Nondiagnostic Computed Tomography–guided Percutaneous Lung Biopsies Are More Likely When Infection Is Suspected

Haas, Brian M.; Elicker, Brett M.; Nguyen, Janet; Ordovás, Karen; Jones, Kirk D.; Henry, Travis S.; Naeger, David M.

doi:10.1097/rti.0000000000000207

Cited by 17 publications

(15 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to these studies, we did not observe a significant change in the percentage of biopsies achieving a diagnostic result following implementation of a low dose protocol. We did observe a lower overall diagnostic biopsy rate, both before and after the protocol change, compared to the range reported in prior studies of 92% to 95.8%, which may be related to our classifying nonspecific pathologies such as inflammation as “non-diagnostic” [16]. Additionally, our group is asked to attempt biopsies on small lesions (<1cm) in cases where the possible clinical benefit outweighs the increased risk of a non-diagnostic result.…”

Section: Discussioncontrasting

confidence: 45%

Instituting a Low-dose CT-guided Lung Biopsy Protocol

et al. 2016

Self Cite

View full text Add to dashboard Cite

Rationale and Objectives We aimed to evaluate whether implementation of a low-dose CT-guided lung biopsy protocol, with the support of individual radiologists in the section, would lead to immediate and sustained decreases in radiation dose associated with CT-guided lung biopsies. Materials and Methods A low-dose CT-guided lung biopsy protocol was developed with modifications of kilovoltage peak (kVp), milliamperes (mA), and scan coverage. 413 CT guided lung biopsies were evaluated over a three-year period beginning in 2009, 175 performed with a standard protocol prior to development of a low dose protocol and 238 performed with a low dose protocol. The dose-length product (DLP) was recorded for each lung biopsy and retrospectively compared between the two protocols. Individual radiologist level DLPs were also compared before and after the protocol change. Results The mean biopsy dose decreased 64.4% with the low dose protocol (113.8 mGy-cm versus 319.7 mGy-cm; p <0.001). This decrease in radiation dose persisted throughout the entire 18 months evaluated following the protocol change. After the protocol change, each attending radiologist demonstrated a decrease in administered radiation dose. The diagnostic outcome rate and complication rate were unchanged over the interval. Conclusion Implementation of a low-dose CT-guided lung biopsy protocol resulted in an immediate reduction in patient radiation dose that was seen with all attending radiologists and persisted for at least 18 months. Such an intervention may be considered at other institutions wishing to reduce patient doses.

show abstract

Section: Discussioncontrasting

confidence: 45%

Instituting a Low-dose CT-guided Lung Biopsy Protocol

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Most previous studies of PTNBs in patients with suspected pulmonary infection assessed small series of predominantly immunocompromised patients with mainly fungal infections and reported causative organism identification rates of 36-80% (8,11,12,(18)(19)(20)(21)(22)(23)30). Although immunocompromised patients are predisposed to various infections and may incur more severe complications from delayed treatment than immunocompetent patients may, we often encounter immunocompetent patients with pulmonary infection of unidentified etiology.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of CT-Guided Percutaneous Transthoracic Needle Lung Biopsies in Patients with Suspected Pulmonary Infection

et al. 2020

View full text Add to dashboard Cite

This study aimed to evaluate the clinical benefits and risks of CT-guided percutaneous transthoracic needle lung biopsies (PTNBs) in patients with a suspected pulmonary infection. Materials and Methods: This study included 351 CT-guided PTNBs performed in 342 patients (mean age, 58.9 years [range, 17-91 years]) with suspected pulmonary infection from January 2010 to December 2016. The proportion of biopsies that revealed the causative organism for pulmonary infection and that influenced patient's treatment were measured. Multivariate analyses were performed to identify factors associated with PTNB that revealed the causative organism or affected the treatment. Finally, the complication rate was measured. Results: CT-guided PTNB revealed the causative organism in 32.5% of biopsies (114/351). The presence of necrotic components in the lesion (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.7; p = 0.028), suspected pulmonary tuberculosis (OR, 2.0; 95% CI, 1.2-3.5; p = 0.010), and fine needle aspiration (OR, 2.5; 95% CI, 1.1-5.8; p = 0.037) were factors associated with biopsies that revealed the causative organism. PTNB influenced patient's treatment in 40.7% (143/ 351) of biopsies. The absence of leukocytosis (OR, 1.9; 95% CI, 1.0-3.7; p = 0.049), presence of a necrotic component in the lesion (OR, 2.4; 95% CI, 1.5-3.8; p < 0.001), and suspected tuberculosis (OR, 1.7; 95% CI, 1.0-2.8; p = 0.040) were factors associated with biopsies that influenced the treatment. The overall complication rate of PTNB was 19% (65/351). Conclusion: In patients with suspected pulmonary infection, approximately 30-40% of CT-guided PTNBs revealed the causative organism or affected the treatment. The complication rate of PTNB for suspected pulmonary infection was relatively low.

