) in the ENB-CBCT group as compared with ENB alone. The median time for the procedure was shorter in patients in the ENB-CBCT group (74 min) than in those in the ENB group (90 min) (p = 0.02). The rate of adverse events was similar in both groups (6.5%, p = 0.7). CONCLUSIONS The use of CBCT might increase the diagnostic yield in ENB-guided peripheral lung nodule biopsies. Future randomized clinical trials are needed to confirm such findings.
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Affiliation(s)
- Fayez Kheir
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.,Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanket R Thakore
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.,Division of Interventional Pulmonary, Department of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, Connecticut, USA
| | - Juan Pablo Uribe Becerra
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad Tahboub
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rahul Kamat
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Ramsy Abdelghani
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.,Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Upendra R Kaphle
- Division of Pulmonary and Critical Care, Kaiser Permanente Roseville and Sacramento Medical Center, Roseville, California, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA,
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16
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Diagnostic Accuracy of CT-Guided Core Needle Biopsy for Thin-Walled Cavitary Pulmonary Lesions. AJR Am J Roentgenol 2020; 216:369-375. [PMID: 33295816 DOI: 10.2214/ajr.20.22780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to evaluate the accuracy of and complications with CT-guided percutaneous core needle biopsy (CNB) of thin-walled cavitary pulmonary lesions. MATERIALS AND METHODS. This retrospective study involved 32 CNBs in 30 patients who had thin-walled cavitary pulmonary lesions (wall thickness < 5 mm) and underwent CT-guided CNB. After the 30 patient records were evaluated for the diagnostic accuracy, sensitivity, and specificity of CT-guided CNB, the results were compared with the final diagnosis after surgery or clinical follow-up. Each patient was reviewed for complications including pneumothorax, thoracotomy tube insertion, hemorrhage, and hemoptysis. RESULTS. The final diagnosis indicated 19 malignant and 11 benign lesions. Two lesions with indeterminate biopsy results (anthracofibrosis and focal interstitial thickening) were excluded. The sensitivity, specificity, and diagnostic accuracy of thin-walled cavities were 89.5%, 100%, and 93.3%, respectively. There were no statistical differences in the accuracy, sensitivity, or specificity according to wall thickness, cavity size, or lesion depth. Chest CT immediately after biopsy revealed mild pneumothorax in seven patients and moderate to severe pneumothorax requiring placement of a thoracotomy tube in one patient. CT after biopsy indicated mild parenchymal hemorrhage in 15 patients and hemoptysis in one patient. CONCLUSION. CT-guided CNB is a useful and accurate diagnostic technique for biopsy of a pulmonary thin-walled cavity.
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17
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Computed Tomography-Guided Biopsy for Small (≤20 mm) Lung Nodules: A Meta-Analysis. J Comput Assist Tomogr 2020; 44:841-846. [PMID: 32976266 DOI: 10.1097/rct.0000000000001071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE This study was designed to evaluate the diagnostic accuracy of computed tomography (CT)-guided biopsy for small lung nodules (SLNs) (≤20 mm) and to assess related complication rates. METHODS We reviewed the Pubmed, Embase, and Cochrane Library databases to identify all relevant studies published as of April 2020. Random effects modeling were then used to evaluate pooled data pertaining to technical success rates, diagnostic accuracy, pneumothorax rates, and rates of hemoptysis. The meta-analysis was conducted using Stata v12.0. RESULTS In total, we identified 25 relevant studies for incorporation into this meta-analysis, incorporating 2922 total CT-guided lung biopsy. Pooled technical success rates, diagnostic accuracy, pneumothorax rates, and hemoptysis rates were 94% (95% confidential interval [CI], 0.91-0.98), 90% (95% CI, 0.88-0.93), 19% (95% CI:, 0.15-0.24), and 12% (95% CI, 0.08-0.15), respectively. We observed significant heterogeneity among these studies for all 4 of these parameters (I = 90.0%, 82.7%, 88.6%, and 88.4%, respectively). When we conducted a meta-regression analysis, we did not identify any variables that influenced diagnostic accuracy or technical success, pneumothorax, or hemoptysis rates. Publication bias risk analyses suggested that there was relatively little risk of publication bias pertaining to pneumothorax rates (P = 0.400) or hemoptysis rates (P = 0.377). In contrast, we detected a high risk of publication bias pertaining to reported technical success rates (P = 0.007) and diagnostic accuracy (P = 0.000). CONCLUSIONS A CT-guided biopsy can be safely and effectively used to diagnose SLNs.
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18
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Abstract
Most focal persistent ground glass nodules (GGNs) do not progress over 10 years. Research suggests that GGNs that do not progress, those that do, and solid lung cancers are fundamentally different diseases, although histologically they seem similar. Surveillance of GGNs to identify those that gradually progress is safe and does not risk losing a window. GGNs with 5 mm solid component or less than 10 mm consolidation (mediastinal and lung windows, respectively, on thin slice CT) are highly curable with resection. The optimal type of resection is unclear; sublobar resection is reasonable but an adequate margin is critically important.
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Affiliation(s)
- Vincent J Mase
- Department of Surgery, Division of Thoracic Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062, USA
| | - Frank C Detterbeck
- Department of Surgery, Division of Thoracic Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062, USA.
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19
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Azour L, Ko JP, Naidich DP, Moore WH. Shades of Gray: Subsolid Nodule Considerations and Management. Chest 2020; 159:2072-2089. [PMID: 33031828 PMCID: PMC7534873 DOI: 10.1016/j.chest.2020.09.252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022] Open
Abstract
Subsolid nodules are common on chest CT imaging and may be either benign or malignant. Their varied features and broad differential diagnoses present management challenges. Although subsolid nodules often represent lung adenocarcinomas, other possibilities are common and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review highlights the similarities and differences among these algorithms, with the intent of providing a resource for comparison and aid in choosing management options.
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Affiliation(s)
- Lea Azour
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY.
| | - Jane P Ko
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
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20
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Liu B. [Diagnosis and Treatment of Pulmonary Multifocal Ground-glass Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:679-684. [PMID: 32741190 PMCID: PMC7467986 DOI: 10.3779/j.issn.1009-3419.2020.102.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In recent years, with the development of the high resolution computed tomography (HRCT) screening program for lung cancer, the multifocal ground-glass nodule (GGN) has been discovered more and more. Because there are still many uncertainties in the diagnosis and treatment of multifocal GGN in lung, this paper reviews the clinical concerns such as the follow-up interval and time, the relationship between main focus and other focuses, diagnosis, treatment and follow-up of residual nodules.
