CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses

Objective

To retrospectively evaluate the safety, diagnostic yield, and risk factors of diagnostic failure of computed tomography (CT) fluoroscopy-guided biopsies of anterior mediastinal masses.

CT引导下经皮肺穿刺切割活检对肺部病变的诊断价值

目的评价CT引导下经皮肺穿刺切割活检术对肺部实质性肿块定性诊断的价值,探讨并发症发生的原因。方法收集我院CT引导下经皮肺穿刺活检的肺部占位性病变91例,均采用切割针和自动枪取材,分析诊断正确率、并发症发生率及其影响因素。结果本组91例,取得有效标本88例,总的穿刺成功率为(96.70%),其中1次穿刺成功84例(成功率为92.30%),2次穿刺成功7例。85例获得准确诊断,包括原发性肺癌79例、结核2例、炎性假瘤2例、淋巴瘤1例、转移瘤1例、错构瘤1例、结节病1例,总的诊断正确率93.40%。本组并发气胸14例(15.38%),出血21例(23.08%),出血并气胸同时发生3例(3.30%)。气胸与出血的发生与穿刺针通过含气肺组织的长度成正相关,气胸的发生与患者肺气肿的存在和2次穿刺相关,位于肺野内带的病灶较中、外带病灶更易发生出血。结论CT引导下经皮肺穿刺切割活检操作简便、安全,诊断准确性高。术前准确定位,分步进针,熟练的技术操作可以减少并发症的发生。     

CT fluoroscopy-guided pancreas transplant biopsies: a retrospective evaluation of predictors of complications and success rates

To identify predictors of biopsy success and complications in CT-guided pancreas transplant (PTX) core biopsy. We retrospectively identified all CT fluoroscopy-guided PTX biopsies performed at our institution (2000–2017) and included 187 biopsies in 99 patients. Potential predictors related to patient characteristics (age, gender, body mass index (BMI), PTX age, PTX volume) and procedure characteristics (biopsy depth, needle size, access path, number of samples, interventionalist’s experience) were correlated with biopsy success (sufficient tissue for histologic diagnosis) and the occurrence of complications. Biopsy success (72.2%) was more likely to be obtained in men [+25.3% (10.9, 39.7)] and when the intervention was performed by an experienced interventionalist [+27.2% (8.1, 46.2)]. Complications (5.9%) occurred more frequently in patients with higher PTX age [OR: 1.014 (1.002, 1.026)] and when many (3–4) tissue samples were obtained [+8.7% (−2.3, 19.7)]. Multivariable regression analysis confirmed male gender [OR: 3.741 (1.736, 8.059)] and high experience [OR: 2.923 (1.255, 6.808)] (biopsy success) as well as older PTX age [OR: 1.019 (1.002, 1.035)] and obtaining many samples [OR: 4.880 (1.240, 19.203)] (complications) as independent predictors. Our results suggest that CT-guided PTX biopsy should be performed by an experienced interventionalist to achieve higher success rates, and not more than two tissue samples should be obtained to reduce complications. Caution is in order in patients with older transplants because of higher complication rates.     

An evaluation of brush biopsy in the diagnosis of peripheral pulmonary lesions

A method of abrasive biopsy of the peripheral bronchial tree is described. Forty-nine patients with peripheral pulmonary lesions have been investigated, and at bronchoscopy brush biopsies have been performed. In 13 cases a firm diagnosis of bronchial carcinoma was made and in nine patients atypical cells were reported. Two of the latter were found on further investigation to have had no carcinoma and one showed squamous metaplasia only on surgical biopsy. In nine patients a false negative result was obtained. These results suggest that the routine use of brush biopsy during bronchoscopy performed in the investigation of peripheral pulmonary lesions helps to increase the accuracy of diagnosis.     

