CT-guided Lung Research Articles

The radiologist’s role in pathologic diagnosis of small lung nodules: radiographic methods of tissue acquisition

: Over the past decade, chest computed tomography (CT) utilization has steadily increased in conjunction with lung cancer CT screening. As a result, small lung nodules have become an increasingly common finding. CT-guided lung biopsy plays a pivotal role in the sampling of these small lung nodules and the subsequent diagnosis of lung cancer. The success of lung biopsies has a substantial downstream impact on diagnosis and treatment planning. It is well-recognized that the efficacy of lung biopsy is both operator-dependent and patient-dependent. Several considerations are necessary for the safe and successful performance of CT-guided lung biopsy. A familiarity with biopsy contraindications and their management can drastically reduce serious complications, such as intractable hemorrhage. Conscientious patient preparation and empathic communication are essential for reducing patient anxiety while increasing patient tolerance for the procedure and its common complications. Strategic and precise nodule-targeting techniques are crucial for obtaining adequate tissue and for improving diagnostic accuracy. On-site cytologic assessment is a powerful tool that can further boost diagnostic yield while also reducing complication rates by eliminating the need for additional biopsy attempts. Vigilant observation and careful assessment throughout the procedure are key factors in the effective mitigation of the most frequently encountered complications. As personalized medicine plays an increasingly integral part in the diagnosis and treatment of early-stage lung cancers, coordination between radiologists, clinicians, pathologists, and the patient becomes especially important.

Microwave Ablation to Cauterize a Bleed after CT-Guided Lung Biopsy

A 72-year-old man with a history of left lung squamous cell carcinoma underwent a biopsy of an enlarging 3.1 × 1.9-cm mass in the right upper lobe (Fig 1). A core biopsy resulted in severe bleeding (Fig 2), necessitating bronchoscopy that demonstrated blood emanating from the right lung. Computed tomography examination showed an active pulmonary parenchymal hemorrhage (Fig 3), ruling out endoscopic therapy. Microwave ablation was performed in an attempt to cauterize the bleed and ablate the lesion.

Impact of the COVID-19 Pandemic on ROSE Utilization and Final Diagnostic, PD-L1 Immunohistochemistry, and Molecular Testing Yields of CT-guided Lung Biopsies

Impact of the COVID-19 Pandemic on ROSE Utilization and Final Diagnostic, PD-L1 Immunohistochemistry, and Molecular Testing Yields of CT-guided Lung Biopsies

S3721 A Rare Case of Glomus Tumor of the Stomach With Metastatic Spread to the Liver and Lungs

Introduction: Glomus tumors are rare mesenchymal neoplasms arising from glomus bodies and occur mostly as benign tumors located in the subungual region of the digits. Glomus tumors of the gastrointestinal tract are rare, where there may be few or no glomus bodies, and the majority are benign, rarely demonstrating malignant behavior. We present a case of a metastatic glomus tumor of the stomach, which was initially deemed benign. Case Description/Methods: We present a 72-year-old woman who underwent excision of a gastric mass with a partial gastrectomy in 2010, suspecting a Gastrointestinal stromal tumor (GIST). However, pathology findings were consistent with glomus tumor of uncertain malignant potential given borderline tumor size (2 cm) and increased mitotic activity ( >=5/50 HPF). She was not started on chemotherapy and was on surveillance. She was asymptomatic until 2016, when she presented with acute abdominal pain. Imaging showed multiple new necrotic metastases throughout the liver with pathology consistent with metastatic glomus tumor. She underwent radioembolization of the right hepatic and left hepatic artery in 2017 and continued to be symptom-free until 2019 when she presented with another episode of abdominal pain; imaging showed an increase in the number of liver lesions and underwent radioembolization with a good response. Repeat surveillance imaging in early 2020 showed a nodule in the lingula (shown in figure 1a). A CT-guided lung biopsy confirmed the diagnosis of an epithelioid neoplasm, consistent with a metastatic glomus tumor. Caris genomic testing did not show any apparent mutations, and no clear molecular targets for treatments were present. She had low ERCC1 and TOPO1, suggesting that oxaliplatin and irinotecan may be considered for treatment in case of disease progression. Discussion: Our case highlights the importance of considering glomus tumors as part of the differentials in GI mesenchymal tumors despite GIST having the highest incidence. It is known that many GI mesenchymal tumors have visual and radiological similarities, and hence a biopsy is required. Although a majority of glomus tumors are benign, obtaining histological and immunohistochemical features is still imperative to make a definitive diagnosis to detect malignant glomus tumors with metastatic potential to visceral organs as they have a poor prognosis.Figure 1.: CT Thorax (1a) and abdomen (1b) w/contrast showing epithelioid neoplasm of the lingula and hypo-dense liver mass respectively.

Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern

This study aimed to assess the diagnostic accuracy and safety of CT-guided percutaneous core needle biopsy (PCNB) with a coaxial needle for the diagnosis of lung cancer in patients with an usual interstitial pneumonia (UIP) pattern of interstitial lung disease. This study included 70 patients with UIP and suspected to have lung cancer. CT-guided PCNB was performed using a 20-gauge coaxial cutting needle. The diagnostic accuracy, sensitivity, specificity, and percentage of nondiagnostic results for PCNB were determined in comparison with the final diagnosis. PCNB-related complications were evaluated. Additionally, the risk factors for nondiagnostic results and pneumothorax were analyzed. The overall diagnostic accuracy, sensitivity, and specificity were 85.7%, 85.5%, and 87.5%, respectively. The percentage of nondiagnostic results was 18.6% (13/70). Two or less biopsy sampling was a risk factor for nondiagnostic results (p = 0.003). The overall complication rate was 35.7% (25/70), and pneumothorax developed in 22 patients (31.4%). A long transpulmonary needle path was a risk factor for the development of pneumothorax (p = 0.007). CT-guided PCNB using a coaxial needle is an effective method with reasonable accuracy and an acceptable complication rate for the diagnosis of lung cancer, even in patients with UIP.

Supplementary benefits of CT-guided transthoracic lung aspiration biopsy for core needle biopsy.

