Thoracic Biopsy Research Articles

Еffectiveness of ct-guided transthoracic biopsy

Objective. To evaluate the effectiveness of CT-guided thoracic biopsy in the diagnosis of lung and mediastinal malignancies.Materials and methods. A retrospective analysis of 32 cases of CT-guided transthoracic biopsy was performed. Lung and mediastinal masses suspicious for malignancy with a size of more than 2.0 cm in the area available for manipulation were the indication for Cor-biopsy with additional examination of impression smears. A step-by-step procedure involved CT positioning of the object, marking by the radiation therapy program, and performing the procedure. The cytological and histological materials were evaluated and compared.Results. The analysis of manipulations performed in 32 patients with lung masses (75±7.7%) and mediastinal masses (25±7.7%) proved the technical effectiveness of the procedure, which lasted 37±9 minutes. The diagnosis was confirmed by cytological analysis of impression smears in 81.3±6.9% of cases, and using histological methods – in 71.9±8% (p>0.05). The agreement between the results obtained by both methods was 53.1±8.8%. Immunohistochemical analysis of the material was performed in 69.6±9.6% of patients. Procedural complications (pneumothorax and hemoptysis) were observed in 21.9±7.3% of patients. Cytological examination allowed the results of a planned histological and immunohistochemical analysis to be foreseen with a high degree of probability.Conclusion. CT-guided transthoracic puncture is a highly effective method of diagnosing lung and mediastinal malignancies, which allows their morphological characterization to be done in 81% of cases.

Dose variations for biopsy, puncture and drainage under CT guidance: A national survey in 1709 patients.

A nation-wide study recently published the dose reference levels for the main CT-guided interventional procedures in 5001 patients. We assessed the impact of patient's age, sex and targeted organ on the patient dose during thoracic and abdominopelvic biopsies and punctures/drainages. Data were extracted from the previous nationwide study. All biopsies, punctures and drainages for thoracic or abdominopelvic locations performed between January 2017 and June 2019 in all participating centers were included in the study. Multivariable analyses were carried out using a linear regression of the dose-length product (DLP) log, adjusted to age, sex, anatomical location, number of helical acquisitions and inclusion center. Of the 5001 patients of the initial study, 2383 benefited from thoracic or abdominopelvic procedures, including 674 percutaneous destructions excluded. 1709 patients (44 centers), 1045 men, 664 women, median age 64.4±14.0 years were included. The mean DLP was 751.2±642.7mGy.cm. It was significantly higher in men than women (p=0.0005) and higher for abdominopelvic procedures than for thoracic locations (p<0.0001). Doses delivered to patients for abdominal and thoracic biopsies and punctures/drainages performed under CT guidance depend on gender and location. Furthers studies taking into account the patient's morphology and anatomical location of the procedure would allow proposing finer dose reference levels.

Prediction of Complication Risk in Computed Tomography-guided Thoracic Biopsy: A Prescription for Improving Procedure Safety.

Computed tomography-guided transthoracic biopsy (CTTB) is a minimally invasive procedure with a high diagnostic yield for a variety of thoracic diseases. We comprehensively assessed a large CTTB cohort to predict procedural and patient factors associated with the risk of complications. The medical record and computed tomography images of 1430 patients who underwent CTTB were reviewed individually to obtain clinical information and technical procedure factors. Statistical analyses included descriptive and summary statistics, univariate analysis with the Fisher test, and multivariate logistic regression. The most common type of complication was pneumothorax (17.4%), followed by bleeding (5.9%). Only 26 patients (1.8%) developed a major complication. Lung lesions carried a higher risk of complications than nonlung lesions. For lung lesions, the nondependent position of the lesion, vertical needle approach, trespassing aerated lung, and involvement of a trainee increased the risk of complication, whereas the use of the coaxial technique was a protective factor. The time with the needle in the lung, the number of biopsy samples, and the distance crossing the aerated lung were identified as additional risk factors in multivariate analysis. For nonlung lesions, trespassing the pleural space was the single best predictor of complications. A logistic regression-based model achieved an area under the receiver operating characteristic curve of 0.975, 0.699, and 0.722 for the prediction of major, minor, and no complications, respectively. Technical procedural factors that can be modified by the operator are highly predictive of the risk of complications in CTTB.

