CT-guided Fine-needle Aspiration Biopsy Research Articles

Assessing the impact of nodule features and software algorithm on pulmonary nodule measurement uncertainty for nodules sized 20 mm or less.

Measurements are not exact, so that if a measurement is repeated, one would get a different value each time. The spread of these values is the measurement uncertainty. Understanding measurement uncertainty of pulmonary nodules is important for proper interpretation of size and growth measurements. Larger amounts of measurement uncertainty may require longer follow-up intervals to be confident that any observed growth is due to actual growth rather than measurement uncertainty. We examined the influence of nodule features and software algorithm on measurement uncertainty of small, solid pulmonary nodules. Volumes of 107 nodules were measured on 4-6 repeated computed tomography (CT) scans (Siemens Somatom AS, 100 kVp, 120 mA, 1.0 mm slice thickness reconstruction) prospectively obtained during CT-guided fine needle aspiration biopsy between 2015-2021 at Department of Diagnostic, Molecular, and Interventional Radiology in Icahn School of Medicine at Mount Sinai, using two different automated volumetric algorithms. For each, the coefficient of variation (standard deviation divided by the mean) of nodule volume measurements was determined. The following features were considered: diameter, location, vessel and pleural attachments, nodule surface area, and extent of the nodule in the three acquisition dimensions of the scanner. Median volume of 107 nodules was 515.23 and 535.53 mm3 for algorithm #1 and #2, respectively with excellent agreement (intraclass correlation coefficient =0.98). Median coefficient of variation of nodule volume was low for the two algorithms, but significantly different (4.6% vs. 8.7%, P<0.001). Both algorithms had a trend of decreasing coefficient of variation of nodule volume with increasing nodule diameter, though only significant for algorithm #2. Coefficient of variation of nodule volume was significantly associated with nodule volume (P=0.02), attachment to blood vessels (P=0.02), and nodule surface area (P=0.001) for algorithm #2 using a multiple linear regression model. Correlation between the coefficient of variation (CoV) of nodule volume and the CoV of the x, y, z measurements for algorithm #1 were 0.29 (P=0.0021), 0.25 (P=0.009), and 0.80 (P<0.001) respectively, and for algorithm #2, 0.46 (P<0.001), 0.52 (P<0.001), and 0.58 (P<0.001), respectively. Even in the best-case scenario represented in this study, using the same measurement algorithm, scanner, and scanning protocol, considerable measurement uncertainty exists in nodule volume measurement for nodules sized 20 mm or less. We found that measurement uncertainty was affected by interactions between nodule volume, algorithm, and shape complexity.

Generalized lymphatic anomaly in adult patients: An eminently radiological diagnosis

Generalized lymphatic anomaly (GLA) is an uncommon congenital disease secondary to the proliferation of lymphatic vessels in any organ except the central nervous system. GLA has a wide spectrum of clinical and radiological presentations, among which osteolytic lesions are the most widespread, being the ribs the most commonly affected bone. GLA is diagnosed mainly in children and young adults; nevertheless, on rare occasions it can remain asymptomatic and be detected incidentally in older patients. We present an unusual case of GLA in an asymptomatic 54-year-old man who had atypically distributed, purely cystic bone lesions on CT; measuring the Hounsfield (HU) of these lesions enabled us to suspect GLA. This suspicion was confirmed with MRI, PET/CT, CT-guided fine-needle aspiration biopsy, and fluoroscopy-guided percutaneous vertebral biopsy. After surgical resection of one of the lesions, histologic study provided the definitive diagnosis.