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Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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21
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Halpenny D, Das K, Ziv E, Plodkowski A, Zheng J, Capanu M, Rekhtman N, Montecalvo J, Solomon SB, Ginsberg MS. Percutaneous computed tomography guided biopsy of sub-solid pulmonary nodules: differentiating solid from ground glass components at the time of biopsy. Clin Imaging 2020; 69:332-338. [PMID: 33059184 DOI: 10.1016/j.clinimag.2020.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 03/03/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This study assessed (i) the ability to identify the solid components of part-solid nodules (PSN) during computed tomography (CT) guided lung biopsy (CTGLB), (ii) the ability of CTGLB to assess the invasive nature of a nodule on pathology. MATERIALS AND METHODS Sixty-nine nodules were studied in 68 patients who underwent CTGLB between 1/1/2014 and 10/31/2015. Diagnostic CT images and CTGLB images were reviewed. On diagnostic CT images, nodules were classified as ground glass nodules (GGN) or PSNs. Nodule size, location, and percentage of solid component were recorded. At the time of biopsy, the ability to visualize the solid component of a PSN, depth of lesion from skin, and ability to identify the needle within the solid component were recorded. RESULTS There were 42 (61%) part-solid nodules and 27 (39%) GGNs. During biopsy, it was possible to differentiate the solid from the ground glass components in 35 (83%) PSNs. Fifty-nine (86%) nodules were neoplastic based on biopsy pathology (all non-small cell lung carcinoma). Thirty-nine (66%) were resected. In all cases biopsy pathology and surgical pathology agreed regarding the presence of lung carcinoma. In 6 (15%) cases biopsy pathology demonstrated purely lepidic growth but had some non-lepidic growth on surgical pathology, including 2 cases with acinar growth as a dominant pattern. CONCLUSION In most patients, the solid and ground glass components of a PSN were distinguishable when performing a CTGLB. In a minority of patients, discrepancy was noted between biopsy pathology and surgical pathology regarding the invasive nature of a nodule.
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Affiliation(s)
- Darragh Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America.
| | - Krishna Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Andrew Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Junting Zheng
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Marinela Capanu
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Joseph Montecalvo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America
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22
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23
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Bortolotto C, Maglia C, Ciuffreda A, Coretti M, Catania R, Antonacci F, Carnevale S, Sarotto I, Dore R, Filippi AR, Chiara G, Regge D, Preda L, Morbini P, Stella GM. The growth of non-solid neoplastic lung nodules is associated with low PD L1 expression, irrespective of sampling technique. J Transl Med 2020; 18:54. [PMID: 32013991 PMCID: PMC6998829 DOI: 10.1186/s12967-020-02241-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 01/05/2023] Open
Abstract
Background Few data are known regarding the molecular features and patterns of growth and presentation which characterize those lung neoplastic lesions presenting as non-solid nodules (NSN). Methods We retrospectively reviewed two different cohorts of NSNs detected by CT scan which, after transthoracic fine-needle aspiration (FNA) and core needle biopsy (CNB) received a final diagnosis of malignancy. All the enrolled patients were then addressed to surgical removal of lung cancer nodules or to exclusive radiotherapy. Exhaustive clinical and radiological features were available for each case. Results In all 62 analysed cases the diagnosis of adenocarcinoma (ADC) was reached. In cytologic samples, EGFR activating mutations were identified in 2 of the 28 cases (7%); no case showed ALK/EML4 or ROS1 translocations. In the histologic samples EGFR activating mutation were found in 4 out of 25 cases (16%). PD-L1 immunostains could be evaluated in 30 cytologic samples, while the remaining 7 did not reach the cellularity threshold for evaluation. TPS was < 1% in 26 cases, > 1% < 50% in 3, and > 50% in 1. All surgical samples showed TPS < 1%. Of the 17 cases that could be evaluated on both samples, 15 were concordantly TPS 0, and 2 showed TPS > 1% < 50 on the biopsy samples. TPS was < 1% in 14 cases, > 1%/< 5% in 4 cases, > 5%/< 50% in 2 cases, > 50% in 1 case. Conclusions Overall PD-L1 immunostaining documented the predominance of low/negative TPS, with high concordance in FNA and corresponding surgical samples. It can be hypothesized that lung ADC with NSN pattern and predominant in situ (i.e. lepidic) components represent the first steps in tumor progression, which have not yet triggered immune response, and/or have not accumulated a significant rate of mutations and neoantigen production, or that they belong to the infiltrated-excluded category of tumors. The negative prediction of response to immunomodulating therapy underlines the importance of rapid surgical treatment of these lesions. Notably, cell block cytology seems to fail in detecting EGFR mutations, thus suggesting that this kind of sampling technique should be not adequate in case of DNA direct sequencing.
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Affiliation(s)
- Chandra Bortolotto
- Department of Intensive Medicine, Unit of Radiology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Claudio Maglia
- Radiology Unit, IRCCS Candiolo Cancer Institute and University of Turin Medical School, Candiolo, TO, Italy
| | - Antonio Ciuffreda
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100, Pavia, Italy
| | - Manuela Coretti
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100, Pavia, Italy
| | - Roberta Catania
- Department of Intensive Medicine, Unit of Radiology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Filippo Antonacci
- Department of Intensive Medicine, Unit of Cardiothoracic Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Sergio Carnevale
- Department of Molecular Medicine, Unit of Pathology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Ivana Sarotto
- Unit of Pathology, IRCCS Candiolo Cancer Institute, Candiolo, TO, Italy
| | - Roberto Dore
- Department of Intensive Medicine, Unit of Radiology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Andrea Riccardo Filippi
- Department of Medical Sciences and Infective Diseases, Unit of Radiation Therapy, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Gabriele Chiara
- Radiology Unit, IRCCS Candiolo Cancer Institute and University of Turin Medical School, Candiolo, TO, Italy
| | - Daniele Regge
- Radiology Unit, IRCCS Candiolo Cancer Institute and University of Turin Medical School, Candiolo, TO, Italy
| | - Lorenzo Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Patrizia Morbini
- Department of Molecular Medicine, Unit of Pathology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Giulia Maria Stella
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100, Pavia, Italy.
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Sihoe AD. Surgical management of ground glass opacities of the lung. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alan D.L. Sihoe
- School of Biomedical SciencesThe University of Hong Kong Hong Kong SAR China
- Gleneagles Hong Kong Hospital Hong Kong SAR China
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25
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Liu B. [Diagnosis and Treatment of Pulmonary Ground-glass Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:449-456. [PMID: 31315784 PMCID: PMC6712268 DOI: 10.3779/j.issn.1009-3419.2019.07.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recent widespread use of high resolution computed tomography (HRCT) for the screening of lung cancer have led to an increase in the detection rate of very faint and smaller lesions known as ground-glass nodule (GGN). However, it had been proved that GGN was well associated with lung cancer in previous studies. Therefore, the classification, imaging characteristics, pathological type, follow-up, suggested managements and other clinical concerns of GGN were reviewed in this paper.
