CT-guided Percutaneous Core Biopsy Research Articles

Intravenous Opioid Medication with Piritramide Reduces the Risk of Pneumothorax During CT-Guided Percutaneous Core Biopsy of the Lung

PurposeCT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax.Materials and MethodsOne hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis.ResultsThe overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate.ConclusionProcedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung.Level of Evidence 4small study cohort.Graphic

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 <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.

PET/CT-guided versus CT-guided percutaneous core biopsies in the diagnosis of bone tumors and tumor-like lesions: which is the better choice?

ObjectiveThe present study aimed to evaluate the diagnostic performance and safety of PET/CT-guided percutaneous core bone biopsy and to compare the PET/CT-guided method to conventional CT-guided percutaneous core biopsies to diagnose Chinese patients with bone tumors and tumor-like lesions.MethodsData for 97 patients with bone tumors and tumor-like lesions diagnosed by percutaneous core bone biopsy from February 2013 to November 2018 were retrospectively analyzed. The study included 42 cases in the PET/CT group and 55 cases in the CT alone group. The diagnostic performance, cost and complications associated with the intervention were compared between the two groups. All patients were eventually confirmed to have bone tumors and tumor-like lesions according to surgical pathology findings.ResultsThere were no significant differences in patient characteristics (P > 0.05). For the patients in the PET/CT group, the overall diagnostic yield of the initial biopsies and the diagnostic accuracy derived from the surgically proven cases were both 97.62%, which was significantly higher than the values in the CT group during the same period (P < 0.05). No major biopsy-related complications (e.g., serious bleeding or tumor dissemination) occurred before, during, or after the intervention. Therefore, no significant difference was observed between the two groups with regard to the complication rate (P > 0.05).ConclusionCompared with CT-guided percutaneous bone biopsy, PET/CT-guided percutaneous bone biopsy is an effective and safe alternative with high diagnostic performance in the evaluation of hypermetabolic bone lesions to diagnose bone tumors and tumor-like lesions.

Chest wall implantation of lung cancer following percutaneous transthoracic biopsy

A 75-year-old man had an incidental finding of a 1.7 cm spiculated lung nodule over the left lower lobe on thoracic CT scan (figure 1). He underwent CT-guided percutaneous thoracic...

CT-guided percutaneous core biopsy for assessment of morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer.

Increased fludeoxyglucose(FDG) uptake in morphologically normal adrenal glands on positron emission tomography-CT (PET-CT) is a diagnostic challenge with major implications on treatment. The purpose of this retrospective study was to report our experience of CT-guided percutaneous core biopsy of morphologically normal adrenal glands showing increased FDG uptake in a context of lung cancer. Biopsies for non-enlarged adrenal glands showing increased FDG uptake in lung cancer patients performed at our institution from December 2014 to December 2016 were retrospectively analyzed. Six biopsies were performed in five patients during the study period. All procedures were performed with the patients in the prone position, using a posterior approach and coaxial 17-gauge needles with 18-gauge automated cutting needles. Patient characteristics, procedural details and final pathological diagnosis were analyzed, as well as the duration of hospitalization. Five of the six biopsies (83.3%) confirmed adrenal metastasis from the primary lung cancer. No complications were reported and the patients were discharged the day after the procedure. The high confirmation rate of metastasis and lack of complications support performing CT-guided percutaneous biopsy of non-enlarged adrenal glands showing increased FDG uptake, for optimal management in lung cancer patients. Morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer are metastasis. This manuscript shows that CT-guided percutaneous biopsy should be proposed. Increased FDG uptake in morphologically normal adrenal glands may indicate metastasis.

Bilateral benign renal oncocytomas and the role of renal biopsy: single institution review