Anomalía linfática generalizada en un paciente adulto, un diagnóstico eminentemente radiológico

Generalized lymphatic anomaly (GLA) is an uncommon congenital disease secondary to the proliferation of lymphatic vessels in any organ except the central nervous system. GLA has a wide spectrum of clinical and radiological presentations, among which osteolytic lesions are the most widespread, being the ribs the most commonly affected bone. GLA is diagnosed mainly in children and young adults; nevertheless, on rare occasions it can remain asymptomatic and be detected incidentally in older patients. We present an unusual case of GLA in an asymptomatic 54-year-old man who had atypically distributed, purely cystic bone lesions on CT; measuring the Hounsfield (HU) of these lesions enabled us to suspect GLA. This suspicion was confirmed with MRI, PET/CT, CT-guided fine-needle aspiration biopsy, and fluoroscopy-guided percutaneous vertebral biopsy. After surgical resection of one of the lesions, histologic study provided the definitive diagnosis.

Efficacy and safety of CT-guided percutaneous fine needle aspiration and biopsy for malignant pulmonary lesions

Background: CT-guided percutaneous transthoracic fine needle aspiration (FNA) and core biopsy (CB) are commonly used to characterise lung lesions. There is conflicting information on which method is superior and wide variation in reported complication rates. Our objectives were to establish the efficacy and safety of percutaneous CT-guided FNA and CB in the diagnosis of malignant lung lesions. Methods: This retrospective study included patients who underwent CT-guided percutaneous FNA and/or CB for lung parenchymal lesions at Kasturba Medical College Mangalore, from January 2013 to December 2020. Ethical clearance was obtained from the Institutional Ethics Committee. Efficacy was determined by the adequacy of samples, sensitivity, specificity and diagnostic accuracy. Safety was assessed using the incidence of complications. Results: A total of 326 patients underwent both FNA and CB, and 49 underwent FNA alone. Adequate samples were obtained in 82.9% of FNA cases and 95.7% of CB cases. Considering biopsy as the gold standard, the sensitivity, specificity and diagnostic accuracy of FNA for malignancy were 95.19%, 80% and 91.27%, respectively. Kappa agreement between the two methods was substantial (0.767). Pneumothorax was the only complication observed, and was seen in 31 patients (8.2%), of which only one required chest tube drainage. The incidence of pneumothorax was significantly higher in patients with pre-existing lung disease such as COPD/emphysema (p value 0.000), patients with smaller lesions (p = 0.009), and deeper lesions from the pleura (p &lt;0.0001). Conclusions: FNA and CB are both safe and effective procedures. In the absence of an onsite cytopathologist, we recommend a combination of both techniques.

Comparison between computed tomography-guided core and fine needle lung biopsy: A meta-analysis.

Background:This meta-analysis was conducted to compare the safety and diagnostic performance between computed tomography (CT)-guided core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in lung nodules/masses patients.Methods:All relevant studies in the Pubmed, Embase, and Cochrane Library databases that were published as of June 2020 were identified. RevMan version 5.3 was used for all data analyses.Results:In total, 9 relevant studies were included in the present meta-analysis. These studies were all retrospective and analyzed outcomes associated with 2175 procedures, including both CT-guided CNB (n = 819) and FNAB (n = 1356) procedures. CNB was associated with significantly higher sample adequacy rates than was FNAB (95.7% vs 85.8%, OR: 0.26; P < .00001), while diagnostic accuracy rates did not differ between these groups (90.1% vs 87.6%, OR: 0.8; P = .46). In addition, no differences in rates of pneumothorax (28.6% vs 23.0%, OR: 1.15; P = .71), hemorrhage (17.3% vs 20.1%, OR: 0.91; P = .62), and chest tube insertion (5.9% vs 4.9%, OR: 1.01; P = .97) were detected between these groups. Significant heterogeneity among included studies was detected for the diagnostic accuracy (I2 = 57%) and pneumothorax (I2 = 77%) endpoints. There were no significant differences between CNB and FNAB with respect to diagnostic accuracy rates for lung nodules (P = .90). In addition, we detected no evidence of significant publication bias.Conclusions:CT-guided CNB could achieve better sample adequacy than FNAB did during the lung biopsy procedure. However, the CNB did not show any superiorities in items of diagnostic accuracy and safety.

