Computed Tomography Guided Needle Biopsy Research Articles

880: PULMONARY AMYLOIDOSIS ASSOCIATED WITH B CELL LYMPHOPROLIFERATIVE DISORDER: A CASE REPORT

Introduction: Amyloidosis is caused by the deposition of misfolded autologous proteins in various organs and can be systemic or localized. AL amyloidosis is often associated with plasma cell disorder but here we report a rare case of Isolated Nodular Pulmonary Amyloidosis associated with a B cell Lymphoproliferative Disorder. Description: An 89 year old female with a past medical history of pulmonary arterial hypertension presented to the clinic with chronic stable exertional dyspnea and no associated symptoms. Four years prior, a computed tomography (CT) of the chest showed multiple bilateral calcified and noncalcified lung nodules with no further work-up. Chest X-ray performed at current presentation revealed extensive pulmonary reticulonodular shadowing at the peripheries with extensive fibrotic changes and scattered nodules. Subsequent CT chest showed interval increase of several bilateral nodules. A PET-CT showed multiple mildly hypermetabolic nodules. A CT guided needle biopsy of an FDG avid right upper lobe nodule measuring 1.5 x 1.4 cm was performed. Pathology was significant for homogenous acellular amorphous material with an entrapped plasma cell infiltrate. Congo red stain confirmed the presence of apple green birefringence diagnostic of amyloidosis. Immunohistochemistry showed a mixture of kappa-positive and lambda-positive cells, with kappa-positive cell predominance suggestive of an atypical plasma cell population. Clonal gene rearrangements were detected in both the immunoglobulin heavy chain and light chain gene which highly suggested the presence of a B-cell Lymphoproliferative Disorder. The patient was subsequently referred to oncology for further management. Discussion: Pulmonary Amyloidosis is an incidental radiological finding with patients being asymptomatic. CT chest may show lung nodules with/without calcifications. Biopsy is required for diagnosis with radiology guided fine needle aspiration. Isolated pulmonary amyloidosis has a good prognosis but should trigger evaluation for autoimmune disorders and B cell lymphoproliferative disorders as in this case with early referral and treatment of the underlying disorder.

Recurrence and disease-free survival outcomes after computed tomography-guided needle biopsy in stage IA non-small cell lung cancer patients in China: a propensity score matching analysis.

Whether preoperative biopsy before radical resection can lead to recurrence and impact patient survival in non-small cell lung cancer (NSCLC) remains controversial. In this study, we carried out a retrospective analysis to determine whether preoperative biopsy can cause disease recurrence and influence disease-free survival (DFS) in patients with stage IA NSCLC. Patients diagnosed with stage IA NSCLC (solid nodule) between January 2010 and December 2014 were identified from the databases of 7 Chinese medical centers and divided into two groups: a preoperative computed tomography (CT)-guided needle biopsy (CTNB) plus radical resection group, and a non-CTNB group. The propensity score matching (PSM) method was adopted to balance the observed covariates, and Kaplan-Meier estimates were used for survival analysis. Cox regression was used in a single-factor analysis to identify the factors affecting DFS in stage IA NSCLC. After initial screening, 730 patients were enrolled in this study, with 186 and 544 patients in the CTNB group and the non-CTNB group, respectively. After PSM, 186 patients were eventually included in each group. No significant differences in basic clinical features were identified between the two groups (P>0.05). The rates of recurrence were 17.2% and 14.0% in the CTNB and non-CTNB groups (χ2=0.735, P=0.391), respectively. No notable differences in DFS (χ2=1.895, P=0.173) or overall survival (OS, χ2=1.785, P=0.182) were observed. Lung adenocarcinoma [hazard ratio (HR), 0.167, P=0.001] and lesion size (>2 cm) (HR, 2.712, P=0.000) were identified as risk factors for DFS in stage IA NSCLC. CTNB does not increase the incidence of recurrence in stage IA NSCLC or affect patient survival; therefore, it is not a risk factor for DFS. Lung adenocarcinoma and lesion size are risk factors for DFS.