BackgroundThe goal was to assess the natural history and management of patients with pathologically proven bilateral (synchronous) RO after undergoing initial partial nephrectomy (PN).MethodsAll patients underwent either robotic/laparoscopic or open PN by two experienced genitourinary oncologists from 2005–2013. Final pathology was determined by surgical excision, CT-guided percutaneous core biopsy (CT-biopsy) or fine needle aspiration (FNA). Patient demographics, tumor characteristics (pathologic data, location, size) type of surgery, pre/post estimated glomerular filtration rate (eGFR) and surgical complications were recorded.ResultsTwelve patients were identified with bilateral RO. Median age at the time of surgery was 68 years (46–77) (Table 1). The median size of the largest tumor(s) resected was 2.75 cm (1.5–5.5 cm) and second largest tumor(s) was 1.75 cm (1.0–4.0 cm). Four patients underwent bilateral staged PN and one patient underwent simultaneous bilateral PN (horseshoe kidney). Two patients underwent RFA at the time of biopsy of the contralateral mass after PN. Five patients underwent CT-bx/FNA (5/5) of the contralateral mass followed by active surveillance.Mean follow up was 34 months. There was no significant change in median creatinine pre- and post-operatively. One patient was lost to follow up and one patient died of unknown causes 5 years post-operatively. eGFR decreased an average of 16.96% post-operatively, including a single patient whose eGFR increased by 7.8% after surgery and a single patient whose eGFR did not change (Table 2).ConclusionsPatients with bilateral renal masses and pathologically proven RO can be safely managed with active surveillance after biopsy confirmation of the contralateral mass.

Pulmonary capillary hemangioma diagnosed by needle core biopsy: Case report and review of the literature

Pulmonary hemangiomas are extremely rare. Here we report a case of a 42year old healthy woman with an incidental nodule identified by computed tomography (CT). In consideration of her smoking history and the appearance of irregular borders of the nodule on CT imaging, despite lack of change after a 9-month follow-up, a CT-guided percutaneous needle core biopsy was performed to rule out lung cancer. A diagnosis of solitary pulmonary capillary hemangioma was made histopathologically. The feasibility of using needle core biopsy to diagnose pulmonary hemangiomas is discussed with the clinical, radiologic and pathological features of this case and a review of literature.

PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

Purpose18F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of 18F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer.MethodsPET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and 18F-FDG-avid bone lesions after whole-body 18F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated.ResultsA total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin’s lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min.ConclusionPET/CT-guided percutaneous biopsy of 18F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer.

Percutaneous CT guided lung biopsy in patients with pulmonary hypertension: Assessment of complications

PurposeTo assess the complications of CT-guided percutaneous transthoracic needle aspiration and/or core biopsy (PTNAB) of lung nodules in patients with pulmonary arterial hypertension (PHTN). Method and materialsWe analyzed PTNAB of 74 lung lesions (mean size: 3.6±2.1 cm) in 74 patients (M: F 38:36; age 68±15 years) with documented PHTN on cardiac ultrasound. 39 patients with lung lesions (M: F 24:15; age 65±14) who underwent PTNAB in the same period with right ventricle systolic pressure (RVSP) <35mmHg were selected as controls. Pulmonary arterial pressures were estimated on cardiac ultrasounds by using the tricuspid regurgitation jet method. Two thoracic radiologists reviewed the medical records and PTNAB images on a PACS station and documented nodule size, location, distance traversed in lung, technical success and complications. ResultsFine needle aspirates were obtained in all and core biopsy in 23% (17/74) of the nodules. 61% (45/74) of the nodules were in the middle and 39% (29/74) were in the outer third of lung. PHTN was mild, moderate and severe in 84% (62/74), 13% (10/74) and 3% (2/74) of the patients. Biopsy was complicated by hemorrhage in 26% (19/74), moderate hemoptysis in 1.3% (1/74), pneumothorax in 17% (12/74), chest tube in 1.3% (1/74) and hemothorax in 1.3% (1/74) of the patients. The complications rate in control group was similar, hemorrhage in 33% (19/39) (p=0.6), moderate hemoptysis in 5% (2/39) (p=0.3), pneumothorax in 28% (11/39) (p=0.2), chest tube in (0/39) (p=0.3), and hemothorax in 3% (1/39) of the patients (p=0.7). ConclusionPercutaneous needle biopsy of lung lesions in patients with mild to moderate PHTN can be performed without significant increase in complications.

Efficacy of an opposite position aspiration on resolution of pneumothorax following CT-guided lung biopsy.