ObjectiveThis study aimed to investigate the diagnostic efficacy of computed tomography (CT)-guided transthoracic lung core needle biopsy combined with aspiration biopsy and the clinical value of this combined routine microbial detection.Materials and methodsWe retrospectively collected the electronic medical records, CT images, pathology, and other data of 1085 patients with sequential core needle biopsy and aspiration biopsy of the same lung lesion under CT guidance in the First Affiliated Hospital of Wenzhou Medical University from January 2016 to January 2021. GenXpert MTB/RIF detection and BD BACTEC™ Mycobacterium/fungus culture were applied to identifying the microbiological results of these patients. We then compared the positive diagnostic rate, false negative rate, and diagnostic sensitivity rate of three methods including core needle biopsy alone, aspiration biopsy alone, and both core needle biopsy and aspiration biopsy.ResultsThe pathological results of cutting histopathology and aspiration of cell wax were examined for 1085 patients. The diagnostic rates of cutting and aspiration pathology were 90.1% (978/1085) and 86.3% (937/1085), respectively, with no significant difference (P > 0.05). Considering both cutting and aspiration pathologies, the diagnostic rate was significantly improved, up to 98% (1063/1085) (P < 0.001). A total of 803 malignant lesions were finally diagnosed (803/1085, 74.0%). The false negative rate by cutting pathology was 11.8% (95/803), which was significantly lower than that by aspiration biopsy [31.1% (250/803), P < 0.001]. Compared with core needle biopsy alone, the false negative rate of malignant lesions decreased to 5.6% (45/803) (P < 0.05). Next, the aspirates of the malignant lesions highly suspected of corresponding infection were cultured. The results showed that 16 cases (3.1%, 16/511) were infected with Mycobacterium tuberculosis complex, Aspergillus niger, and Acinetobacter baumannii, which required clinical treatment. 803 malignant tumors were excluded and 282 cases of benign lesions were diagnosed, including 232 cases of infectious lesions (82.3%, 232/282). The diagnostic rate of Mycobacterium/fungus culture for infectious lesions by aspiration biopsy (47.4%) was significantly higher than that by lung core needle biopsy (22.8%; P < 0.001). The diagnostic rate of aspiration biopsy combined with core needle biopsy was 56% (130/232). The parallel diagnostic rate of aspirated biopsy for GenXpert detection and Mycobacterium/fungal culture combined with core needle biopsy was 64.7% (150/232), which was significantly higher than that of lung core needle biopsy alone (P < 0.001). Finally, pulmonary tuberculosis was diagnosed in 90 cases (38.8%) of infectious lesions. Compared with the sensitivity of core needle biopsy to detect tuberculosis (27.8%, 25/90), the sensitivity of aspirating biopsy for GenXpert detection and Mycobacterium/fungal culture was significantly higher, at 70% (63/90) and 56.7% (51/90), respectively. Although there was no significant difference in the sensitivity of aspirated biopsy for GenXpert and Mycobacterium/fungal culture to detect pulmonary tuberculosis, the sensitivity was significantly increased to 83.3% (P < 0.05) when the two tests were combined. Moreover, when aspirated biopsies were combined with GenXpert detection, Mycobacterium/fungus culture, and core needle biopsy, the sensitivity was as high as 90% (81/90).ConclusionCT-guided lung aspiration biopsy has a significant supplementary effect on core needle biopsies, which is indispensable in clinical application. Additionally, the combination of aspiration biopsy and core needle biopsy can significantly improve the diagnostic rate of benign and malignant lesions. Aspiration biopsy showed that pulmonary malignant lesions are complicated with pulmonary tuberculosis, aspergillus, and other infections. Finally, the diagnostic ability of lung puncture core needle biopsy and aspiration biopsy combined with routine microbial detection under CT positioning in the diagnosis of pulmonary infectious diseases was significantly improved.

Virtual navigation bronchoscopy-guided intraoperative indocyanine green localization in simultaneous surgery for multiple pulmonary nodules.

BackgroundAccurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. Commonly used localization methods have their own advantages and disadvantages. However, clinical work has demonstrated that intraoperative indocyanine green localization under electromagnetic navigation bronchoscopy/virtual navigation bronchoscopy (VNB) is more advantageous than conventional methods for patients with multiple pulmonary nodules undergoing simultaneous surgery, especially for those undergoing bilateral lung surgery.MethodsData of patients undergoing simultaneous surgery for multiple pulmonary nodules with preoperative methylene blue localization by computed tomography (CT)‐guided percutaneous lung puncture (methylene blue group) or intraoperative indocyanine green localization under VNB (virtual navigation group) were retrospectively analyzed. Patient characteristics, pulmonary nodule features, localization time, preoperative location time, location success rate, operation time, complication incidence, visceral pleural staining rate after localization, and pulmonary nodule primary resection success rate were compared between the two groups.ResultsThe methylene blue and virtual navigation groups comprised 39 and 20 patients with 119 and 67 pulmonary nodules resected, respectively. Sex, age, number of pulmonary nodules resected simultaneously, unilateral/bilateral lung surgery, pulmonary nodule size, distance between pulmonary nodules and the visceral pleura, pulmonary nodule consolidation‐to‐tumor ratio, location of pulmonary nodules in the pulmonary lobe, postoperative pathology, visceral pleura staining rate, primary pulmonary nodule resection success rate, and surgical duration did not differ significantly between the groups (p > 0.05). The localization time of the virtual navigation group was significantly shorter than that of the methylene blue group (p < 0.05), regardless of unilateral or bilateral multiple nodules. In the methylene blue group, 25.64% (10/39) of patients presented complications, all of which were pneumothorax, whereas no complications were found in the virtual navigation group.ConclusionsFor patients with multiple pulmonary nodules undergoing simultaneous surgery, indocyanine green injection under VNB can achieve a similar effect on pulmonary nodule localization as classical methylene blue injection under CT‐guided percutaneous lung puncture, with shorter localization time and fewer complications.