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Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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26
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Chae KJ, Hong H, Yoon SH, Hahn S, Jin GY, Park CM, Goo JM. Non-diagnostic Results of Percutaneous Transthoracic Needle Biopsy: A Meta-analysis. Sci Rep 2019; 9:12428. [PMID: 31455841 PMCID: PMC6711972 DOI: 10.1038/s41598-019-48805-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/12/2019] [Indexed: 02/06/2023] Open
Abstract
Non-diagnostic results can affect the diagnostic performance of percutaneous transthoracic needle biopsy (PTNB) but have not been critically meta-analyzed yet. To meta-analyze the incidence and malignancy rate of non-diagnostic results, 3-by-2 table approaches rather than the conventional 2-by-2 approaches are needed to know its impact on the diagnostic performance of PTNB. A systematic literature search identified studies evaluating the diagnostic performance of PTNB with extractable outcomes. A total of 143 studies with 35,059 biopsies were included. The pooled incidence of non-diagnostic results was 6.8% (95% CI, 6.0-7.6%; I2 = 0.91). The pooled malignancy rate of non-diagnostic results was 59.3% (95% CI, 51.7-66.8%; I2 = 0.80), and was correlated with the prevalence of malignancy (correlation coefficient, 0.66; 95% CI, 0.42-0.91). Pooled percentage decrease of sensitivity and specificity due to non-diagnostic results were 4.5% (95% CI, 3.2-5.7%; I2 = 0.64) and 10.7% (95% CI, 7.7-13.7%; I2 = 0.70), respectively, and the pooled incidence of non-diagnostic results was 4.4% (95% CI, 3.2-5.8%; I2 = 0.83) in lesions ultimately diagnosed as malignancies and 10.4% (95% CI, 7.5-13.8%; I2 = 0.74) in benign disease. In conclusion, non-diagnostic results averagely occurred in 6.8% of PTNB and more than half of the results were malignancies. The non-diagnostic results decreased specificity and sensitivity by 10.7% and 4.5%, respectively, demanding efforts to minimize the non-diagnostic results in PTNB.
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Affiliation(s)
- Kum Ju Chae
- Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Seokyung Hahn
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gong Yong Jin
- Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Accuracy and complications of CT-guided pulmonary core biopsy in small nodules: a single-center experience. Cancer Imaging 2019; 19:51. [PMID: 31337425 PMCID: PMC6651998 DOI: 10.1186/s40644-019-0240-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/16/2019] [Indexed: 01/05/2023] Open
Abstract
Background Computed tomography (CT)-guided pulmonary core biopsies of small pulmonary nodules less than 15 millimeters (mm) are challenging for radiologists, and their diagnostic accuracy has been shown to be variable in previous studies. Common complications after the procedure include pneumothorax and pulmonary hemorrhage. The present study compared the diagnostic accuracy of small and large lesions using CT-guided core biopsies and identified the risk factors associated with post-procedure complications. Methods Between January 1, 2016, and December 31, 2017, 198 CT-guided core biopsies performed on 195 patients at our institution were retrospectively enrolled. The lesions were separated into group A (< or = 15 mm) and group B (> 15 mm) according to the longest diameter of the target lesions on CT. Seventeen-gauge introducer needles and 18-gauge automated biopsy instruments were coaxially used for the biopsy procedures. The accuracy and complications, including pneumothorax and pulmonary hemorrhage, of the procedures of each group were recorded. The risk factors for pneumothorax and pulmonary hemorrhage were determined using univariate analysis of variables. Results The diagnostic accuracies of group A (n = 43) and group B (n = 155) were 83.7 % and 96.8 %, respectively (p = 0.005). The risk factors associated with post-biopsy pneumothorax were longer needle path length from the pleura to the lesion (p = 0.020), lesion location in lower lobes (p = 0.002), and patients with obstructive lung function tests (p = 0.034). The risk factors associated with post-biopsy pulmonary hemorrhage were longer needle path length from the pleura to the lesion (p < 0.001), smaller lesions (p < 0.001), non-pleural contact lesions (p < 0.001), patients without restrictive lung function tests (p = 0.034), and patients in supine positions (p < 0.003). Conclusion CT-guided biopsies of small nodules equal to or less than 15 mm using 17-gauge guiding needles and 18-gauge biopsy guns were accurate and safe. The biopsy results of small lesions were less accurate than those of large lesions, but the results were a reliable reference for clinical decision-making. Understanding the risk factors associated with the complications of CT-guided biopsies is necessary for pre-procedural planning and communication.
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Ali E, Takizawa H, Kawakita N, Sawada T, Tsuboi M, Toba H, Takashima M, Matsumoto D, Yoshida M, Kawakami Y, Kondo K, Khairy El-Badrawy M, Tangoku A. Transbronchial Biopsy Using an Ultrathin Bronchoscope Guided by Cone-Beam Computed Tomography and Virtual Bronchoscopic Navigation in the Diagnosis of Pulmonary Nodules. Respiration 2019; 98:321-328. [DOI: 10.1159/000500228] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/08/2019] [Indexed: 11/19/2022] Open
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Kiranantawat N, McDermott S, Petranovic M, Mino-Kenudson M, Muniappan A, Sharma A, Shepard JAO, Digumarthy SR. Determining malignancy in CT guided fine needle aspirate biopsy of subsolid lung nodules: Is core biopsy necessary? Eur J Radiol Open 2019; 6:175-181. [PMID: 31080850 PMCID: PMC6502735 DOI: 10.1016/j.ejro.2019.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To assess the success of determining malignancy in subsolid lung nodules by fine needle aspirate of CT-guided transthoracic needle biopsy. Material and method This IRB approved retrospective study analyzed CTguided transthoracic needle biopsy of 86 consecutive subsolid nodules (size 25 + 14 mm; Age 71 + 10 years: M: F, 27:59), with ground glass opacity of = 50% in 64 (74%) and size < 2 cm in 38 (44%). Fine needle aspirate was performed in all and additional core biopsy in 21 (24%). The biopsy results were correlated with resected surgical pathology in 59 (69%) and by long term clinical and imaging follow-up in 27 (31%). The statistical analysis was performed by Fischer exact test to determine the success rate in < 2cm and =2cm nodules and those with <50% and =50% ground glass opacity. Results The technical success of performing the biopsy was 94.7%. The sensitivity for making a diagnosis of malignancy in small and large subsolid nodules was 88.6 and 95.6% (p=>0.05), with a specificity 100% in both groups. Core biopsy altered the diagnosis only in 1/21 (4.8%). The nondiagnostic biopsy rate was 18 and 11% for lesions with =50% and <50% ground glass opacity (p=>0.05). The incidence of pneumothorax was 21%, none requiring chest tube, and mild hemoptysis in 8%. Conclusion CT-guided transthoracic needle biopsy of both small and large subsolid nodules is highly sensitive and very specific for making the diagnosis of malignancy with a low rate of complications. Additional core biopsy offered no significant advantage over fine needle aspirate biopsy alone.