To evaluate the efficacy of aspiration in an opposite position to deal with pneumothorax after CT-guided lung biopsy. A retrospective study was developed involving 210 patients with pneumothorax who had undergone CT-guided percutaneous core biopsies from January 2012 to March 2014 for various pulmonary lesions. Asymptomatic patients with minimal pneumothorax were treated conservatively. Simple manual aspiration was performed for symptomatic patients with minimal pneumothorax and for all patients with moderate to large pneumothorax. An opposite position aspiration was performed when simple manual aspiration failed. The efficacy of simple manual aspiration and the opposite position aspiration was observed. Among 210 patients with pneumothorax, 128 (61.0%) asymptomatic patients with minimal pneumothorax were treated conservatively. The remaining 82 were treated with attempted simple manual aspiration. Out of these 82 patients, simple manual aspiration was successful in 58 (70.7%, 58/82) cases. The complete and partial regression rates were 17.2% (10/58) and 82.8% (48/58), respectively. In the other 24 patients (29.3%, 24/82), simple aspiration technique was ineffective. An opposite position (from prone to supine or vice versa) was applied, and a new biopsy puncture site was chosen for reaspiration. This procedure was successful in 22 patients but not in 2 patients who had to have a chest tube insertion. The complete and partial regression rates were 25.0% (6/24) and 66.7% (16/24), respectively. Applying the new method, the total effective rate of aspiration improved significantly from 70.7% (58/82) to 97.6% (80/82). The opposite position aspiration can be safe, effective and minimally invasive treatment for CT-guided lung biopsy-induced pneumothorax thus reducing the use of chest tube significantly. (1) Opposite position aspiration can elevate the success rate of aspiration significantly (from 70.7% to 97.6% in our study); (2) this procedure is a safe, effective and minimally invasive treatment for pneumothorax caused by biopsy; and (3) opposite position aspiration is a useful technique to reduce the use of chest tube, which has clinical significance.

Abstract No. 446 - Diagnostic yield of CT-guided percutaneous core biopsy of groundglass pulmonary lesions

PurposeThe purpose of the study is to determine the sensitivity, specificity and accuracy of CT-guided percutaneous core biopsy of groundglass pulmonary lesions.Materials and MethodsA retrospective review of 1873 consecutive CT-guided lung biopsies at our institution between January 1, 2008 and January 31, 2014 was performed. 77 cases (4%) of groundglass pulmonary lesion biopsy were identified and selected for further review. The average patient age was 77 years and 42% of the patients had a previous diagnosis of lung cancer. Pathologic diagnosis from the core biopsy and any subsequent surgical pathology data were recorded. The cases were also reviewed for complications including pneumothorax and hemorrhage.Results51 (66%) of the biopsied lesions were positive for malignancy, 17 (22%) demonstrated benign pathology, 6 (8%) were suspicious for malignancy, and 3 (4%) were non-diagnostic. 28 of the patients with biopsies positive for malignancy subsequently underwent surgical resection with surgical pathology concordant in all cases. There was 1 false negative biopsy, proven to be malignancy following surgical resection. The overall diagnostic yield was 96%. The sensitivity of biopsy was 96% in cases confirmed with surgical pathology. 3 patients (4%) developed pneumothorax requiring chest tube placement. All 23 patients with core biopsy positive for malignancy who did not undergo surgical resection were treated with external beam radiation therapy.ConclusionCT-guided percutaneous biopsy is high yield for ground-glass pulmonary lesions, with high diagnostic accuracy and low complication rate. PurposeThe purpose of the study is to determine the sensitivity, specificity and accuracy of CT-guided percutaneous core biopsy of groundglass pulmonary lesions. The purpose of the study is to determine the sensitivity, specificity and accuracy of CT-guided percutaneous core biopsy of groundglass pulmonary lesions. Materials and MethodsA retrospective review of 1873 consecutive CT-guided lung biopsies at our institution between January 1, 2008 and January 31, 2014 was performed. 77 cases (4%) of groundglass pulmonary lesion biopsy were identified and selected for further review. The average patient age was 77 years and 42% of the patients had a previous diagnosis of lung cancer. Pathologic diagnosis from the core biopsy and any subsequent surgical pathology data were recorded. The cases were also reviewed for complications including pneumothorax and hemorrhage. A retrospective review of 1873 consecutive CT-guided lung biopsies at our institution between January 1, 2008 and January 31, 2014 was performed. 77 cases (4%) of groundglass pulmonary lesion biopsy were identified and selected for further review. The average patient age was 77 years and 42% of the patients had a previous diagnosis of lung cancer. Pathologic diagnosis from the core biopsy and any subsequent surgical pathology data were recorded. The cases were also reviewed for complications including pneumothorax and hemorrhage. Results51 (66%) of the biopsied lesions were positive for malignancy, 17 (22%) demonstrated benign pathology, 6 (8%) were suspicious for malignancy, and 3 (4%) were non-diagnostic. 28 of the patients with biopsies positive for malignancy subsequently underwent surgical resection with surgical pathology concordant in all cases. There was 1 false negative biopsy, proven to be malignancy following surgical resection. The overall diagnostic yield was 96%. The sensitivity of biopsy was 96% in cases confirmed with surgical pathology. 3 patients (4%) developed pneumothorax requiring chest tube placement. All 23 patients with core biopsy positive for malignancy who did not undergo surgical resection were treated with external beam radiation therapy. 51 (66%) of the biopsied lesions were positive for malignancy, 17 (22%) demonstrated benign pathology, 6 (8%) were suspicious for malignancy, and 3 (4%) were non-diagnostic. 28 of the patients with biopsies positive for malignancy subsequently underwent surgical resection with surgical pathology concordant in all cases. There was 1 false negative biopsy, proven to be malignancy following surgical resection. The overall diagnostic yield was 96%. The sensitivity of biopsy was 96% in cases confirmed with surgical pathology. 3 patients (4%) developed pneumothorax requiring chest tube placement. All 23 patients with core biopsy positive for malignancy who did not undergo surgical resection were treated with external beam radiation therapy. ConclusionCT-guided percutaneous biopsy is high yield for ground-glass pulmonary lesions, with high diagnostic accuracy and low complication rate. CT-guided percutaneous biopsy is high yield for ground-glass pulmonary lesions, with high diagnostic accuracy and low complication rate.