ROLE OF NEXT GENERATION SEQUENCING WITH PERCEPTA BRUSHING IN RECLAFFYING LUNG NODULE RISK AFTER A NON-DIAGNSOTIC BRONCHOSCOPY

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: Lung cancer is most common cancer in the world and the most common cause of death from cancer in the United States. With the recent expansion of eligibility for lung cancer screening and expanded acceptance of screening, we are likely to see a growing number of patients with pulmonary nodules. Current ACCP Guidelines recommend non-surgical biopsy for nodule with a risk of malignancy between 5% and 65%, however up to 60% of lung cancer bronchoscopy results are inconclusive. Percepta Genomic Sequencing Classifier (GSC) is an RNA-seq based genomic classifier using cells from a bronchial brushing of benign mucosa to assess risk of lung cancer in a lung nodule in a patient with a history of smoking when the bronchoscopy is inconclusive. The test can reclassify risk. From a pre-bronch intermediate risk, GSC can up-classify to high risk with a 65% PPV or down-classify to low risk with a 91% NPV. We sought to identify the frequency with which Percepta GSC helps to reclassify malignancy risk in intermediate risk nodules to guide further decision-making. METHODS: This was a retrospective review of all inconclusive bronchoscopies in ever smokers with a lung nodule from January 2019 to October 2020 . All nodules were intermediate risk determined by physician-assessed risk (PAR). Right mainstem bronchial brushings for Percepta GSC had been performed in all cases, with the genomic classifier analysis initiated at the time of the non-diagnostic result. The frequency of up and down classification was analyzed. RESULTS: Out of 30 patients classified as intermediate per PAR, 13 (43.3%) patients had an Intermediate GSC result. 8 (26.6%) patients were re-classified with a High GSC result. 9 (30.0%) patients were re-classified with a Low GSC result. In total, in 17 of 30 (56.6%) of patients with a non-diagnostic bronchoscopy, the classifier provided new information to guide further decision-making. For the patients with a Low GSC result, we observed a significant reduction in additional invasive procedures compared to the pre-test management plan. It is interesting to note that out of 9 patient that got reclassified in low category, 1 patient lost to follow up. Seven patients had at least 12 months follow up on their ct chest with nodule size remaining stable. Interestingly one patient on biopsy showed granulomas with culture growing aspergillus and patient treated with voriconazole which resulted in resolution of nodule. CONCLUSIONS: Within this group of patients with a PAR of Intermediate, Percepta GSC provided additional information in the majority of cases where bronchoscopy was non-diagnostic and has helped our lung nodule work up algorithm. Down classification allowed for consideration of deferring CT-guided fine needle aspiration or surgical lung biopsy and pursuing a plan of CT surveillance, helping to avoid unnecessary procedures. Patients with Intermediate results proceeded on the standard diagnostic pathway, and patients re-classified as high risk were considered for more aggressive evaluation to avoid missing a false negative bronchoscopy result. CLINICAL IMPLICATIONS: Bronchoscopy is frequently used for evaluation of pulmonary lesions, but its sensitivity for detecting lung cancer can be limited. Use of the Percepta GSC bronchial genomic classifier can provide additional information when bronchoscopy is inconclusive, with a high NPV for a Low result and a high PPV for a High result, helping to guide decision making. DISCLOSURES: No relevant relationships by Sonya Bracone, source=Web Response No relevant relationships by Abhijit Raval, source=Web Response No relevant relationships by Ashka Raval, source=Web Response

Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat.