Accuracy of CT-Guided Core-Needle Biopsy in Diagnosis of Thoracic Lesions Suspicious for Primitive Malignancy of the Lung: A Five-Year Retrospective Analysis.

Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest methods to obtain tissue specimens, even though there are relatively high rates of pneumothorax (0-60% incidence) and pulmonary hemorrhage (4-27% occurrence rates). The aim of this retrospective study is to assess the diagnostic accuracy of CT-guided core-needle biopsy in the diagnosis of primary lung malignancies and to compare our results with evidence from the literature. Our analysis included 350 thoracic biopsies, performed from 2017 to 2022 with a 64-row CT guidance and 16/18 G needles mounted on a biopsy gun. We included in the final cohort all samples with evidence of primary lung malignancies, precursor lesions, and atypia, as well as inconclusive and negative diagnoses. There was sensitivity of 90.07% (95% CI 86.05-93.25%), accuracy of 98.87% (95% CI 98.12-99.69%), positive predictive value of 100%, and negative value of 98.74% (95% CI 98.23-99.10%). Specificity settled at 100% (93.84-100%). The AUC was 0.952 (95% CI 0.924-0.972). Only three patients experienced major complications after the procedure. Among minor complications, longer distances from the pleura, the presence of emphysema, and the lower dimensions of the lesions were correlated with the development of pneumothorax after the procedure, while longer distances from the pleura and the lower dimensions of the lesions were correlated with intra-alveolar hemorrhage. Immunohistochemistry analysis was performed in 51% of true positive cases, showing TTF-1, CK7, and p40 expression, respectively, in 26%, 24%, and 10% of analyzed samples. The CT-guided thoracic core-needle biopsy is an extremely accurate and safe diagnostic procedure for the histological diagnosis of lung cancer, a first-level interventional radiology exam for peripheral and subpleural lesions of the lung, which is also able to provide adequate samples for advanced pathologic assays (e.g., FISH, PCR) to assess molecular activity and genetic sequencing.

Air on the brain: Cerebral embolism associated with outpatient line

We present a case of a 64-year-old male with a patent foramen ovale who suffered severe complications from a massive air embolism while accessing a tunneled CVC. Air embolism may occur in conjunction with trauma, diving accidents, hemodialysis, cardiopulmonary bypass surgery, neurosurgery, thoracic biopsies, or transpulmonary passage from barotrauma, but it is most often associated with central venous catheter (CVC) insertions [1]. Arterial air embolisms, particularly cerebral air embolisms, are a rare and potentially fatal event that may result in severe, irreversible neurological deficits [2]. High index of suspicion is necessary, especially in those with an underlying cardiac defect such as a patent foramen ovale (PFO), where a paradoxical embolism may occur. With an underlying PFO, a baseline left to right shunt may undergo reversal of the shunt due to a raise in the right atrial pressures, mostly associated with Valsalva, and thus result in cerebral arterial embolism [1,3].

Primary mediastinal large B-cell lymphoma and pregnancy: a challenging clinical scenario.

A 26-weeks pregnant woman presented with progressively worsening dyspnoea and poor general conditions. Using low-dose radiation multi-imaging techniques and thoracic biopsy a primary mediastinal large B cell was diagnosed. A multidisciplinary approach identified the correct hemodynamic management, the best therapeutic strategy and the timing for delivery.