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Affiliation(s)
- Nantaka Kiranantawat
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Milena Petranovic
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Ashok Muniappan
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Jo-Anne O Shepard
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, United States
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Hammer MM, Palazzo LL, Eckel AL, Barbosa EM, Kong CY. A Decision Analysis of Follow-up and Treatment Algorithms for Nonsolid Pulmonary Nodules. Radiology 2018; 290:506-513. [PMID: 30457486 DOI: 10.1148/radiol.2018180867] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate management strategies and treatment options for patients with ground-glass nodules (GGNs) by using decision-analysis models. Materials and Methods A simulation was developed for 1 000 000 hypothetical patients with GGNs undergoing follow-up per the Lung Imaging Reporting and Data System (Lung-RADS) recommendations. The initial age range was 55-75 years (mean, 64 years). Nodules could grow and develop solid components over time. Clinically significant malignancy rates were calibrated to data from the National Lung Screening Trial. Annual versus 3-year-interval follow-up of Lung-RADS category 2 nodules was compared, and different treatment strategies were tested (stereotactic body radiation therapy, surgery, and no therapy). Results Overall, 2.3% (22 584 of 1 000 000) of nodules were clinically significant malignancies; 6.3% (62 559 of 1 000 000) of nodules were treated. Only 30% (18 668 of 62 559) of Lung-RADS category 4B or 4X nodules were clinically significant malignancies. The risk of clinically significant malignancy for persistent nonsolid nodules after baseline was higher than Lung-RADS estimates for categories 2 and 3 (3% vs <1% and 1%-2%, respectively). Overall survival (OS) at 10 years was 72% (527 827 of 737 306; 95% confidence interval [CI]: 71%, 72%) with annual follow-up and 71% (526 507 of 737 306; 95% CI: 71%, 72%) with 3-year-interval follow-up (P < .01). At 10 years, OS among patients whose nodules progressed to Lung-RADS category 4B or 4X was 80% after radiation therapy (49 945 of 62 559; 95% CI: 80%, 80%), 79% after surgery (49 139 of 62 559; 95% CI: 78%, 79%), and 74% after no therapy (46 512 of 62 559; 95% CI: 74%, 75%) (P < .01). Conclusion Simulation modeling suggests that the follow-up interval for evaluating ground-glass nodules can be increased from 1 year to 3 years with minimal change in outcomes. Stereotactic body radiation therapy demonstrated the best outcomes compared with lobectomy and with no therapy for nonsolid nodules. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Mark M Hammer
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Lauren L Palazzo
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Andrew L Eckel
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Eduardo M Barbosa
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Chung Yin Kong
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
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Sihoe ADL, Cardillo G. Solitary pulmonary ground-glass opacity: is it time for new surgical guidelines? Eur J Cardiothorac Surg 2018; 52:848-851. [PMID: 28977403 DOI: 10.1093/ejcts/ezx211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022] Open
Abstract
As screening for lung cancer becomes more common around the world, so too does detection of pulmonary ground-glass opacities (GGOs). Although a number of guidelines have been published that cover the management of GGOs, they typically feature some common themes. These include basing management and surveillance on a limited number of computed tomography imaging criteria only, inadequate consideration of the pros and cons of non-surgical biopsy versus surgery, inadequate consideration of modern advances in surgery for GGOs and inadequate consideration of potential variations in pathology in different parts of the world. As GGOs become increasingly common in thoracic surgical practice, it may be appropriate to draft new guidelines for the clinical management GGOs that take a more distinctly surgical and international perspective.
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Affiliation(s)
- Alan D L Sihoe
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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Yun S, Kang H, Park S, Kim BS, Park JG, Jung MJ. Diagnostic accuracy and complications of CT-guided core needle lung biopsy of solid and part-solid lesions. Br J Radiol 2018; 91:20170946. [PMID: 29770737 DOI: 10.1259/bjr.20170946] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate whether diagnostic accuracy and complications of CT-guided core needle biopsy (CNB) differ for solid and part-solid lung lesions Methods: This retrospective study included 354 consecutive patients from April 2012 to July 2016 who underwent CT-guided CNB of lung lesions by a radiologist. Patient demographics, lung lesions' characteristics; solid or part-solid, underlying pulmonary disease, distance of path, procedure time, complications (hemorrhage or pneumothorax), histopathological results of biopsy specimens and final diagnosis were reviewed. The diagnostic yields, biopsy-related factors and complications were compared for patients with solid lesions and patients with part-solid lesions. Factors related to true diagnoses and complications were analyzed statistically. RESULTS The biopsies of part-solid lesions take more time (p = 0.021). Non-diagnostic biopsies were not statistically different between solid and part-solid lesions (p = 0.804). There was no significant difference in the diagnostic yields including sensitivity, specificity, accuracy, positive predictive value and negative predictive value for solid and part-solid lesions statistically. The occurrence of hemorrhage on postbiopy follow-up CT was significantly higher (p = 0.016) for part-solid lesions. The occurrence of symptomatic major hemorrhage (p = 0.859) and pneumothorax (p = 0.106) was not significantly different between solid and part-solid lesions. CONCLUSION The diagnostic accuracy of CT-guided CNB for diagnosing malignancy was comparable for solid and part-solid lesions. The frequency of hemorrhage on the follow up CT was higher in patients with part-solid lesions, but there were no significant differences in major hemorrhage and pneumothorax for solid and part-solid lesions. Advances in knowledge: The diagnostic yield of CT-guided CNB for diagnosing malignancy is comparable for solid and part-solid lesions. Although the post procedural hemorrhage occurs more frequently in part-solid lesions, the occurrence of symptomatic major hemorrhage is not significantly different. Therefore, CT-guided CNB should be considered for histopathological confirmation of intrapulmonary lesions regardless of the presence of ground-glass opacity portion.
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Affiliation(s)
- Sam Yun
- 1 Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine , Busan , South Korea
| | - Hee Kang
- 1 Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine , Busan , South Korea
| | - Sekyoung Park
- 1 Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine , Busan , South Korea
| | - Beom Su Kim
- 1 Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine , Busan , South Korea
| | - Jung Gu Park
- 1 Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine , Busan , South Korea
| | - Min Jung Jung
- 2 Department of Pathology, Kosin University Gospel Hospital, Kosin University College of Medicine , Busan , South Korea
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Park CH, Im DJ, Lee SM, Lee JW, Hwang SH, Chong S, Cha MJ, Lee KH, Kwon W, Yong HS, Lee JW, Jin GY, Paik SH, Han K, Hur J. LOGIS (LOcalization of Ground-glass-opacity and pulmonary lesions for mInimal Surgery) registry: Design and Rationale. Contemp Clin Trials Commun 2018; 9:60-63. [PMID: 29696225 PMCID: PMC5898551 DOI: 10.1016/j.conctc.2017.12.001] [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: 07/09/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background and purpose An optimal pulmonary localization technique for video-assisted thoracic surgery (VATS) of small lung nodules has not yet been established. The LOcalization of Ground-glass-opacity and pulmonary lesions for mInimal Surgery (LOGIS) registry aims to establish a multicenter database and investigate the usefulness and safety of localization techniques for small pulmonary lesions in individuals undergoing VATS. Methods/Design The LOGIS registry is a large-scale, multicenter cohort study, aiming to enroll 825 patients at 10 institutions. Based on the inclusion and exclusion criteria, all study participants with pulmonary lesions indicated for VATS will be screened and enrolled at each site. All study participants will undergo preoperative lesion localization by the hook-wire or lipiodol localization methods according to site-specific methods. Within a few hours of marking, thoracoscopic surgery will be done under general anesthesia by experienced thoracoscopic surgeons. The primary endpoints are the success and complication rates of the two localization techniques. Secondary endpoints include procedure duration, recurrence rate, and all-cause mortality. Study participant enrollment will be completed within 2 years. Procedure success rates and incidence of complications will be analyzed based on computed tomography findings. Procedure duration, recurrence rate, and all-cause mortality will be compared between the two techniques. The study will require 5 years for completion, including 6 months of preparation, 3.5 years for recruitment, and 1 year of follow-up endpoint assessment. Discussion The LOGIS registry, once complete, will provide objective comparative results regarding the usefulness and safety of the lipiodol and hook-wire localization techniques.
