CT-guided Lung Biopsy Research Articles

Primary low-grade fibromyxoid sarcoma of the large intestine with lung metastases: A case report and review of the literature

A 70-year old man had multiple lung nodules detected on a computed tomography (CT) performed as part of the work-up for an isolated episode of hematuria of several hours' duration. A CT-guided lung biopsy disclosed a morphologically undifferentiated neoplasm, that could not be further subclassified despite an extensive immunohistochemical panel.Four years previously the patient had undergone a left hemicolectomy in another institution to resect a 4.7 cm polypoid ulcerated area in the splenic flexure. The slides from that resection were retrieved for review at our institution. There was a variably cellular, diffuse spindle cell neoplastic proliferation involving the submucosa, muscularis propria and subserosa of the large bowel, composed of elongated spindle cells, with small, inconspicuous nucleoli, arranged in intersecting fascicles. Occasional areas of the tumor showed myxoid stroma. Mitotic activity was low.Immunohistochemistry showed strong and diffuse cytoplasmic staining for MUC4 in both the large bowel and lung tumors. Molecular profiling identified a FUS-CREB3L1 fusion gene.The constellation of morphological, immunohistochemical and molecular features are of low-grade fibromyxoid sarcoma (LGFMS) of the large bowel, with metastatic fibromyxoid sarcoma to the lung.LGFMS is a malignant, often late-metastasizing tumor, with a misleadingly bland histological appearance, that typically arises in the deep soft tissues of the proximal extremities or trunk of young adults. Accurate classification, requiring morphology and ancillary tests, is required for appropriate clinical follow-up and treatment of patients.

INCIDENCE OF SMALL-BORE CHEST TUBE FAILURE IN MANAGEMENT OF IATROGENIC PNEUMOTHORAX FOLLOWING CT-GUIDED LUNG BIOPSY: A VA COHORT UNDERGOING CHEST TUBE PLACEMENT BY INTERVENTIONAL RADIOLOGY

SESSION TITLE: Interventional Pulmonary SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: Our objective was to define the incidence of our institution's rate of small bore chest tube failure in the management of iatrogenic pneumothorax following CT-guided transthoracic lung biopsy by IR. Additionally, we looked to further assess for any difference that exists in incidence rate based on chest tube size. Ultimately, this analysis would be utilized to potentially modify current practices to improve patient safety in those veterans undergoing chest tube insertion following iatrogenic pneumothorax following IR lung biopsy. METHODS: Retrospective chart review of patients from September 2013 to December 2017 who had chest tubes placed by IR for iatrogenic pneumothorax after CT-guided transthoracic lung biopsy at this VA center. 94 cases were identified using the IR's departmental procedure log. 78 cases had sufficient documentation for analysis. Chest tube failure was defined as expanding pneumothorax requiring additional tube or upsized chest tube insertion or tension pneumothorax requiring urgent intervention. The most common reason for exclusion was lack of documentation about the size of chest tube placed. RESULTS: Four cases involved placement of a 6.5 Fr catheter, 3 cases with an 8.5 Fr catheter, 46 cases with a 10 Fr catheter, 5 cases with a 12/12.5 Fr catheter, and 20 cases with a 14 Fr catheter. The overall failure rate in small bore chest tubes was 6.4% (5/78). The failure in small bore chest tubes less than 10 Fr was 28.5% (2/7) compared to 4.2% (3/71) in small bore chest tubes greater than or equal to 10 Fr (p = 0.06 using Fisher Exact test). Tension pneumothorax requiring ICU admission for emergent chest tube upsizing occurred in 3 patients. CONCLUSIONS: In this retrospective analysis of a VA cohort undergoing CT guided lung biopsy whose course was complicated by pneumothorax requiring chest tube, there was an overall incidence of chest tube failure in 6.4%. Though there was a trend in favor of small bore tubes greater than or equal to 10 Fr, there was no statistical difference in complications between various sizes of small bore chest tubes. A larger analysis would be needed to further explore any statistically significant difference in rate of complications between these groups. CLINICAL IMPLICATIONS: In this analysis, the overall rate of small bore chest tube failure in management of iatrogenic pneumothorax following CT-guided lung biopsy was low. Currently, neither this study nor other reviewed research provides compelling data to demonstrate benefit of any one specific size of small bore chest tube versus another. Until this is demonstrated in a more appropriately powered study, management of this condition will be subject to institutional variation. DISCLOSURES: No relevant relationships by Stephen Bujarski, source=Web Response No relevant relationships by Sunjay Devarajan, source=Web Response No relevant relationships by Sarah Tuthill, source=Web Response

