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CT-guided percutaneous transthoracic needle biopsy for paramediastinal and nonparamediastinal lung lesions: Diagnostic yield and complications in 1484 patients.

Wang Y, Jiang F, Tan X, Tian P - Medicine (Baltimore) (2016)

Bottom Line: The cohort was divided into a paramediastinal (n = 195) and a nonparamediastinal group (n = 1289) based on lesion location.Diagnostic yield for malignancy and complication rates were analyzed in both groups.Among 6 defined paramediastinal regions, the overall complication rate was the highest in the posterior region (42.4%) and the lowest in the paraventricular region (13.6%).

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Respiratory and Critical Care Medicine bLung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

ABSTRACT
Computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) is used for identifying paramediastinal lung lesions that cannot be diagnosed by bronchoscopy, but the diagnostic performance and complication rate are unreported.This retrospective study was approved by the institutional review board committee. A total of 1484 patients who underwent PTNB between April 2012 and April 2015 were enrolled. The cohort was divided into a paramediastinal (n = 195) and a nonparamediastinal group (n = 1289) based on lesion location. Diagnostic yield for malignancy and complication rates were analyzed in both groups. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for hemoptysis complication in the paramediastinal group.Percutaneous transthoracic needle biopsy showed 95.6% (109/114) sensitivity and 100% (77/77) specificity for the diagnosis of lesions in the paramediastinal group, with similar accuracy (95.4%, 186/195) to that in the nonparamediastinal group (94.7%, 1221/1289; P = 0.699). Compared with PTNB for nonparamediastinal lesions, PTNB for paramediastinal lesions demonstrated a comparable pneumothorax rate (8.21% vs 8.69%; P = 0.823) and hemothorax rate (2.56% vs 1.47%; P = 0.261), and a higher hemoptysis rate (28.2% vs 19.4%; P = 0.005). Among 6 defined paramediastinal regions, the overall complication rate was the highest in the posterior region (42.4%) and the lowest in the paraventricular region (13.6%). Multivariate analysis revealed that lesion size of 2 to 3 cm (odds ratio [OR] 3.22), intrapulmonary length of needle path >2 cm (OR 8.85), and proximal to pulmonary artery (OR 10.33) were independent risk factors for hemoptysis in the paramediastinal group.Computed tomography-guided PTNB can diagnose paramediastinal lesions with high yield and acceptable complication rates. Given higher rate of hemoptysis in PTNB for paramediastinal lesions, more attention should be paid in cases with high risks.

No MeSH data available.


Related in: MedlinePlus

Hemorrhagic complication of CT-guided PTNB for a lesion in the right anterior region (region 3) in a 46-year-old female. A, CT image showed a 18 mm nodule attached to the right atrium in the right middle lobe. The needle path through the lung exceeded 5 cm and should have avoided injuring the pulmonary artery, vein, and bronchus of the middle lobe, which were identified clearly near the lesion. B, A 17-gauge introducer needle was inserted carefully, and biopsy was carried out with an 18-gauge semiautomatic cutting needle. C, CT showed intrapulmonary hemorrhage along the needle path. This patient presented mild hemoptysis after PTNB. CT = computed tomography, PTNB = percutaneous transthoracic needle biopsy.
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Figure 2: Hemorrhagic complication of CT-guided PTNB for a lesion in the right anterior region (region 3) in a 46-year-old female. A, CT image showed a 18 mm nodule attached to the right atrium in the right middle lobe. The needle path through the lung exceeded 5 cm and should have avoided injuring the pulmonary artery, vein, and bronchus of the middle lobe, which were identified clearly near the lesion. B, A 17-gauge introducer needle was inserted carefully, and biopsy was carried out with an 18-gauge semiautomatic cutting needle. C, CT showed intrapulmonary hemorrhage along the needle path. This patient presented mild hemoptysis after PTNB. CT = computed tomography, PTNB = percutaneous transthoracic needle biopsy.

Mentions: The overall rate of hemoptysis was 20.6% (305 of 1484), with most cases having volumes ≤20 mL (19.1% [284 of 1484]) (Fig. 2). The hemoptysis rate in the paramediastinal group (28.2% [55 of 195]) was significantly higher than that in the nonparamediastinal group (19.4% [250 of 1289]; P = 0.005). Two patients in the nonparamediastinal group suffered massive hemoptysis, which was resolved using tracheal intubation.