CT引导下经皮肺穿刺活检诊断肺部磨玻璃样病变

目的评价CT引导下经皮肺穿刺活检(PTNB)诊断肺部恶性磨玻璃样病变(GGO)的价值。方法回顾性分析60例因肺部GGO而于我院接受CT引导下PTNB患者的临床资料。根据针道距离,分为A_1(5 cm,n=28)、B_1(5~9 cm,n=18)、C_1(9 cm,n=14)组;根据GGO在肺内的百分比,分为A_2(50%~90%,n=32)、B_2(90%,n=28)组。计算CT引导下PTNB诊断各组肺部恶性GGO的效能并比较其效能差异。结果 CT引导下PTNB诊断肺部恶性GGO的敏感度、特异度及准确率分别为87.50%(42/48)、100%(12/12)、90.00%(54/60)。对于A_1、B_1、C_1组及A_2、B_2组,其诊断效能差异均无统计学意义(P均0.05)。结论 CT引导下PTNB诊断肺部恶性GGO具有较高的敏感度、特异度和准确率,且其诊断效能与针道距离及GGO在肺内的百分比无关。     

Percutaneous needle biopsy of pulmonary lesions

Percutaneous needle biopsy of lung lesions has proved useful in the diagnosis of tumors and infectious lesions of the lung. Accurate tissue diagnosis of tumors was obtained in 81 percent of attempts, and an accurate microbiologic diagnosis was obtained in 75 percent of infectious lesions. Eleven percent (23 of 213) of patients biopsied for tumor were spared diagnostic thoracotomy, and only one biopsy gave a false-positive result. There has been no mortality, and the only significant morbidity was a 12 percent incidence of pneumothorax necessitating chest tube insertion. The use of this technique in varied clinical settings has made it a valuable and often primary diagnostic tool for lung lesions.     

Localized malignant pleural mesothelioma of the interlobar fissure mimicking a lung cancer

We report a case of localized malignant pleural mesothelioma (LMPM) of the interlobar fissure mimicking lung cancer. A 74-year-old woman presented with dyspnoea and a left pleural effusion. Chest computed tomography revealed a bulky mass, arising from the left lower lobe with intense uptake at the ¹⁸F-FDG PET. A left lower lobectomy was performed after thoracoscopic pleural biopsies. The final histology revealed an LMPM epithelioid like. We describe the diagnostic and curative path of the disease, speculating on the differential diagnosis and treatment of LMPM.     

Transrectal ultrasound guided biopsy of the prostate: random sextant versus biopsies of sono-morphologically suspicious lesions

Transrectal ultrasound (TRUS) guided multiple systematic random biopsies are presently the method of choice for determining the presence or absence of prostate cancer. TRUS image information is only used to guide the biopsy needle into the prostate, but not to localize and target cancerous lesions. Our aim in this study was to evaluated the possible predictive value of tumor suspicious endosonographic lesions of the prostate for prostate biopsies. We prospectively compared six systematic biopsies with lesion guided biopsies in a consecutive series of 217 patients. All patients had a prostate specific antigen (PSA) level of >4 ng/ml without a history of prostate disease. In a subgroup of 145 men with sonomorphologic lesions suggestive for prostate cancer (hypoechoic areas or asymmetries predominantly in the peripheral zone), lesion-guided biopsies were taken in addition to the systematic biopsies. We evaluated the number of tumors which were diagnosed or missed by both of the biopsy strategies. Of the 217 evaluated patients, 64 (29%) had histology confirmed cancer. Four patients with negative sextant biopsies had a positive TRUS guided biopsy. Out of 145 patients with a normal TRUS, three were cancer positive by sextant biopsy. A total of 1,387 individual biopsy cores were evaluated. Of the 1,304 systematic biopsy cores, 182 (14%) were positive and 1,122 (86%) negative. Of the 329 TRUS lesion guided biopsy cores 139 (42%) were positive and 190 (58%) negative. Patients with tumor suggestive TRUS lesions have a considerably higher risk of being diagnosed with prostate cancer compared to patients without such lesions. Both systematic sextant and TRUS lesion guided biopsies missed detectable prostate cancer in a minority of patients. Taking the endosonographic morphology of the prostate gland into consideration for biopsy strategies may improve the quality of the biopsy and avoid unnecessary invasive procedures in selected cases.     

Stereotactic biopsy of intracranial brain lesions. High diagnostic yield without increased complications: 65 consecutive biopsies with early postoperative CT scans

Diagnostic yield and complication rate were analyzed for a series of 65 consecutive stereotactic biopsies of intra-axial brain lesions. The diagnostic yield was 98.5 +/- 1.5% and the complication rate was 1.5%. A median number of 14 biopsies (range 1-48) were taken per lesion. The biopsy sites followed a clockwise pattern, going from the superficial margin to the center and the deep margin of the lesion with respect to the inner table of the skull. A side window cannula biopsy needle was used. All patients underwent immediate postoperative CT scans within 4 h of biopsy to rule out intracranial complications. All patients were discharged within 24 h after biopsy, unless medical reasons unrelated to the biopsy required further hospitalization. We attribute the high diagnostic yield in our series to the high number of systematically taken biopsies per lesion. The higher number of biopsies did not lead to an increase in complications. From our experience, it appears safe to discharge patients the same day or within 24 h after a stereotactic biopsy if the postoperative CT shows no complication. Stereotactic biopsy could often safely be performed on an outpatient basis.     

