Percutaneous CT-Guided Multisampling Core Needle Biopsy of Thoracic Lesions

Loubeyre, Pierre; Copercini, Michele; Dietrich, Pierre‐Yves

doi:10.2214/ajr.04.1344

Cited by 48 publications

(28 citation statements)

References 18 publications

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“…4,48 TTNA does have a 90% chance of confi rming a diagnosis (range, 76% to 90%), but some report a pneumothorax rate as high as 40%. 4,5,[49][50][51][52][53][54][55][56][57] Additionally, the diagnostic yield is infl uenced by the size of the lesion, the size of the needle, the number of passes, and the presence of rapid on-site evaluation. 4,5,[53][54][55][56] The location of the lesion in the lungs, peripheral vs central, may also infl uence the diagnostic yield of TTNA.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

Memoli

Nietert

Silvestri

2012

Chest

564

496

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385 PULMONARY PROCEDURESsuspicious for lung cancer. 2 With the fi ndings of the NLST indicating a reduction in lung-cancer-specifi c mortality with CT scanning in at-risk people, the number of patients diagnosed with a PN could increase substantially if screening for lung cancer is broadly T he pulmonary nodule (PN) is becoming an increasingly common radiographic fi nding among patients in the United States. Nearly 45 million CT scan examinations are performed each year, and 11% to 30% (4.5-14 million) of those include an examination of the chest. 1 In the recently released National Cancer Institute-sponsored National Lung Screening Trial (NLST), . 25% of the group who underwent lowdose CT scans of the chest had examinations that were Background: The detection of pulmonary nodules (PNs) is likely to increase, especially with the release of the National Lung Screen Trials. When tissue diagnosis is desired, transthoracic needle aspiration (TTNA) is recommended. Several guided-bronchoscopy technologies have been developed to improve the yield of transbronchial biopsy for PN diagnosis: electromagnetic navigation bronchoscopy (ENB ), virtual bronchoscopy (VB), radial endobronchial ultrasound (R-EBUS), ultrathin bronchoscope, and guide sheath. We undertook this meta-analysis to determine the overall diagnostic yield of guided bronchoscopy using one or a combination of the modalities described here. Methods: We performed a MEDLINE search using "bronchoscopy" and "solitary pulmonary nodule." Studies evaluating the diagnostic yield of ENB, VB, R-EBUS, ultrathin bronchoscope, and/or guide sheath for peripheral nodules were included. The overall diagnostic yield and yield based on size were extracted. Adverse events, if reported, were recorded. Meta-analysis techniques incorporating inverse variance weighting and a random-effects meta-analysis approach were used. Results: A total of 3,052 lesions from 39 studies were included. The pooled diagnostic yield was 70%, which is higher than the yield for traditional transbronchial biopsy. The yield increased as the lesion size increased. The pneumothorax rate was 1.5%, which is signifi cantly smaller than that reported for TTNA. Conclusion: This meta-analysis shows that the diagnostic yield of guided bronchoscopic techniques is better than that of traditional transbronchial biopsy. Although the yield remains lower than that of TTNA, the procedural risk is lower. Guided bronchoscopy may be an alternative or be complementary to TTNA for tissue sampling of PN, but further study is needed to determine its role in the evaluation of peripheral pulmonary lesions.CHEST 2012; 142(2):385-393Abbreviations: ENB 5 electromagnetic navigation bronchoscopy; NLST 5 National Lung Screening Trial; PN 5 pulmonary nodule; R-EBUS 5 radial endobronchial ultrasound; TTNA 5 transthoracic needle aspiration; VB 5 virtual bronchoscopy

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

Memoli

Nietert

Silvestri

2012

Chest

564

496

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“…Kim et al reported that a tumor was located in the right side in six of seven patients with thoracic Castleman's disease. 8 Although Loubeyre et al 23 reported that they diagnosed pulmonary Castleman's disease using core needle biopsy, preoperative needle biopsy was carried out in six cases of chest wall mass; the results were nondiagnostic in all cases. All patients except ours underwent surgical exploration and subsequent removal of the mass by thoracotomy or median sternotomy.…”

