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C-arm cone-beam CT-guided transthoracic lung core needle biopsy as a standard diagnostic tool: an observational study.

Jaconi M, Pagni F, Vacirca F, Leni D, Corso R, Cortinovis D, Bidoli P, Bono F, Cuttin MS, Valente MG, Pesci A, Bedini VA, Leone BE - Medicine (Baltimore) (2015)

Bottom Line: A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data.This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate).The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Pathology (MJ, FP, FB, MSC, MGV), University Milan Bicocca; Department of Radiology (FV, DL, RC); Department of Oncology (DC, PB); Department of Health Sciences (AP), Pneumology Unit, University Milan Bicocca; Department of Thoracic Surgery (VB), San Gerardo Hospital, Monza; and Department of Pathology (BEL), Desio Hospital, University Milan Bicocca, Desio, Italy.

ABSTRACT
C-arm cone-beam computed tomography (CT)-guided transthoracic lung core needle biopsy (CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. This article will focus on the clinical features related to CNB in terms of diagnostic performance and complication rate. Moreover, the concept of categorizing pathological diagnosis into 4 categories, which could be used for clinical management, follow-up, and quality assurance is also introduced. We retrospectively collected data regarding 375 C-arm cone-beam CT-guided CNBs from January 2010 and June 2014. Clinical and radiological variables were evaluated in terms of success or failure rate. Pathological reports were inserted in 4 homogenous groups (nondiagnostic--L1, benign--L2, malignant not otherwise specified--L3, and malignant with specific histotype--L4), defining for each category a hierarchy of suggested actions. The sensitivity, specificity, and positive and negative predictive value and accuracy for patients subjected to CNBs were of 96.8%, 100%, 100%, 100%, and 97.2%, respectively. Roughly 75% of our samples were diagnosed as malignant, with 60% lung adenocarcinoma diagnoses. Molecular analyses were performed on 85 malignant samples to verify applicability of targeted therapy. The rate of "nondiagnostic" samples was 12%. C-arm cone-beam CT-guided transthoracic lung CNB can represent the gold standard for the diagnostic evaluation of pulmonary nodules. A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data. This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate). The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.

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“Nondiagnostic” class: histological criteria. (A) Suboptimal sample due to fragmentation and extensive necrosis (Hematoxylin and Eosin H&E, 20×). (B) Sampling from tumor capsule with fibrosis and inflammatory infiltrate (H&E, 20×). H&E = hematoxylin and eosin.
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Figure 1: “Nondiagnostic” class: histological criteria. (A) Suboptimal sample due to fragmentation and extensive necrosis (Hematoxylin and Eosin H&E, 20×). (B) Sampling from tumor capsule with fibrosis and inflammatory infiltrate (H&E, 20×). H&E = hematoxylin and eosin.

Mentions: The category included biopsies for which a definitive diagnosis and biological characterization of the lesion could not be established due to the suboptimal quality and/or quantity of the sample (Figure 1). Patients in this category underwent (Table 3) repeat biopsy with careful clinical–radiological correlation and diagnostic resection.


C-arm cone-beam CT-guided transthoracic lung core needle biopsy as a standard diagnostic tool: an observational study.

Jaconi M, Pagni F, Vacirca F, Leni D, Corso R, Cortinovis D, Bidoli P, Bono F, Cuttin MS, Valente MG, Pesci A, Bedini VA, Leone BE - Medicine (Baltimore) (2015)

“Nondiagnostic” class: histological criteria. (A) Suboptimal sample due to fragmentation and extensive necrosis (Hematoxylin and Eosin H&E, 20×). (B) Sampling from tumor capsule with fibrosis and inflammatory infiltrate (H&E, 20×). H&E = hematoxylin and eosin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554007&req=5

Figure 1: “Nondiagnostic” class: histological criteria. (A) Suboptimal sample due to fragmentation and extensive necrosis (Hematoxylin and Eosin H&E, 20×). (B) Sampling from tumor capsule with fibrosis and inflammatory infiltrate (H&E, 20×). H&E = hematoxylin and eosin.
Mentions: The category included biopsies for which a definitive diagnosis and biological characterization of the lesion could not be established due to the suboptimal quality and/or quantity of the sample (Figure 1). Patients in this category underwent (Table 3) repeat biopsy with careful clinical–radiological correlation and diagnostic resection.

Bottom Line: A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data.This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate).The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Pathology (MJ, FP, FB, MSC, MGV), University Milan Bicocca; Department of Radiology (FV, DL, RC); Department of Oncology (DC, PB); Department of Health Sciences (AP), Pneumology Unit, University Milan Bicocca; Department of Thoracic Surgery (VB), San Gerardo Hospital, Monza; and Department of Pathology (BEL), Desio Hospital, University Milan Bicocca, Desio, Italy.

ABSTRACT
C-arm cone-beam computed tomography (CT)-guided transthoracic lung core needle biopsy (CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. This article will focus on the clinical features related to CNB in terms of diagnostic performance and complication rate. Moreover, the concept of categorizing pathological diagnosis into 4 categories, which could be used for clinical management, follow-up, and quality assurance is also introduced. We retrospectively collected data regarding 375 C-arm cone-beam CT-guided CNBs from January 2010 and June 2014. Clinical and radiological variables were evaluated in terms of success or failure rate. Pathological reports were inserted in 4 homogenous groups (nondiagnostic--L1, benign--L2, malignant not otherwise specified--L3, and malignant with specific histotype--L4), defining for each category a hierarchy of suggested actions. The sensitivity, specificity, and positive and negative predictive value and accuracy for patients subjected to CNBs were of 96.8%, 100%, 100%, 100%, and 97.2%, respectively. Roughly 75% of our samples were diagnosed as malignant, with 60% lung adenocarcinoma diagnoses. Molecular analyses were performed on 85 malignant samples to verify applicability of targeted therapy. The rate of "nondiagnostic" samples was 12%. C-arm cone-beam CT-guided transthoracic lung CNB can represent the gold standard for the diagnostic evaluation of pulmonary nodules. A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data. This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate). The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.

Show MeSH
Related in: MedlinePlus