锥形束CT联合iGuide引导系统在经皮经胸肺穿刺活检术中的应用

目的探讨锥形束CT(CBCT)联合iGuide引导系统在经皮经胸肺穿刺活检术(PTNB)中的应用价值。方法纳入30例因肺部单发病灶接受PTNB的患者。CBCT扫描后,通过iGuide引导系统和三维类CT多平面重组图像规划穿刺路径。采用18G同轴切割针行穿刺活检。记录手术相关资料、穿刺并发症及辐射剂量。结果 30例患者中,穿刺活检病理结果显示恶性病变24例,良性病变6例;28例符合最终病理诊断,1例为取材不够,但重新取材后的病理结果符合最终病理诊断,1例为假阴性结果。PTNB诊断肺部病变的准确率、敏感度、特异度、阳性预测值及阴性预测值分别为96.67%(29/30)、96.00%(24/25)、100%(5/5)、100%(24/24)及83.33%(5/6)。平均手术时间为(13.03±3.61)min,平均有效辐射剂量为(7.95±4.57)mSv。活检术后CBCT复查发现气胸6例(6/30,20.00%),咯血3例(3/30,10.00%)。结论CBCT联合iGuide引导系统引导下PTNB具有较高诊断准确率和安全性以及合理的辐射暴露。     

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

BACKGROUND: Persisting controversy surrounds the use of transthoracic needle aspiration biopsy (TNAB) stemming from its uncertain diagnostic accuracy. A systematic review and meta-analysis was therefore conducted to evaluate the accuracy of TNAB for the diagnosis of solitary or multiple localised pulmonary lesions. METHODS: Searches for English literature papers in Index Medicus (1963-1965) and Medline (1966-1996) were performed and the bibliographies of the retrieved articles were systematically reviewed. Articles evaluating the accuracy of TNAB in series of consecutive patients presenting with solitary or multiple pulmonary lesions were considered. Only papers in which >/=90% of patients were given a final diagnosis according to an appropriate reference standard were included in the meta-analysis. RESULTS: A total of 48 studies were included and five meta-analyses were conducted according to four diagnostic thresholds. From the pooled sensitivity and specificity corresponding to each diagnostic threshold, associated likelihood ratios (LRs) were derived for malignant disease as follows: (1) malignant versus all other categories, LR = 72; (2) malignant or suspicious versus all others, LR = 49; (3) suspicious versus all categories but malignant, LR = 15; (4) benign versus all others, LR = 0.07; and (5) specific benign diagnosis versus all others, LR = 0.005. Differences in methodological quality of the studies, needle types, or whether a cytopathologist participated in the procedure failed to explain the heterogeneity of the results found in almost every meta-analysis. Given a 50% probability of malignancy prior to the TNAB, post-test probabilities of malignancy upon receiving the results would be malignant, 99%; suspicious, 94%; non-specific benign, 7%; and benign with a specific diagnosis, 0.6%. CONCLUSIONS: Given the intermediate pre-test probabilities that would probably lead to performing TNAB, findings of "malignant" or of a specific diagnosis of a benign condition provide definitive results. Findings of "suspicious" markedly increase the probability of malignancy, and "benign" markedly decreases it but may not be considered definitive.     

Complications of percutaneous renal biopsy: an analysis of 1,000 consecutive biopsies.

In a series of 1,000 consecutive percutaneous renal biopsies, adequate tissue for diagnosis was obtained in 94.9%. The rate of complications was 8.1% and was directly related to 1. age of the patient, 2. presence of renal insufficiency, and 3. arterial hypertension. The use of fluoroscopic control for localization of the kidney did not affect the rate of complications, nor did it improve the success rate in obtaining adequate tissue.     