show abstract

“…On the basis of the original pathologic reports, the site investigators categorized PTNB results as diagnostic or nondiagnostic (Table E1 [online]) while blinded to the final diagnosis and any other medical records other than the original pathologic reports. The categorization of PTNB results was prespecified as described in previous studies (5)(6)(7). Diagnostic results consisted of malignancy or specific benign results (5,7).…”

Section: Data Collectionmentioning

confidence: 99%

“…The categorization of PTNB results was prespecified as described in previous studies (5)(6)(7). Diagnostic results consisted of malignancy or specific benign results (5,7). Specific benignity was assigned when the results indicated specific benign diagnoses such as hamartoma or tuberculosis.…”

Section: Data Collectionmentioning

confidence: 99%

See 1 more Smart Citation

Nondiagnostic Percutaneous Transthoracic Needle Biopsy of Lung Lesions: A Multicenter Study of Malignancy Risk

Lee¹,

Lim²,

Suh³

et al. 2019

Radiology

View full text Add to dashboard Cite

To evaluate the malignancy risk of lung lesions that show nondiagnostic results at transthoracic needle biopsy (PTNB) of the lung and to identify any malignancy-associated risk factors in each nondiagnostic category. Materials and Methods: In this retrospective study, 9384 initial PTNBs (9239 patients [mean age, 65 years; age range, 20-99 years] consisting of 5729 men [mean age, 66 years; age range, 20-99 years] and 3510 women [mean age, 63 years; age range, 20-94 years]) were performed in eight institutions between January 2010 and December 2014. PTNB results were categorized as diagnostic (malignant or specifically benign) or nondiagnostic (nonspecific benign pathologic findings, atypical cells, or insufficient specimen), and the proportion of final malignant diagnoses per nondiagnostic category was obtained. Malignancy-associated factors were determined by using multivariable analyses. Results: Nondiagnostic results were present in 27.6% (2590 of 9384) of PTNBs. Proportions of final malignant diagnoses were 21.3% (339 of 1592) for nonspecific benignities, 90.1% (503 of 558) for atypical cells, and 46.6% (205 of 440) for insufficient specimens. In the nonspecific benign category, granulomatous inflammation (odds ratio [OR], 0.04; 95% confidence interval [CI]: 0.02, 0.12; P , .001), abscess (OR, 0.04; 95% CI: 0.01, 0.28; P = .001), and organizing pneumonia (OR, 0.05; 95% CI: 0.01, 0.23; P , .001) were demonstrated to be important factors negating malignancy. Atypical cells suspicious for malignancy were more associated with malignancy (OR, 6.3; 95% CI: 1.9, 21.0; P = .003) than were atypical cells of indeterminate malignancy. All 130 lesions with atypical cells suggestive of malignancy were finally malignant. Conclusion: After nondiagnostic lung biopsies, lesions categorized as atypical cell lesions have a high likelihood of malignancy, with somewhat lower likelihood for lesions with insufficient specimens and nonspecific benign categories.

show abstract

Nondiagnostic Computed Tomography–guided Percutaneous Lung Biopsies Are More Likely When Infection Is Suspected

Cited by 17 publications

References 18 publications

Instituting a Low-dose CT-guided Lung Biopsy Protocol

Instituting a Low-dose CT-guided Lung Biopsy Protocol

Usefulness of CT-Guided Percutaneous Transthoracic Needle Lung Biopsies in Patients with Suspected Pulmonary Infection

Nondiagnostic Percutaneous Transthoracic Needle Biopsy of Lung Lesions: A Multicenter Study of Malignancy Risk

Contact Info

Product

Resources

About