Multidetector CT findings of primary pleural angiosarcoma : a systematic review, an additional cases report

BackgroundTo demonstrate and analyze the relatively common imaging findings in this rare primary pleural angiosarcoma (PPA).Case presentationThree cases of PPA, proven by video-assisted thoracic surgery biopsies are retrospectively reviewed. Patients were all male. Age ranges from 65 to 75 years old age (mean; 69). Major chief complaints were dyspnea and chest pain. One has a history of colon cancer, the other has a tuberculosis history and the other has no known history. Multidetector chest CT and PET CT were all done. Immunohistochemical studies were performed including CD31, CD34, or factor VIII-related antigen, vimentin, and cytokeratin. We also review the literatures on recently published PPA. All masses were from 1 to 10 cm. All three patients had multiple pleural based masses, which were ovoid in shape with relatively sharp margin in unilateral hemithorax. Multiple small circumscribed pleural masses are limited in the pleural space in two patients, whereas two, huge lobulated masses about up to 10 cm were present with pleural and extrapleural involvement in one patient. In two patients with pleural mass only, multiple pleural masses were only seen in parietal pleura in one patient and were in both visceral and parietal pleura in one patient. Pleural effusion were found in one side in one patient and in both sides in one patient. One angiosarcoma was arised from chronic tuberculotic pleurisy sequelae. All pleural masses are heterogenous with irregular internal low densities in all patients. Hematogenous metastases were found in liver, vertebra, rib in one patient, and were in lungs with mediastinal lymph node metastases in the other patient. Three patients survived for longer than 3months after diagnosis, but continued to deteriorate rapidly. Two patients underwent chemotherapy after surgical excision, and the other one with multiple metastases treated chemotherapy after CT-guided biopsy, but eventually all died. As a result of comparative analysis of a total of 13 patients’ images including 10 cases previously published, there was pleural effusion in all except 2 cases.ConclusionsPPA were all necrotic without any vascularized enhancing nature, and manifested as unilateral circumscribed or localized pleural-based masses.

Corrigendum to Tumour seeding after a thoracic biopsy for renal cell carcinoma: a case report and a review of the literature

[This corrects the article DOI: 10.1177/11795549211022261.].

60 Primary mediastinal large B-cell lymphoma: how to manage it during pregnancy

Abstract A 33 years old patient came to our attention, pregnant in her 26th week. She had dyspnoea, cough and weight loss (up to 45 kg of weight) in the previous two weeks. During urgent gynecological check-up she was found in poor general conditions, tachypnoic (respiratory rate &amp;gt;30 acts/minutes) with pale skin and bilateral jugular turgor. There was nothing relevant in her past medical history except for a thrombocytopenia appeared 2 months before. She consulted a haematologist who recommended to look for JAK2 mutation that was excluded. Echocardiography revealed a voluminous hypoechoic mass extrinsically imprinting the roof and the anterior wall of the right atrium that also involved inferior vena cava as a sleeve; a flow acceleration with an average gradient of 6 mmHg was documented at the level of right lower pulmonary vein and a possible infiltration of atrial wall was seen. Left ventricle was normal in size and kinesis; right ventricle also showed preserved contractility of the free wall with reduction in the distal outflow portion due to diffuse soft thickening that surrounded this portion and that extended cranially towards the trunk of pulmonary artery and ascending aorta. There also was a layer of circumferential pericardial effusion, apparently organized, with irregular profile of visceral pericardial sheet adjacent to diaphragmatic wall of right ventricle. On chest contrast computed tomography (CT) a voluminous mediastinal solid mass (13 × 16 × 18 cm) was confirmed with inhomogeneous enhancement for central necrotic components determining complete atelectasis of middle and upper right lung lobes and compression of superior vena cava, of some branches of pulmonary artery and ipsilateral pulmonary veins too; supra-aortic trunks and aorta were surrounded by the mass but open; the mass enveloped the right posterolateral area of the heart, displacing it to the left and compressing right atrium with apparent pericardial infiltration. Moreover there were approximately 16 mm of pericardial effusion and multiple mediastinal adenopathies. A chest and abdomen magnetic resonance confirmed the presence of the known voluminous heteroplastic formation occupying almost all right hemithorax, indissociable from the pericardium, with compression of right heart chambers and cavae veins. A thoracic biopsy of mediastinal mass was urgently performed under ultrasound guidance and followed by systemic steroid therapy. Histological examination showed off the diagnosis of primary large B cell lymphoma of the mediastinum (PMBCL, according to WHO classification 2016). A steroid therapy and chemotherapy cycles were started (Cyclophosphamide-Hydroxydaunorubicin-Oncovin-Prednisone—CHOP scheme). On the second day after chemotherapy, we saw a sudden worsening of clinical conditions: the patient had severe respiratory distress and signs of low cardiac output such as hypotension, elevated heart rate, increased blood lactates, low venous oxygen saturation (SVO2 45%), and elevation N-terminal prohormone of brain natriuretic peptide (NT-proBNP); she was therefore admitted to intensive care unit (ICU) where a gradual optimization of haemodynamic parameters. Then she underwent a second cycle of chemotherapy: dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) and was then successfully discharged. In such cases a careful evaluation and balancing of both haematological and gynecological–obstetric aspects is needed and it requires a multidisciplinary team approach in order to identify the best diagnostic and therapeutic pathway and, most of all, the best timing for delivery depending on gestational age.