EP06.01-008 COVID-Protected Pathways for Image Guided Lunc Cancer Intervention During the COVID-19 Pandemic: A Cohort Study

EP06.01-008 COVID-Protected Pathways for Image Guided Lunc Cancer Intervention During the COVID-19 Pandemic: A Cohort Study

Transtorasik Akciğer Biyopsisi: Tek Bir Merkezdeki İlk Deneyimlerin Retrospektif Değerlendirmesi

Background: To evaluate our first experience on computed tomography (CT)-guided transthoracic lung biopsy and compare our results including complication rates, etc. with the literature. Materials and Methods: Thirty-four CT-guided transthoracic biopsies in 33 consecutive patients with lung lesions using a 15 cm long 16 gauge semi-automatic (coaxial) biopsy needle were retrospectively evaluated. Age, gender, size of the lesion, location, distance to pleura, needle insertion angle, patient position, presence of emphysema and/or complications (pneumothorax and pulmonary hemorrhage), radiological findings before, during and after the biopsy,and pathological diagnosis were retrieved from patient files. The diagnostic success and failure of the method, and complication rates were noted. Results: Pneumothorax and pulmonary hemorrhage were observed in 9 and 7 patients, respectively, and 4 patients had both. Application of a chest tube was necessary in only 4 patients (4 of 9 patients wirth pneumothorax). None of the patients with pulmonary hemorrhage required additional procedures. The biopsy sample was adequate for histopathologic evaluation in 32 patients with a diagnostic accuracy rate of 96.6%. The most frequent diagnosis was squamous cell carcinoma (11/33), followed by other types of primary lung tumors in 14, breast carcinoma metastasis in 2, and B-cell lymphoma in 1 patient. Conclusions: Our rate of complication due to CT-guided transthoracic lung biopsy seems to be comparable with the literature. Pneumothorax and pulmonary hemorrhage may occur in up to one fifth/fourth but the management of these complications does not require additional procedures in the majority of patients, and the diagnostic accuracy rate is high.

Efficacy and Safety Analysis of Multislice Spiral CT-Guided Transthoracic Lung Biopsy in the Diagnosis of Pulmonary Nodules of Different Sizes

Objective. This study is aimed at investigating the efficacy and safety of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different sizes. Methods. Data of 78 patients with pulmonary nodules who underwent CT-guided transthoracic lung biopsy in our hospital from January 2020 to December 2021 were retrospectively analyzed, and they were divided into the small nodules group ( n = 12 ), medium nodules group ( n = 35 ), and large nodules group ( n = 31 ) according to the diameter of pulmonary nodules. The results of puncture biopsy and final diagnosis of pulmonary nodules of different sizes were compared. The incidence of complications in patients with pulmonary nodules of different sizes was compared. Univariate analysis was used to compare the incidence of complications in 78 patients. Logistic multiple regression analysis was used to analyze the independent risk factors of pneumothorax in patients with pulmonary nodule puncture. Logistic multiple regression analysis was used to analyze the independent risk factors of pulmonary hemorrhage in patients with pulmonary nodule puncture. Results. The diagnostic accuracy, sensitivity, and specificity were 83.33%, 100.00%, and 77.78% in small nodules group. The diagnostic accuracy, sensitivity, and specificity of medium nodules group were 85.71%, 100.00%, and 73.68%, respectively. The diagnostic accuracy, sensitivity, and specificity of large nodules group were 93.55%, 100.00%, and 33.33%, respectively. There was no significant difference in the incidence of pneumothorax among the three groups ( P &gt; 0.05 ). The incidence of pulmonary hemorrhage in small nodule group was higher than that in the medium nodule group and large nodule group, and the difference was statistically significant ( P &lt; 0.05 ). There was no significant difference in the incidence of total complications among the three groups ( P &gt; 0.05 ). There were statistically significant differences in clinical data such as the needle tract length, the puncture position, and the distance of the puncture needle passing through the lung tissue in patients with or without pneumothorax ( P &lt; 0.05 ). There were statistically significant differences in needle tract length, distance of puncture needle passing through lung tissue, and size of pulmonary nodules in patients with or without pulmonary hemorrhage ( P &gt; 0.05 ). Logistic multivariate analysis showed that needle tract length ≤ 50 mm , lateral decubitus position, and the distance of puncture needle passing through lung tissue ≥ 14 mm were independent risk factors for pneumothorax after puncture in patients with pulmonary nodules ( P &lt; 0.05 ). The needle tract length &gt; 50 mm , the distance of puncture needle passing through lung tissue ≥ 14 mm , and small nodules (pulmonary nodules diameter ≤ 10 mm ) were independent risk factors for pulmonary hemorrhage after puncture in patients with pulmonary nodules ( P &lt; 0.05 ). Conclusion. Multislice spiral CT-guided transthoracic lung biopsy is effective in diagnosing pulmonary nodules of different sizes.

