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Maehara Y, Miura H, Hirota T, Asai S, Okamoto T, Ohara Y, Yamada K. Frequency and Risk Factors for Air Embolism in Computed Tomography Fluoroscopy-Guided Biopsy of Lung Tumor With the Use of Noncoaxial Automatic Needle. J Comput Assist Tomogr 2023; 47:71-77. [PMID: 36194845 DOI: 10.1097/rct.0000000000001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of the study is to analyze incidence and risk factors for air embolism during computed tomography (CT) fluoroscopy-guided lung biopsies using noncoaxial automatic needle. MATERIALS AND METHODS Between February 2014 and December 2019, 204 CT fluoroscopy-guided lung biopsies (127 men; mean age, 70.6 years) using noncoaxial automatic needle under inspiratory breath holding were performed. We retrospectively evaluated the incidence of air embolism as presence of air in the systemic circulation on whole-chest CT images obtained immediately after biopsy. Risk factors of the patient, tumor and procedural factors (size, location and type of nodule, distance from the pleura, the level of the lesion relative to the left atrium, emphysema, patient position, penetration of a pulmonary vein, etc) were analyzed. RESULTS The technical success rate was 97.1%. Air embolism was radiologically identified in 8 cases (3.92%, 7 males; size, 21.6 ± 18.2 mm; distance to pleura, 11.9 ± 14.5 mm). Two patients showed overt symptoms and the others were asymptomatic. Independent risk factors were needle penetration of the pulmonary vein ( P = 0.0478) and higher location relative to left atrium ( P = 0.0353). Size, location and type of nodule, distance from the pleura, emphysema, patient position, and other variables were not significant risk factors. As other complications, pneumothorax and alveolar hemorrhage were observed in 57.4% and 77.5%, respectively. CONCLUSIONS In CT fluoroscopy-guided lung biopsy using the noncoaxial automatic needles, radiological incidence of air embolism was 3.92%. Given the frequency of air embolism, it is necessary to incorporate this into postprocedure imaging and clinical evaluation.
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Affiliation(s)
- Yosuke Maehara
- From the Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Zhang MW, Zhang Y, Lv SY, Fan XX, Zhu JZ, Zhang BS, Yang ZH. Application value of coaxial puncture needle (technique) in ultrasound-guided puncture biopsy of peripheral pulmonary masses. Medicine (Baltimore) 2022; 101:e31070. [PMID: 36397368 PMCID: PMC9666102 DOI: 10.1097/md.0000000000031070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study aims to investigate the effect of ultrasound (US)-guided coaxial puncture needle in puncture biopsy of peripheral pulmonary masses. In this retrospective analysis, 157 patients who underwent US-guided percutaneous lung biopsy in our hospital were divided into a coaxial biopsy group and a conventional biopsy group (the control group) according to the puncture tools involved, with 73 and 84 patients, respectively. The average puncture time, number of sampling, sampling satisfaction rate, puncture success rate and complication rate between the 2 groups were compared and discussed in detail. One hundred fifty-seven patients underwent puncture biopsy, and 145 patients finally obtained definitive pathological results. The overall puncture success rate was 92.4% ([145/157]; with a puncture success rate of 97.3% [71/73] from the coaxial biopsy group and a puncture success rate of 88.1% [74/84] from the conventional biopsy group (P < .05). For peripheral pulmonary masses ≤3 cm, the average puncture time in the coaxial biopsy group was shorter than that in the conventional biopsy group, and the number of sampling, sampling satisfaction rate and puncture success rate were significantly higher than those in the conventional biopsy group (P < .05). There was no significant difference in the complication rate between the 2 groups (P > .05). For peripheral pulmonary masses >3 cm, the average puncture time in the coaxial biopsy group was still shorter than that in the conventional biopsy group (P < .05). The differences between the 2 groups in the number of sampling, satisfaction rate of the sampling, the success rate of puncture and the incidence of complications were not significant (P > .05). US guided coaxial puncture biopsy could save puncture time, increase the number of sampling, and improve the satisfaction rate of sampling and the success rate of puncture (especially for small lesions) by establishing a biopsy channel on the basis of the coaxial needle sheath. It provided reliable information for the diagnosis, differential diagnosis and individualized accurate treatment of lesions as well.
