CT-guided Biopsy Research Articles

A series of nine newly developed techniques in CT-guided percutaneous lung biopsyPreliminary results from a prospective study.

e21023 Background: CT-guided percutaneous lung biopsy is important for the diagnosis of lung cancer especially in the area of precision medicine. In ASCO 2015, we reported that "Liquid withdraw" technique (to inject small amount of liquid while withdraw of the needle) can prominently reduce incidence of pneumothorax when combined with co-axial technigue in 38 cases. In ASCO 2017, we retrospectively studied 90 patients undergoing CT-guided percutaneous lung biopsy to investigate the role of this technigue in reducing complications and promoting biopsy effectiveness. Based on the above studies, we conducted a prospective study to further evaluate the role of this technique in conjunction with the other eight techniques (Position compensation, Cushion for position adjustment, Skin expansion in advance, Secondary location outside the pleura, Needle core instantaneous replacement, Mutual fix, Simultaneous bleeding arrest, and Cortical displacement) in the precision diagnosis and treatment of lung cancer. Methods: From January 16th, 2018 to October 11th, 2021, a total of 150 CT-guided percutaneous transthoracic biopsy procedures performed in 146 patients were prospectively evaluated. The pathologies and complications secondary to biopsy procedure were analyzed. Pneumothorax and bleeding was graded as mild/very mild, moderate, and severe. All patients were divided into two groups: the lesion depth was < 30mm from the pleura and ≥30mm from pleura. Different complications between the two groups were analyzed using Pearson’s Chi-squared test for categorical values. Results: 148 cases was diagnosed out of 150 biopsies (98.67%), of which 118 cases were malignant (108 cases can be identified which type and source (91.53%), in which 68 cases were adenocarcinoma), 30 cases were benign. Pneumothorax occurred in 27 (18%) cases, among which, 12% were very mild pneumothorax and 6% were mild to moderate pneumothorax. 44 cases (29.33%) happened bleeding, among which, 21.33% could be classified as very mild, while 8% could be classified as mild to moderate. No infection, tumor implantation or aeroembolism observed. There were no statistically significant differences in the incidence of pneumothorax and bleeding at different distances from the pleura( < 30mm vs ≥30mm, P＞0.05). Conclusions: This series of new techniques in CT-guided percutaneous lung biopsy significantly reduced the incidence of pneumothorax and bleeding and were preliminarily proved that can facilitate acquiring more tumor tissue for molecular testing and re-biopsy of lung cancer. Clinical trial information: ChiCTR1800017958 .

Washing solution of tissue biopsy compared with paraffin-embedded tissue for NSCLC gene test.

e21104 Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer related death, whose targeted therapy is precisely based on gene type. Gene diagnosis is as important as pathological diagnosis and driver gene mutations should be detected as soon as possible. There are generally a few sources to obtain patients’ deoxyribonucleic acid (DNA), such as paraffin tissue of tumor, cytological specimens from bronchoalveolar fluid or pleural effusion, free DNA from blood, hydrothorax, ascite, or cerebrospinal fluid. Our research aims to find out whether washing solution of lung mass biopsy in double distilled water is feasible for detecting gene mutation, and whether its gene type is consistent with that from Next Generation Sequencing (NGS) of paraffin tissue. Methods: 25 clinically diagnosed NSCLC patients from Department of Oncology, Second Xiangya Hospital, Central South University were collected. We used double distilled water to wash the CT-guided percutaneous pulmonary mass biopsy, which was processed to extract DNA. DNA samples were tested for epidermal growth factor receptor (EGFR) gene mutation by amplification refractory mutation system (ARMS)-PCR. 6 of them as well as all 25 paraffin tissue samples were tested for large panel gene mutations by NGS. The gene type consistency between washing solution and paraffin tissue was analyzed by GraphPad Prism V9.4.1. Results: 16 of 25 washing solution DNA samples tested by ARMS-PCR were EGFR mutation positive, including 9 cases of EGFR exon19 deletion, 5 cases of EGFR exon21 L858R, and 2 cases of EGFR exon21 L858R and T790M. Other 9 of 25 samples were EGFR mutation negative. 17 of 25 paraffin tissue samples tested by NGS were EGFR mutation positive, including 9 cases of EGFR exon19 deletion, 7 cases of EGFR exon21 L858R, and 1 case of EGFR exon21 L858R with T790M. There was one washing solution sample showed no EGFR mutation while its tissue sample showed EGFR exon21 L858R. Compared to NGS on paraffin tissue, the sensibility of ARMS-PCR on washing solution was 94.1%. The specificity was 100%, positive predictive value was 100%, negative predictive value was 88.9%, accuracy rate was 96.0%, misdiagnosis rate was 0, and omission diagnostic rate was 5.9%. EGFR types of 6 washing solution samples tested by NGS were exactly the same as that by ARMS-PCR and that of paraffin tissue samples by NGS. The time to obtain gene result was significantly different. ARMS-PCR of washing solution took 1 day, NGS of washing solution took around 7 days, while pathological examination and NGS of paraffin-embedded tissue took around 14 days. Conclusions: The washing solution of CT-guided percutaneous lung mass biopsy in double distilled water is feasible to obtain EGFR type rapidly and efficiently for NSCLC. It is the fastest method to get patients’ gene type at present. Thus, the washing solution of biopsy could be a new DNA source for NSCLC gene test and making decision on targeted therapy ahead of time.