A CASE OF RECURRENT RESPIRATORY PAPILLOMATOSIS PROGRESSING TO SQUAMOUS CELL CARCINOMA

SESSION TITLE: Lung Cancer SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Recurrent respiratory papillomatosis (RRP) is an uncommon viral disease caused by human papillomavirus (HPV) types 6 and 11. It is characterized by the proliferation of benign squamous papillomas within the aerodigestive tract. It has an unpredictable clinical course with the tendency to recur and spread throughout the gastrointestinal and respiratory tract. In some cases it can undergo malignant transformation. It usually presents with changes in voice and stridor. We present a case of RPR with malignant transformation. CASE PRESENTATION: An 80-year-old Hispanic woman presented to our pulmonary clinic complaining of progressive hoarseness and stridor over the past 3-4 months. At the moment of presentation she denied having any constitutional symptoms, sputum production or hemoptysis. She is a lifetime non-smoker without significant exposures or travel history. She had a past medical history significant for RPR. On examination she was afebrile, well appearing with normal vital signs, pulmonary, cardiac and abdominal examination. Laboratory data was unrevealing. A computed tomography (CT) of the chest showed several cavitating and non-cavitating pulmonary nodules bilaterally, as well as soft tissue nodules in the tracheal walls, which were suggestive of papillomas (figure 1). The patient underwent laryngeal and tracheal ablation and dilation (figure 2). On repeated CT scan of the chest there was an enlarged right lower lobe cavitary lesion. The patient underwent CT guided lung biopsy that showed squamous cell carcinoma, P16 positive, suggesting malignant conversion of RRP. Positron emission tomography (PET) CT showed metastatic disease involving bilateral lungs. She was started on chemotherapy with carboplatin and gemcitabine and was followed by interventional pulmonology for recurrent dilations and ablation procedures for symptom relief. DISCUSSION: Surgical treatment is the mainstay of therapy for RPR with the goal of complete removal of papillomas and preservation of normal structures while avoiding complications. Other emerging surgical techniques and adjuvant treatment modalities are being used such as the carbodioxide (CO2) laser, microdebriders and Argon Plasma Coagulation (APC). Adjuvant therapy may be needed in up to 20% of cases when patients require more than four surgical procedures per year, there is rapid regrowth of papillomata with airway compromise, or there is distal multisite spread of disease. Other therapies include Human Papilloma Virus (HPV) vaccine, interferon, ribavirin, acyclovir, cidofovir, retinoids COX 2 inhibitors, mumps vaccine, among others. CONCLUSIONS: Recurrent Respiratory Papillomatosis (RRP), it is histologically benign, but in some cases it can progress into malignant. It has unpredictable behavior and is difficult to control and has the potential of causing severe morbidity and death. Further investigation is warranted Reference #1: Derkay CS, Wiatrak B. Recurrent respiratory papillomatosis: a review. Laryngoscope 2008;118(7):1236–1247 Reference #2: Larson DA, Derkay CS. Epidemiology of recurrent respiratory papillomatosis. APMIS 2010;118(6–7):450–454. Reference #3: Bonagura VR, Hatam LJ, Rosenthal DW, et al. Recurrent respiratory papillomatosis: a complex defect in immune responsiveness to human papillomavirus-6 and -11. APMIS 2010;118(6–7):455–470 DISCLOSURES: no disclosure on file for Sixto Arias; no disclosure on file for Yoslay Perez; No relevant relationships by Rene Rico, source=Web Response

