Fluoroscopy-guided percutaneous lung biopsy: a valuable alternative to computed tomography

2008 ◽  
Vol 49 (8) ◽  
pp. 876-882 ◽  
Author(s):  
L. A. Kurban ◽  
L. Gomersall ◽  
J. Weir ◽  
P. Wade
Keyword(s):  
Computed Tomography ◽  
Lung Biopsy ◽  
Computer Software ◽  
Complication Rates ◽  
Ct Guided ◽  
Alternative Modality ◽  
Chest X Ray ◽  
Percutaneous Lung Biopsy ◽  
The Mean ◽  
Lung Biopsies

Background: Computed tomography (CT) fluoroscopy nowadays is the most preferred method of guidance to perform percutaneous lung biopsy of pulmonary masses. Conventional fluoroscopy is an increasingly forgotten technique that still can be used to perform lung biopsies, with many advantages. Purpose: To compare the accuracy, safety, and effective dose (ED) of conventional fluoroscopy-guided needle lung biopsy (FNLB) with CT-guided needle lung biopsy procedures (CTNLB) reported in the literature. Material and Methods: 100 consecutive patients who underwent FNLB were reviewed retrospectively. Using the final histological diagnoses and the clinical and radiological course of the disease as references, the accuracy and sensitivity of FNLB were calculated. The complication rates of FNLB were assessed. Using computer software (XDOSE), the ED was calculated. The accuracy, complication rates, and the ED of FNLB were compared with CTNLB reported in the literature. Results: The overall accuracy rate and sensitivity of FNLB were both 87%, which are comparable to the range of accuracies reported in the literature for CTNLB (74–97%). The complication rates of FNLB were also comparable to the complication rates reported for CTNLB. The commonest complication was pneumothorax, at a rate of 25%. The ED of FNLB was small, significantly lower than reported in the literature for CT-guided procedures. The mean ED of FNLB was 0.029 mSv, which is approximately equivalent to one chest X-ray. Conclusion: Conventional fluoroscopy is an accurate, safe, and low-dose alternative modality to CT to obtain an image-guided histological diagnosis of pulmonary lesions.

Effectiveness of Ultrasound-Guided Radiofrequency Ablation in the Treatment of 36 Renal Cell Carcinoma Tumours Compared with Published Results of Using Computed Tomography Guidance

2012 ◽  
Vol 63 (3_suppl) ◽  
pp. S23-S32 ◽  
Author(s):  
Kellie Davis ◽  
Ania Kielar ◽  
Katayoun Jafari
Keyword(s):  
Computed Tomography ◽  
Radiofrequency Ablation ◽  
Residual Disease ◽  
Tumour Size ◽  
Complication Rates ◽  
Ct Guided ◽  
Renal Lesions ◽  
Contrast Enhanced Ct ◽  
The Mean

This study aimed to analyse the outcomes of ultrasound (US) guided radiofrequency ablation (RFA) in patients with renal lesions and to compare our outcomes with published results of ablations carried out when using computed tomography (CT) guidance. This retrospective study evaluated RFA of 36 renal tumours in 32 patients (M = 21, F = 11). The mean patient age was 70 years (range, 39–89 years). Ablations were performed by using either multi-tined applicators or cooled and/or cluster applicators under US guidance. Applicator size varied from 2–5 cm, depending on the size of the index tumour. Conscious sedation was administered by an anesthetist. Follow-up imaging by using contrast-enhanced CT was performed 1, 3, 6, and 12 months after RFA, and yearly thereafter. The mean tumour follow-up time was 12 months (range, 1–35 months). The mean tumour size was 2.7 cm (range, 1–5 cm). Primary effectiveness was achieved in 31 cases (86.1%), with patients in 5 cases (11.1%) demonstrating residual disease. Three patients had repeated sessions, which were technically successful. The remaining 2 patients were not re-treated because of patient comorbidities. As a result, secondary effectiveness was achieved in 34 patients (94.4%). In 1 patient, a new lesion developed in the same kidney but remote from the 2 prior areas of treatment. Hydrodissection was performed in 3 patients (8.3%), manipulation or electrode repositioning in 11 patients (30.6%), and ureteric cooling in 1 patient (2.8%). Minor and major complications occurred in 3 (8.3%) and 3 (8.3%) patients, respectively. Correlation coefficients were calculated for distance from skin to tumour and risk of complication as well as compared with primary and secondary effectiveness. This study demonstrates that US-guided RFA is an effective treatment for renal lesions, with rates of effectiveness and complication rates comparable with published CT-guided RFA results.

scholarly journals C-Arm Cone-Beam CT Virtual Navigation Versus Conventional CT Guidance in the Transthoracic Lung Biopsy: A Case-Control Study