Simple SummaryDiagnostic imaging is of paramount importance in the diagnosis of thoracic lesions. Radiology has traditionally been considered the diagnostic procedure of choice for these diseases in addition to a correct cytological and histopathologic diagnosis. In human medicine, Computed Tomography (CT) and CT-guided biopsy are used in the presence of lesions which are not adequately diagnosed with other procedures. In the present study, thoracic lesions from 52 dogs and 10 cats of different sex, breed and size underwent both CT-guided fine-needle aspiration (FNAB) and tissue-core biopsy (TCB). In this study, 59 of 62 histopathological samples were diagnostic (95.2%). Cytology was diagnostic in 43 of 62 samples (69.4%). General accuracy for FNAB and TCB were 67.7% and 95.2%, respectively. Combining the two techniques, the overall mean accuracy for diagnosis was 98.4%. CT-guided FNAB cytology can be considered a useful and reliable technique, especially for small lesions or lesions located close to vital organs and therefore dangerous to biopsy in any other way.Diagnosis of thoracic lesions on the basis of history and physical examination is often challenging. Diagnostic imaging is therefore of paramount importance in this field. Radiology has traditionally been considered the diagnostic procedure of choice for these diseases. Nevertheless, it is often not possible to differentiate inflammatory/infectious lesions from neoplastic diseases. A correct cytological and histopathologic diagnosis is therefore needed for an accurate diagnosis and subsequent prognostic and therapeutic approach. In human medicine, Computed Tomography (CT) and CT-guided biopsy are used in the presence of lesions which are not adequately diagnosed with other procedures. In the present study, thoracic lesions from 52 dogs and 10 cats of different sex, breed and size underwent both CT-guided fine-needle aspiration (FNAB) and tissue-core biopsy (TCB). Clinical examination, hematobiochemical analysis and chest radiography were performed on all animals. In this study, 59 of 62 histopathological samples were diagnostic (95.2%). Cytology was diagnostic in 43 of 62 samples (69.4%). General sensitivity, accuracy and PPV for FNAB and TCB were 67.7%, 67.7% and 100% and 96.7%, 95.2% and 98.3%, respectively. Combining the two techniques, the overall mean accuracy for diagnosis was 98.4%. Nineteen of 62 cases showed complications (30.6%). Mild pneumothorax was seen in 16 cases, whereas mild hemorrhage occurred in three cases. No major complications were encountered. CT-guided FNAB cytology can be considered a useful and reliable technique, especially for small lesions or lesions located close to vital organs and therefore dangerous to biopsy in other way.

Clinical value of CT-guided percutaneous fine-needle aspiration biopsy for peritoneal lesions

BackgroundTo investigate the clinical value of CT-guided percutaneous fine-needle aspiration biopsy for peritoneal lesions of unknown nature.MethodsA retrospective analysis was conducted of 84 patients with peritoneal thickening for unknown reasons. There were 26 males and 58 females who underwent CT-guided percutaneous fine-needle aspiration biopsy for peritoneal lesions.ResultAmong these 84 patients, no definite pathologic diagnosis was made in 3 patients, who were lost to the follow-up. The accuracy rate of CT-guided percutaneous fine-needle aspiration biopsy was 95.1% (77/81). Sixty lesions were pathologically-diagnosed with malignancies (74.1%), including 55 with peritoneal metastases, 4 with malignant mesotheliomas, and 1 with a lymphoma. Twenty-four patients (33.8%) were diagnosed as benign lesions, including 11 with tuberculosis and 13 with inflammatory lesions. The complications of CT-guided percutaneous fine-needle aspiration biopsy included bleeding in 1 patient and ascites leakage in 2 patients.ConclusionCT-guided percutaneous fine-needle aspiration biopsy is a safe and effective method for diagnosing peritoneal lesions.

Accuracy and Adequacy of Percutaneous CT-Guided Fine Needle Aspiration Biopsy in Cavitary Pulmonary Lesions