CT Guided Needle Biopsy of Peripheral Lesions-Lesion Characteristics That May Increase the Diagnostic Yield and Reduce the Complication Rate.

Computed tomography-guided needle biopsy (CT-GNB) has a high diagnostic yield for lung cancer but higher complication rates compared to those of other biopsy modalities. We sought to clarify in which thoracic lesions we could achieve a quick pathological diagnosis using CT-GNB, considering the risks and benefits. We retrospectively enrolled 110 patients who underwent CT-GNB and 547 patients who underwent transbronchial biopsy (TBB) for parenchymal lung lesions in clinical practice. The diagnostic rates of CT-GNB and TBB were 87.3% and 75.3%. After failed diagnosis with other biopsy modalities, 92.3% of patients were finally diagnosed using CT-GNB and 65.8% using TBB. In cases with a negative bronchial sign, there was a statistically higher diagnostic rate with CT-GNB than with TBB (p < 0.001: 89.4% vs. 0%). Complication rates were higher with CT-GNB (50.9%) than with TBB (16.3%). However, there were lower rates of complications in cases with inhomogeneous tumors, subpleural lesions, and when more than 15 mm of the punctured needle length was within the target. We conclude that CT-GNB is an effective biopsy modality with a high diagnostic rate that is especially recommended when the bronchus sign is negative. It can be safely performed if risk factors for complications are taken into account.

Small lung tumor biopsy samples are feasible for high quality targeted next generation sequencing.

Next‐generation sequencing (NGS) has been implemented in clinical oncology to analyze multiple genes and to guide therapy. In patients with advanced lung cancer, small biopsies such as computed tomography‐guided needle biopsy (CTNB), endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and transbronchial biopsy (TBB) are less invasive and are preferable to resection to make a pathological diagnosis. However, the quality of DNA/RNA and NGS from small lung tumor biopsy samples is unknown. Between April 2017 and March 2018, 107 consecutive samples were obtained from thoracic tumors or metastatic sites for targeted NGS analysis. Fifteen samples were obtained through CTNB, 11 through EBUS‐TBNA, 11 through TBB and 70 through surgical resection. All samples were formalin‐fixed and paraffin‐embedded. DNA and RNA quality was measured using the ddCq method and the percentage of RNA fragments above 200 nucleotides (DV200), respectively. Our custommade probes were designed to capture exon sequences of 464 cancer‐related genes and transcripts of 463 genes. DNA and RNA yield from the 3 biopsy methods were similar, and less than the yield obtained from resected samples. The quality of DNA and RNA was similar across all methods. Overall, 12 of 15 CTNB samples (80%), all 11 EBUS‐TBNA samples, and 9 of 11 TBB samples (82%) underwent successful NGS assays from DNA. NGS analysis from RNA was successful in all 12 CTNB samples, 9 of 11 EBUS‐TBNA samples (82%), and 8 of 11 TBB samples (73%). CTNB, EBUS‐TBNA and TBB mostly resulted in adequate DNA and RNA quality and enabled high‐quality targeted NGS analysis.

Chronic Cough Caused By an Intra-Abdominal Bronchogenic Cyst: A Case Report and Literature Review

Introduction: Bronchogenic cyst is an extremely rare congenital abnormality that is incidentally found by imaging during health check-up. They can hardly occur in the abdomen with unspecific symptoms or change in laboratory values. Case presentation: Here in, we are going to report a case of a 33 years old male patient who was admitted in our department for an intra-abdominal mass. Pathological result of the resected mass was bronchogenic cyst. Conclusion: In most of the cases, bronchogenic cysts are misdiagnosed. The use of endoscopic ultrasound guided fine needle aspiration, computed tomography guided needle biopsy or intraoperative frozen section biopsy is helpful in confirming their diagnosis and to choose the most appropriate treatment.

