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Kim DR, Nam IC, Baek HJ, Kim JJ, Hwang IK, Lee JS, Kim DJ, Hyun CL, Park SE, Song SW. Fluoroscopy-Guided Percutaneous Transthoracic Pleural Forceps Biopsy in Patients With Exudative Pleural Effusion. Korean J Radiol 2024; 25:706-714. [PMID: 39028012 PMCID: PMC11306004 DOI: 10.3348/kjr.2023.0960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic performance and procedural characteristics of fluoroscopy-guided percutaneous transthoracic pleural forceps biopsy (PTPFB) in patients with exudative pleural effusion. MATERIALS AND METHODS Patients with exudative pleural effusion who underwent PTPFB between May 1, 2014, and February 28, 2023, were included in this retrospective study. The interval between percutaneous catheter drainage (PCD) and PTPFB, number of biopsies, procedural time, and procedure-related complications were evaluated. The sensitivity, specificity, and accuracy of diagnosing malignancy were computed for pleural cytology using PCD drainage, PTPFB, and combined PTPFB and pleural cytology. RESULTS Seventy-one patients, comprising 50 male and 21 female (mean age, 69.5 ± 15.3 years), were included in this study. The final diagnoses were benign lesions in 48 patients (67.6%) and malignant in 23 patients (32.4%). The overall interval between PCD and biopsy was 2.4 ± 3.7 days. The interval between PCD and biopsy in the group that underwent delayed PTPFB was 5.2 ± 3.9 days. The mean number of biopsies was 4.5 ± 1.3. The mean procedural time was 4.4 ± 2.1 minutes. Minor bleeding complications were reported in one patient (1.4%). The sensitivity, specificity, and accuracy for pleural cytology, PTPFB, and combined PTPFB and pleural cytology were 47.8% (11/23), 100% (48/48), and 83.1% (59/71), respectively; 65.2% (15/23), 100% (48/48), and 88.7% (63/71), respectively; and 78.3% (18/23), 100% (48/48), and 93.0% (66/71), respectively. The sensitivity and accuracy of cytology combined with PTPFB were significantly higher than those of cytological testing alone (P = 0.008 and 0.001, respectively). CONCLUSION Fluoroscopy-guided PTPFB is an accurate and safe diagnostic technique for patients with exudative pleural effusion, with acceptable diagnostic performance, low complication rates, and reasonable procedural times.
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Affiliation(s)
- Doo Ri Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - In Chul Nam
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea.
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Miracle Radiology Clinic, Seoul, Republic of Korea
| | - Jeong Jae Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Im Kyung Hwang
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jeong Sub Lee
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Duk Ju Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Chang Lim Hyun
- Department of Pathology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sung Wook Song
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
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Wang XY, Yuan ZF, Gan KH, Zhong Y, Huang JX, Huang WJ, Xie YH, Pei XQ. Contrast-enhanced Imaging in Peripheral Pulmonary Lesions: The Role in US-guided Biopsies. Radiol Cardiothorac Imaging 2024; 6:e230234. [PMID: 38695742 PMCID: PMC11211938 DOI: 10.1148/ryct.230234] [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: 08/14/2023] [Revised: 01/07/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
Purpose To compare the tissue adequacy and diagnostic accuracy of US-guided biopsies of peripheral pulmonary lesions (PPLs) with and without contrast agents. Materials and Methods A retrospective study was conducted at four medical centers in patients with PPLs who underwent US-guided percutaneous transthoracic needle biopsy (PTNB) between January 2017 and October 2022. The patients were divided into contrast-enhanced US (CEUS) and US groups based on whether prebiopsy CEUS evaluation was performed. Tissue adequacy and the diagnostic accuracy of PTNB, stratified by lesion size, were analyzed and compared between groups. A propensity score matching (PSM) analysis was conducted using the nearest-neighbor matching method. Results A total of 1027 lesions were analyzed, with 634 patients (mean age, 59.4 years ± 13.0 [SD]; 413 male) in the US group and 393 patients (mean age, 61.2 years ± 12.5; 270 male) in the CEUS group. The CEUS group produced more acceptable samples than the US group (98.2% vs 95.7%; P = .03) and achieved higher diagnostic accuracy (96.9% vs 94.2%; P = .04), with no evidence of a difference in sensitivity (96.7% vs 94.0%; P = .06). PSM and stratified analyses (n = 358 per group) indicated higher tissue adequacy (99.0% vs 95.7%; P = .04) and diagnostic accuracy (98.5% vs 92.9%; P = .006) in the CEUS group compared with the US group for 2-7-cm PPLs but not for lesions larger than 7 cm. Conclusion PTNB with prebiopsy CEUS evaluation demonstrated significantly better tissue adequacy and diagnostic accuracy compared with US guidance alone for PPLs ranging from 2 to 7 cm, with similar biopsy performance achieved between groups for lesions larger than 7 cm. Keywords: Contrast Material, Thoracic Diseases, Ultrasonography, Image-Guided Biopsy © RSNA, 2024.
