Analysis on the Effects of CT- and Ultrasound-Guided Percutaneous Transthoracic Needle Biopsy Combined with Serum CA125 and CEA on the Diagnosis of Lung Cancer

The number of patients with lung cancer is difficultly diagnosed in the early stage. The purpose of the study was to investigate the effects of CT- and ultrasound-guided percutaneous transthoracic needle biopsy combined with serum CA125 and CEA on the diagnosis of lung cancer. 120 patients with suspected lung cancer admitted to our hospital from January 2019 to January 2020 were selected and divided into an ultrasound group (n = 60) and CT group (n = 60), according to different percutaneous transthoracic needle biopsy modalities. All patients received serum tumor markers detection, so as to compare the CT- and ultrasound-guided percutaneous transthoracic needle biopsy results and pathology results, levels of serum tumor markers among all patients and the patients with different lung cancer types, and diagnostic efficacy of tumor markers, as well as complication rate (CR) in patients. The sensitivity and specificity of ultrasound-guided percutaneous transthoracic needle biopsy were 0.880 and 0.800, respectively, while those of CT-guided percutaneous transthoracic needle biopsy were 0.909 and 0.625, respectively; the CA125 and CEA levels in the lung cancer group were higher than those in the benign group ( P < 0.001 ); the CA125 and CEA levels of the patients with adenocarcinoma were higher than those with squamous carcinoma, and the CEA levels of the patients with small-cell carcinoma were lower than those with adenocarcinoma ( P < 0.05 ); the sensitivity, specificity, and Youden indexes of CA125 were 0.638, 0.833, and 0.471, respectively, while those of CEA were 0.766, 0.778, and 0.544, respectively; there were no significant differences in CR between the two groups ( P > 0.05 ). CT- and ultrasound-guided percutaneous transthoracic needle biopsy is a safe and feasible diagnostic modality for lung cancer, and its combination with serum CA125 and CEA can significantly improve the accuracy of the detection results, which is worthy of promotion and application in clinical practice.

Development And Validation of a Risk Scoring System to Predict Pneumothorax in CT-Guided Percutaneous Transthoracic Needle Biopsy

Objective: To develop and validate a risk scoring system using variables easily obtained for the prediction of pneumothorax in CT-guided percutaneous transthoracic needle biopsy (PTNB).Methods: The derivation cohort was comprised of 1001 patients who underwent CT-guided PTNB. Multivariate logistic regression was used to identify risk factors for pneumothorax, which were treated as the foundation to develop the risk scoring system. To validate the system, a validation cohort group of 230 patients was enrolled.Results: Age, puncture times, puncture depth, smoking index, number of specimens, bleeding from the needle path, and lobular lesion were identified as risk factors in the derivation cohort. A risk scoring system (Hosmer-Lemeshow goodness-of-fit test p =0.33) was developed. The area under the receiver operating characteristic curve (AUROC) was 0.601 by using the risk score system. This risk score system demonstrated a better diagnostic effect with increasing age. In the group of patients older than 80 years, the AUROC was 0.76, showing good predictive power. This risk scoring system was confirmed in the validation cohort with an AUROC of 0.736.Conclusion: This scoring system has a good predictive effect in both derivation and validation cohort.

Bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) for intubated patients with severe lung diseases

Background Examinations based on lung tissue specimen can play a significant role in the diagnosis for critically ill and intubated patients with lung infiltration. However, severe complications including tension pneumothorax and intrabronchial hemorrhage limit the application of needle biopsy. Methods A refined needle biopsy technique, named bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB), was performed on four intubated patients between August 2020 and April 2021. BUS-PTNB was done at bedside, following an EPUBNOW (evaluation, preparation, ultrasound location, bronchus blocking, needle biopsy, observation, and withdrawal of blocker) workflow. Parameters including procedure feasibility, sample acquisition, perioperative conditions, and complications were observed. Tissue specimens were sent to pathological examinations and microbial tests. Results Adequate specimens were successfully obtained from four patients. Diagnosis and treatment were correspondingly refined based on pathological and microbial tests. Intrabronchial hemorrhage occurred in patient 1 but was stopped by endobronchial blocker. Mild pneumothorax happened in patient 4 due to little air leakage, and closed thoracic drainage was placed. During the procedure, peripheral capillary hemoglobin oxygen saturation (SPO2), blood pressure, and heart rate of patient 4 fluctuated but recovered quickly. Vital signs were stable for patient 1–3. Conclusions BUS-PTNB provides a promising, practical and feasible method in acquiring tissue specimen for critically ill patients under intratracheal intubation. It may facilitate the pathological diagnosis or other tissue-based tests for intubated patients and improve clinical outcomes.