Ectopic Parathyroid Hormone Secretion by A Penile Squamous Cell Carcinoma

ABSTRACT Objective: Ectopic paraneoplastic secretion of parathyroid hormone (PTH) is rare, with only 25 cases previously reported in the literature, including only 2 attributed to squamous cell carcinoma. The recent presentation of such a patient and subsequent review of the literature has alerted us to the need for clinicians to consider such an etiology in patients presenting with humeral hypercalcemia of malignancy. Methods: Significant hypercalcemia occurred in a 48-year-old male with metastatic squamous cell carcinoma of the penis. The patient had hypercalcemia, elevated PTH, and normal PTH-related protein (PTHrp), without evidence of tumoral skeletal involvement. Comorbid primary hyperparathyroidism was suspected, but ultrasound and sestamibi scans of the neck were negative, raising the possibility of ectopic PTH production. This was confirmed by computed tomography–guided needle biopsy of a thigh metastatic lesion showing positive histochemical staining for PTH-specific antibodies and markedly elev...

Distant Metastasis and Survival Outcomes after Computed Tomography-guided Needle Biopsy in Stage I-II Non-small Cell Lung Cancer

背景与目的CT引导下穿刺活检（computed tomography-guided needle biopsy, CTNB）是诊断肺癌最常用的一种方法，具有诊断准确性高及并发症少的特点。现有的研究表明CTNB可引起肿瘤的针道转移，然而极少有研究关注CTNB对远处转移和远期生存的影响。本研究旨在探讨术前的CTNB对Ⅰ期-Ⅱ期非小细胞肺癌（non-small cell lung cancer, NSCLC）远处转移和生存的影响。方法研究对象为1, 234例Ⅰ期-Ⅱ期NSCLC术后患者，其中113例术前行CTNB，1, 121例术前未经任何活检。应用倾向性评分匹配方法平衡两组间的临床特征，经配对后纳入后续统计检验共226例。并进一步应用Cox回归分析法和Kaplan-Meier分析法进行生存分析。结果在Ⅰ期-Ⅱ期NSCLC患者中，术前的CTNB组无远处转移时间（distant metastasis free survival, DMFS）显著短于无活检组（P=0.032），而两组间总生存无统计学差异（P=0.086）。结论CT引导下穿刺肺活检可能促进早期肺癌的远处转移，但不影响总生存。

Pulmonary Intraparenchymal Blood Patching Decreases the Rate of Pneumothorax-Related Complications following Percutaneous CT–Guided Needle Biopsy

PurposeTo investigate whether an autologous intraparenchymal blood patch (IPB) reduces the rate of pneumothorax-related complications associated with computed tomography (CT)–guided lung biopsies. Materials and MethodsThis study included 834 patients: 482 who received an IPB and 352 who did not. Retrospective review was performed of all CT–guided lung biopsies performed at a single institution between August 2006 and September 2013. Patients were excluded if no aerated lung was crossed. The rate of pneumothorax, any associated intervention (eg, catheter placement, aspiration), chest tube placement, and chest tube replacement requiring hospital admission were compared by linear and multiple regression analysis. ResultsPatients who received an IPB had a significantly lower rate of pneumothorax (145 of 482 [30%] vs 154 of 352 [44%]; P < .0001), pneumothorax-related intervention (eg, catheter aspiration, pleural blood patch, chest tube placement; 43 of 482 [8.9%] vs 85 of 352 [24.1%]; P < .0001), and chest tube placement along with other determinants requiring hospital admission (18 of 482 [3.7%] vs 27 of 352 [7.7%]; P < .0001). No complications related to the IPB were noted in the study group. ConclusionsAutologous IPB placement is associated with a decreased rate of pneumothorax and associated interventions, including chest tube placement and hospital admission, after CT–guided lung biopsies, with no evidence of any adverse effects. These results suggest that an IPB is safe and effective and should be considered when aerated lung is traversed while performing a CT–guided lung biopsy.

Distant Metastasis and Survival Outcomes after Computed Tomography-Guided Needle Biopsy in Resected Stage I-III Non-Small Cell Lung Cancer.

