Percutaneous Transthoracic Biopsy Research Articles

Utility of artificial intelligence for detection of pneumothorax on chest radiopgraphs done after transthoracic percutaneous transthoracic biopsy guided by computed tomography

ObjetiveTo assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. Material and methodsWe included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. ResultsA total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers’ interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. ConclusionsThe software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.

Dual-Layer Spectral CT as Innovative Imaging Guidance in Lung Biopsies: Could Color-Coded Z-Effective Images Allow More Diagnostic Samplings and Biomarkers Information?

The aim of the study was to try to obtain more information on diagnostic samplings and biomarkers using dual-layer spectral CT in lung biopsies. Lung biopsies were performed by merging images obtained with CBCT with those from spectral CT to use them as functional guidance, experimenting with double sampling to determine the difference between the area with a higher Z-effective number and that with a lower Z-effective number. Ten patients with large lung lesions on spectral CT were selected and underwent percutaneous transthoracic lung mass biopsy. Technical success was calculated. The percentage of neoplastic, inflammatory, fibrotic, necrotic cells, or non-neoplastic lung parenchyma was reported. The possibility of carrying out immunohistochemical or molecular biology investigations was analyzed. All lesions were results malignant in 10/10 samples in the Zmax areas; in the Zmin areas, malignant cells were found in 7/10 samples. Technical success was achieved in 100% of cases for Zmax sampling and in 70% for Zmin sampling (p-value: 0.2105). The biomolecular profile was detected in 9/10 (90%) cases in Zmax areas, while in 4/10 (40%) cases in Zmin areas (p-value: 0.0573). The advantage of Z-effective imaging would be to identify a region of the lesion that is highly vascularized and probably richer in neoplastic cells, thus decreasing the risk of obtaining a non-diagnostic biopsy sample.

Optimization of Lung and Mediastinal Tumor Diagnosis Using Fluoroscopic-Guided Transthoracic Puncture-Biopsy

"Introduction: Pathological confirmation of a newly identified tumor is mandatory to create an adequate treatment plan. Patients may have multiple health comorbidities, making them unsuitable for traditional invasive diagnostic procedures. The percutaneous transthoracic biopsy is a minimally invasive alternative method that can provide tissue samples to identify, diagnose, and classify lung or mediastinal tumors. Materials and methods: Data from patients who underwent fluoroscopic-guided transthoracic needle biopsy (FGTNB) in a tertiary cancer center in the Republic of Moldova from 2019 to 2021 were collected retrospectively. Results: We identified 54 patients with lung and 12 with mediastinal tumors. In the lung tumor group, the median age was 57 years; in the mediastinal tumor group, the median was 27.5 years. Most lung tumors were situated in the superior lobes (79.6%) and were found to be less than 5 cm in diameter (70.4%). Most mediastinal tumors were anteriorly located (66.7%) and were found to be more than 10 cm in diameter (58.3%). The sensitivity of transthoracic percutaneous biopsy was 79.6% in lung tumors and 83.3% in mediastinal tumors. The patients we biopsied were identified with either malignancy, infectious pathology, or pulmonary fibrosis. Transthoracic needle biopsy of the lung showed a low rate of pneumothorax (5.6%) and a low rate of bleeding (3.7%). Mediastinal tumor biopsy had a rate of pneumothorax of 16.7%, significantly higher than lung biopsy. Conclusion: Transthoracic needle biopsy performed under fluoroscopic guidance is a safe and efficient alternative diagnostic procedure for comorbid patients with lung or mediastinal tumors."

Diagnostic Accuracy and Safety Between two Needle Sizes in Percutaneous Trans-Thoracic Biopsy for the Evaluation of Pulmonary Lesions.

