Evaluation of a new transthoracic needle for biopsy of benign and malignant lung lesions.

The results of 88 transthoracic needle biopsies of lung lesions using the Rotex biopsy instrument are analyzed. Of 57 malignant lung lesions, 55 were diagnosed correctly. Two patients with false negative biopsies had technically inadequate examinations. All but one of the 28 benign lung lesions were correctly diagnosed as nonmalignant. One false positive diagnosis of malignancy was made. The occurrence of complications was similar to those reported for conventional fine needle aspiration. The high accuracy rate is attributed to the effectiveness of the Rotex instrument in sampling the lesions and to the use of biplane fluoroscopy.     

PET与CT在肺癌诊断中的联合应用

目的:遴选CT鉴别肺部病变良恶性的征象,利用这些征象降低PET在肺癌诊断中的假阳性和假阴性。方法:42例肺部病变患者行PET和CT检查。若肺部病变放射性摄取明显增高,同时SUV≥2.5,判断为恶性病变。若肺部病变有轻度放射性摄取,但其摄取程度低于或明显低于纵隔,SUV2.5,判断为良性病变。选择CT图像上10种最常见的恶性病变征象和10种常见的良性病变征象加以对照分析。结果:PET显像高代谢恶性病变(真阳性)组11例,在CT上都观察到较多的符合征象;PET显像低代谢良性病变(真阴性)组11例,其中有10例在CT上都观察到较多符合征象,只有1例病变观察到得符合征象和质疑征象基本相等。而PET显像高代谢良性病变(假阳性)组10例,其中有9例在CT上观察到较多质疑征象,另有1例观察到较多符合征象;PET显像低代谢恶性病变(假阴性)组10例,在CT上都观察到较多质疑征象。结论:CT征像可以帮助降低PET在肺癌诊断中的假阳性和假阴性。     

The limitations of gallium scintigraphy in the differentiation between benign and malignant salivary gland mass lesions

The aim of this study was to evaluate the ability of gallium scintigraphy to differentiate between benign and malignant salivary gland mass lesions and to identify what types of lesions surpass its diagnostic utility. By considering the uptake of 67Ga, 193 salivary gland masses were graded visually as negative, weakly positive, moderately positive or strongly positive in comparison to the uptake in the nasal cavity and the liver. The uptake was compared with histopathological findings. Among 39 malignant tumours, uptake was positive in 31 (79%) (strongly positive in 18, moderately positive in seven and weakly positive in six) and uptake was negative in eight (21%). Adenoid cystic carcinoma was the most common malignant tumour in our study (11/39), and uptake was negative in five (45%) of these tumours. Malignant tumours did not differ significantly in size despite differences in uptake. Among 154 benign lesions, uptake was negative in 101 (66%) and positive in 53 (34%) (strongly positive in 12, moderately positive in 19 and weakly positive in 22). Out of 88 pleomorphic adenomas, 41 (47%) showed positive uptake. Sensitivity, specificity and accuracy for gallium study were 80%, 66% and 68%, respectively, when the malignancy criterion was weakly positive uptake. Accuracy was greatest (83%) when the criterion was strongly positive uptake, but this criterion failed to detect more than a half of malignant tumours (46% sensitivity). In conclusion, gallium scintigraphy had limitations in differentiating between benign and malignant salivary gland mass lesions. Adenoid cystic carcinomas and pleomorphic adenomas were the principal sources of false negative and false positive results, respectively.     