Background and objective Several reports describe the needle-tract implantation after percutaneous needle lung biopsy. The present study evaluated whether preoperative computed tomography-guided needle biopsy (CTNB) affected the distant metastasis and overall survival in patients with early non-small cell lung cancer (NSCLC). Methods A total of 1667 patients with pathological stage I-III NSCLC were assimilated. Of these, 168 patients received preoperative CTNB, whereas 1499 patients were not subjected to any biopsy before surgical resection. Propensity score matching method was adopted to balance the observed covariates between the two groups. Cox regression analysis and Kaplan-Meier estimations were used for survival analysis. Subset analysis was performed in the p-stage ≤ II cases. Results The distant metastasis and mortality were not significantly increased for all patients with preoperative CTNB (P = 0.142 and P = 0.125, respectively). The subset analysis of p-stage ≤ II cases showed that CTNB increased the risk of distant metastasis (P = 0.032) while not increasing the risk of mortality (P = 0.086). Conclusion CTNB can increase the risk of distant metastasis in the p-stage ≤ II patients.

When Symptomatic Treatment Becomes Antitumor Treatment for Vipoma: Opportunity for Frail Elderly Adults

To the Editor: An 82-year-old woman was admitted to the emergency department because of a fall with head injury and loss of consciousness. Her hospital record revealed a history of untreated urinary incontinence, dyslipidemia, and hypertension. During the previous 6 weeks, she had had untreated profuse diarrhea (>10 watery stools per day), a 10-kg loss of weight, and severe asthenia. On examination, she showed evidence of delirium with fluctuating level of consciousness and disorientation, ophthalmic zoster lesions, and severe dehydration. Laboratory tests showed hypokalemia 1.5 mmol/L (normal range 3.5–5.0 mmol/L), hypercalcemia 3.2 mmol/L (normal range 2.2–2.6 mmol/L), and acute renal failure. Her electrocardiogram showed inverted T waves and ST depression. Fluid and electrolyte replacement urgently performed under cardiac monitoring led to partial improvement of her condition. Thoracoabdominal computed tomography was performed to investigate the profuse diarrhea and showed a 7-cm hypervascularized tumor in the tail of the pancreas, with nodes of peritoneal carcinomatosis and lesions in the liver and lungs, and a bilateral pulmonary embolism. Emergency physicians consulted the mobile geriatric team, and she was admitted to the geriatric ward, because it was best suited to provide the comprehensive care required. Anticoagulant therapy was initiated, and in consultation with gastroenterologists, short-acting octreotide (somatostatin analogue) 100 μg twice a day for symptomatic diarrhea was initiated, leading to dramatic improvement. To implement the best care plan, comprehensive geriatric assessment was performed 3 weeks after admission.1, 2 Of the 10 standard domains assessed, six were impaired: mild cognitive impairment, mobility and balance disturbance, activity of daily living impairment, malnutrition, and social isolation. It was decided to investigate further her pancreatic tumor to determine the best treatment. Computed tomography–guided needle biopsy of the pancreatic mass diagnosed a well-differentiated neuroendocrine tumor. Chromogranin A was 143 ng/mL (normal <85 ng/mL) and vasoactive intestinal peptide (VIP) was 157 ng/L (normal 23–63 ng/L). Indium-111-octreotide scintigraphy showed an isolated strong uptake in the tail of the pancreas. A potential diagnosis of metastatic VIPoma was reached. The institutional tumor board chose palliative care for this frail 82-year-old woman and decided to switch to a long-acting somatostatin analogue for its antisecretory and antitumor effects. She died 5 months later, before progression of the tumor could be assessed. VIPoma is a rare functional neuroendocrine tumor of the pancreas (pNET) that secretes VIP. Although VIPoma is rare (estimated incidence 0.05–0.2/1,000,000 individuals), the incidence of NET is rising and could be more common in elderly adults.3-5 The typical clinical features of VIPoma result from excessive secretion of VIP and include large-volume secretory diarrhea, hypokalemia, and dehydration.3 Somatostatin analogues, which inhibit the release of neuroendocrine hormones, control hormone-related symptoms in up to 70% to 90% of symptomatic pNETs.6 Forty percent to 95% of VIPomas are metastatic at presentation, and the symptoms related to excessive secretion of VIP are more likely to shorten life expectancy than tumor growth.7 Thus, management of these tumors in frail elderly adults requires collaboration between endocrinologists and geriatricians to weigh the pros and cons of each therapeutic option. Two new therapeutic options are worth mentioning. First, two targeted therapies everolimus and sunitinib, have recently been approved for treatment of progressive metastatic pNET, although no evidence of efficacy in older adults is available.8 Second, somatostatin analogues, which have an excellent tolerance profile, have been shown to have an antitumor effect: in retrospective studies, stabilizing up to 50% of 60% of NET, and in two randomized controlled trials of octreotide long-acting release in metastatic midgut NET and nonfunctioning gastroenteropancreatic NET.6, 9, 10 Somatostatin analogues are thus recommended for antiproliferative purposes in nonresectable, slowly progressive, low proliferative NET.6, 8 Even though there is no evidence of efficacy in older adults, somatostatin analogues have been used in elderly adults for their antisecretory effects and could be a nonaggressive alternative treatment for frail elderly adults. In conclusion, this case illustrates that multidisciplinary collaboration enabled the choice of adequate treatment for this frail elderly woman. Moreover, a well-known symptomatic treatment has been proven to have an antitumor effect, increasing the spectrum of treatment options in this population. Conflict of Interest: All the authors declare no conflict of interest. Author Contributions: All the authors met the ICMJE criteria to be considered as authors. Sponsor's Role: No sponsor.