Section: Discussionmentioning

confidence: 99%

Chest wall Castleman's disease: CT and MRI findings

et al. 2006

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Castleman's disease is an usually benign lymphoid tumor of uncertain etiology that generally appears as a solitary mediastinal mass. We present a case of Castleman's disease in the right chest wall of a 60-year-old woman. Magnetic resonance imaging showed a well-defined, oval mass that was early enhanced on T1-weighted images. The mass was diagnosed by percutaneous core needle biopsy with computed tomography guidance. The patient has remained well for 5 years without an increase in tumor size. We also summarize the international literature.

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“…In high-volume experienced centers, typical yield can exceed 90% for both malignant and benign lesions (24,25). Core biopsies are preferred to FNA because of their higher yield, but more importantly biopsies allow evaluation of tissue architecture, and provide sufficient material for immunohistochemistry and genetic analyses.…”

Section: Ct-guided Fine-needle Aspiration and Biopsymentioning

confidence: 99%

Management of CT screen-detected lung nodule: the thoracic surgeon perspective

Al-Ayoubi¹,

Flores²

2016

Ann. Transl. Med.

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Implementation of lung cancer CT screening programs will increase the incidence of pulmonary nodules and require multidisciplinary efforts for devising appropriate treatment plans. The role of the thoracic surgeon is paramount in leading the discussion and shaping the treatment strategies. Management of CT screendetected lung nodules differ from conventional lung cancer nodules given their smaller size, varied histologies and potentially indolent growth. Here we present a brief overview of the thoracic surgeon's perspective on the clinical evaluation, diagnostic tests and surgical approach to these nodules in the setting of a comprehensive lung cancer screening program. Management of CT screen-detected lung nodule: the thoracic surgeon perspectiveIn the advent of lung cancer CT screening era, increased identification of small lesions warrants further assessment and referral to thoracic specialists for decision making plans. Thoracic surgeons are expected to play a pivotal role in the care and management of these patients, engaging in a leadership role within a multidisciplinary group encompassing primary care practitioners, medical oncologists, pulmonologists, pathologists, radiologists, in addition to thoracic surgeons. Unlike established protocols for management of lung cancer, CT screen-detected pulmonary nodules are often smaller, have variable solid component and may have indolent histologies that require reassessment of our approach. No guidelines currently exist for the evaluation of CT screen-detected lung nodules and management algorithms are still evolving. Here we provide a brief synthesis of the current evidence and present our approach to this problem. Understanding that every patient represents a unique case to be thoroughly assessed and evaluated, we aim to simplify the information offered to serve as a broad guideline to be implemented and adjusted according to personal experiences and institutional preferences. Our approach is centered on two guiding principles: (I) determine the risk of malignancy of the screen-detected lung nodule and (II) determine the medical fitness of the patient to undergo surgical intervention. Determining the risk of malignancyMany quantitative models have been proposed to determine the malignancy risk of a CT-screen detected lung nodule, all of which utilize a combination of clinical and radiographic data to generate a probability score. Accordingly, a nodule would fall into one of three categories: low, intermediate and high probability for malignancy. While no model claims superior predictive ability, most of them remain uncommonly used in clinical practice, and therefore we will avoid elaboration on their different attributes in this discussion. In the setting of a comprehensive lung cancer CT screening program, multidisciplinary evaluation can comfortably replace these models and provide practical algorithms for further workup. Initial evaluationEvery patient referred for a CT-screen detected lung nodule should undergo a thorough and systematic evaluation...

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Percutaneous CT-Guided Multisampling Core Needle Biopsy of Thoracic Lesions

Abstract: Percutaneous CT-guided coaxial multisampling large CNB of suspected thoracic lesions, in a mainly cancer-based population, is an accurate procedure for a specific histologic diagnosis and has a low rate of complications.

Cited by 48 publications

References 18 publications

Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

Chest wall Castleman's disease: CT and MRI findings

Management of CT screen-detected lung nodule: the thoracic surgeon perspective

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