肺肿块穿刺标本癌基因蛋白检测

目的　研究流式细胞仪 (FCM)检测肺癌穿刺标本p5 3蛋白、增殖细胞核抗原 (PCNA)表达的价值。资料与方法　运用FCM检测 6 6例穿刺标本p5 3蛋白、PCNA表达。结果　 (1) 6 6例肺肿块中病理诊断恶性 5 3例 ,13例病理诊断及临床随防诊断为良性病变。 (2 ) 5 3例肺恶性病变p5 3蛋白表达阳性率为 6 2 .3% ,PCNA阳性率为4 5 .3% ;13例良性病变p5 3蛋白表达阳性率为 30 .8% ,PCNA阳性率为 7.7% ;两组p5 3蛋白、PCNA阳性表达有显著性差异 (P <0 .0 5 )。 (3) 5 3例肺恶性病变穿刺敏感性为 94 .3% ,13例肺良性病变穿刺特异性为 76 .9% ,6 6例穿刺诊断准确性为 90 .9% ,气胸发生率为 4 .6 %。结论　运用FCM可以检测肺癌穿刺标本p5 3蛋白、PCNA表达 ,为了解肺癌的分子生物学行为特性提供帮助。     

Comparative evaluation of 99mTc-depreotide and 201Tl chloride single photon emission tomography in the characterization of pulmonary lesions

PURPOSE: To compare (99m)Tc-depreotide and (201)Tl chloride SPET in the characterization of pulmonary lesions. METHODS: Fifty-seven pulmonary lesions from 33 patients suspected of malignancy in computed tomography, were assessed by (99m)Tc-depreotide and (201)Tl early and delayed SPET imaging. Images were visually assessed and the tumour-to-normal (T/N) lung activity ratio for early (ER) and delayed (DR) scans and the retention index (RI), were calculated in every lesion. A final diagnosis was reached for all lesions, based either on histology or prolonged clinical and radiological follow-up. RESULTS: Twenty-three lesions were characterized as malignant and 34 benign. In visual analysis, all malignant lesions accumulated both tracers resulting in sensitivity and negative predictive values of 100%. However, false positive interpretations resulted in a specificity of 64.7% and 67.6% for (99m)Tc-depreotide and (201)Tl, respectively. ER and DR of both agents and the RI of (99m)Tc-depreotide were significantly higher in malignant, compared to benign lesions. In defining thresholds of abnormality from ROC analysis, a significant increase in specificity was observed for both tracers in both scan phases (91.2% for all), as compared to visual analysis (P<0.01). There was no significant difference in the diagnostic performance between (99m)Tc-depreotide DR and (201)Tl DR, although the former provided the highest T/N ratio. CONCLUSION: This study demonstrates that (99m)Tc-depreotide and (201)Tl SPET are equally effective and may be useful in the non-invasive determination of lung malignancy. The specificity of both techniques is significantly improved by quantifying radiopharmaceutical accumulation in pulmonary lesions.     

18F-FDG PET/CT诊断非小细胞肺癌中最大标准摄值法适宜诊断界值的研究

目的 探讨18F-FDG PET/CT最大标准摄取值(SUVmax)在非小细胞肺癌(NSCLC)中的适宜诊断界值.资料与方法 102例行胸部或全身PET/CT检查并经支气管内镜病理、肿块穿刺细胞学检查、术后病理确诊证实的肺部良、恶性病变患者,根据Youden指数最大原则、误诊率与漏诊率同等重要原则、正确率最大原则寻找18F-FDG PET/CT SUVmax鉴别NSCLC与肺良性病变的适宜诊断标准.结果 18F-FDG PET/CT诊断NSCLC与肺良性病变时,Youden指数最大原则下的适宜诊断界值为S UVmax=2.8,误诊率与漏诊率同等重要原则下的适宜诊断界值为SUVmax=5.45,正确率最大原则下的适宜诊断界值为SUVmax=2.8.结论 SUVmax鉴别NSCLC与肺良性病变的适宜诊断标准为2.8.     