Utilidad de la biopsia percutánea core guiada por tomografía computada (TC) en lesiones pulmonares: experiencia de 7 años

CT guided percutaneous biopsy of pulmonary lesions is a widely used technique. To evaluate the yield and complication rate of CT-guided percutaneous core biopsy of pulmonary lesions. A retrospective study of 153 consecutive lung biopsies performed in a 7-year period was undertaken. Patients and lesions characteristics were reviewed. The yield for the diagnosis of malignant and benign lesions and the complication rate were calculated. Lesion size and depth from the pleural surface were analyzed as potential predictive variables for occurrence of a false-negative diagnosis of malignancy. The final diagnosis was established by surgical biopsy of the lesion or clinical and imaging follow up. The mean age of patients was 66 ± 14 years and 55% were mole. The final diagnosis of the lesion was malignant in 139 and benign in 14 cases (prevalence of malignancy 90.8%). For the diagnosis of malignancy, the overall yield of the biopsy was 91.5%o with a sensitivity of 90.6%>. A specific diagnosis of benign lesions was obtained in 5 out of l4 biopsies (35%). We did not identify an association between the lesion size or depth and the rate of false-negative diagnosis of malignancy. The pneumothorax rate was 13.7%o (n = 21) and eight (38%) required drainage. The average lesion depth of patients that had a pneumothorax was significant greater than the cases without the complication. No major bleeding complications occurred. Percutaneous CT-guided cutting needle biopsies of pulmonary lesions have an excellent diagnostic accuracy for malignant pulmonary lesions, at a low complication rate.

Computed Tomography–Guided Percutaneous Needle Biopsy of Pulmonary Nodules: Impact of Nodule Size on Diagnostic Accuracy