Intraosseous extension of supraspinatus calcific tendonitis in a young patient with severe shoulder pain: a rare case report

Abstract Calcific tendinopathy is one of the causes of shoulder pain and limited range of motion when it affects the rotator cuff tendons. Complications of such a condition are rare and include intraosseous and intramuscular migration. Calcific tendonitis can be classified as acute, subacute or chronic based on the onset of symptoms. The incidence of calcific tendonitis affects females more than males, with the median age of onset being between 40 and 60 years old. Diagnostic modalities include radiographs and computed tomography (CT); however, these are suboptimal when compared to the sensitivity of magnetic resonance imaging. Ninety percent of these cases are treated non-surgically. We present a rare case of a young female patient with right shoulder pain and limited range of motion secondary to the intraosseous migration of calcific tendonitis. The patient’s symptoms were resolved after a CT-guided percutaneous bone biopsy of the lesion. Clinical correlation with the aid of imaging and histopathology is a multimodal approach to help diagnose and treat such conditions.

MRI-guided thoraco-abdominal percutaneous needle biopsy: our initial experience.

The aim of this study is to describe the technique and to report early results of thoraco-abdominal biopsies in the Interventional Magnetic Resonance Imaging Suite (IMRIS). We prospectively evaluated patients with indications for MRI-guided biopsy between January 2021 and May 2022. Exclusion criteria were indication for US-/CT-guided biopsy, contraindication to percutaneous biopsy, inability to lie flat for at least 30min, claustrophobic, severe obesity, or non-MRI compatible devices. Biopsies were performed by 3 interventional radiologists, with at least 8years of experience in oncological interventional radiology. Epidemiological, clinical, procedural, and histopathological data were retrospectively collected. From an initial population of 117 patients, 57 patients (32 male, mean age 64 ± 8 y) were finally enrolled. All 57 patients suspected thoraco-abdominal malignant lesions finally underwent MRI-guided percutaneous biopsy. The mean duration of the entire procedure was 37min (range 28-65min); the mean duration of the total needle-in-patient time was 10min (range 6-19min). Technical and clinical success were obtained for all the biopsies performed. Malignancy was demonstrated in 47/57 (82%) cases and benignancy in the remaining 10/57 (18%) cases. No major complications were detected after the biopsies; two minor compliances (severe pain) occurred and were managed conservatively. Our initial experience demonstrated the technical feasibility and the accuracy of MRI-guided biopsies of thoraco-abdominal masses. The reported data associated with the best comfort for the patient and for the operator make the use of MRI a valid alternative to other methods, especially in lesions that are difficult to approach via US or CT. Interventional MRI is one of the most important innovations available for interventional radiologists. This method will broaden the diagnostic and therapeutic possibilities, allowing treatment of lesions up to now not approachable percutaneously. For this, it is necessary to start publishing the data of the few groups that are developing the method. • To evaluate the use of MRI as a guide for percutaneous biopsies of various districts. • Our preliminary experience confirms experience demonstrated the technical feasibility and the accuracy of MRI-guided biopsies of thoraco-abdominal masses. • Interventional MRI can become the reference method for percutaneous biopsies in particular for lesions with difficult percutaneous approach.