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Affiliation(s)
- Mei Wu Zhang
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, P.R. China
- Ningbo Clinical research Center for Medical Imaging, Ningbo, Zhejiang, P.R. China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, Zhejiang, P.R. China
| | - Yan Zhang
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, P.R. China
- Ningbo Clinical research Center for Medical Imaging, Ningbo, Zhejiang, P.R. China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, Zhejiang, P.R. China
| | - Shu Yi Lv
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, P.R. China
- Ningbo Clinical research Center for Medical Imaging, Ningbo, Zhejiang, P.R. China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, Zhejiang, P.R. China
- * Correspondence: Shuyi Lv, Hwa Mei Hospital, University of Chinese Academy of Sciences, No. 41, Xibei Street, Haishu District, Ningbo, Zhejiang, 315010, China (e-mail:)
| | - Xiao Xiang Fan
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, P.R. China
- Ningbo Clinical research Center for Medical Imaging, Ningbo, Zhejiang, P.R. China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, Zhejiang, P.R. China
| | - Jia Zhen Zhu
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, P.R. China
- Ningbo Clinical research Center for Medical Imaging, Ningbo, Zhejiang, P.R. China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, Zhejiang, P.R. China
| | - Bai Song Zhang
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, P.R. China
- Ningbo Clinical research Center for Medical Imaging, Ningbo, Zhejiang, P.R. China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, Zhejiang, P.R. China
| | - Zhen Hua Yang
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, P.R. China
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Curti M, Fontana F, Piacentino F, Ossola C, Coppola A, Carcano G, Venturini M. Dual-layer spectral CT fusion imaging for lung biopsies: more accurate targets, diagnostic samplings, and biomarker information? Eur Radiol Exp 2022; 6:34. [PMID: 35965267 PMCID: PMC9376184 DOI: 10.1186/s41747-022-00290-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
The increasingly widespread use of computed tomography (CT) has increased the number of detected lung lesions, which are then subjected to needle biopsy to obtain histopathological diagnosis. Obtaining high-quality biopsy specimens is fundamental for diagnosis and biomolecular characterisation that guide therapy decision-making. In order to obtain samples with high diagnostic potential, fusion imaging techniques, such as fusion between positron emission tomography and CT, have been introduced to target the biopsy where there more viable neoplastic cells can be sampled. Nowadays, dual-layer spectral CT represents a novel technology enabling an increased tissue characterisation. In particular, Z-effective images, i.e., colour-coded images based on the effective atomic number of tissue components, provide a higher level of discrimination than usual imaged based on x-ray attenuation in Hounsfield units and offer the potential of a better tissue characterisation. Our hypothesis is based on the future use of data provided by spectral CT, in particular by Z-effective images, as a guide for appropriate biopsy sampling for histopathological and biomolecular characterisation in the era of patient tailored-therapy.
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An W, Zhang H, Wang B, Zhong F, Wang S, Liao M. Comparison of CT-Guided Core Needle Biopsy in Pulmonary Ground-Glass and Solid Nodules Based on Propensity Score Matching Analysis. Technol Cancer Res Treat 2022; 21:15330338221085357. [PMID: 35297696 PMCID: PMC8935414 DOI: 10.1177/15330338221085357] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: To compare the diagnostic accuracy and safety of computed tomography (CT)-guided core needle biopsy (CNB) between pulmonary ground-glass and solid nodules using propensity score matching (PSM) method and determine the relevant risk factors. Methods: This was a single-center retrospective cohort study using data from 665 patients who underwent CT-guided CNB of pulmonary nodules in our hospital between May 2019 and May 2021, including 39 ground-glass nodules (GGNs) and 626 solid nodules. We used a 1:4 PSM analysis to compared the diagnostic yields and complications rates of CT-guided CNB between 2 groups. Results: After PSM, 170 cases involved in the comparison (34 GGNs vs 136 solid nodules) were randomly matched (1:4) by patient demographics, clinical history, lesion characteristics, and procedure-related factors. There was no statistically significant difference in the diagnostic yields and complications rates between 2 groups. Significant pneumothorax incidence increase was noted at small lesion size, deep lesion location, and traversing interlobar fissure (P < .05). Post-biopsy hemorrhage was a protective factor for pneumothorax (P < .05). The size/proportion of consolidation of GGN did not influence the diagnostic accuracy and complication incidence (P > .05). Conclusions: The accuracy and safety of CT-guided CNB were comparable for ground-glass and solid nodules and the size/proportion of consolidation of GGN may be not a relevant risk factor. The biopsy should avoid traversing interlobar fissure as far as possible. Smaller lesion size and deeper lesion location may lead to higher pneumothorax rate and post-biopsy hemorrhage may be a protective factor for pneumothorax.
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Affiliation(s)
- Wenting An
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hanfei Zhang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binchen Wang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feiyang Zhong
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shan Wang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meiyan Liao
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
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