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Affiliation(s)
| | | | - Ke-Hong Gan
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Yuan Zhong
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Jia-Xin Huang
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Wei-Jun Huang
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Yu-Huan Xie
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
| | - Xiao-Qing Pei
- From the Department of Medical Ultrasound, State Key Laboratory of
Oncology in South China, Guangdong Provincial Clinical Research Center for
Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (X.Y.W.,
J.X.H., X.Q.P.); Department of Medical Ultrasound, The Tenth Affiliated Hospital
of Southern Medical University (Dongguan People’s Hospital), Dongguan,
China (Z.F.Y., Y.H.X.); Department of Medical Ultrasound, Guangdong Provincial
People’s Hospital (Guangdong Academy of Medical Sciences), Southern
Medical University, Guangzhou, China (K.H.G.); and Department of Medical
Ultrasound, The First People’s Hospital of Foshan, Foshan, China (Y.Z.,
W.J.H.)
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Porcel JM, Lee YCG. Advances in pleural diseases. Eur Respir J 2024; 63:2400593. [PMID: 38901889 DOI: 10.1183/13993003.00593-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/03/2024] [Indexed: 06/22/2024]
Affiliation(s)
- José M Porcel
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Y C Gary Lee
- University of Western Australia; Institute for Respiratory Health and Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
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Hao M, Fang Z, Ding J, Li C, Wei Y, Zhang W. Effects of preoperative needle biopsy for lung cancer on survival and recurrence: a systematic review and meta-analysis. Surg Today 2024; 54:95-105. [PMID: 36348163 DOI: 10.1007/s00595-022-02617-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
Needle biopsy (NB) is used for the diagnosis of lung cancer, but there is still controversy about its effect on the prognosis after surgery. We conducted this meta-analysis to compare the prognosis of lung cancer patients who underwent preoperative NB with that of those who did not. We systematically searched seven databases and Google Scholar for eligible studies. Recurrence-free survival (RFS) and overall survival (OS) were analyzed as primary outcome measures. Nine articles with a collective total of 13,541 patients (NB group, n = 4550; non-NB group, n = 8991) were included in our meta-analysis. OS [hazard ratio (HR) = 1.43 (0.96, 2.12), p = 0.08] and RFS (HR = 1.59 [1.25, 2.01], p = 0.0001) tended to be better in the non-NB group than in the NB group. Pleural recurrence (risk ratio (RR) = 2.40 [1.42, 4.07], p = 0.001) was significantly lower in the non-NB group than in the NB group. The recurrence analysis data did not reach significance, but the overall trend was better for the non-NB group. These findings demonstrate that NB is detrimental to the survival prognosis of lung cancer patients and increases the chance of pleural recurrence.