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Affiliation(s)
- Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Jin Im
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Semin Chong
- Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kye Ho Lee
- Department of Radiology, Dankook University Hospital, Cheonan, Chungnam Province, Republic of Korea
| | - Woocheol Kwon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Jae Wook Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Gong Yong Jin
- Departments of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Sang Hyun Paik
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hur
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Hwang EJ, Kim H, Park CM, Yoon SH, Lim HJ, Goo JM. Cone beam computed tomography virtual navigation-guided transthoracic biopsy of small (≤ 1 cm) pulmonary nodules: impact of nodule visibility during real-time fluoroscopy. Br J Radiol 2018; 91:20170805. [PMID: 29595322 DOI: 10.1259/bjr.20170805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the impact of nodule visibility during real-time fluoroscopy and other biopsy-related variables on the diagnostic accuracy and complication rates of cone beam CT (CBCT) virtual navigation (VN)-guided percutaneous transthoracic needle biopsies (PTNBs) of small (≤1 cm) pulmonary nodules. METHODS Patients (99 males and 114 females; age, 62.1 ± 11.1 years) who underwent CBCT VN-guided biopsies for lung nodules ≤ 1 cm were retrospectively reviewed. The visibility of target nodules was assessed on the captured fluoroscopy images. Diagnostic accuracies were calculated and logistic regression analyses were performed to determine independent influencing factors for the correct diagnosis and complications (pneumothoraxes and hemoptysis) in CBCT VN-guided PTNBs, respectively. RESULTS Among 213 nodules, 63 (29.6%) were invisible on real-time fluoroscopy during VN. The diagnostic accuracy of CBCT VN-guided PTNBs for the invisible nodules was 76.7%, while for the visible nodules was 89.1% (p = 0.042). In the logistic regression analysis, the visibility of a target nodule (odds ratio = 2.49, p = 0.047) was the only independent influencing factor for a correct diagnosis. As regards complication rates, nodule visibility was not a significant factor for the occurrence of a pneumothorax or hemoptysis. CONCLUSION Although nodule visibility on real-time fluoroscopy was an affecting factor for the correct diagnosis, CBCT VN-guided PTNB was feasible for the invisible nodules with diagnostic accuracy of 76.7%. Advance in knowledge: CBCT VN-guided PTNB can be tried safely for the subcentimeter-sized pulmonary nodules regardless of their fluoroscopic visibility.
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Affiliation(s)
- Eui Jin Hwang
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea
| | - Hyungjin Kim
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea
| | - Chang Min Park
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea.,2 Institute of Radiation Medicine, Seoul National University Medical Research Center , Seoul , Korea
| | - Soon Ho Yoon
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea.,2 Institute of Radiation Medicine, Seoul National University Medical Research Center , Seoul , Korea
| | - Hyun-Ju Lim
- 3 Department of Radiology, National Cancer Center , Goyang-si, Gyeonggi-do , Korea
| | - Jin Mo Goo
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea.,2 Institute of Radiation Medicine, Seoul National University Medical Research Center , Seoul , Korea
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Hu R, Lei P, Li B, Liu H, Yang X, Wen T, Hu Y, Tian X. Real-time computerised tomography assisted porous tantalum implant in ARCO stage I-II non-traumatic osteonecrosis of the femoral head: minimum five-year follow up. INTERNATIONAL ORTHOPAEDICS 2018; 42:1535-1544. [PMID: 29589085 DOI: 10.1007/s00264-018-3899-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/13/2018] [Indexed: 11/26/2022]
Abstract
PURPOSES This study was established to investigate the medium-term clinical effect of real-time CT assisted porous tantalum implant for the treatment of ARCO stage I-II non-traumatic osteonecrosis of the femoral head (ONFH). METHODS This study comprised 24 ONFH patients (29 hips) who were treated with intra-operative real-time CT accurate rapid positioning assisted drilling decompression, lesion removal and porous tantalum implant. Harris score, VAS score and imaging in pre-operation and follow-up period were recorded. RESULTS The average operative time and intra-operative blood loss were 72.6 min and 158.8 ml, respectively. The mean follow-up was 5.4 years. No femoral head penetrating, wound infection, and death occurred. Harris and VAS score improved significantly (73.78 vs. 88.11; 7.13 vs. 2.66) at last follow-up (P < 0.05). The functional improvement and pain relief rate was 100% at six months after operation. The effective rate was 86.21% at 12 months after operation and last follow-up. Five pre-operative ARCO stage I hips had no radiographic progress. Meanwhile, four among the 24 ARCO stage II hips progressed into stage III between eight and 12 months after surgery, among which two progressed into stage IV and two remained in stage III at the last follow-up. The average value of Kerboul combined necrotic angle was 263.24°. There was no progress in Kerboul combined necrotic angle among the grades 2 and 3 patients. However, among the six cases at grade 4, four cases with post-operative progress, two patients converted to THA. CONCLUSIONS Our technique is safety and effective in the treatment of ARCO stage I-II non-traumatic ONFH.
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Affiliation(s)
- Ruyin Hu
- Department of Orthopeadics, People's Hospital of Guizhou Province, No. 83 Zhongshan East Road, Guiyang, 550002, Guizhou, People's Republic of China
| | - Pengfei Lei
- Department of Orthopeadics, Xiangya Hospital Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Bo Li
- Department of Orthopeadics, People's Hospital of Guizhou Province, No. 83 Zhongshan East Road, Guiyang, 550002, Guizhou, People's Republic of China
| | - Hao Liu
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Xucheng Yang
- Department of Orthopeadics, Xiangya Hospital Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Ting Wen
- Department of Orthopeadics, Xiangya Hospital Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Yihe Hu
- Department of Orthopeadics, Xiangya Hospital Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Xiaobin Tian
- Department of Orthopeadics, People's Hospital of Guizhou Province, No. 83 Zhongshan East Road, Guiyang, 550002, Guizhou, People's Republic of China.