Development and Validation of a Risk Scoring System to Predict Pneumothorax in CT-guided Percutaneous Transthoracic Needle Biopsy

Objective: To develop and validate a risk scoring system using variables easily obtained for the prediction of pneumothorax in CT-guided percutaneous transthoracic needle biopsy (PTNB). Methods: The derivation cohort was comprised of 1001 patients who underwent CT-guided PTNB. Multivariate logistic regression was used to identify risk factors for pneumothorax, which were treated as the foundation to develop the risk scoring system. To validate the system, a validation cohort group of 230 patients was enrolled. Results: Age, puncture times, puncture depth, smoking index, number of specimens, bleeding from the needle path, and lobular lesion were identified as risk factors in the derivation cohort. A risk scoring system (Hosmer-Lemeshow goodness-of-fit test p =0.33) was developed. The area under the receiver operating characteristic curve (AUROC) was 0.601 by using the risk score system. This risk score system demonstrated a better diagnostic effect with increasing age. In the group of patients older than 80 years, the AUROC was 0.76, showing good predictive power. This risk scoring system was confirmed in the validation cohort with an AUROC of 0.736. Conclusion: This scoring system has a good predictive effect in both derivation and validation cohort.

CT-guided transthoracic core needle biopsies of focal pleural lesions smaller than 10 mm: a retrospective study

BackgroundCT-guided transthoracic core needle biopsy (TCNB) is a minimally invasive diagnostic procedure and a useful radiological method for diagnosing pleural lesions smaller than 10 mm in the presence of loculated pleural effusion. The purpose of this study was to retrospectively assess the diagnostic accuracy of CT-guided TCNB of small pleural lesions and determine the incidence of complications.MethodsThis retrospective study included a total of 56 patients (45 men and 11 women; mean [± SD] age, 71.84 ± 10.11 years) with small costal pleural lesions (thickness of < 10 mm) who underwent TCNB performed at the Department of Radiology from January 2015 to July 2021. One of the inclusion criteria for this study was a loculated pleural effusion greater than 20 mm, with a nondiagnostic cytological analysis. Sensitivity, specificity and positive as well as negative predictive values (PPV, NPV) were calculated.ResultsThe sensitivity of CT-guided TCNB for the diagnosis of small pleural lesions in this study was 84.6% (33 of 39), specificity 100% (17 of 17), PPV 100% (33 of 33), and NPV 73.9% (17 of 23), while diagnostic accuracy was 89.3% (50 of 56). The overall diagnostic contribution of TCNB in our study is comparable with the results of other recent reports. Loculated pleural effusion was considered a protective factor since no complications were noted.ConclusionCT-guided transthoracic core needle biopsy (TCNB) is an accurate diagnostic method for small suspected pleural lesions with a near-zero complication rate in the presence of loculated pleural effusion.

Ultrasound-Guided Percutaneous Bone Biopsy: Feasibility, Diagnostic Yield and Technical Notes.

While nowadays, CT-guided bone biopsy represents the gold standard tool for histopathological and microbiological diagnosis of skeletal lesions, the role of US-guided bone biopsy has not yet been fully explored. US-guided biopsy offers several advantages, such as the absence of ionizing radiation, fast acquisition time, as well as good intra-lesional echo, and structural and vascular characterization. Despite that, a consensus in regard to its applications in bone neoplasms has not been established. Indeed CT-guided technique (or fluoroscopic ones) still represents the standard choice in clinical practice. This review article aims to review the literature data about US-guided bone biopsy, underlying clinical-radiological indications, advantages of the procedure and future perspectives. Bone lesions taking the best advantages of the US-guided biopsy are osteolytic, determining the erosion of the overlying bone cortex and/or with an extraosseous soft-tissue component. Indeed, osteolytic lesions with extra-skeletal soft-tissue involvement represent a clear indication for US-guided biopsy. Moreover, even lytic bone lesions with cortical thinning and/or cortical disruption, especially located in the extremities or pelvis, can be safely sampled with US guidance with very good diagnostic yield. US-guided bone biopsy is proven to be fast, effective and safe. Additionally, it offers real-time needle evaluation, an advantage when compared to CT-guided bone biopsy. In the current clinical settings, it seems relevant to select the exact eligibility criteria for this imaging guidance since the effectiveness can vary depending on the type of lesion and body site involved.