A rare case of primary pulmonary diffuse large B cell lymphoma with CD5 positive expression

Primary pulmonary diffuse large B-cell lymphoma (PPDLBCL) is extremely rare. Its clinical symptoms and signs are nonspe cific, and imaging features also have not yet been well-defined. Further description is important for the diagnosis and treatment of PPDLBCL. Herein, we reported a case of a patient who suffered from bilateral chest pain and dyspnea. Computed tomography (CT) of chest demonstrated bilateral lung mass, consolidations and reverse halo sign, while consolidations and reverse halo sign are uncommon according to previous reports. Tissue samples were taken by CT guided needle biopsy. The histological samples showed PPDLBCL. This case was special in view of positive expression of CD5. After the case was treated by cyclophosphamide pirarubicin vindesine dexamethasone (CHOP) chemotherapy for six courses, her clinical symptoms were partially alleviated, while CT showed progression disease. This case report highlights different imaging features and characteristics of molecular biology, and reviews study progress of PPDLBCL.

Primary pulmonary peripheral T-cell lymphoma: A case report and review of the literature.

Primary pulmonary T-cell lymphoma is a rare condition characterized by fever, cough, dyspnea, and bilateral pulmonary nodules, usually diagnosed by transbronchial biopsy or computed tomography (CT) guided needle biopsy and pathology. In view of its poor prognosis, it is critical to distinguish and diagnose this disease as early as possible. We report here a case of a 39-year-old man who presented with fever, cough, expectoration with multiple nodules, and patch shadow in both lungs by chest CT. Tissue samples were taken by CT guided needle biopsy. The histological sample and immunohistochemistry showed peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS). After the patient was treated by chemotherapy for two courses, his condition deteriorated rapidly and he died 2.3 months after the onset of the disease.

Incidence of Pleural Recurrence after Computed Tomography-Guided Needle Biopsy in Stage I Lung Cancer

