Role of Computed Tomography-guided Biopsies in the Era of Electromagnetic Navigational Bronchoscopy: A Retrospective Study of Factors Predicting Diagnostic Yield in Electromagnetic Navigational Bronchoscopy and Computed Tomography Biopsies

Objectives: Over 25% of the high-risk population screened for lung cancer have an abnormal computed tomography (CT) scan. Conventionally, these lesions have been biopsied with CT guidance with a high diagnostic yield. Electromagnetic navigational bronchoscopy (ENB) with transbronchial biopsy has emerged as a technology that improves the diagnostic sensitivity of conventional bronchoscopic biopsy. It has been used to biopsy lung lesions, due to the low risk of pneumothorax. It is, however, a new technology that is expensive and its role in the diagnosis of the solitary pulmonary nodule (SPN) is yet to be determined. The purpose of this study was to evaluate the diagnostic yield of CT-guided biopsy (CTB) following non-diagnostic ENB biopsy and identify characteristics of the lesion that predicts a low diagnostic yield with ENB, to ensure appropriate use of ENB in the evaluation of SPN. Materials and Methods: One hundred and thirty-five lung lesions were biopsied with ENB from January 2017 to August 2019. Biopsies were considered diagnostic if pathology confirmed malignancy or inflammation in the appropriate clinical and imaging setting. We evaluated lesions for several characteristics including size, lobe, and central/peripheral distribution. The diagnostic yield of CTB in patients who failed ENB biopsies was also evaluated. Logistic regression was used to identify factors likely to predict a non-diagnostic ENB biopsy. Result: Overall, ENB biopsies were performed in 135 patients with solitary lung lesions. ENB biopsies were diagnostic in 52% (70/135) of the patients. In 23 patients with solitary lung lesions, CTBs were performed following a non-diagnostic ENB biopsy. The CTBs were diagnostic in 87% of the patients (20/23). ENB biopsies of lesions <21.5 mm were non-diagnostic in 71% of cases (42/59); 14 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% of them were diagnostic (12/14). ENB biopsies of lesions in the lower lobes were non- diagnostic in 59% of cases (35/59); 12 of these patients with non-diagnostic ENB biopsies had CTBs, and 83% were diagnostic (10/12). ENB biopsies of lesions in the outer 2/3 were non-diagnostic in 57% of cases (50/87); 21 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% were diagnostic (18/21). Conclusion: CTBs have a high diagnostic yield even following non-diagnostic ENB biopsies. Lesions <21.5 mm, in the outer 2/3 of the lung, and in the lower lung have the lowest likelihood of a diagnostic yield with ENB biopsies. Although CTBs have a slightly higher pneumothorax rate, these lesions would be more successfully diagnosed with CTB as opposed to ENB biopsy, in the process expediting the diagnosis and saving valuable medical resources.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205293 ◽

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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Results of Percutaneous Computed Tomography-Guided Biopsy of Adrenal Lesions and Spectrum of Computed Tomography Findings

Journal of Clinical Imaging Science ◽

10.25259/jcis_3_2020 ◽

2020 ◽

Vol 10 ◽

pp. 16

Author(s):

Sriharsha Gunna ◽

Zafar Neyaz ◽

Eesh Bhatia ◽

Rungmei S Marak ◽

Richa Mishra ◽

...

Keyword(s):

Computed Tomography ◽

Multidetector Ct ◽

Diagnostic Yield ◽

Major Complication ◽

Malignant Neoplasms ◽

Safe Procedure ◽

Ct Scanner ◽

Ct Guided ◽

Guided Biopsy ◽

Ct Guided Biopsy

Objective: Adrenal enlargement occurs in various conditions such as infections, benign, and malignant neoplasms. Percutaneous computed tomography (CT)-guided adrenal biopsy is a safe method for obtaining tissue specimen in cases where diagnosis cannot be established on imaging and biochemical grounds. The study aims to evaluate diagnostic yield, accuracy, and complications of percutaneous CT-guided adrenal biopsies. Furthermore, CT findings of various adrenal lesions have been described. Materials and Methods: Data of CT-guided adrenal biopsies performed from September 2009 to May 2019 were analyzed. Biopsies were performed on a 64-slice or a 128-slice multidetector CT scanner using a coaxial technique. Pathological and microbiological reports were retrieved from the hospital information system. Clinical details were obtained from clinical case records. Results: CT-guided adrenal biopsies were performed in 48 patients, 37 males and 11 females. Adrenal insufficiency was present in 31 (64%) cases and bilateral adrenal glands were affected in 35 (73%). Biopsy yielded a diagnosis in 35 cases (72.9%). The final diagnosis was achieved in 43 (90%) cases. Combined accuracy of CT-guided biopsy for identifying malignancy and infection was 88.3%. Adrenal histoplasmosis (AH) was the most common entity diagnosed (44%). After combining histopathology and microbiology results, the sensitivity for diagnosing AH was 100%. One (2%) patient had a major complication in the form of intra-abdominal hemorrhage requiring transfusion. Local hematoma and mild stable pneumothorax were noted in one patient each. Conclusion: Percutaneous CT-guided biopsy is a safe procedure for the diagnosis of adrenal lesions. It has good accuracy for diagnosing adrenal conditions such as infections and malignancies. However, the specific diagnosis of benign adrenal lesions was difficult to make. AH, tuberculosis, and metastasis have overlapping imaging findings.