Assessment of diagnostic accuracy and complication rates of CT-guided percutaneous core-needle biopsy for lung lesion: difference between solid and sub-solid nodules based on propensity score matching analysis

To compare the success and complication rates of computed tomography (CT)-guided percutaneous core-needle biopsy (PCNB) based on the density of lung nodules, using propensity score matching (PSM). This single-centre retrospective study included 1,312 PCNB cases of lung lesions, including solid (n=1,120), part-solid (n=115), and non-solid nodules (n=77), that were detected between March 2013 and March 2021. The diagnostic accuracy and complication rates of pneumothorax and pulmonary haemorrhage were analysed before PSM. To perform PSM, part-solid and non-solid nodules were combined and newly defined as sub-solid nodules. The diagnostic accuracy and complication rates of pneumothorax and pulmonary haemorrhage were then compared between solid and sub-solid nodules after PSM. Among the 1,312 included cases, the success rate and incidence of pneumothorax after CT-guided PCNB for solid, part-solid, and non-solid nodules were not statistically different (p=0.080 and 0.410). However, the rates of overall pulmonary haemorrhage showed statistical differences (p<0.001), particularly between solid and part-solid nodules (p<0.001) and between solid and non-solid nodules (p<0.001). After PSM, the incidence rates of overall pulmonary haemorrhage in solid and sub-solid nodules were 8.9% (17/192) and 29.7% (44/182), respectively, showing a statistically significant difference (p<0.001). There is increased risk of haemorrhage in CT-guided needle biopsy of sub-solid nodules compared to solid nodules. Increased emphasis should be placed on the risk of pulmonary haemorrhage when consenting these patients.

Comparison between percutaneous transthoracic co-axial needle CT-guided biopsy and transbronchial lung biopsy for the diagnosis of persistent pulmonary consolidation

BackgroundDiagnosing persistent pulmonary consolidation still faces challenges. The purpose of this study is to compare the diagnostic yield and the complication rate between percutaneous transthoracic CT-guided coaxial needle biopsy (PTCNB) and transbronchial lung biopsy (TBLB) of persistent pulmonary consolidation.MaterialsFrom January 1, 2016, to December 31, 2020, we have retrospectively enrolled a total of 155 consecutive patients (95 males, 60 females) with persistent pulmonary consolidation who underwent both TBLB and PTCNB. According to the standard reference, the diagnostic yield, accuracy, sensitivity and specificity of PTCNB and TBLB were assessed and compared.ResultsAccording to the standard reference, the final biopsy diagnoses of 11 cases were confirmed true malignant based on the surgical resections, the remaining were confirmed by clinical and imaging follow-up for at least 12 months. The overall diagnostic accuracy, sensitivity and specificity of PTCNB for malignant diagnosis were 91.61%, 72.34% and 100%, whereas of TBLB were 87.74%, 59.57% and 100%. The diagnostic yield of PTCNB and TBLB were 50.32% and 25.16%, respectively. For the TBLB-based negative cases, PTCNB provided a definite diagnostic yield of 37.93%. There were 45 (29.03%), 22 (14.19%) and 13 (8.39%) patients who experienced pneumothorax, intrapulmonary hemorrhage and hemoptysis, respectively, in PTCNB, while there were only 5 (3.22%) cases of mild intraprocedural bleeding occurring in TBLB.ConclusionsCT-guided co-axial needle biopsy is an effective and safe modality, associated with higher diagnostic yield and better diagnostic accuracy compared to transbronchial lung biopsy for malignancy presenting as persistent consolidation, especially as the complementary method for TBLB-based negative lung lesions.Key PointsBoth PTCNB and TBLB showed high diagnostic accuracy for malignancy.PTCNB had a higher diagnostic yield than TBLB for persistent pulmonary consolidation.PTCNB could provide a complementary diagnosis for TBLB-based negative lung consolidation.