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Application of Real-Time 3D Navigation System in CT-Guided Percutaneous Interventional Procedures: A Feasibility Study. Radiol Res Pract 2017; 2017:3151694. [PMID: 29181197 PMCID: PMC5664284 DOI: 10.1155/2017/3151694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/28/2017] [Accepted: 09/17/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction To evaluate the accuracy of a quantitative 3D navigation system for CT-guided interventional procedures in a two-part study. Materials and Methods Twenty-two procedures were performed in abdominal and thoracic phantoms. Accuracies of the 3D anatomy map registration and navigation were evaluated. Time used for the navigated procedures was recorded. In the IRB approved clinical evaluation, 21 patients scheduled for CT-guided thoracic and hepatic biopsy and ablations were recruited. CT-guided procedures were performed without following the 3D navigation display. Accuracy of navigation as well as workflow fitness of the system was evaluated. Results In phantoms, the average 3D anatomy map registration error was 1.79 mm. The average navigated needle placement accuracy for one-pass and two-pass procedures, respectively, was 2.0 ± 0.7 mm and 2.8 ± 1.1 mm in the liver and 2.7 ± 1.7 mm and 3.0 ± 1.4 mm in the lung. The average accuracy of the 3D navigation system in human subjects was 4.6 mm ± 3.1 for all procedures. The system fits the existing workflow of CT-guided interventions with minimum impact. Conclusion A 3D navigation system can be performed along the existing workflow and has the potential to navigate precision needle placement in CT-guided interventional procedures.
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Lee SM, Park CM, Song YS, Kim H, Kim YT, Park YS, Goo JM. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital. Eur Radiol 2017; 27:5119-5126. [PMID: 28656460 DOI: 10.1007/s00330-017-4917-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/25/2017] [Accepted: 05/30/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). METHODS From January 2009-December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. RESULTS Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CONCLUSIONS CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm. KEY POINTS • 91.6% of PSNs with solid component > 5 mm were adenocarcinomas. • PTNBs for PSNs with solid component > 5 mm had 79.5% accuracy. • CT-based resection for PSNs with solid component > 5 mm had 86.4% accuracy. • CT-based resection without biopsy can be a reasonable option in routine practice.
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Affiliation(s)
- Sang Min Lee
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, South Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Yong Sub Song
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
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38
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Tian P, Wang Y, Li L, Zhou Y, Luo W, Li W. CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing. J Thorac Dis 2017; 9:333-343. [PMID: 28275482 PMCID: PMC5334098 DOI: 10.21037/jtd.2017.02.16] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions. METHODS This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample's adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed. RESULTS The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing. CONCLUSIONS The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.
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Affiliation(s)
- Panwen Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongzhao Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wenxin Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Yang W, Jiang H, Khan AN, Allen C, Bertolaccini L, Lv T, Song Y. Transthoracic needle aspiration in solitary pulmonary nodule. Transl Lung Cancer Res 2017; 6:76-85. [PMID: 28331827 DOI: 10.21037/tlcr.2017.02.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With improved awareness of public health and the recent advances in various imaging technologies, the detection rate of solitary pulmonary nodules (SPN) is continuously increasing. Transthoracic needle aspiration (TTNA) has represented a major approach for the diagnosis and differential diagnosis of pulmonary masses, owing to its simplicity and minimal invasiveness. This paper demonstrates the role of TTNA in SPN.
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Affiliation(s)
- Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Hongli Jiang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Ali Nawaz Khan
- Department of Radiology, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsall, Manchester M8 6RB, UK
| | - Carolyn Allen
- Department of Radiology, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsall, Manchester M8 6RB, UK
| | - Luca Bertolaccini
- Thoracic Surgery - AUSL Romagna, Santa Maria delle Croci Teaching Hospital, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
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Nondiagnostic Computed Tomography-guided Percutaneous Lung Biopsies Are More Likely When Infection Is Suspected. J Thorac Imaging 2017; 31:151-5. [PMID: 27043424 DOI: 10.1097/rti.0000000000000207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess the incidence of nondiagnostic computed tomography-guided lung biopsy results, stratified by biopsy indication, and determine the final diagnosis in such cases. MATERIALS AND METHODS Following institutional review board approval, pathology results from CT-guided lung biopsies over a 5-year period at 2 institutions were categorized as diagnostic or nondiagnostic. Each biopsy's indication was categorized as being for a lesion considered likely to be cancer, infection, or uncertain. For all nondiagnostic biopsies, the medical chart was reviewed to determine the final clinical diagnosis. RESULTS A total of 660 biopsies were evaluated, 139 (21%) of which were nondiagnostic. Of these 139 patients, the final clinical diagnosis was infection in 37%, cancer in 30%, and a benign noninfectious diagnosis in 10%; 23% remained undiagnosed at last available follow-up. Among the patients in whom there was a high pretest suspicion for cancer, 13% were nondiagnostic, 45% of which were cancer and 27% were infection. Among biopsies of lesions with pretest probability for both cancer and infection, 51% were nondiagnostic; on clinical follow-up these were determined to be infection in 34% and cancer in 14%. When there was high pretest suspicion for infection, 73% were nondiagnostic, of which 13% were cancer on clinical follow-up, and 88% were infection. The rate of nondiagnostic biopsies was statistically significantly different (P<0.001) among the 3 groups. CONCLUSIONS Nondiagnostic biopsies are common and occur most frequently when there is a moderate or high pretest suspicion for infection. Among all nondiagnostic biopsies, regardless of indication, cancer and infection were diagnosed on follow-up in similar proportions.
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Diagnostic Yield for Cancer and Diagnostic Accuracy of Computed Tomography-guided Core Needle Biopsy of Subsolid Pulmonary Lesions. J Thorac Imaging 2016; 32:50-56. [PMID: 27870823 DOI: 10.1097/rti.0000000000000245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to determine the diagnostic yield for cancer and diagnostic accuracy of computed tomography-guided core needle biopsy (CTNB) in subsolid pulmonary lesions. MATERIALS AND METHODS Fifty-two biopsies of 52 subsolid lesions in 51 patients were identified from a database of 912 lung biopsies and analyzed for the diagnostic yield for cancer and diagnostic accuracy of core CTNB diagnosis as well as complication rates. RESULTS When indeterminate biopsy results were included in the analysis, the diagnostic yield for cancer was 80.8% and the diagnostic accuracy of core needle biopsy was 84.6% (n=52). It was 85.7% and 91.7%, respectively, when indeterminate results were excluded (n=48) and 82.4% and 82.4%, respectively, for biopsies with surgical confirmation (n=17). Attenuation was statistically significant for diagnostic yield for cancer (P=0.028) and diagnostic accuracy of core needle biopsy (P=0.001) when the indeterminate results were excluded (n=48). Attenuation and size were not statistically significant for diagnostic yield for cancer and diagnostic accuracy of needle biopsy (n=52), and size was not statistically significant for either when the indeterminate results were excluded. These results were achieved without any major complications as per the Society of Interventional Radiology Standards of Practice. CONCLUSIONS CTNB offers a high yield in establishing a histopathologic diagnosis of subsolid pulmonary lesions, with both ground-glass and solid-predominance. The pure ground-glass category of lesions requires further research to determine the true diagnostic yield and diagnostic accuracy of core needle biopsies.