Abstract Background: Lung cavity is not a specific radiological finding, Computed Tomography (CT)-guided lung biopsy is a reliable method of diagnosing lung lesions cytologically, Fine Needle Aspiration Biopsy (FNAB) is considered as a relatively safe procedure & accurate procedure with less complication rate. Taking in consideration the serious complication of CT guided lung biopsy and the need for obtaining adequate sample to get benefit of the recent success in targeted therapy of non-small cell lung carcinoma and lung adenocarcinoma. Aim of Study: The aim of this study is to evaluate the accuracy of CT guided fine needle biopsy in cavitary pulmo-nary lesions and to establish technical parameters to bridge the gap between diagnostic accuracy and adequacy of CT guided fine needle biopsy in cavitary pulmonary lesions. Patients and Methods: 52 patients with lung cavities were included (29 male and 23 female) with age (mean ± SD) of 56±12.4 years. Sampling of the maximal wall thickness of the lesion. Aspirated specimens were submitted on positively charged glass slides and the remainder fixed in 95% alcohol. A pathologist performed rapid an onsite preliminary diagnosis and material triage. In all 52 cases Fine Needle Aspirations (FNA) for cytology were obtained, Samples for microbiology were obtained in 10 cases. The results categorized into 4 diagnostic groups malignant, Benign specific, Benign nonspe-cific, and non diagnostic. Results: Histological examinations revealed over all sensitivity (39/41) and specificity (9/10), of CT guided FNAB for diagnosing the malignancy. In 6 cases, molecular studies were requested, positively charged glass slides and cell block paraffin-embedded tissue was used in all cases in 66.6% of the cases all requested molecular tests could be done, in 16.7% the material were sufficient for only some studies while in 16.7% there was no sufficient material for any test. In some cases Epidermal Growth Factor Receptor [EGFR], Anaplastic Lymphoma Kinase [ALK] testing were requested and successfully per-formed.Conclusion: CT-guided fine needle biopsy of cavitary lung lesions combined with rapid on site pathological evalu-ation increase the accuracy and bridge the gap between accuracy and adequacy to provide adequate tissue for molecular testing from the small size sample.

Mediastinal paraganglioma successfully resected by robot-assisted thoracoscopic surgery with en bloc chest wall resection: a case report

BackgroundRobot-assisted thoracoscopic surgery (RATS) is useful for surgery in the apical region of the chest cavity, as it narrows towards the head. Here, we describe a nonfunctional, rib-invasive paraganglioma arising in the posterior mediastinum that was successfully removed using RATS combined with chest wall resection.Case presentationA 31-year-old woman presented with a posterior mediastinal mass on chest computed tomography (CT) scan during a medical check-up 2 years prior. Positron emission tomography/computed tomography scan with F-18 fluorodeoxyglucose revealed a mass associated with standardized uptake maximum value of 2.69. With a preoperative diagnosis of neurogenic tumor by CT-guided percutaneous fine-needle aspiration biopsy, we performed robot-assisted tumor resection combined with chest wall resection. The wristed instruments of the robotic surgical system have increased range of motion and enabled the tumor resection without organ injury in the thoracic cavity. Histopathology examination revealed a non-functional paraganglioma with rib invasion.ConclusionsRATS is a useful technique, enabling safer and easier resection of a mediastinal tumor adjacent to surrounding organs.

CT-guided Core-Needle Biopsy of the Lung Is Safe and More Effective than Fine-Needle Aspiration Biopsy in Patients with Hematologic Malignancies.

To evaluate the safety and diagnostic yield of CT-guided core-needle biopsy (CNB) versus fine-needle aspiration biopsy (FNAB) of lung nodules and masses in patients with hematologic malignancies (HMs). With institutional review board approval, 166 patients were retrospectively reviewed between 2007 and 2017 who were diagnosed with leukemia, lymphoma, or myelodysplastic syndromes (with or without hematopoietic stem cell transplant) and who underwent CT-guided FNAB and/or CNB of the lung. Patient medical records, pathologic reports, and interventional biopsy reports were reviewed. In the study period, 166 patients underwent percutaneous CT-guided lung biopsy; 36% (60 of 166) of the procedures included CNB (CNB + FNAB and CNB only), whereas 64% (106 of 166) were FNAB only. In the CNB group, FNAB was also performed for 92% (55 of 60) of the patients before CNB; 13% (eight of 60) of patients in the CNB group were nondiagnostic versus 45% (48 of 106) of FNAB only (P < .0001). There was no statistically significant difference in the pulmonary complication rates, with 1.7% of CNB and 1.9% of FNAB only requiring chest tube placement (P = .7), 5% of CNB and 2.8% of FNAB only developing hemoptysis (P = .4), and 5% of CNB and 2% of FNAB only developing hemothorax (P = .3). A change in clinical management was observed in 51% of patients with diagnostic biopsies compared with 21% of patients with nondiagnostic biopsies (P = .0002). CT-guided CNB is an effective technique for performing lung biopsy in patients with HMs with higher diagnostic yield compared with FNAB, and a higher, although not a statistically significant, increased risk of bleeding complications and pneumothorax.© RSNA, 2019See also the commentary by Elicker in this issue.