Fatal cardiac air embolism after CT-guided percutaneous needle lung biopsy: medical complication or medical malpractice?

Computed tomography (CT)-guided percutaneous needle biopsy of the lung is a well-recognized and relatively safe diagnostic procedure for suspicious lung masses. Systemic air embolism (SAE) is a rare complication of transthoracic percutaneous lung biopsies. Herein, we present a case of an 81-year-old man who underwent CT-guided percutaneous needle biopsy of a suspicious nodule in the lower lobe of the right lung. Shortly after the procedure, the patient coughed up blood which prompted repeat CT imaging. He was found to have a massive cardiac air embolism. The patient became unresponsive and, despite resuscitation efforts, was pronounced dead. The pathophysiology, risk factors, clinical features, radiological evidence, and autopsy findings associated with SAE are discussed, which may, in light of the current literature, assist with the dilemma between assessing procedural complications and medical liability. Given the instances of SAE in the setting of long operative procedures despite careful technical execution, providing accurate and in-depth information, including procedure-related risks, even the rarest but potentially fatal ones, is recommended for informed consent to reduce medicolegal litigation issues.

Misdiagnosis of primary dumbbell chordoma of the cervical spine.

This study aimed to analyze the clinical characteristics and outcomes of patients with primary dumbbell chordoma of the cervical spine and to summarize the causes of misdiagnosis. The clinical data of patients were retrospectively collected. The diagnostic process, surgical procedures, and outcomes were analyzed, then the difference was compared between dumbbell and non-dumbbell chordomas of the cervical spine. This study included six patients with primary dumbbell chordoma (one male and five females) with a mean age of 32.2±24.5years (range: 5-61years). Five cases with no computed tomography (CT) examination before the first operation were misdiagnosed, and on magnetic resonance imaging (MRI), primary dumbbell chordoma showed the following specific features: extensive invasion of the surrounding soft tissues with an obscure boundary (≥5cm), intervertebral disc sparing, and hemorrhagic necrosis, furthermore, the CT features included atypical destructive vertebral lesions, minimal intralesional calcification, and neural foraminal enlargement. After comparison with non-dumbbell chordomas, it show statistical difference (p<0.05) in terms of calcification, foramen enlargement, FNA, misdiagnosis rate but with different recurrent rate. Primary dumbbell chordomas of the cervical spine can easily be misdiagnosed as neurogenic tumors. Preoperative CT-guided fine-needle aspiration puncture biopsy helps make an accurate diagnosis. Gross total excision with postoperative radiotherapy has been proven effective in reducing the recurrence rate.

Computed Tomography-Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its Utility.

Background Infectious spondylodiscitis is a debilitating condition and evidence-based medicine dictates confirming the diagnosis before treatment. Computed tomography-guided spinal biopsy plays a major role and hence we would like to determine its utility in current clinical practice. Purpose The purpose of this study is to determine the percentage of confirmatory positives of CT-guided spinal biopsy in patients who were clinicoradiologically diagnosed with infectious spondylitis. Material and Methods A retrospective analysis of patients who underwent CT-guided biopsy for suspected infectious spondylodiscitis from 2017 to 2021 in a tertiary medical center was done. The data were filtered and obtained from the electronic database of the institution. Results In all, 259 patients underwent CT-guided biopsy of the spine. The procedure provided confirmatory results in 149 (57.5%) biospecimens. Histopathology examination was confirmatory in 95 (36.6%) of the 241 biospecimens sent. The Mycobacteria Growth Indicator Tube (MGIT) was confirmatory in 51 (19.9%) of the 250 biospecimens sent and drug resistance was seen in 6/51 (11.7%) biospecimens. Xpert TB provided confirmatory results in 72 (27.8%) of the 254 biospecimens sent and rifampicin resistance was seen in 16/72 (22.2%) biospecimens. Bacterial culture was confirmatory in 29 (11.2%) of the 250 biospecimens sent. The complication documented in this study was 0.3%. Conclusion CT-guided spinal biopsy for suspected vertebral osteomyelitis is a safe and effective minimally invasive procedure. It demonstrates a positive yield in more than half of the patients. Knowing the outcome, the patients can be appropriately counseled prior to the procedure. CT-guided biopsy results were affected by prior administration of ATT (antitubercular therapy) in suspected tuberculous spondylitis patients.

