scholarly journals Diagnostic yield of CT-guided lung biopsies: how can we limit negative sampling?

2021 ◽  
Author(s):  
Marcello Andrea Tipaldi ◽  
Edoardo Ronconi ◽  
Miltiadis E Krokidis ◽  
Aleksejs Zolovkins ◽  
Gianluigi Orgera ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Imaging Features ◽  
Technical Success ◽  
Ct Guided ◽  
Fdg Uptake ◽  
Increased Risk ◽  
Ct Guided Biopsy ◽  
Lung Biopsies

Objectives: To investigate whether lesion imaging features may condition the outcome of CT-guided Lung Biopsy (CTLB) and to develop a scoring system of biopsy outcome prediction. Methods: This is a single center retrospective study on 319 CTLBs that were performed in 319 patients (167 males/ 152 females, mean age 68 ± 12.2). Uni- and multivariate analysis were performed aiming to assess the imaging features that are likely to be corelated to a negative biopsy outcome and patients were stratified in groups accordingly. Results: Technical success was 100%. 78% of the biopsies (250/319) led to a concrete histology report (218 malignant/ 32 benign). The remaining lesions led to concrete histology at a second attempt that occurred on a later time. Multivariate analysis revealed increased risk of inconclusive result for nodules with low FDG uptake (OR = 2.64, 95% CI 1.4–4.97; p = 0.003), for nodules with diameter smaller than 18 mm (OR = 2.03, 95% CI 1.14–3.62; p = 0.017) and for nodules that are located in one of the lung bases (OR = 1.96, 95% CI 1.06–3.62; p = 0.033). Three different groups of patients were identified accordingly with low (<30%), medium (30–50%) and high (>50%) probability of obtaining an inconclusive biopsy sample. Conclusions: This study confirms that percutaneous CT guided biopsy in nodules that are either small in diameter or present low PET-FDG uptake or are in one of the lung bases may lead to inconclusive histology. This information should be factored when planning percutaneous biopsies of such nodules in terms of patient informed consent and biopsy strategy. Advances in knowledge: Inconclusive histology after lung biopsy may be subject to factors irrelevant to technical success. Lung biopsy histology outcomes may be predicted and avoided after adequate planning

Diagnostic yield and safety of percutaneous CT-guided biopsy of retroperitoneal lesions and analysis of imaging features

2021 ◽  
pp. 028418512199028
Author(s):  
Anil Kumar Singh ◽  
Zafar Neyaz ◽  
Ritu Verma ◽  
Anshul Gupta ◽  
Richa Mishra ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Microbiological Analysis ◽  
Imaging Features ◽  
Imaging Findings ◽  
Chi Square ◽  
Tissue Samples ◽  
Ct Guided ◽  
Guided Biopsy ◽  
Ct Guided Biopsy

Background Computed tomography (CT)-guided biopsy is emerging as a preferred method for obtaining tissue samples from retroperitoneal lesions due to clear visualization of needle and vessels. Purpose To assess diagnostic yield and safety of CT-guided biopsy of retroperitoneal lesions and compare CT findings in different disease categories. Material and Methods This retrospective analytical study included 86 patients with retroperitoneal lesions who underwent CT-guided biopsy from December 2010 to March 2020. All procedures were performed with co-axial technique and multiple cores were obtained and subjected to histopathology. Additional tests like immunohistochemistry or microbiological analysis were done depending on clinical suspicion. Diagnostic yield calculation and comparison of imaging findings was done by one-way ANOVA, chi-square, and Fisher’s exact tests. Results CT-guided biopsy was technically successful in all cases with a diagnostic yield of 91.9%. Minor complications in the form of small hematomas were seen in two patients. Major disease categories on final diagnosis were lymphoma, tuberculosis, and metastases. A variety of malignant and benign soft-tissue neoplasms were also noted less commonly. With help of immunohistochemistry, lymphoma subtype was established in 88.8% of cases. Addition of microbiological tests like the GeneXpert assay helped in the diagnosis of tuberculosis in some cases. A mass-like appearance and vascular encasement was common in metastatic group and lymphoma. Conclusion Percutaneous CT-guided biopsy is a safe method for the sampling of retroperitoneal lesions with high diagnostic yield. Imaging findings are mostly overlapping; however, some features are more common in a particular disease condition.