Percutaneous trans-thoracic lung biopsy has a crucial role in diagnosing lung lesions including lung cancer. However, there is no clear guideline regarding the needle size in percutaneous trans-thoracic lung biopsy. This study aims to evaluate the diagnostic accuracy and complication rate between two needle sizes for percutaneous trans-thoracic lung biopsy. A retrospective review of patients with lung lesions who underwent percutaneous trans-thoracic lung biopsy between November 2010 and December 2019 was performed. The demographic data, imaging finding, biopsy technique, complication and histologic outcome were recorded and analyzed. Propensity score matching was done to reduce bias in baseline characteristics. Of 377 patients who underwent percutaneous trans-thoracic lung biopsy, 331 patients had complete information. The patients were divided in two groups, comprising of 153 patients in 18G needle group and 178 patients in 20G needle group. After propensity score matching, there were 126 patients left in each group. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value for 18G needle group were 92.9%, 98.1%, 65.0%, 93.7% and 86.7%, respectively. For 20G needle group, the diagnostic accuracy, sensitivity, specificity, predictive value and negative predictive value were 96.0%, 99.0%, 83.3%, 96.2% and 95.2%, respectively. The immediate complication rate was 35.7% and 31.7% in 18G and 20 G needle groups (p= 0.505), respectively. There was no difference in diagnostic accuracy and immediate complication rates between 18G and 20G needle use for percutaneous trans-thoracic lung biopsy.

Utilidad de la inteligencia artificial para la detección de neumotórax en radiografías de tórax de control tras punción percutánea transtorácica guiada por tomografía computarizada

ObjectiveTo assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. Material and methodsWe included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. ResultsA total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers’ interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. ConclusionsThe software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritization tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.

The effectiveness of the puncture channel plugging for reduction of complications after CT-guided percutaneous transthoracic needle biopsy

The effect of plugging the puncture channel with a mixture of hemocoagulase injection on the complications of CT-guided percutaneous transthoracic need biopsy (PTNB) was discussed. The medical records of PTNB were retrospectively studied from June 2017 to May 2022. In the study, the puncture channel of 626 patients were blocked, while remain 681 patients’ were not. The Mantel Haenszel method performed layered analysis and evaluated the correlation of adjusted confounding factors. The Odds Ratio and its 95% confidence interval were calculated using the Woof method. The incidence of high-level pulmonary hemorrhage was significantly reduced in patients with lesions ≤ 2 cm and different needle lengths. Patients with different pleural-needle tip angle and perineedle emphysema were blocked, and the incidence of pneumothorax and thoracic implants was significantly reduced. Through puncture channel plugging, the incidence of pulmonary hemorrhage, pneumothorax and thoracic catheterization of PTNB under CT guidance was reduced.

Metastatic Supraclavicular Lymph Nodes among Patients with Lung Carcinoma in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Metastatic spread of lung cancer to supraclavicular lymph nodes is considered distant metastasis for treatment purposes. Detection of supraclavicular lymph node metastasis in patients with lung cancer serves for tissue diagnosis by itself and also helps avoid more invasive biopsy from the primary lung mass itself. Ultrasonography of the lower neck can detect supraclavicular lymph nodes before they are palpable and can also be used for safe sampling of these lymph nodes. The aim of this study was to find out the prevalence of metastatic supraclavicular lymph nodes among patients with lung carcinoma in a tertiary care centre. A descriptive cross-sectional study done in a tertiary care center, carried out from 15 September 2019 to 14 September 2020. Ethical approval was obtained from the Institutional Review Committee (Reference number: 84(611)E2/076/077). The study was done among 92 patients with biopsy-proven lung cancer (lung mass or supraclavicular lymph node biopsy) who were referred for evaluation, and/or percutaneous transthoracic biopsy. Convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Among 92 patients with proven lung cancer, metastatic supraclavicular lymph nodes were seen in 13 patients (14.10%) (8.17- 19.73, 90% Confidence Interval). Among 13 patients with metastatic lymph nodes, 9 (69.23%) had palpable supraclavicular lymph nodes. The majority 11 (84.61%) had round-shaped lymph nodes. All metastatic lymph nodes showed loss of echogenic fatty hilum. A total of 12 (92.30%) metastatic lymph nodes showed a peripheral disorganized pattern of vascularity. The prevalence of metastatic supraclavicular lymph nodes was lower than in similar studies done in international settings. lung cancer; malignancy; ultrasonography.