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Affiliation(s)
- Meiqi Hao
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Zige Fang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jiatong Ding
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Chenxi Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yiping Wei
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Wenxiong Zhang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
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Park B, Lim JK, Shin KM, Hong J, Cha JG, Cho SH, Park SY, Ryeom HK, Kim SH, Seo AN, Cha SI, Lee J, Lee H, Park J. Clinical Role of Upfront F-18 FDG PET/CT in Determining Biopsy Sites for Lung Cancer Diagnosis. Diagnostics (Basel) 2024; 14:153. [PMID: 38248030 PMCID: PMC10813933 DOI: 10.3390/diagnostics14020153] [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: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE This study aimed to investigate the impact of FDG PET/CT timing for biopsy site selection in patients with stage IV lung cancer regarding complications and diagnostic yield. METHODS This retrospective analysis was performed on 1297 patients (924 men and 373 women with a mean age of 71.4 ± 10.2 years) who underwent percutaneous needle biopsy (PNB) for stage IV lung cancer diagnosis in two hospitals. Data collected included the patient's characteristics, order date of the biopsy and PET/CT exams, biopsy target site (lung or non-lung), guidance modality, complications, sample adequacy, and diagnostic success. Based on the order date of the PNB and PET/CT exams, patients were categorized into upfront and delayed PET/CT groups. RESULTS PNB for non-lung targets resulted in significantly lower rates of minor (8.1% vs. 16.2%), major (0.2% vs. 3.4%), and overall complications (8.3% vs. 19.6%) compared to PNB for lung targets (p < 0.001 for all types of complications). Compared to the delayed PET/CT group, the upfront PET/CT group exhibited a lower probability of lung target selection of PNB (53.9% vs. 67.1%, p < 0.001), including a reduced incidence of major complications (1.0% vs. 2.9%, p = 0.031). Moreover, there was no significant difference in the occurrence of minor and total complications between the two groups. Upfront PET/CT and delayed PET/CT groups showed no significant difference regarding sample adequacy and diagnostic success. CONCLUSIONS Upfront PET/CT may have an impact on the selection of the biopsy site for patients with advanced lung cancer, which could result in a lower rate of major complications with no change in the diagnostic yield. Upfront PET/CT demonstrates potential clinical implications for enhancing the safety of lung cancer diagnosis in clinical practice.
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Affiliation(s)
- Byunggeon Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Kyung Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seo Young Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hoseok Lee
- Department of Radiology, Semyung Radiology Clinic, Gumi 39254, Gyeongsangbuk-do, Republic of Korea
| | - Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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Del Valle JB, Alonso Serena M, Ducrey G, Savluk JL, Borensztein MA. [Ultrasound guided biopsy of lung tumors: evaluation of efficacy and complications]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:439-455. [PMID: 38150205 PMCID: PMC10851407 DOI: 10.31053/1853.0605.v80.n4.40922] [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: 04/12/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction The diagnosis of lung cancer, as well as that of lung nodules, is increasing. Percutaneous biopsy has become a transcendental tool for its diagnosis. Traditionally, computed tomography is used for these procedures because of its ability to clearly demonstrate bone and aerated lung. However, in selected cases it can be performed with ultrasound. Methods Retrospective study conducted between January 2020 and December 2021, during the SARS-CoV-2 pandemic. All patients had pleural-based lung lesions or pleural lesions, some with a known history of cancer. Results Thirty-six procedures were performed, in 32 (88.9%) the sample obtained presented diagnostic yield and the most used additional test was Immunohistochemistry in 23 (63.9%). Complications were reported in 5 patients (13.9%): 2 with mild pneumothorax, 2 with hemothorax (1 mild and 1 moderate) and 1 patient reported pain. Conclusion Ultrasound is a valid method to be used as a guide for biopsies of pleural and peripheral pulmonary lesions. The complications and diagnostic rate has been shown to be in line with the experience of other authors and international guidelines.
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Lin X, Shi H, Fan X, Wang J, Fu Z, Chen Y, Chen S, Chen X, Chen M. Handheld interventional ultrasound/photoacoustic puncture needle navigation based on deep learning segmentation. BIOMEDICAL OPTICS EXPRESS 2023; 14:5979-5993. [PMID: 38021141 PMCID: PMC10659795 DOI: 10.1364/boe.504999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Interventional ultrasound (US) has challenges in accurate localization of the puncture needle due to intrinsic acoustic interferences, which lead to blurred, indistinct, and even invisible needles in handheld linear array transducer-based US navigation, especially the incorrect needle tip positioning. Photoacoustic (PA) imaging can provide complementary image contrast, without additional data acquisition. Herein, we proposed an internal illumination to solely light up the needle tip in PA imaging. Then deep-learning-based feature segmentation alleviates acoustic interferences, enhancing the needle shaft-tip visibility. Further, needle shaft-tip compensation aligned the needle shaft in US image and the needle tip in the PA image. The experiments on phantom, ex vivo chicken breast, preclinical radiofrequency ablation and in vivo biopsy of sentinel lymph nodes were piloted. The target registration error can reach the submillimeter level, achieving precise puncture needle tracking ability with in-plane US/PA navigation.