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

E024 Optic neuritis with neuropsychiatric lupus: a rheumatological emergency

Abstract Background/Aims Optic neuritis (ON) is uncommon rheumatological emergency with prevalence of around 0.6-1% in SLE although neuropsychiatric manifestations are found in 20-40%. The mechanism can be vasculitic or inflammatory or vaso-occlusive, etc. Methods A 24-year-old female with history of systemic lupus erythematosus for four years presented with headache, typical skin rash, alopecia, frothy urine, and pedal oedema from 2-3 months. The patient attendant also complained of mood changes, increased irrelevant talking, and different behaviour. On second day of admission, she complained blurring of vision. Ophthalmological examination revealed blurred disc margins with bilateral papilledema, 6/6 vision in both eyes, and negative Schirmer's test. MRI of brain with orbit showed distension and hyperintensities of both optic nerves on T2W images s/o optic neuritis and small areas of blooming in right parietal lobes, left insula, and thalamus on T2W images and isointense on T1w images and chronic white matter changes. Then, right vision dropped to 6/36 and left to 6/24. 24-hour urinary protein was 2040 mg/day and CT-guided renal biopsy showed coexisting lesions of membranous lupus nephritis: ISN/RPS Class V and focal lupus nephritis: ISN/RPS Class III with a modified NIH disease activity index of 6/24 and chronicity 1/12. ANA (IFA) Reflex to ENA Profile showed nuclear, speckled 3+ ANA with primary titre of 1:100 and end titre of 1:1000, strongly-positive U1RNP, and Sm. Hemoglobin 6.5 gm%, TLC 3700 cells/cumm, Platelets: 1.35 lakhs/cumm, ESR 84 mm/hr, CRP 0.1 mg/L, Serum Ferritin 626 ng/ml. Urine complete, chest-X Ray, liver and thyroid function tests were within normal limits, and viral markers, urine, blood culture, cANCA, and pANCA were negative. Results She was given methylprednisolone pulse therapy for 5 days and on fifth day of pulse therapy, vision was again 6/6 in both eyes with resolving papilledema, normal colour vision and resolving ON on repeat MRI. She was then started on oral steroids and mycophenolate mofetil as induction agent along with supportive care considering presence of concomitant lupus nephritis. Cyclophosphamide shows better results in resistant or worsening ON or severe NPSLE or nephritis. As patient was improving, young, and unmarried mycophenolate was chosen with strict close follow-up. Lin, Y.C. (2009) reviewed 8 patients of SLE-associated-ON reported between 1986 and 2004 and found three had very poor outcomes and only four achieved 20/25 and one 20/80. Even though it is not considered rare, data are scarce and requires more research. Conclusion ON is a rheumatological emergency requiring early aggressive intervention which can be life/organ saving. Suspecting and diagnosing ON in patients with neuropsychiatric lupus is challenging, We need specific guidelines and a national registry for SLE-associated-ON. Mycophenolate is a good option for neuropsychiatric lupus, SLE-associated-ON, and neuromyelitis optic spectrum disorder. Disclosure H. Singh: None. G. Mohan: None. R. Kaur: None. S.H. Jagga: None. K. Kaur: None. C. Bansal: None.

The importance of CT-guided adrenal biopsy in an oncological patient: a case report

The importance of CT-guided adrenal biopsy in an oncological patient: a case report

Pneumothorax after computed tomography-guided lung biopsy: Utility of immediate post-procedure computed tomography and one-hour delayed chest radiography.