Do benign-concordant breast MRI biopsy results require short interval follow-up imaging? Report of longitudinal study and review of the literature

ObjectiveThe objectives of this study were to examine the frequency and outcomes of short interval imaging follow up of benign, concordant breast MRI biopsies and review the published literature on this topic.Materials and methodsThis was an IRB-approved, HIPAA compliant retrospective review of women undergoing MRI-guided breast biopsies between October 1, 2008 and December 31, 2014. Patients with malignant or high risk lesions with recommendation for excision, discordant cases, and those undergoing breast conservation therapy in same quadrant, chemotherapy or mastectomy were excluded. At least 2 years imaging and/or clinical follow-up without development of cancer in the same quadrant as the biopsy was set as the benchmark to confirm benign etiology. A PubMed search of similar articles through 2018 was also performed for the literature review.Results943 consecutive MRI-guided biopsies were performed in 785 women. Of these, 378/943 (40.1%) were benign and met inclusion criteria. Eleven cases were recommended for and underwent repeat MRI-guided biopsy or excision, 2 of which were malignant. The overall false negative rate for benign concordant MRI-guided biopsy was 2/378, 0.5% (95% CI 0.02 to 2.0%). Literature search demonstrated five articles with similar methodologies yielding 628 additional cases of benign concordant breast biopsies. Nine of these cases were eventually diagnosed as malignancy with a false negative rate of 1.4%. Combined with our data, the overall false negative rate is 1.1%.ConclusionsShort interval follow-up exams for benign concordant MRI-guided breast biopsies may not be necessary given the low malignancy rate.     

18F-FDG PET/CT显像诊断心包恶性病变的价值

目的 评价18F-脱氧葡萄糖（FDG）PET/CT对心包恶性病变的诊断价值.方法 对23例心包积液患者进行18F-FDG PET/CT显像,并采用两独立样本非参数检验分析良恶性病灶最大标准摄取值（SUVmax）差异有无统计学意义.结果 经病理检查证实恶性心包积液14例,良性心包积液9例.1例PET/CT假阴性,2例PET/CT假阳性.18F-FDG PET/CT鉴别诊断良恶性心包积液的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为92.9%（13/14）、7/9、87.0%（20/23）、86.7%（13/15）和7/8.良、恶性病变的SUVmax中位值分别为2.2和6.0,两者间比较差异有统计学意义（z=-3.279,P=0.001）.结论 18F-FDG PET/CT是评价心包恶性病变较好的无创性手段,对良恶性心包积液的诊断与鉴别诊断有一定临床价值.     

膈顶部肝脏病变CT引导下切割针活检的准确性和安全性

目的评价膈顶部肝脏病变CT引导下切割针活检的准确性和安全性。方法25例患者在CT引导下用16 G或18 G切割针进行穿刺活检。结果组织学检查恶性病变17例,良性病变8例。总体检查假阴性2例(8%),未发现假阳性,恶性病变和良性病变诊断特异度分别为100%和75%,诊断总准确率92%。并发气胸者2例(8%);1例出现针道出血(4%),1例出现肝包膜下出血(4%)。结论CT引导下膈顶部肝脏病变切割针活检是一种可靠和相对安全的诊断方法。     

Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET

The purpose of this study was to determine the actual standardized uptake value (SUV) by using the lesion size from computer tomography (CT) scan to correct for resolution and partial volume effects in positron emission tomography (PET) imaging. This retrospective study included 47 patients with lung lesions seen on CT scan whose diagnoses were confirmed by biopsy or by follow up CT scan when the PET result was considered negative for malignancy. Each lesion's FDG uptake was quantified by the SUV using two methods: by measuring the maximum voxel SUV (maxSUV) and by using the lesion's size on CT to calculate the actual SUV (corSUV). Among small lesions (2.0 cm or smaller on CT scan), ten were benign and 17 were malignant. The average maxSUV was 1.43+/-0.77 and 3.02+/-1.74 for benign and malignant lesions respectively. When using an SUV of 2.0 as the cutoff to differentiate benignity and malignancy, the sensitivity, specificity, and accuracy were 65%, 70%, and 67% respectively. When an SUV of 2.5 was used for cutoff, the sensitivity, specificity, and accuracy were 47%, 80%, and 59% respectively. The average corSUV was 1.65+/-1.09 and 5.28+/-2.71 for benign and malignant lesions respectively. Whether an SUV of either 2.0 or 2.5 was used for cutoff, the sensitivity, specificity, and accuracy remained 94%, 70%, and 85% respectively. The only malignant lesion that was falsely considered benign with both methods was a bronchioalveolar carcinoma which did not reveal any elevated uptake of fluorine-18 fluorodeoxyglucose (FDG). Of the large lesions (more than 2.0 cm and less than 6.0 cm), one was benign and 19 were malignant and the corSUV technique did not significantly change the accuracy. It is concluded that measuring the SUV by using the CT size to correct for resolution and partial volume effects offers potential value in differentiating malignant from benign lesions in this population. This approach appears to improve the accuracy of FDG-PET for optimal characterization of small lung nodules.     

