Computed Tomography Guided Core Needle Research Articles

The Bull’s-Eye Sign in Liver: Are They Liver Metastases?

Question: A 53-year-old man was admitted to our hospital owing to a 2-month history of right upper quadrant abdominal pain with no weight loss. He had no history of drinking or any other documented medication, and denied fever. He never ate raw or undercooked meat and seafood. Two large hepatic masses were detected by screening ultrasound. Abnormalities were not shown in the extrahepatic bile ducts and pancreas by imaging analyses. White blood cell and eosinophil counts were normal. The hemoglobin level was 12.0 g/dL (normal range 13–17.5 g/dL). Aspartate transaminase and alanine transaminase were normal. Alkaline phosphatase (ALP) was 239 IU/L (normal range 50–130 IU/L), and gamma-glutamyl transpeptidase (γ-GTP) was 171 IU/L (normal range 10–60 IU/L). He had a low serum albumin level (35 g/L). Laboratory examination results suggestive of infection with hepatitis A, B, C, and E were negative. Serum alpha-fetoprotein was within the normal range. Initial contrast-enhanced abdominal computed tomography (CT) was performed owing to suspicion of a malignant hepatic tumor. CT confirmed 2 masses 40 mm and 45 mm in diameter with characteristics of a peripheral rim of heterogeneous enhancement in the right hepatic lobe, which resembled the bull’s-eye sign (Figure A). The bull’s-eye sign was more prominent in conventional portal venous-phase contrast-enhanced CT imaging compared with arterial-phase (Figure B). Chest CT, esophagogastroduodenoscopy and colonoscopy were normal. Screening was also negative for the following autoantibodies: antinuclear antibody, anti–double-stranded DNA, antimitochondrial antibodies, anti–liver/kidney microsomal type 1, anti–smooth muscle antibody, anti–SSA/Ro, anti–SSB/La, anti–Scl-70, cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA), and perinuclear antineutrophil cytoplasmic antibody (p-ANCA). CT guided core needle biopsy of the hepatic lesions was done to get adequate tissue for confirmative diagnosis. Photomicrographs of the histologic liver specimen revealed inflammatory cell infiltration consisting of lymphocytes, plasma cells, and neutrophils (Figure C).

Limitations and usefulness of biopsy techniques for the diagnosis of metastatic bone and soft tissue tumors

BackgroundBiopsies are widely used for diagnosing metastatic tumors in the bone and soft tissues; however, their usefulness and limitations remain unclear. Patients and methodsBiopsies of patients (13 men, 8 women, mean age 76 years) with metastatic tumors in the bone (19 patients) and soft tissues (2 patients) were reviewed retrospectively. Investigators surveyed the lesion sites, medical histories, Eastern Cooperative Oncology Group (ECOG) Performance Status (PS), biopsy sites, methods, comorbidities, diagnoses, treatments, and outcomes. ResultsFive patients had multiple lesions, and 16 patients had one lesion. The ECOG PS scores were PS0 (11 patients), PS1 (7 patients), PS2 (2 patients), and PS3 (1 patient). Biopsy sites included pelvic bone (6 cases), rib bone (5 cases), spinal vertebra (7 cases), soft tissue of the shoulder (2 cases), and inner retroperitoneum (1 case). Diagnostic methods included open biopsy (8 patients), core needle biopsy under general (7 patients) or local (3 patients) anesthesia, and computed tomography–guided core needle biopsy under local anesthesia (3 patients). Histology indicated hematological malignancies (9 cases); breast cancer (3 patients); lung cancer, renal cell cancer, cancer of unknown primary (2 cases each); prostate cancer, endometrial (uterine) cancer, and myxoid liposarcoma (1 case each). The primary site identification rate was 90.5%. Outcomes included three patients “dead of disease.“ ConclusionBiopsies are useful for early diagnosis and for the scrutiny of primary lesions of metastatic bone and soft tissue tumors. If the primary tumor is still unknown after biopsy, evidence-based treatment should be initiated promptly.

Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies.

BACKGROUND: Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them.OBJECTIVES: Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB).DESIGN: Prospective evaluation of complications.SETTING: Single center in Turkey.PATIENTS AND METHODS: For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology.MAIN OUTCOME MEASURES: The complications and risk factors for complications were evaluated.SAMPLE SIZE: 123 adult patients.RESULTS: The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema (P=.022), non-peripheral location of the lesion (P<.001), increased needle pathway (P<.001), fissure penetration (P=.011), increased number of pleura penetrations (P=.024), prolonged needle time across pleura (P=.037), and decreased lesion size (P=.033). The pneumothorax rate increased with non-peripheral location of the lesion (P<.007), fissure penetration (P=.021), prolonged needle time across the pleura (P=.013), and decreased lesion size (P=.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion (P<.001, OR=14.7, 95% CI=3.9–55.4 for alveolar hemorrhage) and (P=.001, OR=156.2, 95% CI =7.34–3324.7 for pneumothorax).CONCLUSION: Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications.LIMITATIONS: Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding.CONFLICT OF INTEREST: None.

