Diagnostic yield and clinical impact of microbiologic diagnosis from CT-guided drainage in patients previously treated with empiric antibiotics

Abstract Purpose Apart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions. Methods In this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP). Results CTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies. Conclusion Use of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations. Level of Evidence Level 3.

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Factors influencing diagnostic yield of CT-guided percutaneous core needle biopsy for bone lesions

Clinical Radiology ◽

10.1016/j.crad.2013.09.003 ◽

2014 ◽

Vol 69 (1) ◽

pp. e43-e47 ◽

Cited By ~ 24

Author(s):

Y. Li ◽

Y. Du ◽

T.Y. Luo ◽

H.F. Yang ◽

J.H. Yu ◽

...

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Bone Lesions ◽

Ct Guided ◽

Core Needle ◽

Factors Influencing ◽

Percutaneous Core Needle Biopsy

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Development, technical validation, and clinical application of a multigene panel for hereditary gastrointestinal cancer and polyposis

Tumori Journal ◽

10.1177/0300891619847085 ◽

2019 ◽

Vol 105 (4) ◽

pp. 338-352 ◽

Cited By ~ 2

Author(s):

Maria Teresa Ricci ◽

Sara Volorio ◽

Stefano Signoroni ◽

Paolo Mariani ◽

Frederique Mariette ◽

...

Keyword(s):

Gastrointestinal Cancer ◽

Diagnostic Yield ◽

Clinical Impact ◽

Clinical Genetics ◽

Single Nucleotide Variants ◽

Single Nucleotide ◽

Panel Testing ◽

Technical Validation ◽

Sensitivity Specificity ◽

Multigene Panel

Introduction: Recent advances in technology and research are rapidly changing the diagnostic approach to hereditary gastrointestinal cancer (HGIC) syndromes. Although the practice of clinical genetics is currently transitioning from targeted criteria-based testing to multigene panels, important challenges remain to be addressed. The aim of this study was to develop and technically validate the performance of a multigene panel for HGIC. Methods: CGT-colon-G14 is an amplicon-based panel designed to detect single nucleotide variants and small insertions/deletions in 14 well-established or presumed high-penetrance genes involved in HGIC. The assay parameters tested were sensitivity, specificity, accuracy, and inter-run and intra-run reproducibility. Performance and clinical impact were determined using 48 samples of patients with suspected HGIC/polyposis previously tested with the targeted approach. Results: The CGT-colon-G14 panel showed 99.99% accuracy and 100% inter- and intra-run reproducibility. Moreover, panel testing detected 1 actionable pathogenic variant and 16 variants with uncertain clinical impact that were missed by the conventional approach because they were located in genes not previously analyzed. Conclusion: Introduction of the CGT-colon-G14 panel into the clinic could provide a higher diagnostic yield than a step-wise approach; however, results may not always be straightforward without the implementation of new genetic counseling models.

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Initial Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Lesions Performed by a Pulmonologist

Journal of Clinical Medicine ◽

10.3390/jcm8060821 ◽

2019 ◽

Vol 8 (6) ◽

pp. 821 ◽

Cited By ~ 2

Author(s):

June Hong Ahn ◽

Jong Geol Jang

Keyword(s):

Diagnostic Accuracy ◽

Complication Rate ◽

Predictive Value ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Safe Procedure ◽

Transthoracic Needle Biopsy ◽

Ct Guided ◽

Lung Lesions ◽

Percutaneous Transthoracic Needle Biopsy

In the diagnosis of lung lesions, computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) has a high diagnostic yield and a low complication rate. The procedure is usually performed by interventional radiologists, but the diagnostic yield and safety of CT-guided PTNB when performed by pulmonologists have not been evaluated. A retrospective study of 239 patients who underwent CT-guided PTNB at Yeungnam University Hospital between March 2017 and April 2018 was conducted. A pulmonologist performed the procedure using a co-axial technique with a 20-gauge needle. Then diagnostic yield and safety were assessed. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of malignancy were 96.1% (171/178), 100% (46/46), 100% (171/171), and 86.8% (46/53), respectively. The diagnostic accuracy was 96.9% (217/224) and the overall complication rate was 33.1% (82/248). Pneumothorax, hemoptysis, and hemothorax occurred in 27.0% (67/248), 5.2% (13/248), and 0.8% (2/248) of the patients, respectively. Univariate analyses revealed that pneumothorax requiring chest tube insertion was a significant risk factor (odds ratio, 25.0; p < 0.001) for diagnostic failure. CT-guided PTNB is a safe procedure with a high diagnostic accuracy, even when performed by an inexperienced pulmonologist. The results were similar to those achieved by interventional radiologists as reported in previously published studies.

