To investigate the predictive factors for a non-diagnostic result and the final diagnosis of pulmonary lesions with an initial non-diagnostic result on CT-guided percutaneous transthoracic needle biopsy.All percutaneous transthoracic needle biopsies performed over a 4-year period were retrospectively reviewed. The initial pathological results were classified into three categories-malignant, benign, and non-diagnostic. A non-diagnostic result was defined when no malignant cells were seen and a specific benign diagnosis could not be made. The demographic data of patients, lesions' characteristics, technique, complications, initial pathological results, and final diagnosis were reviewed. Statistical analysis was performed using binary logistic regression.Of 894 biopsies in 861 patients (male:female, 398:463; mean age 67, range 18-92 years), 690 (77.2%) were positive for malignancy, 55 (6.2%) were specific benign, and 149 (16.7%) were non-diagnostic. Of the 149 non-diagnostic biopsies, excluding 27 cases in which the final diagnosis could not be confirmed, 36% revealed malignant lesions and 64% revealed benign lesions. Predictive factors for a non-diagnostic biopsy included the size ≤ 15 mm, needle tract traversing emphysematous lung parenchyma, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Non-diagnostic biopsies with a history of malignancy or atypical cells on pathology were more likely to be malignant (p = 0.043 and p = 0.001).The predictive factors for a non-diagnostic biopsy were lesion size ≤ 15 mm, needle tract traversing emphysema, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Thirty-six percent of the non-diagnostic biopsies yielded a malignant diagnosis. In cases with a history of malignancy or the presence of atypical cells in the biopsy sample, a repeat biopsy or surgical intervention should be considered.
Abstract Introduction Pleural procedures are performed to prove the diagnosis of pleural effusion. This study was to assess the incidence and outcome of pleural procedure‐related tumour seeding in lung cancer with malignant pleural effusion, and to review the characteristics of the implanted tumours on computed tomography ( CT ) images. Methods From January 2008 to December 2010, 165 patients with the diagnosis of lung cancer with malignant pleural effusion, who underwent at least one pleural procedure and had follow‐up CT , were included. Two radiologists retrospectively reviewed the presence of implanted tumours and their manifestations on CT images. The incidence of tumour seeding, the time to tumour seeding, and hazard ratios for death associated with the procedures and presence of tumour seeding were evaluated. Multivariable logistic regression analysis was used to identify variables that were independently associated with procedure‐related tumour seeding. Results The incidence of procedure‐related tumour seeding was 22.4%. Conventional intercostal drainage ( ICD ) was the independent predictor of tumour seeding. Patients with a history of ICD rapidly developed implanted tumours ( P = 0.0319). The estimated mean time of tumour seeding was 2.9 months. There was an increased risk of death with the presence of tumour seeding ( HR : 3.35, 95% CI : 1.87–6.01). The majority of CT features showed ill‐defined margins with heterogeneous enhancement. Conclusion Pleural procedure‐related tumour seeding in lung cancer with malignant pleural effusion is common. There was a significantly increased risk of death with the presence of tumour seeding. The majority of the CT features in implanted tumours were ill‐defined margins with heterogeneous enhancement.
Explore the definitive diagnoses of imaging-guided transthoracic needle biopsies (TNB) with a pathological result of benign non-specific diagnosis in a tuberculosis-endemic area. The secondary goal was to characterize the initial CT imaging findings between malignancy and benign lesions.All TNB diagnoses considered to have benign non-specific features at the Radiology Department between January 2007 andDecember 2011 were retrospectively reviewedfor definitive diagnosis based on clinical impressions andfor CT imaging characteristics.Sixty-seven cases with TNB were given a benign non-specific diagnosis and had complete pathologic or radiologic follow-ups. Of these 67 cases, 16 (23.9%) were malignant and 51 were benign. Two main definitive diagnoses of benign cases were pulmonary tuberculosis (32.8%) and pneumonia/lung abscess (23.9%). On the CT images, most of lesions in the group of pulmonary tuberculosis (14/22, 63.6%) were not enhanced after contrast administration (p < 0.005), and necrotic mediastinal lymph nodes were significantly found more in final malignancy diagnoses (p < 0.005).The definitive diagnoses of benign non-specific diagnoses based on TNB in this tuberculosis-endemic area had a high rate of both malignancy and pulmonary tuberculosis. Hence, repeated biopsies or radiological follow-ups are advised.
Multiple solitary plasmacytoma is the rare presentation of plasma cell neoplasm that can mimic multiple metastases. Primary endobronchial plasmacytoma is an extremely rare condition of extramedullary plasmacytoma. Here, we describe a case of multiple solitary plasmacytoma that initially presented with an endobronchial mass.The differential diagnosis of multiple lesions in the airway is mainly metastasis and multiple solitary plasmacytoma.
Poster: ECR 2019 / C-2161 / Diagnostic accuracy of various mediastinal width measurements on chest radiographs for traumatic aortic injury score (TRAINS) in patients with associated blunt chest trauma by: W. Sopchoke , J. Sungsiri , O. Akrabaworn, W. Srisintorn, N. Kiranantawat; Songkhla/TH
We aimed to evaluate the feasibility, accuracy, and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions.Consecutive PTNB procedures in an academic institution over a 4-year period were reviewed, 53 of which were performed on patients with cavitary lesions. The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathologic results, and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy.The overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 noninfectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A nonsignificant higher chest tube insertion rate was seen in cavities with a thinner wall.PTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions.
