Fluoroscopically Guided Biopsy of Intrathoracic Lesions: Diagnostic Accuracy of Combined Method Including Automated Gun Biopsy and Fine Needle Aspiration

PURPOSE: The purpose of this study was to evaluate the usefulness of combined automated gun biopsy (AGB) and fine needle aspiration (FNA) in the diagnosis of lung lesions. MATERIALS AND METHODS: Lung lesions in 102 patients were aspirated consecutively using a 21-gauge fine needle and biopsied with an 18-gauge automated gun at intervals of 3 -5 minutes. Final diagnosis was based on the findings of surgery or clinical follow-up. RESULTS: In 50 patients with malignant lesions, diagnostic accuracy was 80% with AGB and 76% with FNA, but using the combined modality, the figure was 94%. In 52 patients with benign lesions, diagnostic accuracy was 54% with AGB and 50% with FNA; using the combined modality, 69 percent accuracy was achieved. For all lesions, the diagnostic accuracy of the combined modality was thus significantly higher than that of a single method (p<.05). The complications which occurred were pneumothorax in six cases (5.9%), chest tubing in two (0.2%) and minor hemoptysis in nine (8.8%). CONCLUSION: In the diagnosis of lung lesions, the combined use of AGB and FNA is safe and can increase diag-nostic accuracy.

CT-Guided Au tomated Needle Biopsy of Pulmonary Lesions: Analysis of Successful Biopsy Rate and Frequency of Pneumothorax and Hemorrhage using an 18-Gauge Cutting Needle

PURPOSE: To determine the rate of successful biopsy and frequency of post-biopsy pneumothorax and hemorrhage using an 18-gauge cutting needle in CT-guided automated needle biopsies according to lesion size, and the distance between lesion and pleura. MATERIALS AND METHODS: Ninety-four patients with focal lung lesion who had undergone CT-guided automated needle biopsies using an 18-gauge cutting needle were retrospectively reviewed. We evaluated the relationship between successful biopsy rate and pneumothorax and hemorrhage according to lesion size and distance between lesion and pleura. For the purposes of this study, size and distance were grouped as follows : 3cm . RESULTS: Biopsy was successful in 78 of 94 patients(83%). When lesions were larger than 2cm in size the diagnostic rate increased (P=0.002), but the distance between lung lesion and pleura was not statistically related to successful biopsy (P>0.005). Where there were post-biopsy complications, the pneumothorax rate was higher in lesions less than 2 cm in size (P=0.041) and in those separated by more than 2 cm from the pleura (P= 0.006). Where separation was of this order, the hemorrhage rate was higher (P=0.021), but statistically, this was not affected by lesion size (P>0.05). CONCLUSION: When 18-gauge cutting needle is used in CT-guided automated needle biopsies of pulmonary lesions, the rate of successful biopsy is affected by lesion size ; the pneumothorax rate is also affected by lesion size, as well as by the distance between lesion and pleura; the hemorrhage rate is influenced only by the distance between lesion and pleura.

CT-Guided Au tomated Needle Biopsy of Pulmonary Lesions: Analysis of Successful Biopsy Rate and Frequency of Pneumothorax and Hemorrhage using an 18-Gauge Cutting Needle

PURPOSE: To determine the rate of successful biopsy and frequency of post-biopsy pneumothorax and hemorrhage using an 18-gauge cutting needle in CT-guided automated needle biopsies according to lesion size, and the distance between lesion and pleura. MATERIALS AND METHODS: Ninety-four patients with focal lung lesion who had undergone CT-guided automated needle biopsies using an 18-gauge cutting needle were retrospectively reviewed. We evaluated the relationship between successful biopsy rate and pneumothorax and hemorrhage according to lesion size and distance between lesion and pleura. For the purposes of this study, size and distance were grouped as follows : 3cm . RESULTS: Biopsy was successful in 78 of 94 patients(83%). When lesions were larger than 2cm in size the diagnostic rate increased (P=0.002), but the distance between lung lesion and pleura was not statistically related to successful biopsy (P>0.005). Where there were post-biopsy complications, the pneumothorax rate was higher in lesions less than 2 cm in size (P=0.041) and in those separated by more than 2 cm from the pleura (P= 0.006). Where separation was of this order, the hemorrhage rate was higher (P=0.021), but statistically, this was not affected by lesion size (P>0.05). CONCLUSION: When 18-gauge cutting needle is used in CT-guided automated needle biopsies of pulmonary lesions, the rate of successful biopsy is affected by lesion size ; the pneumothorax rate is also affected by lesion size, as well as by the distance between lesion and pleura; the hemorrhage rate is influenced only by the distance between lesion and pleura.