Computed tomography guided core needle biopsy of an unusual anterior mediastinal mass: a story of a correct multidisciplinary management

article: Computed tomography guided core needle biopsy of an unusual anterior mediastinal mass: a story of a correct multidisciplinary management - Minerva Pneumologica 2020 December;59(4):86-8 - Minerva Medica - Journals

Diagnostic accuracy and associated complications of percutaneous computed tomography guided core needle biopsy of pulmonary lesions using coaxial technique

This study was conducted to determine the diagnostic accuracy of CT-guided core needle biopsy (CNB) using coaxial technique of pulmonary lesions, its complications and factors affecting them. A total of 122 patients with suspected lung malignancy underwent CT-guided CNB. Final diagnosis was confirmed by histopathology. There were 84 (89.4%) true positive while 26 (92.9%) true negative cases. Diagnostic accuracy, sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy were 97.67%, 72.22%, 89.36%, 92.86% and 90.16% respectively. Pneumothorax was the only complication observed in 10 (8.2%) patients. The odds of pneumothorax was found to be 10.72 times higher among patients with 2.5cm of size of lesions (AOR 10.72, 95% CI 1.49-76.77) while 86% lower among patients having prone position (AOR 0.14, 95% CI 0.021-0.96). Results indicate that percutaneous CT guided biopsy of pulmonary lesions using coaxial technique is a safe procedure with a high diagnostic accuracy and lesser risk of major complications.

Impact of immediate evaluation of touch imprint cytology from computed tomography guided core needle biopsies of mass lesions: Single institution experience.

Background:Computed tomography (CT) guided core needle biopsy (CT-guided CNB) is a minimally invasive, safe and effective manner of tissue sampling in many organs. The aim of our study is to determine the impact of on-site evaluation of touch imprint cytology (TIC) to minimize the number of passes required to obtain adequate tissue for diagnosis.Design:A retrospective review of all CT-guided CNBs performed during 4 year period, where pathologists were present for on-site TIC evaluation. Each case was evaluated for the number of passes required before TIC was interpreted as adequate for diagnosis.Results:A total of 140 CT-guided CNBs were included in the study (liver, lung, kidney, sacral, paraspinal, omental, splenic and adrenal masses). Of the 140 cases, 109 were diagnosed as malignant, 28 as benign and three insufficient. In 106 cases (75.7%), the biopsies were determined adequate by TIC on the first pass, 19 cases (13%) on the second pass and 7 cases (5%) on the third pass. Only in 5 cases (3.6%), more than three passes were required before diagnostic material was obtained. Three cases (2.14%) were interpreted as inadequate both on TIC and on the final diagnosis. Of the biopsies deemed adequate on the first pass, 71% resulted in either termination of the procedure, or only one additional pass was obtained. In five cases, based on the TIC evaluation, a portion of the sample was sent for either flow cytometric analysis or cytogenetic studies.Conclusions:In the majority of cases, adequate material was obtained in the first pass of CT-guided CNB and once this was obtained, either no additional passes, or one additional pass was performed. This study demonstrates the utility of on-site evaluation in minimizing the number of passes required for obtaining adequate diagnostic material and for proper specimen triage for ancillary studies, which in turn decreases the risk to the patient and costs. However, tumor exhaustion in the tissue as a result of TIC is an important pitfall of the procedure, which occurred in 9 (8.2%) of our malignant cases.

Complications From Computed Tomography–Guided Core Needle Biopsy for Patients Receiving Stereotactic Body Radiation Therapy for Early-Stage Lesions of the Lung

BackgroundObtaining a tissue diagnosis has traditionally been standard practice before initiating therapy for early-stage non–small-cell lung cancer (NSCLC). In several recent studies from Europe and Asia, a substantial proportion of patients have received stereotactic body radiation therapy (SBRT) based only on the imaging characteristics of the suspicious lesion. The underlying assumption is that the risk of percutaneous needle biopsy may outweigh the benefits in a population that generally has underlying pulmonary dysfunction and other medical comorbidity. Nevertheless, there is limited information regarding biopsy-related complication rates in high-risk patients with early-stage NSCLC who are treated with SBRT. Materials and MethodsThis was a retrospective review of outcomes after biopsy in patients treated with SBRT. Complications of percutaneous core needle biopsy were analyzed in relation to patient and tumor characteristics. Each biopsy event was analyzed independently for patients with multiple biopsies. ResultsA total of 112 percutaneous biopsies were performed in 103 patients. Pneumothorax of any degree was observed in 40 patients (35%) (95% CI, 27%-45%), and 12 patients (10.7%) had a clinically significant pneumothorax requiring chest tube placement (95% CI, 6%-18%). The time to first fraction of SBRT was not different in patients who had a pneumothorax or placement of a chest tube. On multivariate analysis, age, performance status, smoking history, pack-years of smoking, chronic obstructive pulmonary disease history, and forced expiratory volume in the first second of expiration were not statistically significantly associated with chest tube placement. ConclusionComputed tomography–guided needle biopsy in a primarily medically inoperable patient population is safe, with an acceptable degree of complications.