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High Accuracy of Digital Tomosynthesis-Guided Bronchoscopic Biopsy Confirmed by Intraprocedural Computed Tomography

Respiration ◽

10.1159/000512802 ◽

2021 ◽

pp. 1-8

Author(s):

James Katsis ◽

Lance Roller ◽

Michael Lester ◽

Joyce Johnson ◽

Robert Lentz ◽

...

Keyword(s):

Computed Tomography ◽

Primary Outcome ◽

Diagnostic Yield ◽

Lung Nodule ◽

Digital Tomosynthesis ◽

Biopsy Needle ◽

Bronchoscopic Biopsy ◽

Axial Dimension ◽

Electromagnetic Navigational Bronchoscopy ◽

Room Time

Background: Digital fluoroscopic tomosynthesis-guided electromagnetic navigational bronchoscopy (F-ENB) is a novel adjunct to ENB associated with higher diagnostic yield. The likelihood of F-ENB allowing accurate placement of a biopsy needle within a target remains unclear. Objective: This study intends to determine the accuracy of F-ENB as confirmed by cone-beam computed tomography (CBCT) scan. Methods: Patients undergoing CBCT-assisted ENB for lung nodule biopsy were prospectively enrolled. ENB was performed followed by digital tomosynthesis correction. Once optimal F-ENB alignment was achieved, and a needle was advanced into the expected location of the nodule followed by CBCT. The primary outcome was the percentage of “needle-in-lesion” hits, defined as needle tip within the nodule in 3 planes. Secondary outcomes were diagnostic yield, procedure and room time, complications, radiation, and distance between the needle tip and nodule. Results: Twenty-six patients with a total of 29 nodules were enrolled. Mean nodule size was 13 mm (±4 mm) in maximal axial dimension, 83% (n = 24) were located in the peripheral third of the chest, and 17% (n = 5) had a bronchus sign. F-ENB guidance resulted in needle-in-lesion in 21 of 29 nodules (72%). Mean needle tip-to-nodule distance for nonhits was 1.75 mm (±1.35 mm). There were no complications. Conclusion: F-ENB resulted in a needle-in-lesion biopsy in greater than 70% of nodules despite features traditionally associated with poor diagnostic yield (size, absence of bronchus sign). Mean distance between needle tip and target for nonhits was less than 2 mm. These data suggest F-ENB alignment is accurate for small peripheral nodules.

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Percutaneous CT-guided Biopsy for Lung Lesions 1 cm or Smaller: The Technique, Results and Complications

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2006.54.5.377 ◽

2006 ◽

Vol 54 (5) ◽

pp. 377

Author(s):

Chi Sung Song

Keyword(s):

Ct Guided ◽

Lung Lesions ◽

Guided Biopsy ◽

Ct Guided Biopsy

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Comparing Diagnostic Yield of Electromagnetic Navigational Bronchoscopy Guided With Real Time Cone Beam Computer Tomography Compared to Standard Fluoroscopy Guidance for Peripheral and Central Lung Lesions

Case Medical Research ◽

10.31525/ct1-nct04194333 ◽

2019 ◽

Author(s):

Keyword(s):

Real Time ◽

Computer Tomography ◽

Diagnostic Yield ◽

Cone Beam ◽

Lung Lesions ◽

Electromagnetic Navigational Bronchoscopy ◽

Cone Beam Computer Tomography ◽

Fluoroscopy Guidance

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CT Guided Biopsy of Lung lesions – Prevalence of Pneumothorax and Variables affecting it.

International Journal of Contemporary Medical Research [IJCMR] ◽

10.21276/ijcmr.2019.6.10.31 ◽

2019 ◽

Vol 6 (10) ◽

Author(s):

Manoranjan Mohapatra ◽

Abhishek Sengupta ◽

Girendra Shankar

Keyword(s):

Ct Guided ◽

Lung Lesions ◽

Guided Biopsy ◽

Ct Guided Biopsy

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A retrospective analysis of computed tomography guided biopsy in the diagnosis of primary bone tumors

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171903 ◽

2017 ◽

Vol 3 (3) ◽

pp. 569

Author(s):

Kuriakku Puthur Dominic ◽

Davis Dijoe ◽

Jacob Toms

Keyword(s):

Computed Tomography ◽

Bone Tumors ◽

Diagnostic Efficiency ◽

Ct Guided ◽

Primary Bone Tumor ◽

Primary Bone Tumors ◽

Guided Biopsy ◽

Ct Guided Biopsy ◽

Significant Step ◽

Primary Bone

Background: Primary bone tumors account for a small yet significant number in the total incidence of tumors. Computed tomography (CT) guided percutaneous core biopsy is a novel yet significant step in the approach towards the diagnosis of bone tumors and is increasingly performed by orthopaedic oncologists around the world. This study is aimed to evaluate the diagnostic accuracy of CT guided biopsy in the diagnosis of primary bone tumors. Methods: Patients who underwent CT guided biopsy and subsequent excision for primary bone tumors from January 2008 to July 2015 were analysed. CT guided biopsy results were compared with post-operative histopathological reports to evaluate its sensitivity and specificity.Results: A total of 161 patients were included in the retrospective study. Among them, 147 were true positives, 7 were false negatives, 6 were true negatives and one was false positive. The sensitivity of CT guided biopsy in the diagnosis of primary bone tumor was 95.4 % with specificity of 85.7% with a diagnostic efficiency of 90.5%. The complication rate was 4.3%.Conclusions: CT guided biopsy is a safe, simple and effective procedure to rule out and rule in the diagnosis of primary bone tumors.

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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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