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

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

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

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

Cone-Beam Computed-Tomography-Derived Augmented Fluoroscopy-Guided Biopsy for Peripheral Pulmonary Nodules in a Hybrid Operating Room: A Case Series

Lung cancer is the most lethal cancer type in Taiwan and worldwide. Early detection and treatment advancements have improved survival. However, small peripheral pulmonary nodules (PPN) biopsy is often challenging, relying solely on bronchoscopy with radial endobronchial ultrasound (EBUS). Augmented fluoroscopy overlays the intra-procedural cone-beam computed tomography (CBCT) images with fluoroscopy enabling real-time three-dimensional localization during bronchoscopic transbronchial biopsy. The hybrid operating room (HOR), equipped with various types of C-arm CBCT, is a perfect suite for PPN diagnosis and other interventional pulmonology. This study shares the single institute experience of EBUS transbronchial biopsy of PPN with the aid of augmented fluoroscopic bronchoscopy (AFB) and CBCT in an HOR. We retrospectively enrolled patients who underwent robotic CBCT, augmented fluoroscopy-guided, radial endobronchial ultrasound-confirmed transbronchial biopsy and cryobiopsy in a hybrid operating room. Patient demographic characteristics, computed tomography images, rapid on-site evaluation cytology, and final pathology reports were collected. Forty-one patients underwent transbronchial biopsy and 6 received additional percutaneous transthoracic core-needle biopsy during the same procedure. The overall diagnostic yield was 88%. The complications included three patients with pneumothorax after receiving subsequent CT-guided percutaneous transthoracic needle biopsy, and two patients with hemothorax who underwent transbronchial cryobiopsy. Overall, the bronchoscopic biopsy of PPN using AFB and CBCT as precise guidance in the hybrid operating room is feasible and can be performed safely with a high diagnostic yield.

Does Gelfoam slurry embolization post-pulmonary biopsy reduce risk of pneumothorax? A prospective randomized control study

BackgroundCT-guided percutaneous transthoracic biopsy has become a widely accepted safe method in establishing the etiology of lung masses. Pneumothorax is the most commonly faced complication requiring further therapeutic intervention for treatment with chest tube drainage adding to the time of hospital stay.Aim of workWe aim to evaluate the effect of Gelfoam mixture biopsy tract embolization as a minimal added cost in reducing the overall rate of complications, the need of chest tube placement, and hospital stay.Patient and methodsA total of 138 transthoracic CT-guided lung biopsies were randomized to 70 track embolized patients and 68 control. The study protocol was approved from the National Cancer Institute ethical committee review board. Data were collected from the local PACS system and analyzed, reviewed and performed by one of three interventional radiologists. Patient records were analyzed for primary health risks, pre-procedural CT was analyzed for lesion-related risk factors, and intra-procedural CTs were analyzed for procedure-related risk factors. Outcome measures include incidence of pneumothorax, pneumothoraxes requiring chest tube insertion and hospital admission rates.ResultsMarked pneumothorax requiring chest tube insertion and hospital admission were significantly reduced in the embolized group as 7.1% compared to 19% in the non-embolized group with significant p value of 0.037. Hospital admissions reduced from 19% down to 4.3% in embolized cases with a significant p value of 0.007. On univariate regression analysis, embolization reduced chest tube placement odds by 68% (OR = 0.32, 95% CI 0.109–0.97, p = 0.044). The only significant procedural-related factor was needle pleural angle > 70° where it increased the risk of pneumothorax by 2.85 times and chest tube placement by 3.10 times. Gelfoam embolization significantly reduces the odds of post-procedural hospital admission by 81% (OR = 0.189, 95% CI 0.051–0.699, p = 0.012). In multivariate regression analysis, Gelfoam was significantly protective against chest tube insertion and prolonged hospital stay, by reducing the odds 74.3% (OR = 0.257, 95% CI 0.082–0.808, p = 0.020) and 86% (OR = 0.133, 95% CI 0.027–0.662, p = 0.014), respectively. Needle pleural angle more than 70° increased odds of chest tube insertion by 252%. Lesions that were in very low position related to the diaphragm and just behind ribs were less prone to chest tube insertion by 83% (OR = 0.164, 95% CI 0.035–0.779, p = 0.02), while those showing mediastinal invasion and central lung lesions had increased odds by 6.812 times (95% CI 1.452–31.958, p = 0.015) for longer hospital stays.ConclusionsGelfoam embolization post-CT-guided lung biopsy has proven to statistically reduce large pneumothoraces requiring chest tube insertion, longer hospital stay, and reduced unnecessary expenses.