Purpose This study was undertaken to compare the diagnostic accuracy and complication rate of computed tomography (CT)—guided percutaneous lung biopsies of lung nodules ≤ 1.5 cm versus > 1.5 cm in diameter. Patients and Methods A total of 139 patients (age range, 18-89 years; mean, 62.5 years) underwent CT-guided percutaneous fine-needle aspiration biopsy or 20-gauge core biopsy using an automated biopsy gun. In 37 patients, the lung nodule measured ≤ 1.5 cm (mean, 1.1 cm), and in 102 patients, the lung nodule was > 1.5 cm (mean, 2.8 cm). Diagnostic accuracy was determined by cytopathology results. Major and minor complications were documented. Results Overall diagnostic accuracy, pneumothorax rate, and thoracostomy tube insertion rates were 67.6%, 34.5%, and 5%, respectively. Of the 98 patients with malignancy, 77 patients (78.6%) had a definite diagnostic biopsy. Overall, nodules > 1.5 cm were statistically more likely to result in a diagnostic specimen (73.5%) than nodules ≤ 1.5 cm (51.4%; P = .012). Similarly, diagnostic accuracy for malignancy was higher in nodules > 1.5 cm than in those ≤ 1.5 cm (81.3% vs. 69.6%); however, this was not statistically significant. There was no correlation between nodule size and the incidence of complications. Conclusion Overall, diagnostic accuracy of CT-guided percutaneous lung biopsy of lung nodules ≤ 1.5 cm is slightly lower than that of nodules > 1.5 cm. However, the diagnostic accuracy for malignancy is high in both groups, with a low risk of complications

CT-guided percutaneous core biopsy of deep face and skull-base lesions

To evaluate the diagnostic accuracy of deep face and skull-base computed tomography (CT)-guided core biopsy. Seventeen patients underwent CT-guided percutaneous core biopsies of deep face and skull-base lesions. One biopsy was repeated due to a non-diagnostic sample so 18 biopsy procedures were evaluated. The 17 lesions were centred within the central skull base (n=2), parapharyngeal (n=3), retropharyngeal spaces (n=4), masticator (n=3), pterygopalatine fossa (n=1), and deep lobe of parotid (n=4). Subzygomatic (n=7), retromaxillary (n=9), suprazygomatic (n=1), and transparotid (n=1) needle approaches were used. The diagnostic accuracy was either assessed by a positive histological result from the operative specimen or based on treatment response and clinical follow-up. No immediate or delayed procedural complications were encountered. A histological diagnosis was obtained in 16 of the 18 biopsies (89% diagnostic yield). The pathological diagnosis was confirmed by surgical excision (5/18 biopsies) and by predicted treatment response or clinical follow-up (10/18 biopsies). Diagnosis could not be confirmed for three of the 18 biopsies. The diagnostic accuracy of core biopsy was 13 of 15 (87%) for all samples. CT-guided percutaneous deep face core biopsy is a safe technique with good diagnostic accuracy, allowing diagnosis of benign disease and classification of malignant disease.

Diagnostic Accuracy of CT-Guided Core Biopsy of Ground-Glass Opacity Pulmonary Lesions

The purpose of our study was to evaluate the accuracy of CT-guided percutaneous core biopsy of ground-glass opacity (GGO) pulmonary lesions. The study included 50 patients (24 men, 26 women; age range, 43-78 years) who had a GGO pulmonary lesion and underwent CT-guided core biopsy. Diagnostic accuracy was compared between two groups according to lesion size (< 2 cm vs > or = 2 cm) and GGO component (> 90% vs 50-90%). Each case was reviewed for complications, including pneumothorax, thoracostomy tube insertion, and hemoptysis. Malignancy was finally diagnosed in 33 patients, including three who underwent repeated biopsies, with 33 true-positive and three false-negative findings for an overall sensitivity of 92% (33/36). A benign lesion was finally diagnosed in 10 patients with one false-positive result, for a specificity of 90%. Two benign lesions without confirmative diagnosis because of loss of follow-up and five nondiagnostic samples were excluded from the calculations of sensitivity, specificity, and diagnostic accuracy. The overall diagnostic accuracy was 91%, with a positive predictive value of 97% and a negative predictive value of 75%. Sensitivity and accuracy were not significantly different between the two groups of lesion size and GGO components (p = 0.0491). Ten (18%) patients had pneumothorax, with one (2%) requiring placement of a thoracostomy tube. Mild hemoptysis occurred in seven (13%) patients. CT-guided core biopsy of GGO lesions can yield high diagnostic accuracy and acceptable complication rates approaching those of solid lesions.

CT-guided percutaneous core biopsies of pulmonary lesions. Diagnostic accuracy, complications and therapeutic impact.