To evaluate the outcome and safety of ultrasound-guided percutaneous catheter drainage of exudative pleural effusion.The present study was a retrospective analysis of 412 pleural effusions from 373 patients that underwent ultrasound-guided small-bore catheter drainage in exudative pleural effusions between 2004 and 2009.The two most common causes for drainage were parapneumonic effusion or empyema (52.2%) and malignant effusion (30.3%), while the remains were trauma, iatrogenic, and others. Overall clinical success rate was 76.5%. The success rate was lower among malignant pleural effusion (p = 0.003). Causes of effusion were the only independent predictors related to success. Only five (1.2%) patients developed complication during the procedure. Seventy-five of 412 effusions (15.8%) developed complication during the period of drainage; the majority were drain blockage (9%) and accidental dislodgment (4.1%).Ultrasound-guided small-bore catheter drainage was a safe and efficient procedure for exudative pleural effusions.
To evaluate clot size and stenotic degree on conventional computed tomographic pulmonary angiography (CTPA) with perfusion defect.Fifty-two pulmonary embolism (PE) patients with 144 PE locations underwent dual-energy CTPA with an iodine distribution map. Each PE location was rated as to whether there was a perfusion defect. Clot size, stenotic degree, and other associated PE findings were evaluated. These findings were then correlated with whether the perfusion defect was present.There were no associations between demographics, clinical characteristics, anatomical data, and perfusion defect. The median iodine concentration ratio was 0.11. Imaging interpretation by 2 thoracic radiologists had excellent agreement. The clot size and stenotic degree in PE were significant predictors of perfusion defect on conventional CTPA. Lesions with higher degrees of stenosis had higher percentages of perfusion defect. The generalized estimating equation (GEE) logistic regression confirmed that clot size and stenotic degree could predict PE perfusion defects on conventional CTPA.The 2 significant predictors of perfusion defect were occluded vessels in both small and large branches together, or complete occlusion of the pulmonary artery.
Rationale: Patients with bronchiectasis suffer from sputum production and exacerbated. The aims of this study were roxithromycin, an anti-inflammatory macrolide antibiotic, could alter clinical outcome. Material and Methods: A randomized, double blinded, placebo controlled study was conducted to evaluate the effect of a 12-weeks of roxithromycin (300 mg/d) and a 12-week wash out period in HRCT proved bronchiectasis. Results: 30 bronchiectasis patients mainly from postuberculosis with history of 2.5 times exacerbation per year were studies. During the treatment period patients in the roxithromycin group (n=15, mean age 67 yrs) and the placebo group (n=15, mean age 65 yrs) had improved quality of life by total SGRQ scores 7.31 ± 17.14 vs. 6.31 ± 18.11(mean different +/-SD) but could not reach statistical significant (p = 0.53), at follow up wash out period there was more improvement in all domains of SGRQ scores in the roxithromycin group than the placebo group especially in the impact domain 4.17 vs -3.24 (mean different). There was no parallel improvement in sputum volume, symptom scores and pulmonary function tests. Two patients in treatment group and a patient in control group developed exacerbation and no patients in either group reported side effects. The microbiology results showed colonization of P. aeruginosa and K. pneumonia without any reported emerging drug resistance. Conclusion: 12-week roxithromycin 300 mg once daily in symptomatic stable bronchiectatic patients did not show significant improvement of QoL by SGRQ scores, reduced sputum volume nor improved lung function. Further long term study of anti-inflammatory macrolide should be done in symptomatic bronchiectatic patient.
To determine the clinical role, safety, and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation.A retrospective review of all computed tomography (CT)-guided percutaneous transthoracic needle biopsies (PTNB) at a tertiary care hospital over a 4-year period was performed to identify all cases of PTNB performed for pulmonary consolidation. For each case, CT Chest images were reviewed by two thoracic radiologists. Histopathologic and microbiologic results were obtained and clinical follow-up was performed.Thirty of 1090 (M:F 17:30, mean age 67 years) patients underwent PTNB for pulmonary consolidation (2.8% of all biopsies). A final diagnosis was confirmed in 29 patients through surgical resection, microbiology, or clinicoradiologic follow-up for at least 18 months after biopsy. PTNB had an overall diagnostic accuracy of 83%. A final diagnosis of malignancy was made in 20/29 patients, of which 19 were correctly diagnosed by PTNB, resulting in a sensitivity of 95% and specificity of 100% for malignancy. In all cases of primary lung cancer, adequate tissue for molecular testing was obtained. A benign final diagnosis was made in 9 patients, infection in 5 cases and non-infectious benign etiology in 4 cases. PTNB correctly diagnosed all cases of infection. Minor complications occurred in 13% (4/30) of patients.Pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy. Diagnostic yield is high, especially for malignancy. PTNB of pulmonary consolidation should be considered following non-diagnostic bronchoscopy.