MS09.02 Cases Prepared by Drs. Edell/Murgu

Lung cancer remains the leading cause of cancer-related mortality worldwide. In order to provide adequate and appropriate treatment, staging is crucial. The TNM staging system is the established uniform method of staging lung cancer, both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). The revised classification of the most recent edition (TNM-8) of the TNM staging system, proposed by the International Association for the Study of Lung Cancer (IASLC) and introduced in 2016, is based on detailed analysis of a new large international database of almost 78000 lung cancer cases from 16 countries. The first part of this talk will focus on tissue diagnosis, specifically CT-guided core biopsy. In the era of targeted therapies and customized treatment, the acquisition of an adequate and representative sample, especially in non-surgical patients, is pivotal. Complications, pitfalls and pearls of CT-guided lung biopsies will be addressed. The second part of the talk will be focussing on the changes between TNM-7 and TNM-8 – downstaging of lung atelectasis and pneumonitis, upstaging of diaphragmatic invasion, reclassification of extra-thoracic metastatic disease; the IASLC recommends that radiologists should document the number of metastatic lesions, the diameter of individual metastatic lesions and the number of involved organs at staging examinations. The conundrum relating to nodal staging with CT and FDG-PET imaging will be explored. Lung cancer with multiple sites of pulmonary involvement – multiple primary lung cancers, lung cancer with separate tumour nodules, multiple ground glass/lepidic lesions and lung cancer manifesting as consolidation - will be discussed.

Autologous blood patch after CT-guided lung biopsy might reduce pneumothorax requiring chest tube placement

Autologous blood patch after CT-guided lung biopsy might reduce pneumothorax requiring chest tube placement

Diagnostic Yield of Computed Tomography-Guided Transthoracic Lung Biopsy in Diffuse Lung Diseases

Background: Accurate diagnosis is essential for successful management of diffuse lung disease (DLD). Histopathology may sometimes be necessary. Surgical lung biopsy, the gold standard, carries a risk of morbidity and mortality. Computed tomography (CT) guided transthoracic lung biopsy (CT-TLB) is a minimally invasive method for obtaining lung tissue. However, its diagnostic yield is unknown in DLD. Objective: To assess the diagnostic yield of CT-TLB in DLD according to the predominant high-resolution CT (HRCT) patterns. Methods: Between January 2009 and December 2016, we enrolled all consecutive adult patients with suspicion of DLD who underwent CT-guided transthoracic lung biopsy during the diagnostic work-up. All biopsies were performed by a senior interventional radiologist using CT fluoroscopy. Results: The study included 169 patients (50.3% men) with a mean (±SD) age of 58.3 ± 14 years. Consolidation was the predominant HRCT pattern. A definitive or probable diagnosis was made in 66.3%. The most frequent diagnosis was organizing pneumonia (36.2%). Diagnostic yield was higher when the predominant HRCT pattern was consolidation or nodular. The most common complication was pneumothorax (17.8%); other complications included mild hemoptysis (7.7%), hemothorax (1.2%), and death (0.59%). No acute exacerbation of the underlying condition was observed. Conclusions: CT-TLB proved to be accurate and safe for the diagnosis of DLD. The overall diagnostic yield of the procedure was 66.3%. Given its low complication rates, CT-TLB can be an option in patients whose respiratory function is seriously impaired and in those with substantial comorbidities, where more invasive procedures cannot be performed for reasons of safety.

Reinforcing the Importance and Feasibility of Implementing a Low-dose Protocol for CT-guided Biopsies

This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses. Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner. Voluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity. Implementation of a low-dose protocol for CT-guided biopsies resulted in 21% and 36% of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety.

Nursing measures and observation on complications of CT-guided percutaneous lung biopsy

目的 探讨CT引导下肺穿刺活检的并发症观察及护理对策。 方法 采用随机数字表法将接受CT引导下肺穿刺活检的患者290例分为对照组和观察组，各145例。对照组采取常规护理，观察组采取循证护理。记录分析检测结果、护理方式对并发症和患者住院情况的影响、穿刺与病灶因素对并发症的影响等。 结果 CT引导下肺穿刺活检的准确率为86.55%(251/290)，并发症率为37.59%(109/290)。对照组的并发症率为46.21%(67/145)，高于观察组的28.97%(42/145)，差异有统计学意义(χ2＝9.187，P＝0.002)。穿刺次数和深度、病灶直径以及病灶周围有无病变等因素对并发症有明显影响，差异均有统计学意义(对照组：χ2＝45.210、30.774、24.452、13.109，P＝0.000、0.000、0.000、0.000。观察组：χ2＝16.533、29.567、6.319、4.832，P＝0.000、0.000、0.042、0.028)。对照组的住院时间、护患纠纷率均明显多于观察组，但患者满意度、住院费用均低于观察组，差异均有统计学意义(均P<0.05)。 结论 CT引导下肺穿刺活检具有较高准确率，联合护理干预可降低并发症发生率。

Air embolism after CT-guided percutaneous lung biopsy.

Air embolism after CT-guided percutaneous lung biopsy.