CT-guided fine-needle aspiration biopsy of solitary pulmonary nodules under 15 mm in diameter: time for an afterthought?

Many studies on fine-needle aspiration biopsy (FNAB) for undetermined pulmonary nodules reported that diagnostic accuracy tended to decline, whereas complication prevalence raised as the size of nodule decreased. Reconsideration on the effectiveness of FNAB would be appropriate considering the dramatic increase in the identification of small nodules with screening programs and new demands of target therapies. The aim of this study was to verify the efficacy of FNAB in pulmonary nodules smaller than 15 mm. A retrospective, cohort study was conducted on patients with undetermined solitary pulmonary nodules (SPNs) who underwent computer tomography (CT) guided FNAB at our Institution from January 2012 to December 2014. Patients with SPNs with diameter up to 15 mm were considered; inclusion criteria comprised ASA 3, FEV1 <70% of predicted, cardiac comorbidity or previous chest surgery. FNAB diagnostic performance and clinical efficacy were calculated. Out of 225 patients referred for FNAB, 68 covered inclusion criteria. Forty-nine out of 68 smears (72%) were adequate for diagnosis. Specificity was 100% (95% CI: 77-100%), sensitivity was 100% (95% CI: 90-100%). Positive and negative predictive values were 1.0 (95% CI: 0.9-1.0) and 1.0 (95% CI: 0.77-1.0) respectively. A post-biopsy pneumothorax was detected in 27 cases (39%); the pneumothorax rate was significantly affected by the number of passages (P=0.01). The satisfactory results of our study lead to reconsidering FNAB in patients with pulmonary nodules below 15 mm in diameter, especially in order to avoid unnecessary surgery.

04:03 PM Abstract No. 410 Comparative analysis before and after the utilization of an introducer needle technique for CT-guided fine-needle aspiration biopsy of lung nodules

04:03 PM Abstract No. 410 Comparative analysis before and after the utilization of an introducer needle technique for CT-guided fine-needle aspiration biopsy of lung nodules

Diagnostic yield, adequacy and accuracy of CT-scan guided fine needle aspiration lung biopsies: An analysis from a referral centre

Background: CT-guided fine needle aspiration biopsy (FNAB) has become the primary tool for the pathologic characterisation and testing of lung masses. Evolving approaches in therapy for NSCLC require the pathologists to fully characterise lung lesions while making certain that enough tissue remains for molecular analysis.

CT-guided Lung Fine Needle Aspiration Biopsy: Analysis of Efficacy, Yield and Intricacies

AbstractAim: This study aims to evaluate various factors that affect the cytological yield while performing computed tomography (CT) guided lung fine needle aspiration biopsy and to determine the complication rate of this procedure. Materials and Methods: In this cross sectional study, we analyzed 70 patients undergoing CT-guided transthoracic lung fine-needle aspiration biopsy (FNAB). 22-gauge spinal needle was used in sixty patients and 20-gauge in ten patients. The presence and absence of an onsite cytopathologist affecting the adequacy of yield for a conclusive cytodiagnosis was compared in groups of 35 patients each. The incidence of complications such as pneumothorax, pulmonary hemorrhage was recorded. Results: Cytological yield was adequate for a conclusive cytodiagnosis in 59 cases (84.2%). Thirty-seven cases (52.8%) were malignant with adenocarcinoma (70.2%) being the most common, 22 cases (31.4%) had benign etiology. Cytological yield was adequate for a conclusive diagnosis in the group (n = 35) with an onsite cytopathologist (100%) compared with those cases without an onsite cytopathologist (68.6%) (P = 0.005). Pneumothorax was observed in 16 cases (22.8%), the incidence of pneumothorax was higher when there was an intervening parenchyma (P = 0.005). Conclusion: CT-guided transthoracic FNAB is an accurate method to rule out malignancy with a reasonable rate of complications. The presence of an onsite-cytopathologist significantly improves the adequacy of yield for a conclusive cytodiagnosis, and should be routinely employed. Pneumothorax and pulmonary hemorrhage are the most common complications as a result of FNAB. The incidence of pneumothorax is higher when there is intervening lung parenchyma.