ULCERATIVE COLITIS-INDUCED PLEURAL DISEASE

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Fellow Case Reports INTRODUCTION: Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease, are associated with a large number of extraintestinal manifestations. We are presenting a case of ulcerative colitis induced pleural disease CASE PRESENTATION: 21 y/o man with a history of ulcerative colitis (UC) on mesalamine who presented to the clinic with persistent cough. Two months prior to clinic presentation he visited the emergency department complaining of stabbing chest pain associated with dry cough. CTA chest at that time showed no pulmonary embolism. However, it showed bilateral pleural densities measuring up to 13 mm in depth and 22 mm in circumference. The patient denied travel to TB endemic areas. He is a current smoker with a 2-pack year history. Infectious workup was unremarkable for TB and histoplasmosis. His ESR and CRP were within normal limits. A two month follow up CT chest showed new pleural densities with enlargement of the old ones up to 18 mm in depth and 55 mm in circumference. Plan was for trans thoracic biopsy. Three weeks later at the time of biopsy, limited CT chest showed significant improvement in the bilateral densities and resolution of the patient's cough. Three months follow up CT chest showed complete resolution of the pleural based densities. DISCUSSION: Rarely, Inflammatory Bowel Disease (IBD) involves the pleural space and pericardium, causing inflammatory exudative pleural and/or pericardial effusions. Most patients are young, male, and have UC during the quiescent phase of the disease. The manifestations of pleural disease can be classified as: pneumothorax, pleural thickening, pleuritis, and pleural effusion (usually unilateral, an exudate with neutrophils, and may be hemorrhagic). Our patient didn't have a pleural effusion. Ongoing bowel inflammation is not a prerequisite for the onset of respiratory alterations, because bronchopulmonary disease that develops after colectomy has been reported. Pulmonary abnormalities in IBD can present years after the onset of bowel disease and can affect any part of the lungs. These may be overt or subclinical and do not correlate with the duration of IBD.Mesalamine may also induce pleural disease and its immunologically mediated. Cessation of the drug is needed sometimes, and the use of corticosteroids may be limited to patients with poor response or severe symptoms. Our patient continued to be on Mesalamine without further problems. Differentiating between Mesalamine and IBD related pleuritis can be challenging. However pleural or pericardial biopsies are rarely necessary and mostly will show nonspecific acute and chronic inflammatory changes. CONCLUSIONS: Pulmonary involvement should be considered when pleurisy developed in UC. Also Mesalamine-induced pleuritis is a real clinical entity and its pathogenesis is immunologically mediated. REFERENCE #1: Lu, Shuming MD, PhDa; Wang, Lihua MDb; Zhang, Weisheng MD, PhDc,*; Zhang, Zhuqing MDd; Liu, Lina MDa; Wang, Yingde MDa; Meng, Hua MDa,* Ulcerative colitis with acute pleurisy, Medicine: July 2017 - Volume 96 - Issue 30 - p e7630doi: 10.1097/MD.0000000000007630 REFERENCE #2: Alessandro Tozzi, MD, Maria Rosa Biagini, MD, Carlotta Rastelli, MD, Andrea Galli, MD, Donatella Baldi, MD, Stefano Milani, MD, Mesalamine-induced Pleuritis in a Patient with Ulcerative Colitis, Inflammatory Bowel Diseases, Volume 15, Issue 1, 1 January 2009, Pages 158–159 REFERENCE #3: Moeser A, Pletz MW, Hagel S, Kroegel C, Stallmach A. Lung disease and ulcerative colitis--mesalazine-induced bronchiolitis obliterans with organizing pneumonia or pulmonary manifestation of inflammatory bowel disease? Z Gastroenterol. 2015 Sep;53(9):1091-8. doi: 10.1055/s-0041-103377. Epub 2015 Sep 14. PMID: 26367026. DISCLOSURES: No relevant relationships by Yazan Addasi, source=Web Response No relevant relationships by Ian Jackson, source=Web Response No relevant relationships by Carolina Landeen, source=Web Response No relevant relationships by Ali Nayfeh, source=Web Response