Abstract No. 502 Increased rate of pneumothorax in underweight patient after CT-guided lung biopsy

Identify the influence of body mass index on rates of clinically significant pneumothorax after CT-guided lung nodule biopsy requiring additional management. Retrospective analysis of 98 CT-guided lung nodule biopsies was performed to evaluate for development of clinically significant pneumothorax requiring chest tube placement. The procedures were performed by two experienced interventional radiologists using standardized, outpatient protocol for CT-guided lung biopsy. The patients were categorized by body mass index (BMI) as follows = overweight. Statistical analysis was performed using Chi-square analysis, Fisher’s Exact test and linear regression analysis to determine significance. Based on the standard BMI scale, 75% of underweight patients suffered a pneumothorax requiring chest tube placement. Four out of 34 normal-weight patients and 4 out of 40 overweight patients experienced a pneumothorax. None of the twenty obese patients developed a pneumothorax. Significance was determined at a level <.05. The chi-square value was 21.011, df = 3 with a p-value of 0.0001407. The Fisher’s exact test was used to compare underweight patients to the remainder of the patient population. This also demonstrated a high-level of significance with the two-tailed p values = 0.0028. Underweight patients are at a higher risk of developing a clinically significant pneumothorax after CT-guided lung biopsy. This may be due to technical factors such as a lack of the stabilizing effect of the body habitus in heavier patients. Underweight patients may have more severe confounding disease processes such as COPD. Patient’s capacity to control respiration may also be altered in these populations adding to the complexity of the procedure and increasing the complication rate. Significant care and peri-procedural caution must be exercised in the under-weight patient. Perhaps use of pleural closure devices should be considered in high-risk patients.

Abstract No. 608 Value of performing outpatient CT-guided percutaneous lung biopsy at a large, tertiary care center after unsuccessful outside hospital biopsy attempt

To determine the value of performing outpatient CT-guided percutaneous lung biopsy (CTLB) at a large, tertiary care center after unsuccessful outside hospital biopsy attempt. Retrospective review of 402 consecutive patients undergoing outpatient CTLB at MD Anderson Cancer Center for the 120-day period ending June 15, 2017 was undertaken. The reason for biopsy was determined based upon the interventional radiology preprocedure clinic note. Demographics, procedure and imaging variables, complications, and pathology results were collected. Of the total number of patients biopsied during this period, 5% (20/402) were either denied biopsy at an outside hospital (OSH) or had an inadequate biopsy result which precluded treatment decision planning. 3 patients were denied biopsy at OSH for high risk and/or technical difficulty; 9 patients underwent repeat biopsy for prior non-diagnostic biopsy at OSH; and 8 patients underwent repeat biopsy for incomplete biopsy at OSH. The mean age was 66 years (15 – 90), 50.7% were female, and 17.2% had history of COPD. Median lesion size was 1.5 cm (0.5 – 9.4). Biopsy was performed with core in 98.0%, fine-needle aspiration (FNA) in 51.0%, and both core and FNA in 49.0% of cases. Median number of core samples was 3 (1 – 8) using a median 20-gauge (18 – 20) needle and median number of FNA samples was 3 (1 – 8) using a 22-gauge needle. Of these 20 patients, 3/20 (15.0%) developed PTX (CTCAE Grade 1) and 1/20 (5.0%) required chest tube placement for expanding PTX (CTCAE Grade 2). All 20 patients (100.0%) had a successful diagnostic biopsy based on histology and/or requested molecular testing. 20 patients underwent CTLB at MD Anderson Cancer Center after unsuccessful outside hospital biopsy attempt. The advanced experience of providers allowed for aggressive biopsy sampling with complication rates within the expected thresholds of the institution and yielded meaningful pathology outcomes based on histology and/or requested molecular testing. On an annualized basis, this represents 60 previously unserved patients that could safely receive a diagnosis, demonstrating the value of higher level care centers in the broader healthcare value chain.

3:54 PM Abstract No. 97 Sensitivity and specificity of single inspiratory and expiratory chest radiographs for detection of pneumothorax after CT-guided lung biopsy

3:54 PM Abstract No. 97 Sensitivity and specificity of single inspiratory and expiratory chest radiographs for detection of pneumothorax after CT-guided lung biopsy

Coaxial technique-promoted diagnostic accuracy of CT-guided percutaneous cutting needle biopsy for small and deep lung lesions.