Evaluation of thoracic diseases with computed tomography guided biopsy

Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology (FNAC) and fine needle aspiration biopsy (FNAB) are reliable techniques for diagnosing various thoracic diseases. These modalities are used for diagnosis in suspicious lung, pleural, mediastinal and vertebral and pulmonary lesions.The aim. We conducted a study in a Pulmonary Medicine Department of tertiary care hospital to study the efficacy and safety of CT guided FNCA/FNAB in thoracic diseases.Methods. A retrospective study was conducted at a tertiary care center with Information and Ethics committee permission within a total duration of two years. The study included patients presenting with following: 1) mediastinal mass lesions, 2) pulmonary solitary pulmonary nodules/masses, 3) pulmonary cavity, cyst and consolidation of undiagnosed etiology, 4) pleural mass, nodules, loculated collections, 5) extra-pulmonary and spinal tuberculosis suspects with pre/paravertebral abscess. Procedure details, radiological images and pathological and microbiological reports were retrieved from case record book of patients available in department.Results. Study population consisted of 108 patients. Neoplastic diseases were 85 (78.70%) and Non- neoplastic diseases 23 (21.29%). In neoplastic diseases 78.82% patients had lung Cancer of which 85.07% non small cell carcinoma and 14.92% small cell lung cancer. Out of non small cell lung cancer adenocarcinoma of lung was the commonest. The most common non neoplastic diseases was tuberculosis. CT guided biopsy procedure was performed without any complications in 61.11%. The most common complication was pneumothorax (27.77%). The yield of CT guided biopsy was 98.14%.Conclusion. Percutaneous CT-guided lung biopsy is an effective, highly accurate, and safe method of obtaining tissue for the diagnosis of indeterminate pulmonary lesions especially in neoplastic diseases and tuberculosis.

Rapid death due to pulmonary epithelioid haemangioendothelioma in several weeks: A case report

A 49-year-old woman was admitted to our hospital because of haemoptysis for 6 days. This patient claimed no medical history except high blood sugar. Chest computed tomography (CT) showed infection and multiple nodules on both sides of the lung. Blood tests showed no obvious abnormalities. Tracheoscopy showed haemorrhagic discharge in the left upper lobe and an old thrombus obstructing the lumen in the anterior basal segment of the right lower lobe. Then, CT-guided percutaneous lung biopsy was performed. The pathological results suggested multiple nodular-like lesions in the submitted tissues, and tumour cells were round or short fusiform, forming a solid nest structure, visible mitosis, and a vascular cavity-like structure containing red blood cells. Immunohistochemistry revealed positive staining for Vimentin, Bcl-2, CD31, and CD34; negative staining for CD68, SMA, CR, and D2-40; and 40% Ki67+ positivity. Based on the earlier data, the patient was diagnosed with pulmonary epithelioid haemangioendothelioma. This patient did not receive any treatment for several reasons. Unfortunately, the patient died 8 weeks after diagnosis. In conclusion, we present a case featuring the rapid death due to PEH.