Role of Ultrasound-Guided Tru-cut Biopsy in the Diagnosis of Peripheral Lung and Pleural Lesions

Background Transthoracic needle biopsy is a well-established technique for diagnosing pulmonary lesions. Computed tomography (CT) is usually used as guidance. Ultrasound (US)-guided biopsy is a relatively affordable modality for diagnosis of peripheral lung lesions (PLLs; also known as peripheral pulmonary lesions [PPLs]) and peripheral pleural lesions. Objectives The purpose of this study was to study the diagnostic yield of US guidance sampling a consecutive series of peripheral lung and pleural lesions and potential factors influencing the diagnostic yield with recording the occurrence of any complications. Patients and Methods This was a prospective study that was conducted at Ain Shams University Hospitals upon a population of 60 patients, during the period from September 2018 to August 2019. A special puncture transducer is used to perform US-guided biopsy with visualization of the biopsy needle and the lesion; facilitating the sampling procedure. Results The use of US-guided transthoracic needle biopsies across 60 patients was shown to have a yield of 75% which found the occurrence of 45 conclusive and 15 non-conclusive results From this study population, 70% (n = 42/45) were found to have malignant manifestations, of which 26 were undifferentiated high grade adenocarcinoma, and 9 were moderately differentiated adenocarcinoma. As for complications arising from the biopsy procedure, twenty percent 20% (n = 12) of patients suffered from complications in the form of hemoptysis in 8 which was controlled by hemostatic measures and 4 patients acquired pneumothorax, three (¾) of them received high flow oxygen and conservative treatment and only one (1/4) patient had intercostal tube placement. Diagnostic yield was significantly increased with the presence of Wedge shaped hypoechoic lesions(p &lt; 0.001), hard Mass consistency was significantly highly associated with conclusive results (p &lt; 0.001), as well as a significant link between the longitudinal diameter of masses that had a mean length of 45.05mm ±12.93mm (#x0003D; 0.029).It also showed that more biopsies taken were highly significant correlation with conclusive outcomes (p &lt; 0.001). Conclusion US-guided biopsy is a robust and accurate procedure to effectively diagnose peripheral lung lesions, with a low incidence of complications and gradually improving results with the mastery of the procedure.

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

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.

Diagnostic Performance of Electromagnetic Navigation Bronchoscopy-Guided Biopsy for Lung Nodules in the Era of Molecular Testing

Electromagnetic navigation bronchoscopy (ENB) is an emerging technique used to evaluate peripheral lung lesions. The aim of this study was to determine the diagnostic yield, safety profile, and adequacy of specimens obtained using ENB for molecular testing. This single-center, prospective pilot study recruited patients with peripheral pulmonary nodules that were not suitable for biopsy via percutaneous transthoracic needle biopsy methods. The possibility of molecular testing, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and programmed death ligand 1 (PD-L1), was identified with non-small cell lung cancer (NSCLC) tissue obtained using ENB. ENB-guided biopsy was performed on 30 pulmonary nodules in 30 patients. ENB-guided biopsy was successfully performed in 96.6% (29/30) of cases, but one case failed to approach the target lesion. The diagnostic accuracy of ENB-guided biopsy was 68.0% (17/25). Biopsy-related pneumothorax occurred in one patient and there was no major bleeding or deaths related to the procedure. Among 13 patients diagnosed with NSCLC, molecular testing was successfully performed in 92.3% (12/13). ENB-guided biopsy demonstrated acceptable accuracy and excellent sample adequacy, with a high possibility of achieving molecular testing and a good safety profile to evaluate peripheral pulmonary nodules, even when the percutaneous approach was difficult and/or dangerous.

The first report of co-existence of pulmonary tuberculosis and lung malignancy in a kidney transplant recipient: a case report and literature review

Background Along with the medical development, organ transplant patients increase dramatically. Since these transplant patients take immunosuppressants for a long term, their immune functions are in a suppressed state, prone to all kinds of opportunistic infections and cancer. However, it is rarely reported that the kidney transplant recipients (KTRs) have pulmonary tuberculosis and lung cancer simultaneously. Case presentation A 60-year-old male was admitted because of persistent lung shadow for 2 years without any obvious symptom 8 years after renal transplant. T-SPOT test was positive but other etiological examinations for Mycobacterium tuberculosis were negative. Chest CT scan revealed two pulmonary lesions in the right upper and lower lobe respectively. 18F-fluorodesoxyglucose positron-emission tomography (FDG-PET) CT found FDG intake increased in both pulmonary consolidation lesions. CT-guided percutaneous transthoracic needle biopsy revealed lung adenocarcinoma and tuberculosis. The video-assisted thoracoscopic surgery was operated to resect the malignancy lesions. The patient received specific anti-tuberculosis therapy and was discharged. At the follow-up of 6 months post drug withdrawal, the patient was recovered very well. Conclusions We for the first time reported co-existence of smear-negative pulmonary TB and lung adenocarcinoma in a KTR, which highlighted the clinical awareness of co-occurrence of TB and malignancy after renal transplant and emphasized the value of biopsy and 18F-FDG-PET in early diagnosis of TB and cancer.