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Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa029 ◽

2020 ◽

Author(s):

Gabrielle M Haeusler ◽

Richard De Abreu Lourenco ◽

Hannah Clark ◽

Karin A Thursky ◽

Monica A Slavin ◽

...

Keyword(s):

Febrile Neutropenia ◽

Bloodstream Infection ◽

Healthcare Workers ◽

Diagnostic Yield ◽

Infectious Complications ◽

Blood Cultures ◽

Children With Cancer ◽

Persistent Fever ◽

Empiric Antibiotics ◽

Clinical Instability

Abstract Background The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics. Methods Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken. Results A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures. Conclusions In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.

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FNA and CNB in the Diagnosis of Pulmonary Lesions: A Single-center Experience on 665 Patients, Comparison between Two Periods

Tumori Journal ◽

10.5301/tj.5000633 ◽

2017 ◽

Vol 103 (4) ◽

pp. 360-366 ◽

Cited By ~ 2

Author(s):

Alfonso Vittorio Marchianò ◽

Maria Cosentino ◽

Giuseppe Di Tolla ◽

Francesca Gabriella Greco ◽

Mario Silva ◽

...

Keyword(s):

Needle Biopsy ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Complication Rates ◽

Multivariate Logistic Regression ◽

Ct Guided ◽

Fine Needle ◽

Pulmonary Lesions ◽

Single Center Experience ◽

Lung Biopsies

Purpose To evaluate the diagnostic yield and complication rate of 2 different biopsy techniques (fine-needle aspiration, FNA, and core-needle biopsy, CNB) in the diagnosis of pulmonary lesions in 2 distinct periods, 2010-2012 and 2013-2015. Methods We retrospectively analyzed the results of 691 CT-guided lung biopsies in 665 patients who were divided into 2 groups: cohort 1 (January 2010 to December 2012) was composed of 271 consecutive patients with 284 procedures either by FNA or CNB; cohort 2 (January 2013 to December 2015) was composed of 394 patients with 407 CNBs. Univariate and multivariate logistic regression modeling was used for selected outcomes including diagnostic yield, bleeding and pneumothorax. Results Cohort 1 comprised 165 men and 106 women (mean age 68.5 years) with 180 FNAs and 104 CNBs; cohort 2 comprised 229 men and 165 women (mean age 66.4 years) with 407 CNBs. The diagnostic yield increased in cohort 2 with respect to cohort 1. There was a slight increase in CT procedure complications (pneumothorax and bleeding) from cohort 1 to cohort 2. The overall risk of complications was greater for lesions <20 mm and for lesions at >20 mm distance from the pleura. Conclusions CT-guided CNB had a higher diagnostic yield than discretional use of either FNA or CNB; there was a slight but acceptable increase in complication rates.

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CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy.

American Journal of Roentgenology ◽

10.2214/ajr.172.5.10227522 ◽

1999 ◽

Vol 172 (5) ◽

pp. 1389-1392 ◽

Cited By ~ 72

Author(s):

S G Leffler ◽

F S Chew

Keyword(s):

Diagnostic Yield ◽

Percutaneous Biopsy ◽

Bone Lesions ◽

Ct Guided ◽

Sclerotic Bone ◽

Sclerotic Bone Lesions

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Clinical Outcome of ET-743 (Trabectedin; Yondelis) in High-Grade Uterine Sarcomas: Report on Five Patients and a Review of the Literature

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e31819c0f59 ◽

2009 ◽

Vol 19 (2) ◽

pp. 245-248 ◽

Cited By ~ 18

Author(s):

Frédéric Amant ◽

An Coosemans ◽

Vincent Renard ◽

Els Everaert ◽

Ignace Vergote

Keyword(s):

Clinical Benefit ◽

Response Rate ◽

Uterine Sarcoma ◽

Current Data ◽

Clinical Impact ◽

High Grade ◽

Review Of The Literature ◽

Uterine Sarcomas ◽

Previously Treated ◽

Undifferentiated Uterine Sarcoma

AbstractThe clinical impact of ET-743 (trabectedin; Yondelis) in women with leiomyosarcoma and undifferentiated uterine sarcoma in patients previously treated with chemotherapy is investigated. Current data show a clinical benefit in 2/5 patients, of which 1 had a partial remission during 9 months. Pooling the treatment outcomes with literature data, a response in 5 (38%) of 13 patients and a clinical benefit in 7 (54%) of 13 patients for all high-grade uterine sarcomas is calculated. When only uterine leiomyosarcomas are concerned, response rate is 5 (45%) of 11 patients with a clinical benefit in 7 (64%) of 11 patients. These results on the use of ET-743 in uterine sarcoma patients support the conductance of larger trials.

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