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Choi SH, Chae EJ, Shin SY, Kim EY, Kim JE, Lee HJ, Oh SY, Lee SM. Comparisons of clinical outcomes in patients with and without a preoperative tissue diagnosis in the persistent malignant-looking, ground-glass-opacity nodules. Medicine (Baltimore) 2016; 95:e4359. [PMID: 27559945 PMCID: PMC5400311 DOI: 10.1097/md.0000000000004359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
To evaluate the clinical usefulness of surgical resection of persistent malignant-looking ground-glass-opacity nodules (GGN) without a preoperative tissue diagnosis.From September 1998 to November 2011, we retrospectively enrolled 288 patients (126 men, 162 women; mean age, 59.3 years) with lung adenocarcinoma proven by surgery and which appeared as GGN on chest computed tomography (CT, ground-glass-opacity [GGO] proportion >20%). We divided the study subjects into 2 groups: patients with a preoperative tissue diagnosis (PTD group, n = 207) and patients without a preoperative tissue diagnosis (No-PTD group, n = 81). In patients with GGN having GGO ≥ 90% (n = 140), we divided them into 2 groups: PTD group (n = 83) and No-PTD group (n = 57). The clinical and surgical outcomes were compared between the 2 groups.In 204 patients who underwent lobectomy for stage Ia lung cancer, there was no significantly different recurrence-free survival between the 2 groups (P = 0.721). A significantly lower percentage of No-PTD group waited >14 days for surgery (77.8% vs 87.9%, P = 0.030) and were hospitalized for >7 days (56.8% vs 89.9%, P < 0.001). They showed a shorter mean surgery time (136.9 vs 155.0 minutes, P = 0.019). In patients with GGN having GGO ≥ 90%, the results were the same as those of all of the study subjects.No-PTD group can gain benefits perioperatively, showing no different recurrence-free survival with PTD group in stage Ia lung cancer.
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Affiliation(s)
- Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
- Correspondence: Eun Jin Chae, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul 138-736, Korea (e-mail: )
| | - So Youn Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
- Department of Radiology, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine, Jeonju, Korea
| | - Ji-Eun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
| | - Hyun Joo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Seoul
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Yan GW, Yan GW, Sun QQ, Niu XK, Li B, Bhetuwal A, Xu XX, Du Y, Yang HF. Computed tomography fluoroscopy guided percutaneous lung biopsy for ground-glass opacity pulmonary lesions: A meta-analysis. World J Meta-Anal 2016; 4:55-62. [DOI: 10.13105/wjma.v4.i2.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/11/2016] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To obtain the diagnostic performance of percutaneous transthoracic needle biopsy (PTNB) under Computed tomography (CT) fluoroscopy guidance for lung ground-glass opacity (GGO).
METHODS: We searched for English- and Chinese-language studies in PubMed, EMBASE, EBSCO, OVID, and CNKI (China National Knowledge Infrastructure) database. Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software. From the pooled data, we calculated sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) curves were constructed and incidence of complications was recorded.
RESULTS: Four documents included in this present meta-analysis met the criteria for analysis. The pooled Sen, Spe, +LR, -LR and DOR with 95%CI were 0.91 (0.86-0.95), 1.0 (0.91-1.0), 18.64 (4.83-71.93), 0.11 (0.05-0.26) and 153.17 (30.78-762.33), respectively. The area under the SROC curve was 0.98. The incidence of pneumothorax and hemoptysis was 17.86%-51.80% and 10.50%-19.40%, respectively.
CONCLUSION: CT fluoroscopy-guided PTNB, which has an acceptable incidence of complications, can be used as a primary examination method for lung GGO, with moderate sensitivity and specificity.
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Klein JS. Transthoracic needle aspiration biopsy for the cytologic diagnosis of subsolid lung nodules. Cancer Cytopathol 2016; 124:451-2. [PMID: 26990028 DOI: 10.1002/cncy.21712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/17/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Jeffrey S Klein
- Professor of Radiology, Department of Radiology, University of Vermont College of Medicine and Editor, RadioGraphics, Radiological Society of North America
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Yarmus LB, Arias S, Feller-Kopman D, Semaan R, Wang KP, Frimpong B, Oakjones Burgess K, Thompson R, Chen A, Ortiz R, Lee HJ. Electromagnetic navigation transthoracic needle aspiration for the diagnosis of pulmonary nodules: a safety and feasibility pilot study. J Thorac Dis 2016; 8:186-94. [PMID: 26904228 DOI: 10.3978/j.issn.2072-1439.2016.01.47] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pulmonary nodules remain a diagnostic challenge for physicians. Minimally invasive biopsy methods include bronchoscopy and CT guided transthoracic needle aspiration (TTNA). A novel electromagnetic guidance transthoracic needle aspiration (ETTNA) procedure which can be combined with navigational bronchoscopy (NB) and endobronchial ultrasound (EBUS) in a single setting has become available. METHODS A prospective pilot study examining the safety, feasibility and diagnostic yield of ETTNA in a single procedural setting. All patients enrolled underwent EBUS for lung cancer staging followed by NB and ETTNA. Feasibility of performing ETTNA and a safety assessment by recording procedural related complications including pneumothorax or bleeding was performed. Diagnostic yield of ETTNA defined by a definitive pathologic tissue diagnosis was recorded. An additional diagnostic yield analysis was performed using a cohort analysis of combined interventions (EBUS + NB + ETTNA). All non-diagnostic biopsies were either followed with radiographic imaging or a surgical biopsy was performed. RESULTS Twenty-four subjects were enrolled. ETTNA was feasible in 96% of cases. No bleeding events occurred. There were five pneumothoraces (21%) of which only two (8%) subjects required drainage. The diagnostic yield for ETTNA alone was 83% and increased to 87% (P=0.0016) when ETTNA was combined with NB. When ETTNA and NB were performed with EBUS for complete staging, the diagnostic yield increased further to 92% (P=0.0001). CONCLUSIONS This is the first human pilot study demonstrating an acceptable safety and feasibility profile with a novel ETTNA system. Further studies are needed to investigate the increased diagnostic yield from this pilot study.