Comparison of Various Needles in Renal Biopsy: Clinical and Animal Studies

PURPOSE: To compare the efficacy of 14 gauge(G) Vim-Silverman needle biopsy with that of 16G automatic gunbiopsy for kidneys and to determine the optimal needle size for renal biopsy. MATERIALS AND METHODS: Weretrospectively reviewed the pathologic and medical records of 119 (110 native, 9 allograft) patients who hadundergone 14G Vim-Silverman needle biopsy and 71 (34 native, 37 allograft) who had undergone 16G automatic gunbiopsy. The number of retrieved glomeruli and post-biopsy complications were compared between the two groups. Exvivo renal biopsies of a dog were performed using an automatic gun mounted with 14G-20G needles and the numbers ofretrieved glomeruli were compared. RESULTS: The number (mean+/-standard deviation) of retrieved glomeruli perbiopsy in native/allograft/total kidneys was 32.1+/-20.9/24.0+/-15.2/31.5+/-20.6 in the 14G Vim-Silverman needlebiopsy group, and 26.9+/-16.2/14.3+/-10.1/20.9+/-14.9 in the 16G automatic gun biopsy group. In the dog, the numberof retrieved glomeruli per biopsy was 17.2+/-6.3/9.2+/-3.9/5.7+/-4.5/3.9+/-2.6 in the 14G/16G/18G/20G groups,respectively. CONCLUSION: Although significantly more glomeruli were retrieved in the 14G Vim-Silverman needlebiopsy group, the number retrieved in the 16G automatic gun biopsy group was sufficient for adequate pathologicinterpretation. Experimental study suggests that when an 18G automatic gun is used, sufficient glomeruli areretrieved.

Fluoroscopically Guided Automated Gun Biopsy of Chest Lesions: Diagnostic Accuracy and Complications

PURPOSE: To determine the diagnostic accuracy and frequency of complications of fluoroscopy-guidedtransthoracic needle biopsy, using an automated gun biopsy system. MATERIALS AND METHODS: We retrospectively reviewed 86 patients who underwent automated gun biopsy between October 1995 and October 1996. An 18-gauge cutting needle was used in all cases. All biopsies were performed under fluoroscopic guidance by one interventional radiologist. RESULTS: Tissue sufficient for histologic diagnosis was obtained in 73 of 86 biopsies(84.9%). Fifty-six lesions were malignent and 30 were benign. Sensitivity and diagnostic accuracy for malignant lesions were 87.5% and 87.5%, respectively while cell type specificity in malignant diagnosis was 91.7%(11/12). Sensitivity and diagnostic accuracy for benign lesions were 80.0% and 73.3%, respectively. Postbioptic pneumothorax occurred in three of 86 biopsies(3.5%), one of which required placement of a chest tube. CONCLUSION: Automated gun biopsy is a simple, safe method for the diagnosis of focal chest lesions. An automated biopsy device offers high diagnostic accuracy in cases involving malignant and benign lesions of the chest, and is particularly useful for determining malignant cell type and specific diagnosis of benign lesions.

CT-Guided Biopsy of Pulmonary Lesions: A Comparison of Diagnostic Accuracy and Complication Rate betweenAutomated Gun Biopsy and Fine Needle Aspiration Biopsy