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Affiliation(s)
- Xiangwei Lin
- School of Biomedical Engineering, Shenzhen University, 1066 Xueyuan Ave, Shenzhen 518057, China
| | - Hongji Shi
- School of Biomedical Engineering, Shenzhen University, 1066 Xueyuan Ave, Shenzhen 518057, China
| | - Xiaozhou Fan
- Department of Ultrasound, Air Force Medical Center, Air Force Medical University, 30 Fucheng Road, Beijing 100142, China
| | - Jiaxin Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, 11 Huandong Road, Beijing 102488, China
| | - Zhenyu Fu
- School of Biomedical Engineering, Shenzhen University, 1066 Xueyuan Ave, Shenzhen 518057, China
| | - Yuqing Chen
- School of Biomedical Engineering, Shenzhen University, 1066 Xueyuan Ave, Shenzhen 518057, China
| | - Siping Chen
- School of Biomedical Engineering, Shenzhen University, 1066 Xueyuan Ave, Shenzhen 518057, China
| | - Xin Chen
- School of Biomedical Engineering, Shenzhen University, 1066 Xueyuan Ave, Shenzhen 518057, China
| | - Mian Chen
- School of Biomedical Engineering, Shenzhen University, 1066 Xueyuan Ave, Shenzhen 518057, China
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Kukuljan M, Mršić E, Oštarijaš E. CT-guided transthoracic core needle biopsies of focal pleural lesions smaller than 10 mm: a retrospective study. Cancer Imaging 2023; 23:48. [PMID: 37218004 DOI: 10.1186/s40644-023-00569-4] [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: 09/19/2022] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND CT-guided transthoracic core needle biopsy (TCNB) is a minimally invasive diagnostic procedure and a useful radiological method for diagnosing pleural lesions smaller than 10 mm in the presence of loculated pleural effusion. The purpose of this study was to retrospectively assess the diagnostic accuracy of CT-guided TCNB of small pleural lesions and determine the incidence of complications. METHODS This retrospective study included a total of 56 patients (45 men and 11 women; mean [± SD] age, 71.84 ± 10.11 years) with small costal pleural lesions (thickness of < 10 mm) who underwent TCNB performed at the Department of Radiology from January 2015 to July 2021. One of the inclusion criteria for this study was a loculated pleural effusion greater than 20 mm, with a nondiagnostic cytological analysis. Sensitivity, specificity and positive as well as negative predictive values (PPV, NPV) were calculated. RESULTS The sensitivity of CT-guided TCNB for the diagnosis of small pleural lesions in this study was 84.6% (33 of 39), specificity 100% (17 of 17), PPV 100% (33 of 33), and NPV 73.9% (17 of 23), while diagnostic accuracy was 89.3% (50 of 56). The overall diagnostic contribution of TCNB in our study is comparable with the results of other recent reports. Loculated pleural effusion was considered a protective factor since no complications were noted. CONCLUSION CT-guided transthoracic core needle biopsy (TCNB) is an accurate diagnostic method for small suspected pleural lesions with a near-zero complication rate in the presence of loculated pleural effusion.
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Affiliation(s)
- Melita Kukuljan
- Department of Radiology, Rijeka Clinical Hospital Centre, University of Rijeka, Rijeka, Croatia
| | - Ena Mršić
- Department of Radiology, Rijeka Clinical Hospital Centre, University of Rijeka, Rijeka, Croatia
| | - Eduard Oštarijaš
- Doctoral School of Pharmacological and Pharmaceutical Sciences, University of Pécs Medical School, Pécs, Hungary.
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Botana Rial M, Pérez Pallarés J, Cases Viedma E, López González FJ, Porcel JM, Rodríguez M, Romero Romero B, Valdés Cuadrado L, Villena Garrido V, Cordovilla Pérez R. Diagnosis and Treatment of Pleural Effusion. Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery. Update 2022. Arch Bronconeumol 2023; 59:27-35. [PMID: 36273933 DOI: 10.1016/j.arbres.2022.09.017] [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: 07/04/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/27/2022]
Abstract
Pleural effusion (PE) is a common yet complex disease that requires specialized, multidisciplinary management. Recent advances, novel diagnostic techniques, and innovative patient-centered therapeutic proposals have prompted an update of the current guidelines. This document provides recommendations and protocols based on a critical review of the literature on the epidemiology, etiology, diagnosis, prognosis, and new therapeutic options in PE, and addresses some cost-effectiveness issues related to the main types of PE.