Coaxial technique is extensively applied to facilitate percutaneous lung lesion biopsy. However, the impact of coaxial technique on diagnostic accuracy remains undecided. We reviewed 485 patients who underwent percutaneous CT-guided needle biopsies of lung lesions in our hospital. All of these biopsies were performed using either a cutting needle alone (n = 268) or a cutting needle combined with a coaxial needle (n = 217). The diagnostic accuracy and complications resulting from the two techniques were then compared. The diagnostic accuracies of the two techniques were comparably high, at 98.2% (with coaxial technique) and 95.9% (without coaxial technique), p = 0.24. Subgroup analysis discovered that for patients with lesions measuring < 1.5 cm and needle path length ≥ 4 cm, the coaxial technique achieved a higher diagnostic accuracy (95.5% vs. 72.7%, p = 0.023). The biopsy was well tolerated in all of the patients. Pneumothorax occurred less often in patients who were biopsied with the coaxial technique (19 versus 43, p = 0.024). Thus, the application of the coaxial technique could improve diagnostic accuracy in patients with small and deep lung lesions, and could reduce the risk of pneumothorax. The combined use of cutting needles with coaxial needles is the preferred technique for performing percutaneous CT-guided lung biopsies.

Percutaneous computed tomography-guided lung biopsies: preliminary results using an augmented reality navigation system.

"Augmented reality" is a technique to create a composite view by augmenting the real intervention field, visualized by the doctor, with additional information coming from a virtual volume generated using computed tomography (CT), magnetic resonance or ultrasound images previously acquired from the same patient. In the present study we verified the accuracy and validated the clinical use of an augmented reality navigation system produced to perform percutaneous CT-guided lung biopsies. One hundred and eighty consecutive patients with solitary parenchymal lung lesions, enrolled using a nonrandom enrollment system, underwent percutaneous CT-guided aspiration and core biopsy using a traditional technique (group C, 90 patients) and navigation system assistance (group S, 90 patients). For each patient we recorded the largest lesion diameter, procedure time, overall number of CT scans, radiation dose, and complications. The entire experimental project was evaluated and approved by the local institutional review board (ethics committee). Each procedure was concluded successfully and a pathological diagnosis was reached in 96% of cases in group S and 90% of cases in group C. Procedure time, overall number of CT scans and incident x-ray radiation dose (CTDIvol) were significantly reduced in navigation system-assisted procedures (P <0.001; z = 5.64) compared with traditional CT-guided procedures. The percentage of procedural complications was 14% in group S and 17% in group C. The augmented reality navigation system used in this study was a highly safe, technically reliable and effective support tool in percutaneous CT-guided lung biopsy, allowing to shorten the procedure time and reduce the incident x-ray radiation dose to patients and the rate of insufficient specimens. Furthermore, it has the potential to increase the number of procedures executed in the allocated time without increasing the number of complications.

Systemic air embolism after percutaneous computed tomography-guided lung biopsy due to a kink in the coaxial biopsy system: a case report

BackgroundSystemic air embolism is a rare but potentially life-threatening complication of percutaneous computed tomography (CT)-guided lung biopsy. The incidence might be underestimated because of failure to diagnose this adverse event in asymptomatic patients; early recognition is difficult.Case presentationWe report the case of a 73-year-old man with systemic air embolism, a complication of percutaneous CT-guided lung biopsy, due to a kink in the coaxial biopsy system. Serial post-procedure CT scans demonstrated the causal relationship.ConclusionsSequential post-biopsy CT scans demonstrated a causal relationship between this systemic air embolism and percutaneous biopsy, and allowed the radiologist to track the course of the emboli and their resolution. Awareness of air entry via the introducer needle and an early post-biopsy CT scan are crucial for early detection of systemic air embolism. If air embolism occurs in an asymptomatic patient, we recommend performing a delayed chest CT scan to follow the air’s course.

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis.

BackgroundAdvances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis.We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs.MethodsA systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter.ResultsFrom 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69–80) using the BR approach and 93% (95% CI, 90–96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88–95) was superior to the BR approach (66%, 95% CI: 55–76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75–85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach.ConclusionsCT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.

Clinical application of planar puncture template-assisted computed tomography-guided percutaneous biopsy for small pulmonary nodules.