ObjectiveA risk of tumor seeding after percutaneous needle biopsy has been reported in various organs, including the lung. This study retrospectively evaluated the proportion of ipsilateral pleural recurrence after computed tomography-guided needle biopsy (CTNB) in p-stage I lung cancer patients.MethodsOf the 321 patients diagnosed with p-stage I lung cancer, 124 underwent CTNB before surgery, while 197 underwent non-CTNB procedures, including bronchoscopic biopsy in 188 patients and thoracoscopic wedge resection in 9. These patients were retrospectively analyzed.ResultsWhile the tumor size was significantly larger in the non-CTNB group (25±9 mm) in comparison to the CTNB group (19±9 mm) (p<0.001), percentage of pleural, vascular, or lymphatic invasions were comparable between the two groups. Eight patients developed ipsilateral pleural recurrences, one (1%) in the CTNB group, and 7 (4%) in the non-CTNB group. Of these, 3 patients developed pleural recurrence only at first, 1 (1%) in the CTNB group, and 2 (1%) in the non-CTNB group. The differences in the proportions of these pleural recurrences between the 2 groups were not significant. Subgroup analyses by baseline characteristics such as tumor size, pT stage, or microscopic pleural invasion, showed that proportions of pleural recurrences in CTNB group were not high compared with non-CTNB group in each subgroup. Analysis of progression-free survival showed that recurrences in CTNB were not high compared with non-CTNB.ConclusionsThe pleural recurrence was not significantly increased after CTNB in p-stage I lung cancer patients in this particular study.

An Unusual Presentation of Pulmonary Nocardiosis

Nocardia is an ubiquitous microorganism found in soil, organic matter, and water. It is particularly common in immunocompromised patients. A 51-year-old man, nonsmoker with medical history of hypertension and chronic alcoholism, presented with a 2-week history of a right upper quadrant pain, right-side chest pain, general malaise, fatigue, anorexia, 20-lb weight loss, night sweats, unquantified fever, and visual/auditory hallucinations. An abdominal and chest computed tomography reported a right pleura–based mass that eroded into the chest wall. The patient was admitted with diagnosis of suspected primary lung malignancy with a postobstructive pneumonic infection. Intravenous antibiotic was started with vancomycin and piperacillin/tazobactam. Computed tomography–guided needle biopsy was done and pathology reported a gram-positive filamentous branching bacteria, weakly acid-fast positive, consistent with a Nocardia infection. Trimethoprim/sulfamethoxazole therapy, together with pleural effusion management, ensured further resolution of this invasive pleuropulmonary infection.

Constrictive Pericarditis Presenting as a Large Mediastinal Mass Causing Functional Tricuspid and Pulmonary Stenosis

A 71 year-old man was admitted with progressive shortness of breath and signs of right heart failure. Chest x-ray showed extensive pericardial calcifications (Figure 1). Echocardiography and computed tomography revealed a large mass (77×56 mm) in the anterior mediastinum compressing the right heart cavities, particularly at the level of the atrioventricular groove, resulting in hemodynamically significant functional tricuspid stenosis (Figure 2 and online-only Data Supplement Movie I). In addition, there was mild functional pulmonary stenosis caused by a circular calcified plaque (Figure 3 and online-only Data Supplement Movie II). Contrast uptake by the mass in the computed tomography images was minimal. Computed tomography–guided needle biopsy revealed only necrotic tissue. Cardiac magnetic resonance imaging demonstrated that the mass was heterogeneous, did not exhibit significant contrast uptake, and did not infiltrate the wall of the right-sided cardiac chambers, and also highlighted flow acceleration across the tricuspid valve by external compression (Figures 4 and 5 and online-only Data Supplement Movie III). A detailed history …

How Long Is Long Enough?

How Long Is Long Enough?

腎癌腸腰筋転移の一例

Skeletal muscle metastasis is a rare event in renal cell carcinoma (RCC). Only thirty-two cases have been reported until now. A 69-year-old female had a nephrectomy for right RCC (clear cell carcinoma, grade 2, pT1) in 1994. She has been followed up every three months after nephrectomy. After twelve years from nephrectomy, computed tomography (CT) showed a 3 cm mass in the right iliopsoas muscle. CT guided needle biopsy revealed tumor cells suspicious of renal cell carcinoma metastasis. The tumor was surgically removed and histologically diagnosed as renal cell carcinoma metastasized to the iliopsoas muscle.