DIAGNOSTIC ACCURACY AND COMPLICATIONS OF PERCUTANEOUS CT-GUIDED NEEDLE BIOPSY OF LUNG NODULES IN 161 PATIENTS

Objective: Transthoracic needle biopsy is a diagnostic method that has proven its reliability in lung nodules and is frequently applied in daily practice. The diagnostic accuracy of biopsies performed with computed tomography navigation is quite high, even if the lesion sizes are smaller than 1 cm. We aimed to evaluate the diagnostic accuracy and complications of the computed tomography-guided percutaneous transthoracic needle biopsy procedure performed in our center.
 Material and Methods: Patients who underwent computed tomography guided percutaneous transthoracic pulmonary nodule biopsy procedure between January 2017 and January 2020 were included in the study. The size and anatomic location of lesions, the distance between the pleura and the lesion, the angle of the needle with the pleura, the procedure time, the number of pathologic samples taken per patient, the total radiation dose, complications, and the pathological results of the lesions were analyzed from the patients’ computed tomography images and patients’ records.
 Results: Among the 161 patients admitted for the transthoracic percutaneous needle biopsy procedure, 135 were male (mean age 64.3±11.1 years) and 26 were females (mean age 61.3±15.4 years). The pathological evaluation of 32 patients were reported as non-diagnostic. The diagnostic accuracy of computed tomography guided transthoracic biopsy was calculated as 80.1%. Major complications occurred in 10 patients (6.2%), and minor complications occurred in 60 patients (37.2%). The rate of procedure requiring chest tube insertion was 4.9%. The mean effective radiation dose of the patients per procedure was calculated as 5.26±3.25 mSv.
 Conclusion: Computed tomography guided transthoracic biopsy procedure are a method with a high diagnostic accuracy rate, low rate of complications and can be preferred in all appropriate pulmonary nodules.

An initial experience of computed tomography-guided trans superior vena caval biopsy: a novel approach for precarious mediastinal lesions.

PurposeAs interventional radiologists, we encounter precarious deep-seated mediastinal lesions in our day-to-day practice. The conventional technique of percutaneous transthoracic biopsy of these lesions carries significant intrinsic complications. Endovascular approaches for such lesions under fluoroscopic guidance have been described in previous literature but with significant technical constraints. In this article, we would like to describe the novel approach of computed tomography (CT)-guided trans superior vena caval biopsy, which we have performed in 3 consecutive precarious mediastinal lesions.Material and methodsWe placed a vascular sheath under ultrasound and fluoroscopic guidance considering the intended angle of needle puncture and length to reach the target lesion from the puncture site. With the sheath in situ, the trans superior vena caval biopsy was performed under CT guidance, and multiple cores of target tissue were safely and successfully obtained.ResultsWe have carefully and successfully employed this novel technique of CT-guided trans superior vena caval approach for 3 tricky deep-seated mediastinal lesions with very low risk of complications.ConclusionsThrough this article, we would like to enhance the importance of thought-provoking new techniques in tackling complex challenging referrals.