Optimization of pleural multisite anesthetic technique during CT-guide microwave ablation of peripheral lung malignancy for improving treatment tolerance

Objective To assess the effect and safety of subpleural multisite anesthesia based on the area of thermal radiation during CT-guided lung malignancy microwave ablation (MWA) on the incidence of moderate or severe pain and the analgesic drug usage. Materials and methods Consecutive patients with lung malignancies were retrospectively evaluated between January 2016 and December 2019. Patients undergoing CT-guided lung malignancy MWA were either given in the method of (a) standard subpleural puncture point anesthesia between January 2016 and June 2018 and (b) subpleural multisite anesthesia based on the area of thermal radiation between July 2018 and December 2019. The relationship between local anesthesia mode and moderate or severe pain, and pain medications usage was assessed by using multivariable logistic regression models. Results A total of 243 consecutive patients were included in the study. Moderate or severe pain occurred in 84 of 124 (67.7%) patients with subpleural puncture point anesthesia and in 20 of 119 (16.8%) patients with subpleural anesthesia in the area of thermal radiation (p=.001). The intravenous pain medication was required in 56 of 124 (45.2%) patients with subpleural puncture point anesthesia and in 9 of 119 (7.6%) patients with subpleural multisite anesthesia based on the area of thermal radiation (p=.001). Local anesthesia methods (p = 0.001), pleura-to-lesion distance (p=.02) and tumor size (p=.015) were independent risk factors for developing moderate or severe pain. There were no differences in adverse events and local tumor progression rate. Conclusions Subpleural multisite anesthesia based on the area of thermal radiation for peripheral lung malignancy MWA can result in lower intraprocedural pain compared with the subpleural puncture point anesthesia. Thus, a subpleural multisite anesthesia technique may be most helpful when performing MWA of peripheral malignancy in patients who are not sedated with general or intravenous anesthesia.

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

To determine whether the injection of haemocoagulase into the biopsy tract can reduce pneumothorax and pulmonary haemorrhage after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). A retrospective study was performed involving patients with undiagnosed pulmonary lesions scheduled for PTLB between January 2020 and March 2021. Patients were assigned to the haemocoagulase group or the non-haemocoagulase group. After CT-guided biopsies were performed with a 17 G coaxial system, patients in the haemocoagulase group received a haemocoagulase injection (0.2-0.5 units) in the biopsy tract as the sheath was withdrawn. Postoperative image studies were performed to evaluate complications, including pneumothorax and pulmonary haemorrhage. Factors, including the patient's position, lesion location, and pathological results, were evaluated to determine their associations with the complications. A total of 100 patients were included, with 44 men and a mean age of 53 years old. The overall incidences of pneumothorax and pulmonary haemorrhage were 15% and 13%, respectively. The incidences of pneumothorax and pulmonary haemorrhage were statistically significantly lower in the haemocoagulase group (8% and 6%, respectively) than in the non-haemocoagulase group (22% and 20%, respectively; p=0.04 and 0.03, respectively). There was no statistically significant difference in haemoptysis between the haemocoagulase (6%) and non-haemocoagulase (2%) groups (p=0.23). There were also no statistically significant associations of pneumothorax or pulmonary haemorrhage with the patients' positions, lesion location, or pathological results. Biopsy tract haemocoagulase injection reduced the incidences of postoperative pneumothorax and pulmonary haemorrhage after PTLB.

Predictors of Invasiveness in Adenocarcinoma of Lung with Lepidic Growth Pattern.

