CT-guided Percutaneous Transthoracic Aspiration Biopsy for Pulmonary Lesions:Comparison between Lesion Size and Depth
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Objective To evaluate the influence of lesion size and depth on the diagnostic accuracy and the rate of pneumothorax in patients undergone CT-guided transthoracic aspiration biopsy for pulmonary lesions.Methods CT-guided percutaneous transthoracic biopsy was performed in 398 patients that had surgical resection or clinical follow-up.According to lesion size,lesions were divided into≤2 cm,2～4 cm and ≥4 cm.Lesion depth was measured from the pleura surface to the edge of the lesion.This depth was classified in three categories:≤1 cm,1～3 cm and ≥3 cm.Comparison of the diagnostic accuracy and the frequency of pneumothorax in different size and depth of lesion was performed.Results(1)The overall diagnostic accuracy of CT-guided percutaneous needle aspiration biopsy was 83.2%(331/398).Pneumothorax occurred in 58(14.6%)of 398 biopsy;(2)The diagnostic accurate rate in different size of lesion was 73.3%(44/60),81.5%(176/216)and 91.0%(111/122)respectively,χ2=9.91,P0.01.The occurred rate of pneumothorax in different size of lesion was 20%(12/60),16.7%(36/216)and 8.2%(10/122)respectively,χ2=6.16,P0.05;(3)The diagnostic accurate rate in different depth lesion was 83.0%(117/141),85.9%(122/142)and 80.0%(92/115)respectively,χ2=1.59,P0.05.The occurred rate of pneumothorax in different depth lesion was 2.8%(4/141),14.8%(21/142)and 28.7%(33/115),χ2=34.03,P0.01.Conclusion CT-guided biopsy has less accuracy and high occurred rate of pneumothorax in smaller pulmonary lesion than that in larger lesions.The diagnostic accuracy is similar for different depth lesions.The occurred rate of pneumothorax is increased with increasing depth of the lesion.Keywords:
Percutaneous biopsy
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Core biopsy
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Fiducial marker
Nodule (geology)
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Background: This study aims to correlate nodule, patient, and technical risk factors less commonly investigated in the literature with pneumothorax development during computed tomography-guided core needle lung nodule biopsy. Patients and Methods: Retrospective data on 671 computed tomography-guided percutaneous core needle lung biopsies from 671 patients at a tertiary care center between March 2014 and August 2016. Univariate and multivariable logistic regression analyses were used to identify pneumothorax risk factors. Results: The overall incidence of pneumothorax was 26.7% (n=179). Risk factors identified on univariate analysis include anterior [odds ratio (OR)=1.98; P <0.001] and lateral (OR=2.17; P= 0.002) pleural surface puncture relative to posterior puncture, traversing more than one pleural surface with the biopsy needle (OR=2.35; P= 0.06), patient positioning in supine (OR=2.01; P <0.001) and decubitus nodule side up (OR=2.54; P= 0.001) orientation relative to decubitus nodule side down positioning, and presence of emphysema in the path of the biopsy needle (OR=3.32; P <0.001). In the multivariable analysis, the presence of emphysematous parenchyma in the path of the biopsy needle was correlated most strongly with increased odds of pneumothorax development (OR=3.03; P= 0.0004). Increased body mass index (OR=0.95; P= 0.001) and larger nodule width (cm; OR=0.74; P= 0.02) were protective factors most strongly correlated with decreased odds of pneumothorax development. Conclusion: Emphysema in the needle biopsy path is most strongly associated with pneumothorax development. Increases in patient body mass index and width of the target lung nodule are most strongly associated with decreased odds of pneumothorax.
Nodule (geology)
Univariate analysis
Lung biopsy
Supine position
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Objectives: The aim of this retrospective study was to investigate the relationship between lung lesion lobar distribution, lesion size, and lung biopsy diagnostic yield. Material and Methods: This retrospective study was performed between January 1, 2013, and April 30, 2019, on CT-guided percutaneous transthoracic needle biopsies of 1522 lung lesions, median size 3.65 cm (range: 0.5– 15.5 cm). Lung lesions were localized as follows: upper lobes, right middle lobe and lingual, lower lobes superior segments, and lower lobes basal segments. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and/or pathology reports. Results were considered diagnostic if malignancy or a specific benign diagnosis was established, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results: The positive predictive value (PPV) of a diagnostic yield was 85%, regardless of lobar distribution. Because all PPVs were relatively high across locations (84–87%), we failed to find statistically significant difference in PPV between locations ( P = 0.79). Furthermore, for every 1 cm increase in target size, the odds of a diagnostic yield increased by 1.42-fold or 42% above 85%. Although target size increased the diagnostic yield differently by location (between 1.4- and 1.8-fold across locations), these differences failed to be statistically significant, P = 0.55. Conclusion: Percutaneous transthoracic needle biopsy of lung lesions achieved high diagnostic yield (PPV: 84– 87%) across all lobes. A 42% odds increase in yield was achieved for every 1 cm increase in target size. However, this increase in size failed to be statistically significant between lobes.