Clinical value of lung scintigraphy with Tc-99m gluconate in distinguishing benign from malignant lung diseases.

One hundred patients were studied with three-phase lung scintigraphy with Tc-99m gluconate. The results showed that there were statistically significant differences between benign and malignant lung lesions in the intensity of accumulation, the blood supply index ratio, and the radioactive uptake ratio. However, no difference was observed between the benign lung lesions and the healthy lungs. Analysis of false negatives and false positives revealed that false negatives had something to do with the cell types of the malignancies, in addition to the relatively small size of the lesions; the false positives were mostly caused by acute inflammation, for which obstructive pneumonitis might be responsible in part. It is concluded that Tc-99m gluconate is tumor-avid and can be used as an agent for positive imaging of lung cancer, because quantitative parameters, blood supply index ratio, and radioactive uptake ratio are more objective in distinguishing malignant lung lesions from benign ones, and are of relatively higher sensitivity and specificity. Thus, lung scintigraphy with Tc-99m gluconate provides an efficient supplementary measure for differentiating between malignant and benign lung lesions.     

Characterization of small pulmonary nodules by CT

Small pulmonary nodules with diameters 10 mm are very frequent findings at CT examinations. Despite the traditional opinion that every pulmonary nodule should be considered malignant until proven otherwise, the vast majority of small lesions are benign, and therefore biopsy may not be necessary in all cases. During the last few years, several CT-based methods have been developed to differentiate between benign and malignant lesions non-invasively. A negative quantitative contrast-enhanced CT is a strong predictor for benignity. Repeat nodule volume measurements at short-term follow-up CT examinations can detect growth suggesting malignancy. Limitations and potential pitfalls of these methods must be observed to avoid false negative test results leading to delayed diagnosis and treatment of malignant tumours. An algorithm for diagnostic workup of incidentally detected small pulmonary nodules in subjects without known malignancy is proposed in this article.     

New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid

OBJECTIVE: The purpose of our study was to provide new sonographic criteria for fine-needle aspiration biopsy of nonpalpable solid thyroid nodules. MATERIALS AND METHODS: Sonographic scans of 155 nonpalpable thyroid nodules in 132 patients were prospectively classified as having positive or negative findings. Sonographic findings that suggested malignancy included microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was more tall than it was wide. If even one of these sonographic features was present, the nodule was classified as positive (malignant). If a nodule had none of the features described, it was classified as negative (benign). The final diagnosis of a lesion as benign (n = 106) or malignant (n = 49) was confirmed by fine-needle aspiration biopsy and follow-up (>6 months) in 83 benign nodules, by fine-needle aspiration biopsy and surgery in 44 malignant and 15 benign lesions, and by surgery alone in five malignant and eight benign lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated on the basis of our proposed classification method. RESULTS: Of 82 lesions classified as positive, 46 were malignant. Of 73 lesions classified as negative, three were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 93.8%, 66%, 56.1%, 95.9%, and 74.8%, respectively. CONCLUSION: Considering the high level of sensitivity of our proposed sonographic classification, fine-needle aspiration biopsy should be performed on thyroid nodules classified as positive, regardless of palpability.     