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Affiliation(s)
- Maribel Botana Rial
- Unidad de Técnicas Broncopleurales, Servicio de Neumología, Hospital Álvaro Cunqueiro (Vigo), Instituto de Investigación Sanitaria Galicia Sur, Spain.
| | - Javier Pérez Pallarés
- Servicio de Neumología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Enrique Cases Viedma
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - José Manuel Porcel
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, IRB Lleida, Universidad de Lleida, Lleida, Spain
| | - María Rodríguez
- Departamento de Cirugía Torácica, Clínica Universidad de Navarra. Madrid, Spain
| | - Beatriz Romero Romero
- Unidad de Endoscopia Respiratoria, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain
| | - Luis Valdés Cuadrado
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago de Compostela, Departamento de Medicina, Universidad de Santiago de Compostela, Spain
| | - Victoria Villena Garrido
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Spain
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Possible Role of Chest Ultrasound in the Assessment of Costo-Phrenic Angle Lesions Prior to Medical Thoracoscopy: A Retrospective Pilot Case Series. Diagnostics (Basel) 2022; 12:diagnostics12112587. [PMID: 36359431 PMCID: PMC9689413 DOI: 10.3390/diagnostics12112587] [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: 09/16/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Pleural malignancy (PM) and malignant pleural effusion (MPE) represent an increasing burden of diseases. Costo-phrenic angle (CPA) could be involved by malignant small nodularities or thickenings in the case of MPE. The aim of this study was to evaluate whether lung ultrasound (LUS), performed prior to medical thoracoscopy (MT), could detect pleural abnormalities in CPA not easily detectable by chest computed tomography scan (CCT). Methods: Patients suspected for PM and MPE were retrospectively recruited. Patients underwent both LUS examination with a linear array and CCT prior to diagnostic medical thoracoscopy. LUS pathological findings in CPA were compared with pathological findings detected by CCT. Findings were confirmed by subsequent MT, the gold standard for PMs. Results: Twenty-eight patients were recruited. LUS detected 23 cases of pleural abnormalities in CPA. CCT was detected 12 pleural abnormalities. Inter-rater agreement between the two techniques was minimal (Cohen’s Kappa: 0.28). MT detected PMs in CPA in 22 patients. LUS had a sensitivity of 100% and specificity of 83%. CCT had a sensitivity of 54% and specificity of 100%. A better sensitivity for CCT was reached analysing only all abnormalities > 5 mm (64.3%). Conclusions: LUS examination, in the case of PMs, could change and speed up diagnostic workup.
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11
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Zhang Y, Tang J, Zhou X, Chen W, Zhang S, Li Y, Zhou D, He L, Tang Q. Diagnostic ability and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy diagnosis for malignant pleural mesothelioma. Front Surg 2022; 9:1022505. [PMID: 36225215 PMCID: PMC9548622 DOI: 10.3389/fsurg.2022.1022505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a highly invasive malignant tumor. Ultrasound guidance has the advantages of real-time, convenience and nonradiative. We sought to identify diagnostic value and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy (US-PPNB) for MPM. Methods Patients who underwent US-PPNB between March 2014 and March 2020 and were finally diagnosed with MPM were retrospectively analyzed. We retrospectively analyzed the US-PPNBs pathological results of all patients clinically confirmed as MPM, and divided US-PPNBs into correctly and incorrectly diagnosed groups. Patient, thoracic, and biopsy variables that affected diagnostic accuracy were assessed. All variables significant on univariate analyses were subjected to multivariate logistic regression to identify significant predictors of diagnostic accuracy. We derived cutoffs for all significant continuous variables and used the Mantel–Haenszel test to determine whether the diagnostic accuracy of US-PPNB for MPM increased with pleural thickness. Results In total, 49 patients with clinically confirmed MPM underwent US-PPNB; 37 diagnoses were correct and 12 were incorrect (accuracy = 75.5%). The pleura was significantly thicker in the correctly diagnosed group (p < 0.001). The pleural thickness cutoff was 4.15 mm and diagnostic accuracy increased with pleural thickness grade (p for trend <0.05). The diagnostic accuracy was significantly higher when 16-G rather than 18-G biopsy needles were used (p < 0.05). Multivariate logistic regression showed that pleural thickness (odds ratio: 17.2, 95% confidence interval: 2.8–104.1, p = 0.002) and needle size (odds ratio: 6.8, 95% confidence interval: 1.0–44.5, p = 0.044) independently predicted diagnostic accuracy. Conclusion US-PPNB afforded high MPM diagnostic accuracy, and pleural thickness and needle size significantly impacted accuracy.