To evaluate the diagnostic accuracy, complications, and therapeutic impact of CT-guided percutaneous core biopsies of pulmonary lesions. Seventy-nine patients underwent diagnostic CT-guided percutaneous core biopsies of pulmonary lesions between July 1995 and March 1999. Evaluation included corresponding clinical data, pathologic results, and therapeutic consequences. There were 29 benign and 50 malignant lesions. Percutaneous core biopsy had an overall diagnostic accuracy of 95%. For malignant lesions, core biopsy was positive in 48 patients (sensitivity 96%), and for benign lesions, in 27 (sensitivity 93%). There were no false-positive findings. Pneumothoraces were observed in 19 patients (24%) and 4 of them required a chest drain (5%). There were no hematothoraces or major bleeding complications; however, postinterventional local hemorrhages were observed in 23 patients (29%). No hemoptysis was noted. Percutaneous core biopsies of pulmonary lesions offer excellent diagnostic accuracy for both benign and malignant pulmonary lesions at a low complication rate.

CT-GUIDED PERCUTANEOUS CORE BIOPSIES OF PULMONARY LESIONS. Diagnostic accuracy, complications and therapeutic impact

To evaluate the diagnostic accuracy, complications, and therapeutic impact of CT-guided percutaneous core biopsies of pulmonary lesions. Seventy-nine patients underwent diagnostic CT-guided percutaneous core biopsies of pulmonary lesions between July 1995 and March 1999. Evaluation included corresponding clinical data, pathologic results, and therapeutic consequences. There were 29 benign and 50 malignant lesions. Percutaneous core biopsy had an overall diagnostic accuracy of 95%. For malignant lesions, core biopsy was positive in 48 patients (sensitivity 96%), and for benign lesions, in 27 (sensitivity 93%). There were no false-positive findings. Pneumothoraces were observed in 19 patients (24%) and 4 of them required a chest drain (5%). There were no hematothoraces or major bleeding complications; however, postinterventional local hemorrhages were observed in 23 patients (29%). No hemoptysis was noted. Percutaneous core biopsies of pulmonary lesions offer excellent diagnostic accuracy for both benign and malignant pulmonary lesions at a low complication rate.

Perinephric xanthogranulomatosis: CT diagnosis and confirmation by CT-guided percutaneous biopsy

Xanthogranulomatosis is an idiopathic, rare process in which lipid-laden histiocytes may deposit in various locations in the body, which if systemic is called Erdheim–Chester disease. A rare case of isolated retroperitoneal, bilateral perinephric xanthogranulomatosis is reported. The diagnosis was suspected on cross-sectional imaging and was confirmed by CT-guided percutaneous core biopsy.

CT-guided percutaneous core biopsy of the lung: Results and complications

CT-guided percutaneous core biopsy of the lung: Results and complications

CT-guided core-needle biopsy in omental pathology

To assess the accuracy and clinical usefulness of CT-guided core-needle biopsy in the diagnosis of omental pathology. We retrospectively reviewed the results of CT-guided percutaneous core biopsies in 25 patients with focal (n = 2) or diffuse (n = 23) omental pathology. These results were compared to the final diagnoses as determined by laparotomy (n = 15), laparoscopic biopsy (n = 3), endoscopic biopsy (n = 1), or by the results of percutaneous biopsy and clinical-radiological and bacteriological modalities (n = 6). The final diagnoses showed 4 patients with isolated omental pathology and 21 with widespread peritoneal involvement. The CT-guided biopsies were performed with 1.0-1.8-mm Surecut core-needles. In 16 patients, the final diagnosis was metastatic adenocarcinoma--with the primary tumor sites in the ovary (n = 3), stomach (n = 1), appendix (n = 2), and unknown (n = 10). In the remaining 9 patients, the final diagnosis was hepatocellular carcinoma, lymphoma, and mesothelioma in 1 patient each; tuberculosis in 5; and actinomycosis in 1. Sufficient histological (n = 16) or cytological (n = 8) material was obtained by CT biopsy in 24/25 (96%) cases; the specimen was insufficient for diagnosis in 1 case. In differentiating benign from malignant disease, CT-guided biopsy showed a sensitivity, specificity and accuracy of respectively 89.5%, 100% and 92%. It gave a specific diagnosis in 78.9% (15/19) of patients with malignant conditions and in 50% (3/6) of patients with benign disorders. There were no biopsy-related complications. CT-guided percutaneous core-needle biopsy of the omentum is a safe, useful and highly accurate procedure for diagnosing malignant omental pathology.