Benignity
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Nodule (geology)
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Needle biopsies were done on 125 chest lesions in 117 patients, for the purpose of evaluating the procedure in relation to size and location of the lesions. Fifty of these lesions were centrally located, and 75 were peripherally located. Sixty-four lesions, with diameters of 2 cm or less, were classified as "small," and 61 were classified as "large". In peripheral lesions diagnostic yield was higher, but accuracy was lower than it was in central lesions. Diagnostic yield was the same in small lesions as it was in large ones, although accuracy was higher in small lesions. The complication rate was lower in central lesions than it was in peripheral lesions; the rate did not differ between large and small lesions.
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Percutaneous biopsy
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Lung biopsy
Coaxial
Pulmonary hemorrhage
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Objective To evaluate the usefulness of extrapleural locating method in CT-guidod transthoracic pulmonary biopsy to prevent or reduce the size of peumothorax.Methods One hundred and fifteen cases of CT-gnided transthoracic pulmonary biopsy with the pulmonary lesions not in direct contact with the pleura were selected.Of 115 cases,46 were performed with extrapleural locating method (EPL) and 69 cases with lesion edge locating method (LEL).Taking the maximum distance between the partial and visceral pleura (MPVD) measured on the CT image after the procedure as the index of the volume of pneumothorax.The incidence and volume of pneumothorax of both groups were compared and statistically analysed with R ×C Chi-Square test.The retention time of the biopsy needle in the lung parenchyma of the two group was documented and the average time was calculated in each group.Results The incidence of pneumothorax was 45.7% (21/46),median 0.4 cm with EPL group,and 66.7% (46/69) and median 0.3cm with LEL group.When the distance between the lesion and pleura was equal or smaller than 2 cm (≤2cm),the incidence of pneumothorax was 39.4% (13/33) with EPL group and 73.2% (30/41) with LEL group,and the difference of incidence and volume of the pneumothorax between two groups was statistically signifieant(X2 =9.981,P =0.019).When the distance was larger than 2 cm( >2 cm),the incidence and volume of pneumothorax between two groups were not significant statistically.The average retention time of the biopsy needle in the lung parenchyma was (7.2±1.8)s with EPL group and (58.3±11.6) s with LEL group.Conclusion The extrapleural locating method can reduce effectively the retention time of the biopsy needle in the lung parenchyma and the incidence and volume of pneumothorax in CT-gnided transthoracic pulmonary biopsy.
Key words:
Biopsy,needle; lung; Stereotaxic techniques; Tomography,X-ray computed
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Ultrasound-Guided Biopsy of Pleural-Based Pulmonary Lesions by Injection of Contrast-Enhancing Drugs
In this study, a total of 58 patients with single subpleural pulmonary lesions (males: 36, females: 22, mean age: 63 ± 16.2 years) who underwent CEUS and had a definite diagnosis (benign lesions:25, malignant lesions:33) were enrolled. After the contrast agent injection, the arrival times, intensity and uniformity of enhancement, as well as the display rate of internal necrosis were recorded and compared between malignant and benign lesions. Furthermore, the nodules were divided into two size subgroups: ≥5 cm (group 1), and <5 cm (group 2). The display rate of internal necrosis and change of pre-scheduled puncture paths were compared between subgroups. Also, the number of biopsies, diagnostic accuracy rate, and the incidence of complications were recorded. Finally, internal necrosis was demonstrated in 20 of 58 lesions (34.5%). There was a statistically significant difference in the arrival times and intensity of enhancement between benign and malignant lesions (p < 0.05). Sixteen of them had changed the planned puncture path due to the large necrosis area (80%, 16/20). For lesions in group 1, necrosis was found in 15 lesions and there was a statistically significant difference in the necrosis rate between the two subgroups (15/26 vs 5/32, p = 0.001). The change in the pre-scheduled puncture path occurred in 12 patients in group 1 while 4 patients in group 2 exhibited a change in the planned puncture path (p = 0.004). The average number of punctures was 2.9 ± 0.7 times. The total diagnosis rate was 98.3%. Local pneumothorax occurred in 2 patients. Hemoptysis occurred in 1 patient. No serious complications occurred. In conclusion, CEUS guided biopsy is an effective, sensitive, and safe method for the diagnosis of pleural-based pulmonary lesions by facilitating a distinction between necrosis and active tissue. The current findings indicated that CEUS before a biopsy may be especially vital in lesions ≥ 5 cm.
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