Transparent Machine Learning Models to Diagnose Suspicious Thoracic Lesions Leveraging CT Guided Biopsy Data

To train and validate machine learning models capable of classifying suspicious thoracic lesions as benign or malignant and to further classify malignant lesions by pathologic subtype while quantifying feature importance for each classification. 796 patients who had undergone CT guided thoracic biopsy for a concerning thoracic lesion (79.3% lung, 11.4% mediastinum, 6.5% pleura, 2.7% chest wall) were retrospectively enrolled. Lesions were classified as malignant or benign based on ground-truth pathology result, and malignant lesions were classified as primary or secondary cancer. Clinical variables were extracted from EMR and radiology reports. Supervised binary and multiclass classification models were trained to classify lesions based on the input features and evaluated on a held-out test set. Model specific feature analyses were performed to identify variables most predictive of each class, as well as to assess the independent importance of clinical, and imaging features. Binary classification models achieved a top accuracy of 80.6%, with predictive features included smoking history, age, lesion size, and lesion location. Multiclass classification models achieved a top weighted average f1-score of 0.73. Features predictive of primary cancer included smoking history, race, and age, while features predictive of secondary cancer included lesion location, and a history of cancer. Machine learning models enable classification of suspicious thoracic lesions based on clinical and imaging variables, achieving clinically useful performance while identifying importance of individual input features on a pathology-proven dataset. We believe models such as these are more likely to be trusted and adopted by clinicians.

Spindle cell sarcoma of the right atrium causing right atrial pseudoaneurysm: a case report and review of the literature

BackgroundSpindle cell sarcomas of the right atrium are extremely rare primary cardiac tumours, with very few cases reported in the medical literature. Pseudoaneurysms caused by cardiac spindle cell sarcoma have never been reported worldwide.Case presentationA 32-year-old woman was referred to our hospital for recurrent pericardial haemorrhagic effusion and pleural effusion. Three-dimensional transthoracic echocardiogram, contrast chest CT, and contrast MRI revealed a pseudoaneurysm on the right side of the right atrium with a thrombus. There was a defect between the pseudoaneurysm and the right atrium. PET-CT suggested that FDG metabolism inhomogeneity increased in the mass in the right atrium. Exfoliative cytology detection of massive pericardial effusion and pleural effusion revealed no tumour cells. Spindle cell sarcoma of the right atrium was not confirmed until the patient underwent right thoracic exploration and biopsy. Before a confirmed diagnosis, symptomatic treatment, such as chest effusion and pericardium effusion drainage, and transfusion of red blood cells were mainly used to relieve the patient’s symptoms. Unfortunately, the patient was lost to optimal treatments and passed away 20 days after the pathological diagnosis was made.ConclusionThe prognosis of spindle cell sarcomas remains poor due to delays in diagnosis, early metastasis and few available therapeutic options. Recurrent pericardial effusion and pleural effusion, especially in the nature of haemorrhagic effusion, and/or right atrial pseudoaneurysm shown on the transthoracic echocardiogram must be considered and highly suspected as malignancy by patients and physicians. If the diagnosis cannot be confirmed, histopathology should be performed as soon as possible to avoid losing the best treatment opportunity.

Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guidelines from the College of American Pathologists (CAP)

With a growing number of clinically relevant biomarkers needed to guide the management of patients with non-small cell lung cancer (NSCLC), pathologists are keenly aware of the need to collect adequate tissue not only for a diagnosis, but also for ancillary studies to provide predictive and prognostic information. Small specimens collected by minimally invasive techniques such as fine needle aspiration and core needle biopsy often fall short in meeting adequacy requirements for lung cancer molecular biomarkers. The College of American Pathologists (CAP) recently published an evidence-based clinical practice guideline, “Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies”, to help direct clinicians and pathology laboratory personnel to optimally collect and handle thoracic small specimens for ancillary testing. This review summarizes the published guideline statements and provides a brief overview of the recommendations and how they impact the practice of pathology.

Ultrasound-guided percutaneous biopsy of thoracic lesions: high diagnostic yield and low complication rate

To investigate the use of ultrasound (US)-guided biopsy of thoracic lesions aiming to determine diagnostic success and complication rates and to identify factors that may affect sample adequacy and safety. This was a retrospective study of consecutive percutaneous US-guided biopsy over 10-year period, including 147 procedures in 146 patients (66±7 years, 83 men, 63 women) with lesions located in the lung (67/147), chest wall (54/147), mediastinum (14/147) and pleura (12/147). Overall diagnostic success, yield for benign and malignant diagnoses and diagnostic success according to lesion location, biopsy type (fine-need aspiration [FNA] or core-needle biopsy [CNB]) and number of specimens were calculated. Presence of complications and effect of age, lesion location, biopsy type, and number of specimens were measured. The overall diagnostic success rate was 90.5% and was similar for malignant (90.6%) and benign (87.5%) diagnoses. Specimen adequacy was similar for FNA and CNB (91.2% and 88.9%, p=0.66); number of specimens did not affect yield. Diagnostic success was highest for mediastinal and chest wall lesions (92.9% and 94.4%) and lowest for pleural lesions (75%), albeit not statistically significant (p=0.45). Complications occurred in 4/147(2.7%) cases, exclusively in lung lesions, and were not associated with any covariates analysed. US-guided biopsy is an effective and safe technique for diagnosis of thoracic lesions, with high diagnostic yield and low complication rate. In the presence of an adequate acoustic window, US guidance can be valuable for diagnosis of peripheral lung and mediastinal lesions. Radiologists performing thoracic biopsy should be encouraged to implement or expand the use of US guidance in their practice.

Tumour Seeding After a Thoracic Biopsy for Renal Cell Carcinoma: A Case Report and a Review of the Literature

The role of percutaneous tumour biopsies had gain importance in the management of renal cell carcinoma to provide diagnostic specimen for the patients with metastatic disease that could benefit a systemic treatment. Among the possible complications of this procedure, however, there is the risk of tumoral cells seeding along the biopsy’s tract; this complication, albeit being reported as anecdotal, could have devastating effects. Here we report a case of a young male who developed subcutaneous chest metastasis of renal cell carcinoma after a biopsy of a lung nodule. We subsequently reviewed other cases reported in literature

CT Fluoroscopy Guided Thoracic Biopsies (CTTB) Are Highly Accurate and Safe: Outcomes and Predictive Modeling of Complications Utilizing Machine Learning