The aims of this study were to evaluate the clinical application of planar puncture template (PPT) in computed tomography (CT)-guided percutaneous needle lung biopsy. A total of 56 patients with small pulmonary nodules who received CT-guided percutaneous lung biopsy assisted by PPT were included in the study. Five steps were included in the study: fixing position, CT scanning and designing needle pathway, installing navigation system and template, puncturing fixation needle, and performing biopsy needle insertion and biopsy. The success rate of puncture, pathological results, and complications were analyzed. In addition, the factors that influenced the success rate and complications were analyzed. Biopsy was successfully completed in all 56 patients. The nodule diameter was 0.45-3 cm. The fixation needle technique was applied in 47 cases. Biopsy was performed 1 time in 50% of patients and 2 times in 38% of patients. For pathology, only one case showed no positive result, with a puncture success rate of 98%. The diagnostic rate of malignant tumor was 73%. For complications, the incidence of needle tract bleeding was 68%, the incidence of pneumothorax was 30%, and the thoracic drainage was required in two patients. Hemoptysis was observed in two cases. Univariate analysis: The nodule size was related to both the rate of 1-time biopsy and incidence of complications. Smaller nodule was relevant to lower rate of 1-time biopsy (P = 0.01) and higher incidence of complications (P < 0.05). The fixation needle was related to 1-time biopsy rate. The 1-time biopsy rate was significantly higher in patients with fixation needle than those without fixation needle (P = 0.001). Meanwhile, no significant difference was observed in the incidence of complications in different number of fixation needles (P > 0.05). PPT-assisted lung biopsy technology can provide high success rate and low complication incidence. It would be helpful to make the puncture procedures more standard for better clinical applications.

50 - Role of CT guided lung biopsy in solitary pulmonary nodules with a moderate to high risk of malignancy

50 - Role of CT guided lung biopsy in solitary pulmonary nodules with a moderate to high risk of malignancy

Comparison of diagnostic yield and safety profile of radial endobronchial ultrasound-guided bronchoscopic lung biopsy with computed tomography-guided percutaneous needle biopsy in evaluation of peripheral pulmonary lesions: A randomized controlled trial.

Background:Peripheral pulmonary lesions (PPLs) pose a diagnostic challenge, and the optimal investigation in many such cases remains unclear. Computed tomography (CT)-guided percutaneous needle biopsy (CT-PNB) has been the modality of choice for such lesions with a high diagnostic accuracy but with high rates of pneumothorax. Endobronchial ultrasound (EBUS) with a radial probe is an alternate diagnostic modality with increased diagnostic yield of bronchoscopy in the evaluation of PPL. We conducted a randomized controlled trial comparing the diagnostic accuracy and complication rates of radial EBUS with CT-guided lung biopsy for the evaluation of PPL.Methods:Fifty patients with PPL surrounded by lung parenchyma on all sides were randomly assigned to either radial EBUS or CT-PNB group (25 each).Results:Both groups had similar clinicoradiologic characteristics. The diagnostic accuracy of radial EBUS was comparable to CT-PNB with no statistically significant difference (72 vs. 84%; P = 0.306). However, the yield was significantly lower in right upper lobe lesions (20% vs. 83.3%; P = 0.03). CT-PNB group had significantly higher pneumothorax rates than radial EBUS (20% vs. 0%; P = 0.03). The lesions that were more than 2 cm, those with ultrasound feature of continuous hyperechoic margin around the lesion (P = 0.007), and the position of the ultrasound probe within the lesion (P < 0.001) were associated with a higher diagnostic yield with radial EBUS.Conclusion:Our findings suggest that radial EBUS is a safer investigation than CT-PNB with a comparable diagnostic accuracy for PPL not abutting the chest wall (CTRI/2017/02/007762).

Percutaneous low-dose CT-guided lung biopsy with an augmented reality navigation system: validation of the technique on 496 suspected lesions

PurposeTo validate a CT-navigation system during percutaneous lung biopsy (PLB). MethodsFour hundred-ninety-six patients underwent low-dose CT-guided PLB. Lesion diameter (LD), procedural time (PT), histologic validity, lesion distance from pleural surface (DPS), needle distance travelled during procedure (DTP), complications and radiation exposure were recorded. ResultsHysto-patological diagnosis was obtained in 96.2% cases. Mean PT, DPS, DTP, LD were respectively 29.5min, 12.4mm, 17.9mm, 20.7mm. In cases of major complications (4.6%), higher values of DTP were measured. ConclusionsCT-navigation system allowed a good success in terms of diagnosis in small lesions and when a long DTP is required.