Solitary cavities of the lung: diagnostic implications of cavity wall thickness

Sixty-five solitary cavities of the lung were evaluated for wall thickness. All lesions in which the thickest part of the cavity wall was 1 mm were benign. Of the lesions whose thickest measurement was 4 mm or less, 92% were benign. Of cavities that were 5-15 mm in their thickest part, 51% were benign and 49% malignant. Of those over 15 mm thick, 95% were malignant. Measurement of the thickest part of te cavity wall gives a more reliable indication of benignancy or malignancy than measurement of the thinnest part.     

Powered cutting needle biopsy of the pleura and chest wall

Over a 24 month period, 35 patients seen consecutively with a pleural or chest wall mass had a percutaneous biopsy using an 18 gauge cutting needle operated by a specially designed, hand held, spring loaded trigger system (Biopty TM, Biopsy instrument, Radiplast A.B. Sweden). Biopsies were performed under local anaesthesia with ultrasound, fluoroscopic, or computed tomography guidance, depending on the site and nature of the lesion. An excellent specimen, consisting of a core of tissue, was consistently obtained and a specific histological diagnosis was possible in 30 patients (28 malignant lesions and two benign lesions). In two patients there was an unequivocal diagnosis of malignancy but the tumour was too necrotic to allow a cell type to be established. In three patients the specimen consisted predominantly of dense fibrous tissue. One of these was a presumed false negative result for malignancy; the other two are presumed true negative results. There were no complications of the procedure.     

Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy--initial experience

PURPOSE: To retrospectively evaluate the accuracy of the fused positron emission tomographic (PET)/computed tomographic (CT) image for characterization of adrenal lesions in patients who have proved malignancy or are suspected of having malignancy. MATERIALS AND METHODS: Institutional review board approval was received for this retrospective HIPAA-compliant study, and informed consent was waived. Forty-one adrenal lesions in 38 patients (21 men, 17 women; mean age, 66 years; range, 37-86 years) were evaluated with PET/CT. Of the 41 lesions, nine were assumed to be malignant with documentation of enlargement (n = 8) or reduction in size in response to treatment (n = 1), and 32 were assumed to be benign with documentation of stability for 6 months (n = 31) or with confirmation with biopsy results (n = 1). The PET examination findings were positive when adrenal lesion maximum standardized uptake values (SUVs) exceeded hepatic maximum SUVs. CT contrast medium washout analysis was used to further characterize two lesions with PET findings positive for malignancy. The t test was used to assess significant (P < .05) differences between fluorine 18 fluorodeoxyglucose (FDG) uptake of benign lesions and that of malignant lesions. RESULTS: At PET/CT, findings for all malignant lesions were positive (mean adrenal lesion-liver activity ratio, 4.04; range, 1.53-17.08). Of the 32 benign lesions, most (30 of 32) had activity less than that of the liver (mean ratio, 0.66; range, 0.22-0.94). PET/CT demonstrated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 93.8%, 81.8%, 100%, and 95.1%, respectively. Incorporating contrast material-enhanced CT with delayed imaging increased specificity to 100% because two lesions with PET findings positive for malignancy were characterized as benign. There was a significant difference between maximum SUV (P < .05) and the ratio of adrenal lesion-liver FDG activity (P < .001) in benign versus malignant adrenal lesions. CONCLUSION: PET/CT provides a powerful combination of functional and attenuation information for adrenal lesion characterization. All malignant lesions were detected at PET/CT, with no false-negative results.     