To evaluate the utility of immediate post-procedure computed tomography (IPP-CT) and routine one-hour chest radiography (1HR-CXR) for detecting and managing pneumothorax in patients undergoing computed tomography (CT)-guided percutaneous lung biopsy. All CT-guided percutaneous lung biopsies performed between May 2014 and August 2021 at a single institution were included. Data from 275 procedures performed on 267 patients (147 men; mean age: 63.5 ± 14.1 years; range 18-91 years) who underwent routine 1HR-CXR were reviewed. Incidences of pneumothorax and procedure-related complications on IPP-CT and 1HR-CXR were recorded. Associated variables, including tract embolization methods, needle diameter/type, access site, lesion size, needle tract distance, and number of biopsy samples obtained were analyzed and compared between groups with and without pneumothorax. Post-procedure complications included pneumothorax (30.9%, 85/275) and hemoptysis (0.7%, 2/275). Pneumothorax was detected on IPP-CT and 1HR-CXR in 89.4% (76/85) and 100% (85/85), respectively. A chest tube was placed in 4% (11/275) of the cases. In 3.3% (9/275) of the cases, delayed pneumothorax was detected only on 1HR-CXR, but no patient in this group necessitated chest tube placement. The incidence of pneumothorax was not significantly different between tract embolization methods (p = 0.36), needle diameters (p = 0.36) and types (p = 0.33), access sites (p = 0.07), and lesion sizes (p = 0.88). On logistic regression, a lower biopsy sample number (OR = 0.49) was a protective factor, but a longer needle tract distance (OR = 1.16) was a significant risk factor for pneumothorax. Following CT-guided percutaneous lung biopsy, pneumothorax detected on IPP-CT strongly indicates persistent pneumothorax on 1HR-CXR and possible chest tube placement. If no pneumothorax is identified on IPP-CT, follow-up 1HR-CXR may be required only for those who develop symptoms of pneumothorax.

Contrast-Enhanced Cone-Beam Breast CT-Guided Biopsies in Breast Phantoms: Accuracy, Rate of Diagnostic Success, and Total Intervention Time

Contrast-Enhanced Cone-Beam Breast CT-Guided Biopsies in Breast Phantoms: Accuracy, Rate of Diagnostic Success, and Total Intervention Time

Utility of clinicoradiological, microbiological, histopathological, and molecular methods in the diagnosis of spinal tuberculosis.

The diagnosis of STB is mainly based on clinicoradiological observations substantiated by bacterial culture, staining, Gene Xpert, and histopathology. The purpose of the study was to correlate these methods to evaluate the effectiveness in the diagnosis of STB. A total of 178 clinicoradiologically suspected cases of STB were included in the study. The specimens for diagnostic workup were collected either during surgery or by CT-guided biopsy. All these specimens were tested for tuberculosis through ZN staining, solid culture, histopathology, and PCR. The sensitivity, specificity, PPV, and NPV of each test were calculated using histopathology as a gold standard. Out of the 178 cases, a total of 15 cases were excluded from this study. Among the remaining 163 cases, TB was diagnosed in 143 [87.73%] on histopathology, 130 [79.75%] on Gene Xpert, 40 [24.53%] on culture, and 23 [14.11%] on ZN stain. The sensitivity, specificity, PPV, and NPV of Gene Xpert were 86.71, 70, 95.38, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of AFB culture were 27.97, 100, 100, and 16.26%, respectively. The sensitivity, specificity, PPV, and NPV of AFB stain were 16.08, 100, 100, and 14.29%, respectively. Gene Xpert showed a moderate agreement [Ƙc = 0.4432] with histopathology. No single diagnostic modality can ascertain the diagnosis, and it is desirable to have a combination of diagnostic batteries for better results. A combination of Gene Xpert and histopathology aids in early and reliable diagnosis of STB.

25 - Improving patient selection and referral for CT-guided lung biopsy at a tertiary referral centre

25 - Improving patient selection and referral for CT-guided lung biopsy at a tertiary referral centre

Fibrin-associated large B-cell lymphoma around vascular prosthesis mimicking recurrent abdominal aortic aneurysm

Fibrin-associated large B-cell lymphoma around vascular prosthesis mimicking recurrent abdominal aortic aneurysm