Adequacy of lung cancer tissue samples for ancillary molecular testing in conventionally obtained biopsy material: A 3-year experience of the Louisiana State University (LSU) public hospital in New Orleans.

105 Background: The National Comprehensive Cancer Network recommends that all patients with lung adenocarcinoma (LA) be tested for EGFR mutation and ALK gene rearrangement (EGFR/ALK). Metastatic LA is diagnosed with biopsies often sufficient only for non-molecular based diagnostic techniques; our institutional experience suggested conventionally obtained material was inadequate for EGFR/ALK. We analyzed biopsies performed only with the intent of diagnosing malignancy for adequacy for EGFR/ALK. Methods: We identified patients from LSU diagnosed with metastatic LA whose specimens were sent for EGFR/ALK from January 1, 2009, to June 30, 2013. Data collected included number of specimens sent for EGFR/ALK, number of samples with inadequate tumor, biopsy technique utilized and number of rebiopsy attempts for EGFR/ALK. Results: 54 patients were evaluated in the study time period: 58 individual biopsy specimens were sent for EGFR/ALK. 24/58 (41%) of specimens were found to be inadequate for EGFR/ALK. 11/26 (42%) of bronchoscopically obtained biopsies were inadequate, 9/18 (50%) of computed tomography guided core needle (CTGCN) biopsies were inadequate and 4/14 (28%) samples obtained via thoracentesis, wedge resection, craniotomy, spinal tumor excision, fine needle aspiration of lymph nodes or video assisted thoracoscopic surgery were inadequate. 4/54 (7%) patients underwent rebiopsy, 3 via bronchoscopy and 1 via CTGCN; 3/4 (75%) rebiopsies were sufficient for EGFR/ALK analysis. Conclusions: A substantial proportion of initial LA diagnostic biopsies were inadequate for EGFR/ALK analysis. While EGFR/ALK analysis is now standard of care for patients with LA, only a small percentage of patients in our study underwent rebiopsy. Our institutional practice will be modified to encourage additional biopsies for the specific purpose of molecular testing at the time of initial biopsy for those with suspected LA.

Value of Computed Tomography–guided Core Needle Biopsy in Diagnosis of Primary Pulmonary Lymphomas

PurposeTo evaluate the value of computed tomography (CT)–guided core needle biopsy in diagnosis of primary pulmonary lymphoma and its subtypes. Materials and MethodsA retrospective analysis of the records of all patients with primary pulmonary lymphoma between January 2005 and August 2011 was performed. There were 25 patients referred to the radiology department for CT-guided core needle biopsy. The success rate and complications were assessed. ResultsA definitive diagnosis and accurate histologic subtype were obtained in 21 patients with a success rate of 84.0%. Diagnosis was made in the other four patients with bronchoscopy and surgery. Non-Hodgkin lymphoma (NHL) was the diagnosis in all patients. Most subtypes were mucosa-associated lymphoid tissue (MALT) lymphomas (n = 19). The remaining subtypes included three diffuse large B-cell NHLs, two peripheral T-cell lymphomas not otherwise specified, and one anaplastic large cell NHL. The success rate of core needle biopsy was 95% (18 of 19) for MALT lymphomas, 67% (2 of 3) for diffuse large B cell NHLs, and 33% (1 of 3) for other NHLs. The success rate for MALT lymphomas was significantly higher than that of non-MALT lymphomas according to Fisher exact t test (P = .031). No serious complications occurred in any patients. ConclusionsCT-guided core needle biopsy is a reliable procedure to assist in diagnosis and classification of primary pulmonary lymphomas, especially MALT lymphomas.

Computed Tomography Guided Core Needle Biopsy Diagnosis of Pelvic Actinomycosis

Background. Pelvic actinomycosis is a chronic suppurative inflammatory disease caused by the anaerobic Gram-positive bacilli Actinomyces israelii. The propensity of this disease to simulate gynecological malignancies has been described previously. The great majority of these patients were diagnosed with actinomycotic diseases during or after exploratory laparotomy, but rarely preoperatively. We reviewed the literature pertaining the management of pelvic actinomycosis.Case. A nulliparous woman with a long history of intrauterine contraceptive device (IUD) and recent Papanicolaou smear findings consistent with the presence of actinomyces presented with chronic vague lower abdominal pain, weight loss, poor appetite, and recent increase in abdominal girth associated with a large immobile pelvic mass. Transcutaneous computed tomography guided core needle biopsy established the diagnosis of pelvic actinomycosis obviating immediate surgical intervention. Intravenous and subsequent long-term oral penicillin therapy was constituted and resulted in a significant decrease in the size of the pelvic mass.Conclusion. In patients presenting with pelvic masses and a history of IUD placement, actinomycotic infection should be considered and diagnosis attempted by imaging guided needle biopsy. Furthermore, this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis followed by prolonged antibiotic therapy might eliminate the need for extensive extirpative surgery and assist in maintaining future fertility.