CT-Guided Fine-Needle Aspiration Biopsy of Pulmonary Nodules 8 mm or Less Has a Higher Diagnostic Accuracy than Positron Emission Tomography–CT

PurposeTo compare diagnostic accuracy of CT-guided fine-needle aspiration biopsy (FNA-B) with positron emission tomography (PET)–CT for pulmonary nodules ≤ 8 mm. Materials and MethodsA retrospective review of all CT-guided lung FNA-Bs performed between 2011 and 2014 at a single institution was undertaken to evaluate patients who had FNA-B and PET-CT imaging of nodules of ≤ 8 mm. Patients without surgical pathology or 2-year follow-up CT scans were excluded. Of 1,896 patients, 41 patients with 43 subcentimeter pulmonary nodules met study criteria. The McNemar test was used to compare FNA-B with PET-CT results. ResultsFNA-B had a sensitivity and diagnostic accuracy of 88.9% and 81.4%, respectively. PET-CT had an overall sensitivity and diagnostic accuracy of 38.9% and 46.5%, respectively. FNA-B had a significantly higher sensitivity and diagnostic accuracy for malignant nodules compared with PET-CT (P < .001). Pneumothorax rate after FNA-B was 13.9%, and chest tube insertion rate was 0%. ConclusionsFNA-B is a safe procedure with superior sensitivity and higher diagnostic accuracy compared with PET-CT in pulmonary nodules ≤ 8mm in size.

Biopsy: CT-guided fine needle aspiration is best? radiologist perspective

Availability of computed tomography (CT) and advances in lung screening techniques allowed the identification of growing number of pulmonary nodules. The ability to differentiate between benign and malignant lesions is a challenge. Cytological or tissue sampling of suspected nodules by percutaneous guided imaging, has increasingly been placed as an effective and safe alternative. Analysed cases of fine needle aspiration biopsy (FNAB) and core biopsy performed at the Intervention Center of our institution. As well, review of literature to compare indications, limitations and complications of techniques. FNAB is often used in a number of situations. Thyroid, breast nodules, and suspicious lymph nodes are examples. Percutaneous CT-guided FNAB is widely accepted as an accurate and safe procedure for pulmonary nodules. Core biopsy has gained space, with higher accuracy, low false negative indices, high positivity and similar complication. Interventionist practice is the first option in the diagnostic approach of suspected pulmonary nodules. Both strategies have a minimal morbi-mortality rate if compared to conventional surgical biopsy.

Salivary duct carcinoma treated with cetuximab-based targeted therapy: A case report.

Salivary duct carcinoma is a highly aggressive disease with a poor prognosis. Surgical resection is currently the only curative treatment, as there is no effective systemic therapy for this malignancy. Recently, trastuzumab has been shown to exhibit therapeutic efficacy in the treatment of salivary duct carcinoma; similarly, molecularly targeted agents, such as cetuximab, are expected to be useful for salivary duct carcinoma treatment. We herein describe the case of a 56-year-old man diagnosed with salivary duct carcinoma in the left submandibular region, with ipsilateral multiple metastases to the neck lymph nodes. Radical resection of the tumor and submandibular gland with neck dissection were performed. One month after radical surgery, computed tomography (CT) scans indicated metastasis in the lower lobe of the left lung. CT-guided transthoracic fine-needle aspiration biopsy revealed a single metastasis and lung metastasectomy was immediately performed. The tumor cells of the primary lesion and those of the lung metastasis were immunohistochemically positive for epidermal growth factor receptor. One month later, multiple right lung metastases appeared, and the patient was treated with cisplatin/5-fluorouracil (5-FU) chemotherapy plus cetuximab, achieving a complete radiographic response. However, multiple lung metastases developed during adjuvant weekly cetuximab monotherapy. Subsequently, treatment with S-1 and weekly cetuximab was initiated, and the multiple lung metastases have been maintained as stable disease for 5 months. To the best of our knowledge, this is the first report of cetuximab use for the treatment of salivary duct carcinoma. Although cisplatin/5-FU chemotherapy plus cetuximab was efficacious in treating the lung metastasis, cetuximab monotherapy was insufficient for controlling tumor growth.