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 115
Author(s):  
Lian Yang ◽  
Yue Wang ◽  
Lin Li ◽  
Dehan Liu ◽  
Xin Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Biopsy ◽  
Cone Beam ◽  
Ct Guidance ◽  
Complication Rates ◽  
Virtual Navigation ◽  
Ct Guided ◽  
Significant Difference ◽  
Lung Biopsies ◽  
Conventional Ct

C-arm cone-beam computed tomography (CBCT) virtual navigation-guided lung biopsy has been developed in the last decade as an alternative to conventional CT-guided lung biopsy. This study aims to compare the biopsy accuracy and safety between these two techniques and explores the risk factors of biopsy-related complications. A total of 217 consecutive patients undergoing conventional CT- or C-arm CBCT virtual navigation-guided lung biopsy from 1 June 2018 to 31 December 2019 in this single-center were retrospectively reviewed. Multiple factors (e.g., prior emphysema, lesion size, etc.) were compared between two biopsy techniques. The risk factors of complications were explored by using logistic regression. The patients’ median age and male-to-female ratio were 63 years and 2.1:1, respectively. Eighty-two (82) patients (37.8%) underwent conventional CT-guided biopsies, and the other 135 patients (62.2%) C-arm CBCT virtual navigation-guided biopsies. Compared with patients undergoing C-arm CBCT virtual navigation-guided lung biopsies, patients undergoing conventional CT-guided lung biopsies showed higher needle repositioning rate, longer operation time, and higher effective dose of X-ray (52.4% vs. 6.7%, 25 min vs. 15 min, and 13.4 mSv vs. 7.6 mSv, respectively; p < 0.001, each). In total, the accurate biopsy was achieved in 215 of 217 patients (99.1%), without a significant difference between the two biopsy techniques (p = 1.000). The overall complication rates, including pneumothorax and pulmonary hemorrhage/hemoptysis, are 26.3% (57/217), with most minor complications (56/57, 98.2%). The needle repositioning was the only independent risk factor of complications with an odds ratio of 6.169 (p < 0.001). In conclusion, the C-arm CBCT virtual navigation is better in percutaneous lung biopsy than conventional CT guidance, facilitating needle positioning and reducing radiation exposure. Needle repositioning should be avoided because it brings about more biopsy-related complications.

scholarly journals Image-Guided Microwave Ablation of Hepatocellular Carcinoma (≤5.0 cm): Is MR Guidance More Effective Than CT Guidance?

2021 ◽  
Author(s):  
Zhaonan Li ◽  
Chaoyan Wang ◽  
Guangyan Si ◽  
Xueliang Zhou ◽  
Yahua Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Microwave Ablation ◽  
Rank Test ◽  
Tumor Diameter ◽  
Complication Rates ◽  
Ct Guided ◽  
Cox Regression Analysis ◽  
Log Rank Test ◽  
The Mean

Abstract BackgroundPercutaneous tumor ablation is usually performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor may be challenging. MRI guidance can provide more reliable visualization of the target tumor and allow for multiplanar capabilities, making it the modality of choice. Due to the lack of comparative studies of microwave ablation(MWA) guided by different images. This study retrospectively compared the effectiveness of computed tomography (CT)-guided versus magnetic resonance (MR)-guided MWA for hepatocellular carcinoma (HCC≤5.0 cm). MethodsIn this retrospective study, 47 patients and 54 patients received MWA under the guidance of CT and MR, respectively. The inclusion criteria were a single HCC≤5.0 cm or a maximum of three. The local tumor progression (LTP), overall survival (OS), prognostic factors for local progression, and safety of this technique were assessed.ResultsAll procedures were technically successful. The complication rates of the two groups were significantly different with respect to liver abscess and pleural effusion (P<0.05). The mean LTP was 44.264 months in the CT-guided group versus 47.745 months in the MR-guided group of HCC (P = 0.629, log-rank test). The mean OS was 56.772 months in the patients who underwent the CBCT-guided procedure versus 58.123 months in those who underwent the MR-guided procedure (P = 0.630, log-rank test). Multivariate Cox regression analysis further illustrated that tumor diameter (<3 cm) and the number of lesions (single) were important factors affecting LTP and OS.ConclusionsCT-guided and MR-guided MWA are safe and effective in the treatment of HCC with a diameter of less than 5 cm. Furthermore, MR-guided MWA could reduce the incidence of complications.

