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CT-guided core needle biopsy of pleural lesions: evaluating diagnostic yield and associated complications.

Niu XK, Bhetuwal A, Yang HF - Korean J Radiol (2015)

Bottom Line: The influencing factors had no significant effect in altering diagnostic accuracy.As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients.Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province 610000, China.

ABSTRACT

Objective: The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors.

Materials and methods: From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [± standard deviation] age, 51.1 ± 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis.

Results: Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax.

Conclusion: CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

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54-year-old man with multiple pleural-based nodules and right sided pleural effusion undergoing CT-guided biopsy for left anterior nodular pleural lesion measuring 0.8 mm. Histopathology of specimen revealed pleural fibrosis.
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Figure 1: 54-year-old man with multiple pleural-based nodules and right sided pleural effusion undergoing CT-guided biopsy for left anterior nodular pleural lesion measuring 0.8 mm. Histopathology of specimen revealed pleural fibrosis.

Mentions: At the site of puncture, approximately 3 mL of 1% lidocaine was injected subcutaneously as local anesthesia. Two experienced operators performed CT-guided biopsy procedures with a 19-G needle (TruGuide, Bard, AZ, USA) and image guidance. After needle insertion, a CT scan was done to confirm the position of the needle after which the stylet was removed and core biopsy was performed with the matching 20-G cutting needle (Magnum Needles, Bard, AZ, USA) and a biopsy gun (Magnum, Bard, AZ, USA) (Figs. 1, 2). The operator visually checked adequacy of the specimen. If the sample amount was judged as insufficient, a new inner needle was inserted through the remaining outer needle, the tip position was once more adjusted under CT scan and the tissue sample was again obtained. The operator repeated this procedure until sufficient amount of tissue for histopathological diagnosis was obtained. Specimens were obtained from individual patients; and each specimen was placed in an individual 10% formalin-filled container. The baseline characteristics of the lesions and procedures are summarized in Table 1. Immediately after biopsy, unenhanced CT scan (slice thickness, 10 mm) of the whole thorax was performed to check for immediate pneumothorax. If immediate development of small, asymptomatic pneumothorax was observed, the patient was treated conservatively by administration of supplemental oxygen. Follow-up chest radiography was performed to evaluate the stability of pneumothorax. Any immediate occurrence of a moderate pneumothorax, defined as a collapse of the lung surface ≥ 2 cm from the site of the needle puncture, was aspirated by reinsertion of the coaxial needle guide. Patients were given chest tube insertion if the pneumothorax worsened or was accompanied by symptoms such as respiratory distress, shortness of breath, pain and decreased oxygen saturation. Patients without any complications or with stable, mild complications were discharged after 24 hours of observation. The discharged patients were instructed to return to the nearest emergency department upon development of symptoms such as substantial pain and shortness of breath.


CT-guided core needle biopsy of pleural lesions: evaluating diagnostic yield and associated complications.

Niu XK, Bhetuwal A, Yang HF - Korean J Radiol (2015)

54-year-old man with multiple pleural-based nodules and right sided pleural effusion undergoing CT-guided biopsy for left anterior nodular pleural lesion measuring 0.8 mm. Histopathology of specimen revealed pleural fibrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296272&req=5

Figure 1: 54-year-old man with multiple pleural-based nodules and right sided pleural effusion undergoing CT-guided biopsy for left anterior nodular pleural lesion measuring 0.8 mm. Histopathology of specimen revealed pleural fibrosis.
Mentions: At the site of puncture, approximately 3 mL of 1% lidocaine was injected subcutaneously as local anesthesia. Two experienced operators performed CT-guided biopsy procedures with a 19-G needle (TruGuide, Bard, AZ, USA) and image guidance. After needle insertion, a CT scan was done to confirm the position of the needle after which the stylet was removed and core biopsy was performed with the matching 20-G cutting needle (Magnum Needles, Bard, AZ, USA) and a biopsy gun (Magnum, Bard, AZ, USA) (Figs. 1, 2). The operator visually checked adequacy of the specimen. If the sample amount was judged as insufficient, a new inner needle was inserted through the remaining outer needle, the tip position was once more adjusted under CT scan and the tissue sample was again obtained. The operator repeated this procedure until sufficient amount of tissue for histopathological diagnosis was obtained. Specimens were obtained from individual patients; and each specimen was placed in an individual 10% formalin-filled container. The baseline characteristics of the lesions and procedures are summarized in Table 1. Immediately after biopsy, unenhanced CT scan (slice thickness, 10 mm) of the whole thorax was performed to check for immediate pneumothorax. If immediate development of small, asymptomatic pneumothorax was observed, the patient was treated conservatively by administration of supplemental oxygen. Follow-up chest radiography was performed to evaluate the stability of pneumothorax. Any immediate occurrence of a moderate pneumothorax, defined as a collapse of the lung surface ≥ 2 cm from the site of the needle puncture, was aspirated by reinsertion of the coaxial needle guide. Patients were given chest tube insertion if the pneumothorax worsened or was accompanied by symptoms such as respiratory distress, shortness of breath, pain and decreased oxygen saturation. Patients without any complications or with stable, mild complications were discharged after 24 hours of observation. The discharged patients were instructed to return to the nearest emergency department upon development of symptoms such as substantial pain and shortness of breath.

Bottom Line: The influencing factors had no significant effect in altering diagnostic accuracy.As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients.Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province 610000, China.

ABSTRACT

Objective: The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors.

Materials and methods: From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [± standard deviation] age, 51.1 ± 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis.

Results: Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax.

Conclusion: CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

Show MeSH
Related in: MedlinePlus