67P - CT-guided fine-needle aspiration biopsy of pulmonary lesions under 15 mm of diameter: Results on 68 consecutive patients

Background: Most reports on lung fine needle aspiration cytology (FNAC) demonstrate that the diagnostic accuracy tends to decrease with the size of the lesions, and that the frequency of complications increases as the size of lesions decreases. The aim of this prospective study was to describe the accuracy and incidence of complications related to FNAC of solitary pulmonary nodules (SPNs) of 15 mm or less in diameter. Moreover, we evaluated how this procedure during the initial evaluation of patients with SPN can reduce the number of unnecessary surgery. Methods: From January 2012 to December 2014, 225 patients with an SPN between 7-15 mm in diameter were referred to our Institution. Patients with risk factors such as ASA 3, FEV1 <70% of predicted, cardiac comorbidity or previous chest surgery were enrolled. A total of 68 patients were candidate to CT guided FNAC. Results: The prevalence of malignant pathology in the whole population was 61%. Forty-nine out of 68 smears (72%) were considered adequate for diagnosis. Sensitivity was 83%, specificity was 100%. Positive and negative predictive values were 83% and 100%. Out of the total number, 16 patients (23%) avoided surgery. A post-biopsy pneumothorax was detected in 27 cases (39%). The pneumothorax rate was significantly affected by the number of passages (p = 0.01). Conclusions: In our experience the diagnostic accuracy value was high. Subjecting patients with undiagnosed pulmonary lesions to FNAC during the initial evaluation significantly reduces the number of unnecessary surgical procedures. Legal entity responsible for the study: Fondazione Ca' Granda Policlinico - Milan Funding: Fondazione Ca' Granda Policlinico - Milan Disclosure: All authors have declared no conflicts of interest.

Lung Cancer Diagnosis by Fine Needle Aspiration Is Associated With Reduction in Resection of Nonmalignant Lung Nodules

The rates of resection of nonmalignant lung nodules suspected preoperatively to be lung cancer vary widely and are reported to be as high as 40%. We determined the impact of the frequent use of computed tomography (CT)-guided fine needle aspiration (FNA) on the resection rate of nonmalignant nodules and frequency of resections of benign disease among patients undergoing evaluation for lung cancer resection operation in an academic medical center. Eligible patients underwent CT-guided FNA, surgical resection, or both during the 12-month period between July 2013 and July 2014 for known or suspected first primary resectable stage I-III lung cancer. Patient data were extracted from the electronic medical records. One hundred ninety-seven patients underwent surgical resection; among them the overall resection rate of nonmalignant lesions was 13.1% (26/197). For those with preoperative FNA, the rate was 7.9% (11/139), and for those with no biopsy, the rate was 25.9% (15/58) (p= 0.001). The sensitivity and specificity of FNA biopsy were 96% and 98%, respectively. The false-negative rate was 3.9% (5/128). The resection rate of nonmalignant nodules was significantly lower for patients with preoperative CT-guided FNA biopsy than in those without. The diagnostic accuracy of FNA in these patients at moderate to high risk for lung cancer is higher than that of positron emission tomography, with a low rate of adverse events. These findings suggest that the frequent use of preoperative diagnostic confirmation by FNA results in a low rate of nonmalignant resection.