The role of ultrasound-guided transthoracic Tru-Cut core biopsy in the diagnosis peripheral thorax lesion

BackgroundThe nature of opaque lesions such as effusions, atelectasis, masses, and consolidations can be clarified by sonography. This study investigated the sensitivity and accuracy of ultrasound-guided percutaneous core needle biopsy in different thoracic tumors (lung, pleural, chest wall, and mediastinal).ResultsSixty patients underwent ultrasound-guided percutaneous transthoracic core biopsy of peripheral thoracic masses with a Tru-Cut needle with a big bore. Twenty masses were in the lung, seventeen lesions were in the pleura, ten masses were in the mediastinum, eleven were enlarged palpable lymph nodes, and two masses were in chest wall. The sensitivity, PPV, and accuracy for detection of chest tumors in the chest wall, mediastinum, lung, and pleura were 100% for all, and in LN 88.9, 100, and 90.9%, respectively. The overall diagnostic performance of sonar-guided Tru-Cut needle biopsy in diagnosis was 97.78% sensitivity, 98.18% accuracy, and 100% PPV.ConclusionTru-Cut needle percutaneous transthoracic core biopsy is a convenient and sensitive process in obtaining samples under ultrasound guidance for exact histological diagnosis of thoracic tumors. The diagnostic efficiency is high, and the technique can also be used in outpatients, which is relatively simple.Trial registrationNCT, NCT04741958 Registered 5 February 2021, retrospectively registered,

Cuban Blue Scorpion Venom and Lung Carcinoma: Is it Always True What Does Not Kill Me Makes Me Stronger?

Historically snake, scorpion, and hymenoptera venom have been used to treat various diseases. It is well known that alternative and/or complementary treatment options are widely used, especially among cancer patients. The case we describe here has lung carcinoma and received blue scorpion venom as an alternative therapy. A 86 years old male patient was admitted complaining of dyspnea. Thorax computed tomography (CT) showed a mass lesion and intraparenchymal nodules on the left upper lobe. Percutaneous transthoracic biopsy was performed, and the diagnosis was reported to be an epidermoid carcinoma. After the shared decision, A shared decision with the family and oncology specialists, the patient decided to try Cuban blue scorpion venom oral drops. Initially, it was well tolerated. However on the sixth day of treatment, sudden death occurred. Scorpion venom has been considered as a natural source for cancer therapy. Rhopalurus junceus is an endemic scorpion species from Cuba. Although it belongs to the most dangerous species related to human scorpionism, and no fatal stings have been reported. Currently published articles investigate the composition and in vitro anticancer activity of the venom; there are no controlled clinical trials evaluating toxicity or effectiveness. Uncontrolled use of alternative treatment options may lead to unexpected interactions with concomitant medications.

Propensity-score-matching analysis to compare efficacy and safety between 16-gauge and 18-gauge needle in ultrasound-guided biopsy for peripheral pulmonary lesions

BackgroundDefinitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications.Materials and methodsIn total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC.ResultsThe overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05).ConclusionHigher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.

Systemic Air Embolism Complicating Computed Tomography-guided Percutaneous Transthoracic Biopsy of Cavitary Lung Lesions: A Systematic Review.

Cavitary lung lesions often pose a diagnostic challenge, and tissue sampling can be required to obtain a confident diagnosis. Many authors contend that a computed tomography-guided percutaneous transthoracic lung biopsy (PTLB) of a cavitary lung lesion places a patient at higher risk for systemic air embolism (SAE) compared with biopsy of a noncavitary lesion. We reviewed the literature for studies of SAE complicating PTLB. We searched English-language articles indexed through PubMed, Embase, and Ovid Medline and included articles published up to March 31, 2020. We identified 10 case reports of SAE complicating PTLB, and 3 case-cohort studies comparing cavitary and noncavitary lesion biopsy. Among the case-cohort studies reviewed, 4 SAE occurred among 145 biopsies of cavitary lesions (2.7%), and 65 SAE occurred among 3050 biopsies of noncavitary lesions (2.1%). The pooled odds ratio of PTLB complicating SAE of cavitary lesions compared with noncavitary lesions was 1.29 (95% confidence interval: 0.47-3.60). No deaths following SAE after computed tomography-guided PTLB of cavitary lesions were reported in recent literature. On the basis of available evidence, air embolism rates are similar for PTLB of cavitary and noncavitary lesions. Additional research and registry studies are necessary to better understand this topic.

