Computed Tomography–Navigated Transthoracic Core Biopsy of Pulmonary Lesions

Heyer, C. M.; Reichelt, Stefanie; Peters, Sören; Walther, Jörg; Müller, Klaus‐Michael; Nicolas, Volkmar

doi:10.1016/j.acra.2008.02.018

Cited by 89 publications

(45 citation statements)

References 57 publications

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“…In particular, we found no association between patient position (including the ipsilateral decubitus) and hemoptysis. This is in keeping with previous studies showing no influence of patient position on the risk of pulmonary bleeding or pneumothorax (20,29). Some authors found age, emphysema, subsolid type, nonperipheral, middle, and basal location, and dual antiplatelet therapy to be significantly associated with pulmonary hemorrhage after TTNB, but most of these studies used only univariate analysis (15-17, 21, 29).…”

Section: Risk Factors For Hemoptysis Following Transthoracic Needle Bmentioning

confidence: 51%

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Chassagnon

Grégory²,

Ahmar³

et al. 2017

Diagn Interv Radiol

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C omputed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a well-established method for investigating pulmonary nodules and masses. It offers a better diagnostic yield than bronchoscopy for the assessment of lung nodules and peripheral lesions (1, 2). Referral for CT-guided TTNB is expected to increase in the coming years. One reason is the higher proportion of adenocarcinomas among current lung cancers, which are more likely to be peripheral and not reachable by bronchoscopy (3, 4). Another reason is the recommendation of re-biopsy for molecular analysis of non-small cell lung cancers that progress or recur (5-7). Although TTNB is considered a safe and efficient method for obtaining a definite pathologic diagnosis, complications are reported in up to two-thirds of procedures (8, 9). The three main complications of TTNB are pneumothorax, alveolar hemorrhage, and hemoptysis. These complications are rarely life threatening, and pulmonary bleeding is usually self-resolving. However, severe hemoptysis can necessitate endobronchial tamponade, arterial embolization, or surgery (8, 10).It is important for the operator to be aware of potentially modifiable risk factors. Several modifiable risk factors for pneumothorax have been reported in the literature, including angle between needle and pleural surface (11), transpulmonary needle-path length (12, 13), patient position during the procedure (11), and operator's level of experience (12). A large pleural angle, a long needle path, the prone position, and limited expertise are all reported to increase the risk of pneumothorax. By contrast, data on risk factors for hemoptysis in this setting are scarce, and most published studies of transthoracic biopsy have combined alveolar hemorrhage and hemoptysis under the term "pulmonary bleeding. " Chakrabarti et al. (14) 347 C H E S T I MAG I N G O R I G I N A L A R T I C L E PURPOSEWe aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy. METHODSAll procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient-and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable. RESULTSA total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16-0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant ...

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Section: Risk Factors For Hemoptysis Following Transthoracic Needle Bmentioning

confidence: 51%

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Chassagnon

Grégory²,

Ahmar³

et al. 2017

Diagn Interv Radiol

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“…Our meta-analysis demonstrated an overall pneumothorax rate of just 1.0%, and an overall intercostal drain insertion rate of 0.4%. In comparison, many studies describing CT-PNB report pneumothorax rates .25% [49,[51][52][53][54], and as high as 69% [55], with many of these patients requiring admission or even intercostal catheter drainage. Pulmonary haemorrhage is less frequent, but still complicates 1-10% of CT-PNB [51,52].…”

Section: Discussionmentioning

confidence: 99%

Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis

Steinfort¹,

Khor²,

Manser³

et al. 2010

Eur Respir J

373

309

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Improved diagnostic sensitivity of bronchsocopy for the investigation of peripheral pulmonary lesions (PPLs) with the use of radial probe endobroncial ultrasound (EBUS) has been reported, although diagnostic performance varies considerably.A systematic review of published literature evaluating radial probe EBUS accuracy was performed to determine point sensitivity and specificity, and to construct a summary receiveroperating characteristic curve. Sub-group analysis and linear regression was used to identify possible sources of study heterogeneity.16 studies with 1,420 patients fulfilled inclusion criteria. Significant inter-study variation in EBUS method was noted. EBUS had point specificity of 1.00 (95% CI 0.99-1.00) and point sensitivity of 0.73 (95% CI 0.70-0.76) for the detection of lung cancer, with a positive likelihood ratio of 26.84 (12.60-57.20) and a negative likelihood ratio of 0.28 (0.23-0.36). Significant interstudy heterogeneity for sensitivity was observed, with prevalence of malignancy, lesion size and reference standard used being possible sources.EBUS is a safe and relatively accurate tool in the investigation of PPLs. Diagnostic sensitivity of EBUS may be influenced by the prevalence of malignancy in the patient cohort being examined and lesion size. Further methodologically rigorous studies on well-defined patient populations are required to evaluate the generalisability of our results.

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“…On the other hand, BTPNA might be a more appropriate choice for nodules in certain anatomical locations like centrally located nodules. In those cases, especially where two pleural planes need to be traversed, the transthoracic approach contains a high risk for the development of a pneumothorax [14]. Furthermore, the sensitivity of transthoracic needle aspiration drops with increasing distance between the nodule and the pleura [15].…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic Transparenchymal Nodule Access: Feasibility and Safety in an Endoscopic Unit

Harzheim¹,

Sterman

Shah³

et al. 2016

Respiration

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Background: The minimal invasive investigation of solitary pulmonary nodules becomes increasingly important with the emergence of lung cancer screening. Objectives: We report the results of the first utilization of a recently developed procedure in a bronchoscopy suite, which approaches solitary pulmonary nodules via a transparenchymal path. Methods: This study was a prospective, single-arm interventional study. We investigated patients with a solitary pulmonary nodule detected on CT imaging, which was suspicious for malignancy. The subject's CT was employed to calculate an airway wall point of entry (POE) as well as an avascular path through lung tissue from the POE to the solitary pulmonary nodule. Using a set of catheter-based tools under fused fluoroscopy guidance, a tunnelled tract was created from the POE to the nodule. The patients were surveyed for at least 72 h in our hospital. The primary end point of the study was to evaluate the feasibility to access and biopsy solitary pulmonary nodules outside of an operation theatre. Results: Six patients were recruited, and a tunnel pathway was created in 5 patients. There were no adverse events during the procedures. Two pneumothoraces were diagnosed by chest X-ray 2 h after the procedure, with one pneumothorax requiring drainage. Adequate biopsies were obtained from all 5 patients in whom a tunnel path was created. Conclusions: This study demonstrates that bronchoscopic transparenchymal access of solitary pulmonary nodules is feasible outside an operation theatre.

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Computed Tomography–Navigated Transthoracic Core Biopsy of Pulmonary Lesions

Cited by 89 publications

References 57 publications

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis

Bronchoscopic Transparenchymal Nodule Access: Feasibility and Safety in an Endoscopic Unit

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