The PEARL Approach for CT-guided Lung Biopsy: Assessment of                     Complication Rate

Najafi, Arash; Ahmar, Marc Al; Bonnet, Baptiste; Delpla, Alexandre; Kobe, Adrian; Madani, Khaled; Roux, Charles; Deschamps, Frédèric; Baère, Thierry De; Tsélikas, Lambros

doi:10.1148/radiol.2021210360

Cited by 26 publications

(13 citation statements)

References 30 publications

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“…The diagnostic yields for tissue diagnosis and molecular profiling that we achieved are at least similar to those reported for advanced endoscopy-based and CT-based biopsy methods [ 19 , 20 , 21 , 22 , 23 ] but with a much better safety profile [ 23 , 24 , 25 , 26 ]. No currently available studies aiming at assessing the role of US-NAB for the diagnosis of superficial metastases reported clinically important complications [ 9 , 10 , 11 ].…”

Section: Discussionsupporting

confidence: 74%

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial

Livi

Sotgiu

Cancellieri

et al. 2022

Cancers

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Background and Objective: Studies which evaluated the role of an ultrasound-guided needle aspiration biopsy (US-NAB) of metastases from lung cancer located in “superficial” organs/tissues are scant, and none of them assessed the possible impact of rapid on-site evaluation (ROSE) on diagnostic accuracy and safety outcomes. Methods: Consecutive patients with suspected superficial metastases from lung cancer were randomized 1:1 to US-NAB without (US-NAB group) or with ROSE (ROSE group). The diagnostic yield for a tissue diagnosis was the primary outcome. Secondary outcomes included the diagnostic yield for cancer genotyping, the diagnostic yield for PD-L1 testing, and safety. Results: During the study period, 136 patients were randomized to receive an US-NAB with (n = 68) or without ROSE (n = 68). We found no significant differences between the ROSE group and the US-NAB group in terms of the diagnostic yields for tissue diagnosis (94.1% vs. 97%, respectively; p = 0.68), cancer genotyping (88% vs. 91.8%, respectively; p = 0.56), and PD-L1 testing (93.5% vs. 90.6%, respectively; p = 0.60). Compared to the diagnostic US-NAB procedures, the non-diagnostic procedures were characterized by less common use of a cutting needle (66.6% vs. 96.9%, respectively; p = 0.0004) and less common retrieval of a tissue core (37.5% vs. 98.5%; p = 0.0001). Only one adverse event (vasovagal syncope) was recorded. Conclusion: US-NAB of superficial metastases is safe and has an excellent diagnostic success regardless of the availability of ROSE. These findings provide a strong rationale for using US-NAB as the first-step method for tissue acquisition whenever a suspected superficial metastatic lesion is identified in patients with suspected lung cancer.

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Section: Discussionsupporting

confidence: 74%

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial

Livi

Sotgiu

Cancellieri

et al. 2022

Cancers

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“…Many techniques have been proposed to decrease the rate of pneumothorax before (needle track/approach) and during the procedure (blood patch, three instances of withdrawal, removal of the needle during expiration and rapid needle-out patient-rollover time approach defined as the time between removal of the biopsy needle and placing the patient biopsy-side down). Recently, N ajafi et al [ 18 ] reported the PEARL approach showing that such a method significantly reduced the frequency of pneumothorax requiring drainage. The PEARL approach combines patient positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover and pleural patching.…”

Section: Discussionmentioning

confidence: 99%

“…However, many techniques could be proposed to increase diagnostic performances: particularly the control of the needle deployed inside the nodule to check the site of the cutting part (which is feasible with semi-automatic biopsy needles) and the guidance according to respiration cycle with control of the needle always at the same time (generally expiration). 18 F-FDG PET/CT could be helpful in this regard for necrotic tumors to select a non-necrotic area for the biopsy.…”