Lung adenocarcinoma with lepidic growth pattern (LPA) is characterized by tumor cell proliferation along intact alveolar walls, and further classified as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive lepidic predominant adenocarcinoma (iLPA). Accurate diagnosis of lepidic lesions is critical for appropriate prognostication and management as five-year survival in patients with iLPA is lower than in those with AIS and MIA. We aimed to evaluate the accuracy of CT-guided core needle lung biopsy classifying LPA lesions and identify clinical and radiologic predictors of invasive disease in biopsied lesions. Thirty-four cases of adenocarcinoma with non-invasive lepidic growth pattern on core biopsy pathology that subsequently were resected between 2011 and 2018 were identified. Invasive LPA vs. non-invasive LPA (AIS or MIA) was defined based on explant pathology. Histopathology of core biopsy and resected tumor specimens was compared for concordance, and clinical, radiologic and pathologic variables were analyzed to assess for correlation with invasive disease. The majority of explanted tumors (70.6%) revealed invasive disease. Asian race (p = 0.03), history of extrathoracic malignancy (p = 0.02) and absence of smoking history (p = 0.03) were associated with invasive disease. CT-measured tumor size was not associated with invasiveness (p = 0.15). CT appearance of density (p = 0.61), shape (p = 0.78), and margin (p = 0.24) did not demonstrate a significant difference between the two subgroups. Invasiveness of tumors with lepidic growth patterns can be underestimated on transthoracic core needle biopsies. Asian race, absence of smoking, and history of extrathoracic malignancy were associated with invasive disease.

Computed tomography-guided cutting needle biopsy for lung nodules: when the biopsy-based benign results are real benign

BackgroundComputed tomography (CT)-guided cutting needle biopsy (CNB) is an effective diagnostic method for lung nodules (LNs). The false-negative rate of CT-guided lung biopsy is reported to be up to 16%. This study aimed to determine the predictors of true-negative results in LNs with CNB-based benign results.MethodsFrom January 2011 to December 2015, 96 patients with CNB-based nonspecific benign results were included in this study as the training group to detect predictors of true-negative results. From January 2016 to December 2018, an additional 57 patients were included as a validation group to test the reliability of the predictors.ResultsIn the training group, a total of 96 patients underwent CT-guided CNB for 96 LNs. The CNB-based results were true negatives for 82 LNs and false negatives for 14 LNs. The negative predictive value of the CNB-based benign results was 85.4% (82/96). Univariate and multivariate logistic regression analyses revealed that CNB-based granulomatous inflammation (P = 0.013, hazard ratio = 0.110, 95% confidential interval = 0.019–0.625) was the independent predictor of true-negative results. The area under the receiver operator characteristic (ROC) curve was 0.697 (P = 0.019). In the validation group, biopsy results for 47 patients were true negative, and 10 were false negative. When the predictor was used on the validation group, the area under the ROC curve was 0.759 (P = 0.011).ConclusionsMost of the CNB-based benign results were true negatives, and CNB-based granulomatous inflammation could be considered a predictor of true-negative results.

IDIOPATHIC PLEUROPARENCHYMAL FIBROELASTOSIS, AN UNKNOWN ENTITY: A CASE REPORT

TYPE: Late Breaking Abstract TOPIC: Lung Pathology INTRODUCTION: Idiopathic pleuroparenchymal fibroelastosis (PPFE) is rare condition characterized by fibrosis involving pleura and subpleural lung parenchyma, predominantly in the upper lobes. PPFE is specific clinical-pathological entity of idiopathic interstitial pneumonias (IIPs). CASE PRESENTATION: A 78-years-old male, former smoker, presented to our attention for worsening dyspnea, with a chest CT scan showing bilateral pleural thickening, multiple solid pulmonary nodules, most in the right upper lobe (10 mm), and bronchiectasis. In his past history occupational exposure to asbestos, COPD, chronic respiratory failure. He performed PET/CT showed multiple consolidations with 18F-FDG uptake in RUL, RLL and bilateral hilar lymph nodes. We performed a CT-guided percutaneous lung biopsy at RUL with histological report of fibroelastosis. DISCUSSION: Little is knowns about PPFE etiology, and most cases are considered idiopathic, although some cases are familiar, others have been reported in association with a previous bone marrow transplant or secondary to occupational exposure. Symptoms are similar to those of other interstitial pneumonias, but imaging and pathological findings have typical features of PPFE. The differential diagnoses include IPF, chronic hypersensitivity pneumonitis, pulmonary sarcoidosis, pneumoconiosis, connective tissue disease-related ILD, and pulmonary infections, although PPFE has also been reported in association with other ILD patterns, including IPF predominantly at lower lobes (pattern UIP). Few cases of PPFE presenting with positive uptake at PET/CT have been reported in literature. CONCLUSIONS: PPFE is still unknown entity, but it deserves to be suspected and early diagnosed since it is not very rare as previously believed and some patients has very poor outcome due to rapid clinical deterioration. DISCLOSURE: No significant relationships. KEYWORD: Fibroelastosis