CT-guided percutaneous transthoracic needle biopsy for paramediastinal and nonparamediastinal lung lesions: Diagnostic yield and complications in 1484 patients.

Wang Y, Jiang F, Tan X, Tian P - Medicine (Baltimore) (2016)

Hemorrhagic complication of CT-guided PTNB for a lesion in the right anterior region (region 3) in a 46-year-old female. A, CT image showed a 18 mm nodule attached to the right atrium in the right middle lobe. The needle path through the lung exceeded 5 cm and should have avoided injuring the pulmonary artery, vein, and bronchus of the middle lobe, which were identified clearly near the lesion. B, A 17-gauge introducer needle was inserted carefully, and biopsy was carried out with an 18-gauge semiautomatic cutting needle. C, CT showed intrapulmonary hemorrhage along the needle path. This patient presented mild hemoptysis after PTNB. CT = computed tomography, PTNB = percutaneous transthoracic needle biopsy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979835&req=5

Figure 2: Hemorrhagic complication of CT-guided PTNB for a lesion in the right anterior region (region 3) in a 46-year-old female. A, CT image showed a 18 mm nodule attached to the right atrium in the right middle lobe. The needle path through the lung exceeded 5 cm and should have avoided injuring the pulmonary artery, vein, and bronchus of the middle lobe, which were identified clearly near the lesion. B, A 17-gauge introducer needle was inserted carefully, and biopsy was carried out with an 18-gauge semiautomatic cutting needle. C, CT showed intrapulmonary hemorrhage along the needle path. This patient presented mild hemoptysis after PTNB. CT = computed tomography, PTNB = percutaneous transthoracic needle biopsy.
Mentions: The overall rate of hemoptysis was 20.6% (305 of 1484), with most cases having volumes ≤20 mL (19.1% [284 of 1484]) (Fig. 2). The hemoptysis rate in the paramediastinal group (28.2% [55 of 195]) was significantly higher than that in the nonparamediastinal group (19.4% [250 of 1289]; P = 0.005). Two patients in the nonparamediastinal group suffered massive hemoptysis, which was resolved using tracheal intubation.

Bottom Line: The cohort was divided into a paramediastinal (n = 195) and a nonparamediastinal group (n = 1289) based on lesion location.Diagnostic yield for malignancy and complication rates were analyzed in both groups.Among 6 defined paramediastinal regions, the overall complication rate was the highest in the posterior region (42.4%) and the lowest in the paraventricular region (13.6%).

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Respiratory and Critical Care Medicine bLung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

ABSTRACT
Computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) is used for identifying paramediastinal lung lesions that cannot be diagnosed by bronchoscopy, but the diagnostic performance and complication rate are unreported.This retrospective study was approved by the institutional review board committee. A total of 1484 patients who underwent PTNB between April 2012 and April 2015 were enrolled. The cohort was divided into a paramediastinal (n = 195) and a nonparamediastinal group (n = 1289) based on lesion location. Diagnostic yield for malignancy and complication rates were analyzed in both groups. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for hemoptysis complication in the paramediastinal group.Percutaneous transthoracic needle biopsy showed 95.6% (109/114) sensitivity and 100% (77/77) specificity for the diagnosis of lesions in the paramediastinal group, with similar accuracy (95.4%, 186/195) to that in the nonparamediastinal group (94.7%, 1221/1289; P = 0.699). Compared with PTNB for nonparamediastinal lesions, PTNB for paramediastinal lesions demonstrated a comparable pneumothorax rate (8.21% vs 8.69%; P = 0.823) and hemothorax rate (2.56% vs 1.47%; P = 0.261), and a higher hemoptysis rate (28.2% vs 19.4%; P = 0.005). Among 6 defined paramediastinal regions, the overall complication rate was the highest in the posterior region (42.4%) and the lowest in the paraventricular region (13.6%). Multivariate analysis revealed that lesion size of 2 to 3 cm (odds ratio [OR] 3.22), intrapulmonary length of needle path >2 cm (OR 8.85), and proximal to pulmonary artery (OR 10.33) were independent risk factors for hemoptysis in the paramediastinal group.Computed tomography-guided PTNB can diagnose paramediastinal lesions with high yield and acceptable complication rates. Given higher rate of hemoptysis in PTNB for paramediastinal lesions, more attention should be paid in cases with high risks.

No MeSH data available.


Related in: MedlinePlus