CT-guided biopsy of lung lesions: defining the best needle option for a specific diagnosis

Guimarães, Marcos Duarte; Marchiori, Edson; Hochhegger, Bruno; Chojniak, Rubens; Gross, Jefferson Luiz

doi:10.6061/clinics/2014(05)07

Cited by 24 publications

(24 citation statements)

References 22 publications

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“…However, as suggested by Tai et al (15), hemoptysis limited to hemorrhagic sputum may have been underreported. The higher rate of hemoptysis in our study may also be related to the use of cutting needles and a coaxial technique, which were found to increase the risk of bleeding in some series (15,16,23) but not in others (17,(23)(24)(25).…”

Section: Discussionmentioning

confidence: 53%

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: Discussionmentioning

confidence: 53%

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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“…Percutaneous transthoracic lung needle biopsy achieves a high technical success rate of 88–97% [ 4 , 8 – 13 ]. Our success rate of 84.1% is close to the reported range.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Technical Success and Rate of Complications of Image-Guided Percutaneous Transthoracic Lung Needle Biopsy of Pulmonary Tumors

et al. 2015

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PurposeTo investigate predictors of technical success and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of potentially malignant pulmonary tumors.Material and MethodsFrom 2008 to 2009, technical success and rate of complications of CT-guided percutaneous transthoracic lung needle biopsies of patients with suspicious pulmonary tumors were retrospectively evaluated. The influence on technical success and rate of complications was assessed for intervention-related predictors (lesion diameter, length of biopsy pathway, number of pleural transgressions, and needle size) and patient-related predictors (age, gender, reduced lung function). In addition, technical success and rate of complications were compared between different interventional radiologists.ResultsOne hundred thirty-eight patients underwent biopsies by 15 interventional radiologists. The overall technical success rate was 84.1% and was significantly different between interventional radiologists (range 25%-100%; p<0.01). Intervention-related and patient-related predictors did not influence the technical success rate. The overall complication rate was 59.4% with 39.1% minor complications and 21.0% major complications. The rate of complications was influenced by lesion diameter and distance of biopsy pathway. Interventional radiologist-related rates of complications were not statistically different.ConclusionsTechnical success of percutaneous, transthoracic lung needle biopsies of pulmonary tumors is probably dependent on the interventional radiologist. In addition, lesion diameter and length of biopsy pathway are predictors of the rate of complications.

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“…Indeed, inadequate biopsies can cause misdiagnosis and delay appropriate treatment. Functional imaging methods are essential for effective image-guided percutaneous biopsy and obviate the need for more invasive procedures for proper diagnosis and therapeutic planning 20 , 21 .…”

Section: Discussionmentioning

confidence: 99%

Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging

Guimarães¹,

Hochhegger²,

Benveniste³

et al. 2014

Clinics

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OBJECTIVES:To evaluate the preliminary results obtained using diffusion-weighted magnetic resonance imaging and the apparent diffusion coefficient for planning computed tomography-guided biopsies of selected mediastinal lesions.METHODS:Eight patients with mediastinal lesions suspicious for malignancy were referred for computed tomography-guided biopsy. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient measurement were performed to assist in biopsy planning with diffusion/computed tomography fused images. We selected mediastinal lesions that could provide discordant diagnoses depending on the biopsy site, including large heterogeneous masses, lesions associated with lung atelectasis or consolidation, lesions involving large mediastinal vessels and lesions for which the results of biopsy using other methods and histopathological examination were divergent from the clinical and radiological suspicion.RESULTS:In all cases, the biopsy needle was successfully directed to areas of higher signal intensity on diffusion-weighted sequences and the lowest apparent diffusion coefficient within the lesion (mean, 0.8 [range, 0.6–1.1]×10-3 mm2/s), suggesting high cellularity. All biopsies provided adequate material for specific histopathological diagnoses of four lymphomas, two sarcomas and two thymomas.CONCLUSION:Functional imaging tools, such as diffusion-weighted imaging and the apparent diffusion coefficient, are promising for implementation in noninvasive and imaging-guided procedures. However, additional studies are needed to confirm that mediastinal biopsy can be improved with these techniques.

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CT-guided biopsy of lung lesions: defining the best needle option for a specific diagnosis

Cited by 24 publications

References 22 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

Predictors of Technical Success and Rate of Complications of Image-Guided Percutaneous Transthoracic Lung Needle Biopsy of Pulmonary Tumors

Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging

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