Spinal gout in a renal transplant patient: a case report and literature review

Background Gout in the axial spine is rare. We present a case report on a renal transplant patient who developed fever and acute back pain at the L5 through S1 level secondary to sodium urate deposits. We review the literature on this rare disease and propose a management algorithm based on a resulting analysis. Case Description A 37-year-old man with a history of gout and a renal transplant for IgA nephropathy presented with acute back pain and fever without evidence of neurological deficits. Magnetic resonance imaging revealed a uniformly contrast-enhancing infiltrative process involving the right pedicle, lamina, and inferior facet of the L5 vertebra. Computed tomography–guided needle biopsy revealed a friable white tissue consistent with sodium urate crystals. Conservative treatment with steroids and narcotics was used with good symptomatic relief. Conclusion Although few cases of gout involving the spine have been reported, its prevalence is likely grossly underestimated. Most patients have a history of gout and have elevated levels of serum urate level on presentation. The disease most commonly involves the lumbar spine. Patients usually have neurological deficits on presentation, and surgical decompression produces favorable outcomes. However, conservative medical management is appropriate for those with back pain only. Aggressive control of hyperuricemia is essential regardless of the method of treatment.

Computed tomography guided needle biopsy: experience from 1,300 procedures

Computed tomography (CT) guided biopsy is widely accepted as effective and safe for diagnosis in many settings. Accuracy depends on target organ and needle type. Cutting needles present advantages over fine needles. This study presents experience from CT guided biopsies performed at an oncology center. Retrospective study at Hospital do Câncer A. C. Camargo, São Paulo. 1,300 consecutive CT guided biopsies performed between July 1994 and February 2000 were analyzed. Nodules or masses were suspected as primary malignancy in 845 cases (65%) or metastatic lesion in 455 (35%). 628 lesions were thoracic, 281 abdominal, 208 retroperitoneal, 134 musculoskeletal and 49 head/neck. All biopsies were performed by one radiologist or under his supervision: 765 (59%) with 22-gauge fine-needle/aspiration technique and 535 (41%) with automated 16 or 18-gauge cutting-needle biopsy. Adequate samples were obtained in 70-92% of fine-needle and 93-100% of cutting-needle biopsies. The specific diagnosis rates were 54-67% for fine-needle and 82-100% for cutting-needle biopsies, according to biopsy site. For any site, sample adequacy and specific diagnosis rate were always better for cutting-needle biopsy. Among 530 lung biopsies, there were 84 pneumothorax (16%) and two hemothorax (0.3%) cases, with thoracic drainage in 24 (4.9%). Among abdominal and retroperitoneal biopsies, there were two cases of major bleeding and one of peritonitis. Both types of needle showed satisfactory results, but cutting-needle biopsy should be used when specific diagnosis is desired without greater incidence of complications.

Pyogenic Vertebral Osteomyelitis: A Review of 14 Cases

To review and evaluate the management of 14 patients with pyogenic vertebral osteomyelitis at National University Hospital, Singapore between 1998 and 2001. Demographic pattern, predisposing factors, clinical presentation, co-morbidities, microbiology, treatment, and complications of 14 patients were retrospectively reviewed. The mean age at presentation was 62.5 years and the male to female ratio was 6:1. The mean follow-up duration was 12.5 months. The most common predisposing condition was diabetes mellitus (n=5). The most common site of infection was the lumbar spine (n=8), followed by the thoracic (n=4) and cervical (n=2) spine. Staphylococcus aureus was the most common causative organism isolated (n=9), followed by methicillin-resistant S aureus (n=3), Pseudomonas pseudomallei (n=1), and Streptococcus agalactiae (n=1). 12 patients were treated surgically: 8 by an anterior approach, 3 by a posterior approach, and one by a combination of the 2. The mean period of antibiotic use was 11.4 weeks. One patient with melioidosis involving the T9 to T11 vertebrae caused by P pseudomallei died of empyema and septicaemia 22 months after presentation. Pyogenic vertebral osteomyelitis is not uncommon in the elderly, especially those with predisposing conditions such as diabetes mellitus. Computed tomography-guided needle biopsy is recommended to investigate causative microorganisms. Aggressive surgical debridement and prolonged antibiotic therapy were necessary in patients with methicillin-resistant S aureus, P pseudomallei, and S agalactiae.