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Affiliation(s)
- Lonny B Yarmus
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Sixto Arias
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - David Feller-Kopman
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Roy Semaan
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Ko Pen Wang
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Bernice Frimpong
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Karen Oakjones Burgess
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Richard Thompson
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Alex Chen
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Ricardo Ortiz
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
| | - Hans J Lee
- 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA
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Abstract
BACKGROUND Image guided transthoracic needle aspiration (TTNA) is a valuable tool used for the diagnosis of countless thoracic diseases. Computed tomography (CT) is the most common imaging modality used for guidance followed by ultrasound (US) for lesions abutting the pleural surface. Novel approaches using virtual CT guidance have recently been introduced. The objective of this review is to examine the current literature for TTNA biopsy of the lung focusing on diagnostic accuracy and safety. METHODS MEDLINE was searched from inception to October 2015 for all case series examining image guided TTNA. Articles focusing on fluoroscopic guidance as well as influence of rapid on-site evaluation (ROSE) on yield were excluded. The diagnostic accuracy, defined as the number of true positives divided by the number of biopsies done, as well as the complication rate [pneumothorax (PTX), bleeding] was examined for CT guided TTNA, US guided TTNA as well as CT guided electromagnetic navigational-TTNA (E-TTNA). Of the 490 articles recovered 75 were included in our analysis. RESULTS The overall pooled diagnostic accuracy for CT guided TTNA using 48 articles that met the inclusion and exclusion criteria was 92.1% (9,567/10,383). A similar yield was obtained examining ten articles using US guided TTNA of 88.7% (446/503). E-TTNA, being a new modality, only had one pilot study citing a diagnostic accuracy of 83% (19/23). Pooled PTX and hemorrhage rates were 20.5% and 2.8% respectively for CT guided TTNA. The PTX rate was lower in US guided TTNA at a pooled rate of 4.4%. E-TTNA showed a similar rate of PTX at 20% with no incidence of bleeding in a single pilot study available. CONCLUSIONS Image guided TTNA is a safe and accurate modality for the biopsy of lung pathology. This study found similar yield and safety profiles with the three imaging modalities examined.
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Affiliation(s)
- David M DiBardino
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lonny B Yarmus
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Roy W Semaan
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Moreland A, Novogrodsky E, Brody L, Durack J, Erinjeri J, Getrajdman G, Solomon S, Yarmohammadi H, Maybody M. Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors. Eur Radiol 2016; 26:3483-91. [PMID: 26787605 DOI: 10.1007/s00330-015-4200-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/09/2015] [Accepted: 12/30/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the incidence and risk factors of pneumothoraces requiring prolonged maintenance of a chest tube following CT-guided percutaneous lung biopsy in a retrospective, single-centre case series. MATERIALS AND METHODS All patients undergoing CT-guided percutaneous lung biopsies between June 2012 and May 2014 who required chest tube insertion for symptomatic or enlarging pneumothoraces were identified. Based on chest tube dwell time, patients were divided into two groups: short term (0-2 days) or prolonged (3 or more days). The following risk factors were stratified between groups: patient demographics, target lesion characteristics, and procedural/periprocedural technique and outcomes. RESULTS A total of 2337 patients underwent lung biopsy; 543 developed pneumothorax (23.2 %), 187 required chest tube placement (8.0 %), and 55 required a chest tube for 3 days or more (2.9 % of all biopsies, 29.9 % of all chest tubes). The median chest tube dwell time for short-term and prolonged groups was 1.0 days and 4.7 days, respectively. The transfissural needle path predicted prolonged chest tube requirement (OR: 2.5; p = 0.023). Other factors were not significantly different between groups. CONCLUSION Of patients undergoing CT-guided lung biopsy, 2.9 % required a chest tube for 3 or more days. Transfissural needle path during biopsy was a risk factor for prolonged chest tube requirement. KEY POINTS • CT-guided percutaneous lung biopsy (CPLB) is an important method for diagnosing lung lesions • A total of 2.9 % of patients require a chest tube for ≥3 days following CPLB • Transfissural needle path is a risk factor for prolonged chest tube time.
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Affiliation(s)
- Anna Moreland
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Eitan Novogrodsky
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Lynn Brody
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeremy Durack
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Majid Maybody
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Prognostic impact of cytological fluid tumor markers in non-small cell lung cancer. Tumour Biol 2015; 37:3205-13. [DOI: 10.1007/s13277-015-4034-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022] Open
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Ikezawa Y, Sukoh N, Shinagawa N, Nakano K, Oizumi S, Nishimura M. Endobronchial ultrasonography with a guide sheath for pure or mixed ground-glass opacity lesions. Respiration 2015; 88:137-43. [PMID: 24993187 DOI: 10.1159/000362885] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/15/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Ground-glass opacity (GGO) lesions are difficult to diagnose by transbronchial biopsy (TBB). OBJECTIVES We attempted to diagnose solitary peripheral GGO predominant-type lesions by TBB using endobronchial ultrasonography with a guide sheath (EBUS-GS) under X-ray fluoroscopic guidance, and to evaluate several factors associated with diagnostic yield. METHODS The medical records of 67 patients with GGO predominant-type lesions who underwent TBB using EBUS-GS under X-ray fluoroscopic guidance were retrospectively reviewed. RESULTS Of the 67 lesions, 38 (57%) were successfully diagnosed by EBUS-GS (5/11 pure GGO lesions and 33/56 mixed GGO lesions). The diagnosable lesions were significantly larger than the nondiagnosable lesions (24 vs. 17 mm, respectively; p < 0.01). Regarding the diagnostic yield by signs on computed tomography, the lesions with a bronchus leading directly to a lesion had a significantly higher diagnostic yield than the others (p < 0.05). When GGO lesions were confirmed under X-ray fluoroscopic guidance, the diagnostic yield was 79% (vs. 40% in lesions not visible on X-ray fluoroscopy; p < 0.05). CONCLUSIONS EBUS-GS is a useful and valuable diagnostic modality, even for GGO predominant-type lesions located at the lung periphery.
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Affiliation(s)
- Yasuyuki Ikezawa
- First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan
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Kim H, Park CM, Koh JM, Lee SM, Goo JM. Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol 2015; 20:47-57. [PMID: 24100062 DOI: 10.5152/dir.2013.13223] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pulmonary subsolid nodules (SSNs) refer to pulmonary nodules with pure ground-glass nodules and part-solid ground-glass nodules. SSNs are frequently encountered in the clinical setting, such as screening chest computed tomography (CT). The main concern regarding pulmonary SSNs, particularly when they are persistent, has been lung adenocarcinoma and its precursors. The CT manifestations of SSNs help radiologists and clinicians manage these lesions. However, the management plan for SSNs has not previously been standardized. Recently, the Fleischner Society published recommendations for the management of incidentally detected SSNs. The guidelines reflect the new lung adenocarcinoma classification system proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) and include six specific recommendations according to the nodule size, solid portion and multiplicity. This review aims to increase the understanding of SSNs and the imaging features of SSNs according to their histology, natural course, possible radiologic interventions, such as biopsy, localization prior to surgery, and current management.
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Affiliation(s)
- Hyungjin Kim
- From the Department of Radiology (H.K., C.M.P. e-mail: , S.M.L., J.M.G.), Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea; Cancer Research Institute (C.M.P., J.M.G.), Seoul National University, Seoul, Korea; Department of Pathology (J.M.K.), Seoul National University Hospital, Seoul, Korea
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