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

2017 ◽  
Vol 45 (6) ◽  
pp. 2101-2109 ◽  
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.

scholarly journals Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions

2020 ◽  
Vol 30 (4) ◽  
pp. 546-551
Author(s):  
Kazuhiro Ito ◽  
Junichi Shimada ◽  
Masanori Shimomura ◽  
Kunihiko Terauchi ◽  
Motohiro Nishimura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lesion Size ◽  
Ct Guided ◽  
Pulmonary Lesions ◽  
Pleural Surface ◽  
Intraoperative Fluoroscopy ◽  
Safety And Reliability ◽  
Preoperative Ct ◽  
The Mean ◽  
Lipiodol Marking

Abstract OBJECTIVES This study aimed to evaluate the safety and reliability of percutaneous computed tomography (CT)-guided lipiodol marking for undetectable pulmonary lesions before video-assisted thoracic surgery (VATS). METHODS We retrospectively analysed the cases of CT-guided lipiodol marking followed by VATS in 9 institutes from May 2006 to March 2018. Lipiodol (0.2–0.5 ml) was percutaneously injected closely adjacent to undetectable pulmonary lesions with computed-tomography guidance. Lipiodol spots were identified using C-arm-shaped fluoroscopy during VATS. We grasped the lipiodol spots, including the target lesions, with ring-shaped forceps and resected them. RESULTS Of 1182 lesions, 1181 (99.9%) were successfully marked. In 1 case, the injected lipiodol diffused, and no spot was created. Of the 1181 lesions, 1179 (99.8%) were successfully resected with intraoperative fluoroscopy. Two lipiodol spots were not detected because of the lipiodol distribution during the division of pleural adhesions. The mean lesion size was 9.1 mm (range 1–48 mm). The mean distance from the pleural surface was 10.2 mm (range 0–43 mm). Lipiodol marking-induced pneumothorax occurred in 495 (57.1%) of 867 cases. Of these, chest drainage was required in 59 patients (6.8%). The other complications were 19 (2.2%) cases of bloody sputum, 3 (0.35%) cases of intravascular air, 1 (0.12%) case of pneumonia and 1 (0.12%) case of cerebral infarction. There were no lipiodol marking-induced deaths or sequelae. CONCLUSIONS Preoperative CT-guided lipiodol marking followed by VATS resection was shown to be a safe and reliable procedure with a high success rate and acceptably low severe complication rate.

scholarly journals Biopince Full Core Biopsy Device for Percutaneous Lung Biopsy: A Retrospective Analysis of 184 Procedures Analyzing Complication Rates and Procedure Success

2021 ◽  
pp. 17-25
Author(s):  
Robert Bernstein ◽  
Ryan Garrow
Keyword(s):  
Core Biopsy ◽  
Lung Biopsy ◽  
Research Question ◽  
Outpatient Setting ◽  
High Rate ◽  
Complication Rates ◽  
Core Needle ◽  
Biopsy Device ◽  
Percutaneous Lung Biopsy ◽  
Full Core

Background: Unlike fine needle aspiration, core needle biopsies allow the collection of intact tissue for pathological and molecular evaluation. In outpatient clinical practice, full core needle lung biopsy may be underused because of concerns that it might be too dangerous. We describe our experience using a full core device for percutaneous lung biopsy in a large cohort of patients. Research Question: Is percutaneous full core needle lung biopsy effective and safe in the outpatient setting? Study Design and Methods: The analyzed population comprised patients with lung masses >1.1 cm who underwent percutaneous lung biopsy with a full core device. Analyzed data included core mass dimensions, distance from pleural edge to mass, lobe location, type, outcomes, and complications. Biopsy success was defined as adequate tissue acquisition for pathological evaluation that yielded a diagnosis. Biopsy procedures with incomplete data were excluded from this analysis. Results: We analyzed data from 184 lung biopsies performed on 182 patients (mean age, 70±11.7 years). Most biopsies were parenchymal (54.9%). The overall diagnostic success rate was 98.4%. No complications were reported for 77.2% of biopsies. Minor complications occurred during 39 biopsies (21.2%) and were primarily pneumothorax (16.8%). Major complications occurred during 4 biopsies (2.1%): 3 patients with pneumothorax required emergency department (ED) management and 1 patient went to the ED for severe pain. All complications resolved within 24 hours without hospitalization or transfusion. Crosstabulation analyses showed no significant differences between the lung lobe locations in terms of rates of disposition and complications, and between the lesion types in terms of rates of disposition and complications. Interpretation: Percutaneous lung biopsy performed using a full core biopsy device demonstrated a high rate of diagnostic success and a low risk of clinically significant procedural complications in an outpatient setting.

scholarly journals Coronary artery air embolism complicating a CT-guided percutaneous lung biopsy

2019 ◽  
Vol 29 (1) ◽  
pp. 81 ◽  
Author(s):  
Ashwin Deshmukh ◽  
Nirav Kadavani ◽  
Ritu Kakkar ◽  
Shrinivas Desai ◽  
GanapathiM Bhat
Keyword(s):  
Coronary Artery ◽  
Lung Biopsy ◽  
Air Embolism ◽  
Ct Guided ◽  
Percutaneous Lung Biopsy

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

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.

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

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 293-298 ◽  
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

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