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

2017 ◽  
Vol 103 (4) ◽  
pp. 360-366 ◽  
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.

scholarly journals CT-guided percutaneous lung biopsy: Correlation between diagnostic yield, lung lesion size, and lobar distribution

2021 ◽  
Vol 5 ◽  
pp. 14
Author(s):  
Matthew Wilson ◽  
Adib R. Karam ◽  
Grayson L. Baird ◽  
Michael S. Furman ◽  
David J. Grand
Keyword(s):  
Retrospective Study ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Lesion Size ◽  
Lung Lesion ◽  
Target Size ◽  
Transthoracic Needle Biopsy ◽  
Ct Guided ◽  
Lung Lesions ◽  
Significant Difference

Objectives: The aim of this retrospective study was to investigate the relationship between lung lesion lobar distribution, lesion size, and lung biopsy diagnostic yield. Material and Methods: This retrospective study was performed between January 1, 2013, and April 30, 2019, on CT-guided percutaneous transthoracic needle biopsies of 1522 lung lesions, median size 3.65 cm (range: 0.5– 15.5 cm). Lung lesions were localized as follows: upper lobes, right middle lobe and lingual, lower lobes superior segments, and lower lobes basal segments. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and/or pathology reports. Results were considered diagnostic if malignancy or a specific benign diagnosis was established, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results: The positive predictive value (PPV) of a diagnostic yield was 85%, regardless of lobar distribution. Because all PPVs were relatively high across locations (84–87%), we failed to find statistically significant difference in PPV between locations (P = 0.79). Furthermore, for every 1 cm increase in target size, the odds of a diagnostic yield increased by 1.42-fold or 42% above 85%. Although target size increased the diagnostic yield differently by location (between 1.4- and 1.8-fold across locations), these differences failed to be statistically significant, P = 0.55. Conclusion: Percutaneous transthoracic needle biopsy of lung lesions achieved high diagnostic yield (PPV: 84– 87%) across all lobes. A 42% odds increase in yield was achieved for every 1 cm increase in target size. However, this increase in size failed to be statistically significant between lobes.

scholarly journals Benign Notochordal Cell Tumor of the Sacrum with Atypical Imaging Features: The Value of CT Guided Biopsy for Diagnosis

2013 ◽  
Vol 7 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Dario Pasalic ◽  
Patrick H. Luetmer ◽  
Christopher H. Hunt ◽  
Peter S. Rose ◽  
Felix E. Diehn ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Definitive Diagnosis ◽  
Cell Tumor ◽  
Invasive Technique ◽  
Imaging Features ◽  
Ct Guided ◽  
Notochordal Cell ◽  
Orthopedic Surgeons ◽  
Guided Biopsy ◽  
Ct Guided Biopsy

We report a case of a benign notochordal cell tumor (BNCT) of the sacrum with atypical imaging features, which was incidentally discovered in a 74-year-old man undergoing evaluation for progressively worsening hip and back pain. It is important for radiologists, pathologists and orthopedic surgeons to be aware of the diagnosis of BNCT and be familiar with its radiographic features to avoid unnecessary treatment. This case illustrates the advantage of percutaneous computed tomography (CT)-guided biopsy as a minimally invasive technique for definitive diagnosis of a BNCT with atypical imaging features.

scholarly journals Concordance of PD-L1 Status Between Image-Guided Percutaneous Biopsies and Matched Surgical Specimen in Non-Small Cell Lung Cancer

2021 ◽  
Vol 10 ◽  
Author(s):  
Liang Zhao ◽  
Peiqiong Chen ◽  
Kaili Fu ◽  
Jinluan Li ◽  
Yaqing Dai ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Ct Guided ◽  
Tissue Sections ◽  
Image Guided ◽  
Guided Biopsy ◽  
Pet Ct ◽  
Ct Guided Biopsy ◽  
Lung Biopsies

