Innovative technique for CT-guided lung nodule/tumor marking prior to surgery: high efficacy and low complication rates

Abstract Background Preoperative computed tomography (CT)-guided localization has been shown to significantly improve lung nodule video-assisted thoracoscopic surgery (VATS)-based wedge resection technical success rates. However, at present, there was insufficient research regarding the optimal approaches to localization of these nodules prior to resection. We aimed to compare the relative clinical efficacy of preoperative CT-guided methylene blue and coil-based lung nodule localization. Methods In total, 91 patients with lung nodules were subjected to either CT-guided methylene blue (n = 34) or coil (n = 57) localization and VATS resection from January 2014 to December 2018. We compared baseline data, localization-associated complication rates, as well as the technical success of localization and resection between these two groups of patients. Results In total, 42 lung nodules in 34 patients underwent methylene blue localization, with associated localization and wedge resection technical success rates of 97.6 and 97.6%, respectively. A total of 71 lung nodules in 57 patients underwent coil localization, with associated localization and wedge resection technical success rates of 94.4 and 97.2%, respectively. There were no significant differences in technical success rates of localization or wedge resection between these groups (p = 0.416 and 1.000, respectively). The coil group sustained a longer duration between localization and VATS relative to the methylene blue group (13.2 vs. 2.5 hours, p = 0.003). Conclusion Both methylene blue and coil localization can be safely and effectively implemented for conducting the diagnostic wedge resection of lung nodules. The coil-based approach is compatible with a longer period of time between localization and VATS procedures.

Download Full-text

Implementation of ultra-low-dose lung protocols in CT-guided lung biopsies: feasibility and safety in the clinical setting

Journal of International Medical Research ◽

10.1177/0300060517712165 ◽

2017 ◽

Vol 45 (6) ◽

pp. 2101-2109 ◽

Cited By ~ 3

Author(s):

Barbara K Frisch ◽

Karin Slebocki ◽

Kamal Mammadov ◽

Michael Puesken ◽

Ingrid Becker ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Low Dose ◽

Standard Dose ◽

Complication Rates ◽

Dose Length Product ◽

Ct Guided ◽

Total Radiation Dose ◽

Lung Biopsies ◽

Histological Results

Objective To evaluate the use of ultra-low-dose computed tomography (ULDCT) for CT-guided lung biopsy versus standard-dose CT (SDCT). Methods CT-guided lung biopsies from 115 patients (50 ULDCT, 65 SDCT) were analyzed retrospectively. SDCT settings were 120 kVp with automatic mAs modulation. ULDCT settings were 80 kVp with fixed exposure (20 mAs). Two radiologists evaluated image quality (i.e., needle artifacts, lesion contouring, vessel recognition, visibility of interlobar fissures). Complications and histological results were also evaluated. Results ULDCT was considered feasible for all lung interventions, showing the same diagnostic accuracy as SDCT. Its mean total radiation dose (dose–length product) was significantly reduced to 34 mGy-cm (SDCT 426 mGy-cm). Image quality and complication rates ( P = 0.469) were consistent. Conclusions ULDCT for CT-guided lung biopsies appears safe and accurate, with a significantly reduced radiation dose. We therefore recommend routine clinical use of ULDCT for the benefit of patients and interventionalists.

Download Full-text

CT-guided cryoablation of primary and metastatic lung tumors: low recurrence and complication rates

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2016.12.798 ◽

2017 ◽

Vol 28 (2) ◽

pp. S86 ◽

Cited By ~ 1

Author(s):

H Aoun ◽

P Littrup ◽

F Memon ◽

B Adam ◽

M Prus

Keyword(s):

Lung Tumors ◽

Complication Rates ◽

Ct Guided ◽

Metastatic Lung

Download Full-text

Feasibility and safety of percutaneous computed tomography guided radiofrequency ablation of lymph nodes in oligometastatic patients: a single center’s experience

British Journal of Radiology ◽

10.1259/bjr.20200445 ◽

2021 ◽

Vol 94 (1121) ◽

pp. 20200445

Author(s):

Dimitrios Filippiadis ◽

George Charalampopoulos ◽

Athanasios Tsochatzis ◽

Lazaros Reppas ◽

Argyro Mazioti ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Lymph Nodes ◽

Clinical Success ◽

Complete Response ◽

Tumor Control ◽

Complication Rates ◽

Ct Guided ◽

Female Ratio ◽

Contrast Enhanced Ct ◽

The Mean

Objectives: To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. Methods: Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40–87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded. Results: Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure. Conclusion: CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy. Advances in knowledge: With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.