Computed tomography detection of stapled interlobar fissure facilitates diagnosing postoperative lobar torsion: A case report

IntroductionAtelectasis of the right middle lobe following right upper lobectomy may result from lobar torsion, bronchial kink, or impacted mucus plug. Although clinical consequence of lobar torsion could be serious, differentiating it from bronchial kink is occasionally challenging.Presentation of caseA 39-year old man with non-small cell lung cancer of cT1aN0M0 stage IA underwent right upper lobectomy. On postoperative day 1, we identified middle lobe atelectasis on the chest X-ray and performed bronchoscopy, which showed an obstruction of the right middle lobe bronchus without mucoid impaction. We injected air using a bronchoscope to the middle lobe, which re-expanded it. However, on postoperative day 2, chest X-ray showed a slightly collapsed and opacified middle lobe. Although enhanced computed tomography showed a patent middle lobe pulmonary artery, we noticed that a staple placed in the horizontal fissure was in contact with the lower lobe, implying the possibility of lobar torsion. Rethoracotomy on postoperative day 2 revealed a 240° clockwise rotation of the congested middle lobe. Therefore, we performed simple detorsion. The patient was discharged 10 days after rethoracotomy without further adverse events.DiscussionIn our case, patency of the pulmonary artery and temporary improvement of the atelectasis using a bronchoscopic aeration maneuver could not rule out the possibility of lobar torsion.ConclusionThe position of the staple placed on the interlobar fissure should be evaluated using computed tomography in postoperative middle lobe atelectasis. If the aeration maneuver for middle lobe atelectasis using bronchoscope fails, rethoracotomy should be considered.     

Castleman's disease in the interlobar fissure resected by video-assisted thoracoscopic surgery; report of a case

An abnormal shadow was detected on the chest X-ray of a 33-year-old man in a medical check-up. Chest computed tomography (CT) showed a 2 x 2 x 3 cm tumor which was enhanced, round, homogeneous, and adjacent to the pulmonary artery in the right interlobar fissure. Video-assisted thoracoscopic surgery was performed in August 2002 for diagnosis and treatment. The tumor was surgically removed and grossly round, elastic and hard. The histopathological diagnosis was hyaline vascular type of Castleman's disease. Postoperative course was uneventful, and the patient was discharged on the third postoperative day. Interlobar Castleman's disease successfully resected by video-assisted thoracoscopic surgery is rare.     

Percutaneous Trucut lung biopsy in the diagnosis of localised pulmonary lesions.

In a prospective evaluation of percutaneous Trucut needle biopsy for localised intrathoracic lesions in 89 patients histological specimens were obtained in 81. Malignancy was diagnosed in 66 cases. Subsequently definitive histological reports were available in 18 of these patients with complete concordance of malignant cell type. Sixteen patients had non-malignant histological appearances, which were later confirmed objectively in six. In three patients there was no follow up information, but in the remainder the clinical course was entirely consistent with the histological appearances of the biopsy specimens. Adequate specimens were obtained from only two of the five lesions less than 2 cm in diameter. Lesions deeper than 8 cm from the site of biopsy were associated with significantly more haemorrhagic complications than more superficial lesions. Comparison with other series indicates that Trucut needle biopsy which produces histological specimens has greater diagnostic accuracy than cytological techniques for both malignant and non-malignant localised lesions. It is concluded that this technique has a definite place in the investigation of this common problem in carefully selected patients provided that strict attention is paid to the details of the technique.     

CT guided fine needle aspiration biopsy of biliopancreatic lesions: Report of 30 cases

CT guided percutaneous fine needle aspiration biopsy was performed on 30 patients with pancreatic and periampullary neoplasms, in the Department of Surgery, China-Japan Friendship Hospital, between March 1985 and January 1986. We obtained positive cytodiagnosis from all cases of carcinoma of the pancreatic head (9 cases), body and tail (4 cases), and ampullary carcinomas (5 cases) (100 per cent). In 2 of 3 duodenal carcinomas (66.6 per cent), and 6 of 7 distal common duct carcinomas (86 per cent), a positive cytodiagnosis was also obtained. On the other hand, 2 cases of pancreatitis both gave a negative cytodiagnosis, i.e. no false positives were obtained. Out of the 30 cases who underwent CT guided biopsy, a correct diagnosis was obtained in 28, i.e. a diagnostic accuracy of 93.3 per cent. The cytodiagnosis of the other two cases was either suspicious or false negative. There have been no clinical complications noted.