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Affiliation(s)
- Yuxin Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxin Tang
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinghua Zhou
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wuxi Chen
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyu Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuqin Li
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Dazhi Zhou
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liantu He
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Correspondence: Liantu He Qing Tang
| | - Qing Tang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Correspondence: Liantu He Qing Tang
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Nguyen ET, Bayanati H, Hurrell C, Aitken M, Cheung EM, Gupta A, Harris S, Sedlic T, Taylor JL, Gahide G, Dennie C. Canadian Association of Radiologists/Canadian Association of Interventional Radiologists/Canadian Society of Thoracic Radiology Guidelines on Thoracic Interventions. Can Assoc Radiol J 2022; 74:272-287. [PMID: 36154303 DOI: 10.1177/08465371221122807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thoracic interventions are frequently performed by radiologists, but guidelines on appropriateness criteria and technical considerations to ensure patient safety regarding such interventions is lacking. These guidelines, developed by the Canadian Association of Radiologists, Canadian Association of Interventional Radiologists and Canadian Society of Thoracic Radiology focus on the interventions commonly performed by thoracic radiologists. They provide evidence-based recommendations and expert consensus informed best practices for patient preparation; biopsies of the lung, mediastinum, pleura and chest wall; thoracentesis; pre-operative lung nodule localization; and potential complications and their management.
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Affiliation(s)
- Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Hamid Bayanati
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Matthew Aitken
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada,St. Michael's Hospital, University of Toronto, ON, Canada
| | - Edward M Cheung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Ashish Gupta
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Scott Harris
- Health Sciences Centre, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Tony Sedlic
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jana Lyn Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Gerald Gahide
- Service de radiologie interventionelle, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Larocque N, Brook OR. Lung, Pleural, and Mediastinal Biopsies: From Preprocedural Assessment to Technique and Management of Complications. Semin Intervent Radiol 2022; 39:218-225. [PMID: 36062222 PMCID: PMC9433161 DOI: 10.1055/s-0042-1751292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Biopsies of the lung, pleura, and mediastinum play a crucial role in the workup of thoracic lesions. Percutaneous image-guided biopsy of thoracic lesions is a relatively safe and noninvasive way to obtain a pathologic diagnosis which is required to direct patient management. This article reviews how to safely perform image-guided biopsies of the lung, pleura, and mediastinum, from the preprocedural assessment to reviewing intraprocedural techniques, and how to avoid and manage complications.
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Affiliation(s)
- Natasha Larocque
- Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Olga R. Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Palumbo MG, Quarato CMI, Lacedonia D, Lucia D, Simeone A, Di Micco C, De Cosmo S, Scioscia G, Foschino Barbaro MP, Sperandeo M. A Transthoracic Ultrasound-Guided Needle Biopsy Provided the Diagnosis for a Synovial Sarcoma of the Pleura. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case report is presented of a 72-year-old woman with monophasic synovial sarcoma of the buttocks, diagnosed four years before. The tumor was treated with surgical removal followed by radiotherapy. The patient regularly underwent follow-up examinations and the last chest computed tomogram (CT) showed a left-sided pleural mass and ipsilateral effusion. The patient was admitted in hospital to obtain a specific histological diagnosis before treatment of chest pathology was initiated. An ultrasound (US)-guided fine needle aspiration biopsy (FNAB) of the pleural lesion and US-guided thoracentesis with drainage of blood serum pleural fluid were performed. The pathological examination of the lesion revealed a definitive diagnosis of synovial sarcoma of the pleura. For pleural-based lesions, the diagnostic accuracy of US-guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate, the absence of radiation exposure to patients, and a significantly reduced procedural time. The presence of pleural effusion creates a favorable acoustic window for US-guided biopsy of pleural lesion, which is useful for the diagnosis.