MYCOBACTERIAL INFECTION MIMICKING LUNG METASTASIS

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Tuberculosis (TB) may present as multiple pulmonary nodules mimicking lung metastases. CASE PRESENTATION: A 57-year-old female presented to the hospital with generalized weakness, failure to thrive, and shortness of breath. She had lost 10 pounds in the past 10 months. She had shortness of breath for 3 weeks, associated with cough productive of white–greenish sputum. She denied any fevers, chills, recent travel. On further evaluation- CXR showed a thick-walled cavitary lesion in the right lung apex, irregular wedge-shaped opacification in the left lung apex. CT Angiography chest showed multifocal pneumonia with multiple ground glass nodular foci throughout the lungs. Multifocal pneumonia or malignancy was considered. She was empirically treated with ceftriaxone, azithromycin. Work up for pneumonia was negative. As a part of the malignancy workup, EGD and colonoscopy were unremarkable. CT-guided lung biopsy was done with the suspicion of malignancy. The pathology report showed markedly necrotic lung parenchyma with ill-defined granuloma, many acid-fast bacilli on AFB stain with no evidence of malignancy. Unfortunately, the patient was lost to follow-up and thus could not peruse further workup. DISCUSSION: Bilateral multiple pulmonary nodules are suggestive of metastases, multiple nodules with an upper lobe predominance, Pulmonary Tuberculosis, or Mycobacterium Avium Complex should be considered in the differential diagnosis. CONCLUSIONS: Many asymptomatic cases of TB are detected incidentally on chest radiography, and patients are often negative for acid-fast bacilli staining and culture despite having active TB. It is important to know the imaging findings characteristic of pulmonary TB and its variant forms. DISCLOSURE: Nothing to declare. KEYWORD: Tuberculosis

CT-guided lung biopsy: diagnostic accuracy and complication rates of biopsy techniques

Objective: We aimed to evaluate the diagnostic accuracy and complication rates of computed tomography (CT)-guided core needle biopsy and fine needle aspiration biopsy (FNAB). Materials and Methods: Patients who underwent CT-guided lung mass biopsy were included. The patients were evaluated in terms of age, gender, lesion diameter, lesion localization, depth of the mass, type of biopsy procedure (core needle biopsies and FNAB). Results: The accuracy rate of FNAB in diagnostic material was found to be 100% in terms of benign, malignant and all lesions. The specificity and sensitivity of FNAB was found to be 100%. The diagnostic accuracy rate of core needle biopsy was found to be 70% in benign lesions, 100% in malignant lesions. The specificity of core needle biopsy was 90% and sensitivity 100%. There was no statistically significant difference between the two biopsy techniques in terms of complications. Conclusion: In conclusion, we found that the diagnostic rates of FNAB and core needle biopsy were close in malignant lesions, the diagnostic rate of core needle biopsy was higher in benign lesions, and there was no difference in terms of complications in both biopsy techniques.

Abstract No. 548 Does body habitus affect the outcome of CT-guided lung biopsies?

Core biopsy is performed to on suspicious lung nodules to determine etiology and obtain tissue for molecular testing. The most common complication of core biopsy is pneumothorax. As obesity prevalence trends upwards worldwide, it is important to understand how changes in body mass index (BMI) affect outcome in patients requiring CT-guided lung biopsy.