ObjectiveProgrammed death-ligand 1 (PD-L1) expression status is a crucial index for identifying patients who will benefit from anti-programmed cell death protein 1 (PD-1)/PD-L1 therapy for non-small cell lung cancer (NSCLC). However, the concordance of Tumor Proportion Score (TPS) between biopsies and matched surgical specimens remains controversial. This study aims to evaluate the concordance of PD-L1 expression between image-guided percutaneous biopsies and matched surgical specimens.MethodWe evaluated 157 patients diagnosed with operable NSCLC on both surgical tissue sections and matched lung biopsies retrospectively. The patients underwent either regular computed tomography (CT)-guided biopsy (n = 82) or positron emission tomography (PET)/CT-guided biopsy (n = 75). The concordance between surgical specimens and lung biopsies for PD-L1 TPS was evaluated using Cohen’s kappa (κ) coefficient.ResultsImmunohistochemical expression of PD-L1 was evaluated in both surgical resected specimens and matched biopsies in the eligible 138 patients. The concordance rate of PD-L1 expression between surgical tissue sections and matched biopsies was fairly high at 84.1% (116/138), and the κ value was 0.73 (95% CI: 0.63–0.83, P &lt; 0.001). The concordance rate was higher for tissue sections from PET/CT-guided biopsy than for tissue sections from CT-guided biopsy [88.6% (62/70, κ value: 0.81) vs 79.4% (54/68, κ value: 0.66)].ConclusionPD-L1 TPS was strongly concordant between surgical specimens and matched lung biopsies. Thus, the routine evaluation of PD-L1 expression in diagnostic percutaneous biopsies could be reliable for identifying patients who will benefit from anti-PD-1/PD-L1 immunotherapy.

Transoesophageal endobronchial ultrasound-guided needle aspiration (EUS-B-NA) for poorly accessible thoracic lesions: a case series

2020 ◽  
Vol 13 (12) ◽  
pp. e239170
Author(s):  
David Quigley ◽  
Parthiban Nadarajan ◽  
Finbar O Connell
Keyword(s):  
Diagnostic Yield ◽  
Case Series ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
High Likelihood ◽  
Ultrasound Guided ◽  
Upper Airways ◽  
Ct Guided ◽  
Appropriate Treatment ◽  
Ct Guided Biopsy

Endobronchial ultrasound (EBUS) has long been a common diagnostic tool used in the diagnosis of pulmonary pathologies. In the last decade, increased interest has been shown in its usage via the oesophagus for sampling lesions inaccessible via the airways. We describe three cases in which we used this modality to biopsy lesions not visualised via conventional EBUS and which would be too risky to be attempted via a CT-guided biopsy with a high likelihood of complications. More focused education on using EBUS via the oesophagus for respiratory trainees could greatly improve overall clinical practice. It improves the diagnostic yield of lesions and prevents subsequent referral to gastrointestinal colleagues which may delay diagnosis especially during the COVID-19 pandemic as was the case in our patient cohort where services are already limited. EBUS, due to its smaller size, is less irritant to the upper airways and requires less sedation than endoscopic ultrasound (EUS) scopes. It is also shorter than an EUS scope improving manoeuvrability. Each of our cases resulted in early histological diagnosis and subsequent appropriate treatment.

Diagnosis of Pleural Lymphoma in a Kidney Transplant Patient by Medical Pleuroscopy with Cryoprobe Biopsies

2019 ◽  
Vol 8 (1) ◽  
pp. 3
Author(s):  
Roy Joseph Cho
Keyword(s):  
Pleural Effusion ◽  
Kidney Transplant ◽  
Diagnostic Yield ◽  
Kidney Transplant Patient ◽  
Kidney Transplant Recipients ◽  
Ct Guided ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission ◽  
Increased Risk ◽  
Risk Of Malignancy

Kidney transplant recipients are at increased risk of malignancy compared to age and gender matched populations. The development of a pleural effusion after transplantation requires further workup to determine if the etiology is malignant. We report a caseof a patient with recurrent left-sided pleural effusion without a definitive diagnosis despite multiple thoracentesis. Positron emission tomography–computed tomography (PET-CT) was performed that showed nodular pleural lesions in the left hemithoraxwith low level fluorodeoxyglucose (FDG) uptake not amenable to CT guided biopsy. Pleuroscopy allowed for direct visualization of the nodules and a diagnosis of non-Hodgkin lymphoma was obtained with forceps and cryoprobe biopsy. Pleuroscopyis minimally invasive with high diagnostic yield and should be considered early in the setting of abnormal pleura and recurrentpleural effusions that is lymphocytic predominant despite negative cytology.

Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis

2021 ◽  
pp. neurintsurg-2021-017419
Author(s):  
Giorgos D Michalopoulos ◽  
Yagiz Ugur Yolcu ◽  
Abdul Karim Ghaith ◽  
Mohammed Ali Alvi ◽  
Carrie M Carr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Diagnostic Performance ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Ct Guided ◽  
Spinal Lesions ◽  
Guided Biopsy ◽  
Ct Guided Biopsy

BackgroundCT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes.MethodsA systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included.ResultsThirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered.ConclusionIn our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.

scholarly journals Feasibility and outcome of CT-guided lung biopsy in patients with hematological diseases and suspected fungal pneumonia

2013 ◽  
Vol 7 (10) ◽  
pp. 748-752 ◽  
Author(s):  
Sanjeev Kumar Sharma ◽  
Suman Kumar ◽  
Avinash Kumar Singh ◽  
Tulika Seth ◽  
Pravas Mishra ◽  
...  
Keyword(s):  
Ct Scan ◽  
Lung Biopsy ◽  
Needle Aspiration ◽  
Definitive Diagnosis ◽  
Aspiration Cytology ◽  
Ct Guided ◽  
Fine Needle ◽  
Hematological Diseases ◽  
Needle Aspiration Cytology ◽  
Lung Biopsies

Introduction: Fungal pneumonia is a major cause of morbidity and mortality in immunocompromised patients with hematological diseases. This study is aimed to evaluate the feasibility and outcome of computed tomography (CT) guided lung biopsy or fine needle aspiration cytology (FNAC) in the diagnosis of fungal pneumonia in patients with hematological diseases. Methodology: Seven hundred and seventy six consecutive patients with febrile neutropenia were evaluated prospectively over the period of three years. Patients with suspected fungal pneumonia, based on typical CT scan findings, were considered for lung biopsy. Results: Of the 776 patients evaluated for fever, 235 (30.3%) showed CT scan findings consistent with fungal pneumonia. Of the 235 patients, CT-guided lung biopsy/FNAC was recommended for 178 patients but could be performed in only 34 (19.1%) patients. Fungal pneumonia was proven in 15 (44%) out of 34 patients (aspergillus in 12;  mucormycosis in 3 patients). Lung biopsies could not be performed for a number of reasons. These included  thrombocytopenia,  nodules being too small, infection improving with empiric treatment and patient recovering clinically, and the patient being too sick to undergo intervention. The median absolute neutrophil count (ANC) of patients at the time of lung biopsy was 0.41x109/l in patients whose lung biopsy/FNAC showed fungal pneumonia, compared to 2.10x109/l in patients whose biopsy/FNAC showed necrotizing pneumonitis. Conclusion: CT-guided lung biopsy/FNAC can allow the definitive diagnosis of fungal pneumonia in selected patients with various hematological diseases and should be attempted whenever clinically indicated and radiologically feasible.

scholarly journals Diagnostic yield of percutaneous computed tomography guided core needle biopsy of lung lesion and its complications in tertiary hospital

2020 ◽  
Vol 8 (12) ◽  
pp. 4223
Author(s):  
Prakash Kayastha ◽  
Binaya Adhikari ◽  
Sundar Suwal ◽  
Benu Lohani ◽  
Sharma Paudel
Keyword(s):  
Computed Tomography ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Lung Lesion ◽  
Ct Guided ◽  
Core Needle ◽  
Lung Lesions ◽  
Image Guided

Background: Early diagnosis of lung cancer can reduce its mortality and morbidity. Minimally invasive image guided percutaneous core needle biopsy can obtain tissue sample for diagnosis and staging of lung cancer, which is crucial for correct management of lung lesions. Common complications of lung biopsy include pneumothorax, parenchymal haemorrhage and haemoptysis. The study was aimed to determine diagnostic yield and complications of the percutaneous computed tomography (CT) guided core needle biopsy of lung lesion in tertiary hospital.Methods: Hospital based prospective study was performed in 40 patients in Tribhuvan University Teaching Hospital. CT guided biopsy of lung lesions was performed with 18-gauge semi-automated biopsy instrument. The complications following the biopsy were recorded and correlated with different factors using chi-square test. Histopathology report were obtained to measure the diagnostic yield.Results: Among 40 patients who underwent guided lung biopsy, histopathology showed definitive diagnosis in 37 patients; 31 malignant and 6 benign lesions. Parenchymal haemorrhage, pneumothorax and haemoptysis were seen in 13, 8 and 5 respectively; however, none required active intervention. Emphysema in traversing lung and numbers of pleural punctures used were predictive factors of complication (p value <0.05).Conclusions: The study showed percutaneous image guided core needle biopsy has high diagnostic yield with fewer complication rates and is thus recommended for routine biopsies of lung lesions.

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