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Affiliation(s)
- Maria Giovanna Palumbo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Universitario Riuniti di Foggia, Foggia, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Universitario Riuniti di Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Universitario Riuniti di Foggia, Foggia, Italy
| | - Dimitri Lucia
- Unit of Pathology, IRCCS Fondazione “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy
| | - Anna Simeone
- Unit of Radiology, IRCCS Fondazione “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy
| | - Concetta Di Micco
- Unit of Oncology, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Salvatore De Cosmo
- Unit of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Universitario Riuniti di Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Universitario Riuniti di Foggia, Foggia, Italy
| | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, IRCCS Fondazione “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy
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Gershman E, Vaynshteyn I, Freidkin L, Pertzov B, Rosengarten D, Kramer MR. Marked safety and high diagnostic yield of freehand ultrasound-guided core-needle biopsies performed by pulmonologists. Thorac Cancer 2022; 13:1577-1582. [PMID: 35474608 PMCID: PMC9161330 DOI: 10.1111/1759-7714.14413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Adequate tissue sampling is fundamental for establishing a definitive diagnosis, assessing prognosis and tailoring therapy. Each of the methods for obtaining tissue (e.g., endoscopic, image guidance and surgical biopsies) results in a different diagnostic yield and complication rate profile. Objectives Present feasibility, and assess safety and efficacy of freehand transthoracic ultrasound‐guided core‐needle biopsies (USGNB) of thoracic lesions performed by pulmonologist. Methods A retrospective analysis study of ultrasound‐guided core‐needle biopsies of thoracic lesions performed at the Pulmonary Institute of Rabin Medical Center was conducted from September 2020 to October 2021. All core‐needle biopsies were performed under local anesthesia with guidance of Mindray TE7 2019 US system. Procedural variables including complications and pathological diagnostic yield were the primary end point. IRB 0671‐21‐RMC. Results In total 91 biopsy procedures were analyzed in38 females and 53 males, average age 71.1 years. Twenty‐three (25.3%) cases were lung lesions, 7 (7.7%) – mediastinal, 13 (14.3%) – chest wall, 27 (29.7%) – pleural, and 21 (23.1%) supraclavicular lesions. Average lesion size was 51.6 mm, the largest in the mediastinum and the smallest in supraclavicular locations (97.7mm and 28.0 mm, respectively). Overall pathological diagnostic yield was 90%, highest success in chest wall (100%) and lowest in mediastinal biopsies (71.4%). We had only one complication –hemothorax resolved by chest tube drainage‐ accounting for only 1.1% complication rate. Conclusion Safety and efficacy were demonstrated in freehand US‐guided core‐needle biopsy of thoracic lesions performed by pulmonologists. We suggest thoracic ultrasound and USG‐CNB be part of training and clinical practice in interventional pulmonology.
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Affiliation(s)
- Evgeni Gershman
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Vaynshteyn
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Lev Freidkin
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Reuven Kramer
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Analysis on the Effects of CT- and Ultrasound-Guided Percutaneous Transthoracic Needle Biopsy Combined with Serum CA125 and CEA on the Diagnosis of Lung Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2289432. [PMID: 35035813 PMCID: PMC8759864 DOI: 10.1155/2022/2289432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022]
Abstract
The number of patients with lung cancer is difficultly diagnosed in the early stage. The purpose of the study was to investigate the effects of CT- and ultrasound-guided percutaneous transthoracic needle biopsy combined with serum CA125 and CEA on the diagnosis of lung cancer. 120 patients with suspected lung cancer admitted to our hospital from January 2019 to January 2020 were selected and divided into an ultrasound group (n = 60) and CT group (n = 60), according to different percutaneous transthoracic needle biopsy modalities. All patients received serum tumor markers detection, so as to compare the CT- and ultrasound-guided percutaneous transthoracic needle biopsy results and pathology results, levels of serum tumor markers among all patients and the patients with different lung cancer types, and diagnostic efficacy of tumor markers, as well as complication rate (CR) in patients. The sensitivity and specificity of ultrasound-guided percutaneous transthoracic needle biopsy were 0.880 and 0.800, respectively, while those of CT-guided percutaneous transthoracic needle biopsy were 0.909 and 0.625, respectively; the CA125 and CEA levels in the lung cancer group were higher than those in the benign group (P < 0.001); the CA125 and CEA levels of the patients with adenocarcinoma were higher than those with squamous carcinoma, and the CEA levels of the patients with small-cell carcinoma were lower than those with adenocarcinoma (P < 0.05); the sensitivity, specificity, and Youden indexes of CA125 were 0.638, 0.833, and 0.471, respectively, while those of CEA were 0.766, 0.778, and 0.544, respectively; there were no significant differences in CR between the two groups (P > 0.05). CT- and ultrasound-guided percutaneous transthoracic needle biopsy is a safe and feasible diagnostic modality for lung cancer, and its combination with serum CA125 and CEA can significantly improve the accuracy of the detection results, which is worthy of promotion and application in clinical practice.
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Editor's Notebook: September 2021. AJR Am J Roentgenol 2021; 217:527-528. [PMID: 34415203 DOI: 10.2214/ajr.21.26336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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