Safety and diagnostic accuracy of percutaneous CT-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels.

We aimed to evaluate the safety and diagnostic accuracy of computed tomography (CT)-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. This retrospective study examined the safety and diagnostic accuracy of percutaneous CT-guided biopsy for small lung nodules (≤20 mm) located within 10 mm of the pericardium or great vessels. Technical aspects and factors influencing complications were assessed, and diagnostic accuracy was calculated. A total of 168 biopsies were performed in 168 patients. The complications were mainly pneumothorax (34.5%; 58 of 168 patients), chest tube insertion (5.3%; 9 of 168 patients), and pulmonary hemorrhage (61.3%; 103 of 168 procedures), with no patient mortality. One patient (0.6%) was admitted because of hemorrhage complications. Significant independent risk factors for pneumothorax were nodules resided in upper or middle lobes and lateral patient position, and for hemorrhage, longer distance from structures and longer needle trajectory through the lung parenchyma. Overall, the sensitivity, accuracy, and specificity were 91.0%, 92.2%, and 100%, respectively. Percutaneous CT-guided transthoracic biopsy was highly accurate in small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. Complications are common, but most were minor and self-limited.

Assessment of quality and accuracy of YouTube videos on percutaneous transthoracic biopsy

Aim: YouTube is an essential source of medical information for patients, but may also be misleading, depending on the kind of content quality. The aim of this study is to evaluate the quality of YouTube videos on percutaneous transthoracic lung biopsy. Methods: A search on YouTube was performed with the terms ‘Lung Biopsy,’ ‘CT-Guided Lung Biopsy,’ ‘US-Guided Lung Biopsy,’ and ‘Percutaneous Transthoracic Biopsy.’ Relevant English videos were examined and scored by two reviewers. Video characteristics, uploaded sources, and content quality were assessed using different indices. Correlation analysis was conducted to investigate the possible correlation for global quality score. Results: Fifteen videos (47%) were uploaded by a healthcare professional, nine videos (28%) by a product company, six videos (19%) by an individual user, and 2 (6%) by an academic institution. The videos had a median (IQR) quality score of 2 (range 1-5), and a median (IQR) length of 235 (46-751) seconds. The quality of the videos varied, depending on the uploaded sources as well as whether they were uploaded by academic institutions, which had the highest quality. Some important components regarding the biopsy procedure, such as complications, were not evaluated in most videos. Conclusion: YouTube videos on percutaneous transthoracic lung biopsy (PTLB) had a low median content quality score, while some important points were grossly overlooked. Thus, YouTube videos may be a misleading source of patient information. Academic institutions and healthcare professionals should be creating accurate multimedia content for patients seeking informative medical information.

Predicting lung nodules malignancy

BackgroundIt is critical to developing an accurate method for differentiating between malignant and benign solitary pulmonary nodules. This study aimed was to establish a predicting model of lung nodules malignancy in a real-world setting. MethodsThe authors retrospectively analysed the clinical and computed tomography (CT) data of 121 patients with lung nodules, submitted to percutaneous CT-guided transthoracic biopsy, between 2014 and 2015. Multiple logistic regression was used to screen independent predictors for malignancy and to establish a clinical prediction model to evaluate the probability of malignancy. ResultsFrom a total of 121 patients, 75 (62%) were men and with a mean age of 64.7 years old. Multivariate logistic regression analysis identified six independent predictors of malignancy: age, gender, smoking status, current extra-pulmonary cancer, air bronchogram and nodule size (p<0.05). The area under the curve (AUC) was 0.8573. ConclusionsThe prediction model established in this study can be used to assess the probability of malignancy in the Portuguese population, thereby providing help for the diagnosis of lung nodules and the selection of follow-up interventions.