False-negative results after stereotactically guided vacuum biopsy

The purpose of this study was to determine the false negative rate of stereotactically guided vacuum biopsy (VB). Data of patients with benign lesions in VB were evaluated retrospectively during a median follow-up period of 21 months. A total of 404 VB were considered benign and representative and were recommended for follow-up. Of these 404 lesions, 195 were completely removed radiologically. Follow-up data were available for 354/404 patients (87.6%), with intervals ranging from 3 to 66 months (median 21, mean 22.4). Reintervention or surgery was necessary in 13/354 (3.7%) cases. Of these cases, 5/354 (1.4%) turned out to be false negatives. Four of these cases showed large areas of microcalcifications or several clusters, and only partial removal was possible due to the size of the lesions.Although VB is an accurate procedure for diagnosing nonpalpable breast lesions with a low cancer miss rate, we consider the exclusion of malignancy in cases of disseminated microcalcifications or several clusters as a limitation. The radiologic-pathologic correlation in these cases is a challenge, particularly in terms of the residuals. Strict follow-up of benign lesions is essential to avoid delayed cancer diagnosis.     

X-ray controlled percutaneous needle aspiration biopsy of the lungs (author's transl)]

Between 1976 and 1978 percutaneous needle aspiration biopsies of 120 pulmonary and pleural lesions were performed. Cytologic examination of malignant and benign lesions was correct in 64% of the cases, false negative results were obtained in 19%. Complications included: pneumothorax in 21 patients (11 requiring chest tube placement); insignificant hemothorax in 5 and hemoptysis in 1. Needle biopsy of intrathoracic lesions proved to be technically simple and relatively safe. This procedure allows early diagnosis of malignant lung tumours which may improve long term prognosis.     

Application of a quantitative model to differentiate benign from malignant breast lesions detected by dynamic,gadolinium-enhanced MRI

Both benign and malignant breast lesions may exhibit intense contrast enhancement when imaged using gadolinium-enhanced MRI. We propose a quantitative approach for fitting dynamic signal intensity (SI) data that may distinguish benign from malignant lesions. We studied 78 lesions in 75 women (18 malignancies, 16 fibroadenomas, and 44 other benign breast lesions) to determine the potential of this model for decreasing false-positive MR results. Twenty-eight lesions showed no enhancement; all were benign. One lesion showed a complex pattern not amenable to region-of-interest analysis and was considered a false positive. SI versus time data for the remaining 49 lesions were fit to the proposed model. We found that one parameter, M, the normalized slope of the SI enhancement profile evaluated at half the maximal signal intensity, seemed to be highly correlated with malignancy and offered improved discrimination between malignant and benign lesions compared to a previously published two-point slope method.     

<Superscript>18</Superscript>F-FDG PET/CT to differentiate malignant necrotic lymph node from benign cystic lesions in the neck

Objective

Patients presenting with cystic lesions in the neck without obvious signs of malignancy constitute a diagnostic challenge since fine needle aspiration is often insufficient and a diagnosis may not be reached until surgical resection/biopsy is performed. The differential diagnosis of a cystic cervical mass comprises a variety of benign conditions, but malignancy must be ruled out. We examined the diagnostic performance of fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) PET/CT to identify malignancy.

Methods

We retrospectively included consecutive patients referred from the Department of ENT Head and Neck Surgery for ¹⁸F-FDG PET/CT-scans because of a solitary neck cyst. Scan results were compared to histopathology and follow-up.

Results

The study comprised 58 patients. Twenty patients (34%) were diagnosed with cancer during follow-up. PET/CT suggested malignancy in 34 patients (19 true positive, 15 false positive) and showed no malignancy in 24 (23 true negative, 1 false negative). The sensitivity, specificity, accuracy, positive and negative predictive values were 95% (76–99%), 61% (45–74%), 72% (60–82%), 56% (39–71%), and 96% (80–99%), respectively (95% confidence intervals in brackets). The primary tumor was identified in 14 out of the 20 patients with confirmed cancer. Increased metabolism, as evaluated by PET, was the only imaging characteristic among several others, which associated independently with malignancy in the cystic neck lesions, odds ratio 1.27 (1.07–1.50), p = 0.006.

Conclusion

¹⁸F-FDG PET/CT could reliably rule out malignancy (NPV 96%), albeit with a high frequency of false positive scans, requiring further diagnostic work-up. Increased metabolism was the best imaging parameter to differentiate between malignant and benign lesions.