Download Full-text

Computed Tomography-Guided Radiofrequency Thermocoagulation of the Gasserian Ganglion Using an Alternative to Hartel Anterior Approach: A Bicentral Study

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/293 ◽

2020 ◽

Vol 3;23 (6;3) ◽

pp. 293-298 ◽

Cited By ~ 1

Author(s):

Dimitrios K. Filippiadis

Keyword(s):

Computed Tomography ◽

Pain Relief ◽

Anterior Approach ◽

Anatomic Variation ◽

Control Group ◽

Complication Rates ◽

Gasserian Ganglion ◽

Ct Guided ◽

Radiofrequency Thermocoagulation ◽

Number Of Patients

Background: Trigeminal neuralgia (TN) is associated with multiple mechanisms involving peripheral and central nervous system pathologies. Among percutaneous treatments offered, radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostly due to anatomic variation, cannulation of the foramen ovale using the Hartel approach has a failure rate of 5.17%. Objectives: To report safety and efficacy of continuous RFT with an alternative to Hartel anterior approach under computed tomography (CT) guidance in patients with classic TN. Study Design: Retrospective institutional database review; bicentral study. Setting: Although this was a retrospective database research, institutional review board approval was obtained. Methods: Institutional database review identified 10 patients (men 8, women 2) who underwent CT-guided RFT of the Gasserian ganglion. Preoperational evaluation included physical examination and magnetic resonance imaging. Under anesthesiology control and local sterility measures, a radiofrequency needle was advanced, and its approach was evaluated with sequential CT scans. Motor and sensory electrostimulation tests evaluated correct electrode location. Pain prior, 1 week, 1, 3, and 6 months after were compared by means of a numeric visual scale (NVS) questionnaire. Results: Mean self-reported pain NVS score prior to RFT was 9.2 ± 0.919 units. One week after the RFT mean NVS score was 1.10 ± 1.287 units (pain reduction mean value of 8.1 units). At 3 and 6 months after thermocoagulation the mean NVS score was 2.80 ± 1.549 units and 2.90 ± 1.370 units, respectively. There were no postoperative complications. Three patients experienced facial numbness, which gradually resolved over a period of 1 month. Limitations: Retrospective nature; small number of patients; lack of a control group undergoing a different treatment of TN. Conclusions: Percutaneous CT-guided RFT of the Gasserian ganglion constitutes a safe and efficacious technique for the treatment of TN, with significant pain relief and minimal complication rates improving life quality in this group of patients. Key words: Trigeminal nerve, neuralgia, pain, radiofrequency, ablation, percutaneous, computed tomography, imaging

Download Full-text

Ectopic spleen presenting as a slowly enlarging lung nodule in the right lower lobe following gastric pull up operation

BMJ Case Reports ◽

10.1136/bcr-2020-237912 ◽

2021 ◽

Vol 14 (2) ◽

pp. e237912

Author(s):

Anas Alfahad ◽

Rima Hussain ◽

Mamatha Devaraj ◽

Alexandr Svec

Keyword(s):

Case Report ◽

Oesophageal Cancer ◽

Lung Nodule ◽

Lower Lobe ◽

Ct Guided ◽

Ectopic Spleen ◽

Guided Biopsy ◽

Ct Guided Biopsy ◽

The Right ◽

Gastric Pull Up

This is a case report of an elderly man who was investigated at our respiratory clinic for slowly enlarging right lower lobe lung nodule on the background of oesophageal cancer diagnosed more than 11 years ago with gastric pull up. CT guided biopsy confirms the diagnosis of intrathoracic ectopic spleen.

Download Full-text

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.

Download Full-text

P1.03-012 Experience with BioSentryTM Tract Sealant System for Percutaneous CT-Guided Lung Nodule Biopsies in an Oncology Population

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2016.11.683 ◽

2017 ◽

Vol 12 (1) ◽

pp. S549-S550

Author(s):

Patricia De Groot ◽

Girish Shroff ◽

Judy Ahrar ◽

Garrett Gladish ◽

Bradley Sabloff ◽

...

Keyword(s):

Lung Nodule ◽

Ct Guided

Download Full-text

The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience

Acta Radiologica ◽

10.1080/02841850701416528 ◽

2007 ◽

Vol 48 (7) ◽

pp. 806-813 ◽

Cited By ~ 30

Author(s):

H. Egilmez ◽

I. Oztoprak ◽

M. Atalar ◽

A. Cetin ◽

C. Gumus ◽

...

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrostomy ◽

Complication Rates ◽

Safe Procedure ◽

Single Center ◽

Macroscopic Hematuria ◽

Ct Guided ◽

Single Center Experience ◽

Major Complications ◽

Inpatient Settings

Background: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging. Purpose: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center. Material and Methods: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications. Results: PCN procedures were performed via 1–3 punctures in patients with grades 0–1 and 2 hydronephrosis, and via 1–2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0–1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure. Conclusion: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis.

Download Full-text