CT guided transthoracic biopsy (CTTB) is an established, minimally invasive method for diagnostic evaluation of a variety of thoracic diseases. We assessed a large CTTB cohort diagnostic accuracy, complication rates, and developed machine learning models to predict complications. We retrospectively identified 796 CTTB patients in a tertiary hospital (5-year interval). We gathered and coded patient demographics, characteristics of each lesion biopsied, type of biopsy, diagnostic yield, type of diagnosis, and complication rates. Statistical analyses included summary statistics, multivariate logistic regression and machine learning (neural network) methods. Seven hundred ninety-six CTTBs were performed (43% fine needle aspirations, 5% core biopsies, 52% both). Diagnostic yield was 97.0% (73.9% malignant, 23.1% benign). Complications occurred in 14.7% (12.7% minor, 2.0% major). The most common complication was pneumothorax (13.1%), mostly minor. Multivariate logistic regression models could predict severity of complications with accuracies ranging from 65.5% to 83.5%, with smaller lesion dimension the strongest predictor. Type of biopsy was not a statistically significant predictor. A neural network model improved accuracy to 77.0%-94.2%. CTTB performed by thoracic radiologists in a tertiary hospital demonstrate excellent diagnostic yield (97.0%) with a low clinically important complication rate (2.0%). Machine learning methods including neural networks can accurately predict the likelihood of complications, offering pathways to potentially improve patient selection and procedural technique, in order to further optimize the risk-benefit ratio of CTTB.

Challenges and countermeasures of thoracic oncology in the epidemic of COVID-19.

Since December, 2019, a 2019 novel coronavirus disease (COVID-19) infected by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province, and the epidemic situation has continued to spread globally. The epidemic spread of COVID-19 has brought great challenges to the clinical practice of thoracic oncology. Outpatient clinics need to strengthen the differential diagnosis of initial symptoms, pulmonary ground-glass opacity (GGO), consolidation, interstitial and/or interlobular septal thickening, and crazy paving appearance. In the routine of oncology, the differential diagnosis of adverse events from COVID-19 is also significant, including radiation pneumonitis, checkpoint inhibitor pneumonitis (CIP), neutropenic fever, and so on. During the epidemic, indications of transbronchial biopsy (TBB) and CT-guided percutaneous thoracic biopsy are strictly controlled. For patients who are planning to undergo biopsy operation, screening to exclude the possibility of COVID-19 should be carried out. For confirmed or suspected patients, three-level protection should be performed during the operation. Disinfection and isolation measures should be strictly carried out during the operation. At last, more attention to the protection of cancer patients and give priority to the treatment of infected cancer patients.

Abstract No. 528 Evaluation of a low-dose computed tomography technique for computed tomography–guided thoracic biopsy

Abstract No. 528 Evaluation of a low-dose computed tomography technique for computed tomography–guided thoracic biopsy

La radiologie interventionnelle en oncologie thoracique

Interventional radiology is essential in the management of patients with lung cancer, both on the diagnostic and therapeutic side. All the interventional radiology procedures have to be approved in multidisciplinary meeting. Percutaneous thoracic biopsy can be guided by CT or US depend on lesion’s size and depth with sufficient material for histological diagnosis (molecular analysis and genotyping). The therapeutic approach in interventional radiology has made great progress in recent years both for the curative treatment of primary lesions and for the management of complications. With excellent tolerance and few complications, percutaneous tumor ablation by radiofrequency or microwaves for the lung tumors smaller than 2 cm is an alternative of choice in nonoperable patients. The endovascular treatment of hemoptysis or superior vena cava syndrome is effective and improve the quality of life of the patients. The recent advances with angiography 3D and Cone Beam Computed Tomography improve the accuracy and efficiency of the treatment, and have become an indispensable aid to the radiologist.

Comparison of Transbronchial Forcep Biopsy (TBFB) vs Transbronchial Needle Aspiration (TBNA) in Mediastinal and Thoracic Biopsies for Procuring the Optimal Sample for Diagnosis and Ancillary Studies

Comparison of Transbronchial Forcep Biopsy (TBFB) vs Transbronchial Needle Aspiration (TBNA) in Mediastinal and Thoracic Biopsies for Procuring the Optimal Sample for Diagnosis and Ancillary Studies