Section: Diagnostic Performancesmentioning

confidence: 99%

Transthoracic lung biopsy for pulmonary nodules ≤20 mm in routine clinical care

et al. 2021

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BACKGROUNDComputed tomography (CT) screening has improved lung cancer survival, yet increasingly detected small lung lesions. The number of transthoracic lung biopsies (TTLB) for small nodules is thus expected to rise significantly.RESEARCH QUESTIONTo evaluate the diagnostic accuracy and safety of CT-guided TTLB for nodules ≤20 mm versus nodules >20mm.STUDY DESIGN AND METHODSData for CT-guided TTLBs from 474 consecutive patients were prospectively collected over a 3-year period (198 lesions ≤20 mm and 276 lesions >20 mm) in a teaching hospital and analysed in terms of diagnostic performance and complications.RESULTSThere were more conclusive biopsies in the >20 mm lesion group (n=236; 85.5%) than in ≤20 mm lesion group (n=140; 70.7%; p<0.001). The overall accuracy, sensitivity, specificity, and negative predictive value for diagnosing malignant lesions after first TTLB were 88.4%, 84%, 100%, and 70.1% for ≤20 mm lesions and 94.2%, 93%, 100%, and 74.6% for >20 mm lesions, respectively. Pneumothorax requiring drainage was significantly more common for ≤20 mm lesions, compared to TTLB of larger lesions (9.6% versus 4.3%; p=0.02). Prolonged hospital stay due to pneumothorax occurred in 27 (17.4%) TTLBs of ≤20 mm lesions and 15 (7%) TTLBs of >20mm lesions (p=0.002). There were no deaths. The only variable significantly associated with diagnostic failure in the ≤20mm lesion group was the radiologist's experience.INTERPRETATIONTTLBs for lesions ≤20 mm were associated with slightly lower diagnostic performance, whereas the higher rate of major complications was still inferior to that extrapolated from United States insurance databases.

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“…Even more interestingly a chest tube was inserted in 13% in the control group and only 1% in the PEARL group (P = 0.002). 34 Comparison with surgery and SBRT Percutaneous thermal ablation is particularly attractive in the setting of oligometastatic disease, where resection of all tumours is often not feasible, and especially central ones that will require extended anatomic resection. Direct comparison in between thermal ablation of lung metastases and other local treatment are scarce, without any randomized trial available.…”

Section: Complications and Side Effectsmentioning

confidence: 99%

The percutaneous management of pulmonary metastases

de Baere,

Bonnet,

Tselikas

et al. 2023

J Med Imag Rad Onc

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SummaryLocal treatment of lung metastases has been in the front scene since late 90s when an international registry of thoracic surgery reported a median overall survival of 35 months in resected patients versus 15 months in non‐resected patients. Today, other local therapies are available for patients with oligometastatic lung disease, including image guided thermal ablation, such as ablation, microwave ablation, and cryoablation. Image‐guided ablation is increasingly offered, and now recommended in guidelines as option to surgery. Today, the size of the target tumour remains the main driver of success and selection of patients with limited tumour size allowing for local tumour control in the range of 90% in most recent and larger series targeting lung metastases up to 3.5 cm. Overall survival exceeding five‐years in large series of thermal ablation for lung metastases from colorectal origin are align with outcome of same patients treated with surgical resection. Moreover, thermal ablation in such population allows for one‐year chemotherapy holidays in all comers and over 18 months in lung only metastatic patients, allowing for improved patient quality of life and preserving further lines of systemic treatment when needed. Tolerance of thermal ablation is excellent and better than surgery with no lost in respiratory function, allowing for repeated treatment when needed. In the future, it is likely that practice of lung surgery for small oligometastatic lung disease will decrease, and that minimally invasive techniques will replace surgery in such indications. Randomized study will be difficult to obtain as demonstrated by discontinuation of many studies testing the hypothesis of surgery versus observation, or surgery versus SBRT.

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The PEARL Approach for CT-guided Lung Biopsy: Assessment of Complication Rate

Cited by 26 publications

References 30 publications

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial

Transthoracic lung biopsy for pulmonary nodules ≤20 mm in routine clinical care

The percutaneous management of pulmonary metastases

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