PURPOSE: To compare the efficacy and safety of CT-guided automated gun biopsy with those of fine needleaspiration biopsy of pulmonary lesions. MATERIALS AND METHODS: Under CT guidance, we performed automated gunbiopsies in 115 cases of 109 patients and fine needle aspiration biopsies in 119 cases of 108 patients withpulmonary lesions. Between the two methods, we compared the diagnostic rate, diagnostic accuracy and frequency ofcomplications according to the depth and diameter of pulmonary lesions. RESULTS: The overall diagnostic rates ofautomated gun biopsy and fine needle aspiration biopsy were 76.5% (88/115) and 64.7% (77/119) respectively. Therewas a significant statistical difference (p=0.048), especially in the case of malignant lesions less than 3 cm(p=0.027) and more than 6 cm (p=0.008) in maximal diameter. The diagnostic accuracy of automated gun biopsy andfine needle aspiration biopsy showed significant statistical difference only in malignant lesions more than 6cm inmaximal diameter (p=0.008), and in the lesions located from 1 cm to less than 3cm from the pleura (p=0.030), asseen on CT. There was no significant statistical difference in the frequency of complications. CONCLUSION:Automated gun biopsy of pulmonary lesions under CT guidance is safe, with complications rate comparable to thoseof fine needle aspiration biopsy. A higher overall diagnostic rate can be achieved by automated gun biopsy than byfine needle aspiration biopsy. For the diagnosis of pulmonary lesions under CT guidance, automated gun biopsy istherefore a more useful procedure than fine needle aspiration biopsy.

Implantation Metastasis After Percutaneous Transthoracic Fine Needle Biopsy of Lung Cancer: A Case Report

Percutaneous transthoracic fine needle aspiration(PCNA) and biopsy(PCNB) are well-accepted methods for thediagnosis of various intrathoracic lesions. Implantation of cancer cells along the needle tract is one of therarest complications of these techniques, but was found along the needle tract in a patient who underwent PCNB forlung cancer.

Plugging the Biopsy Tract in Rabbit Liver: Gelfoam, Fibrin Sealant and NBCA

PURPOSE: To evaluate the effect of plugging the biopsy tract in rabbit liver and the pathologic changes caused by plugging materials. MATERIALS AND METHODS: Thirty-two New Zealand White rabbits were divided into four groups(eight rabbits in each) and compared with one another. They were labeled group A(control), B(gelfoam),C(fibrin sealant) or D(NBCA). The liver was exposed and biopsied with an 18G disposible biopsy gun. The inner Tru-cut needle was withdrawn and plugging was undertaken through the outer cannula of the biopsy gun. Bleeding times of each material were compared. The rabbits were sacrificed and pathologically evaluated for 17 days. RESULTS: Mean bleeding times were 46.7+/-34.5 sec in group A, 42.9+/-54.7 sec in group B, 12.6+/-15.0 sec in group C, and 0 sec in group D. In groups C and D, these results were statistically significant(p<0.01). Pathologically, fibrin sealant was lowest in foreign body reaction and fibrosis. NBCA was effective for the prevention of hemorrhage. CONCLUSION: NBCA and fibrin sealant effectively plug the biopsy tract through the outer cannula of an18 G biopsy gun.

Predisposing Factors of Pneumothorax in Percutaneous Transthoracic Fine Needle Aspiration Biopsy: Comparison between CT Emphysema score and Pulmonary Function Test

PURPOSE: To compare the CT emphysema score with various factors of pulmonary function test by simple spirometry and to use the result as a predictor of pneumothorax in percutaneous transthoracic fine needle aspiration biopsy. MATERIALS AND METHODS: The CT scans of 106 patients who had undergone percutaneous transthoracic fine needle aspiration biopsy of lung lesions within the previous 18 months were retrospectively reviewed. In 75 of these 106 cases, the results of the pulmonary function test were also reviewed. On plain chestradiography, pneumothorax was noted in 20 cases (19%). Emphysema was blindly evaluated. We divided each lung into four segments and determined the severity and involved volume of emphysema, as seen on CT. Sseverity was classified as one of four grades, as follow: absence of emphysema=0; low attenuation area of less than 5mm=1; low attenuation area of more than 5mm, and vascular pruning with normal lung intervening=2; and diffuse low attenuation without intervening normal lung, and larger confluent low attenuation with vascular pruning and distortion of branching pattern occupying all or almost all the involved parenchyma=3. The involved area was also classified as one of four grades: less than 25%=1; 25-49%=2; 51-74%=3; and more than 75%=4. The CT emphysema score was defined as the average of the grade of severity multiplied by the grade of involved area. Pulmonary function tests, consisting of simple spirometry and a pulmonologist's interpretation, were evaluated. We also evaluated depth and size of lesion as known predisposing factors in postbioptic pneumothorax. Statistical analysis was performed using the chi-square test, Wilcoxon ranks sum W test and the student t test. RESULTS: A comparision between the two groups of occurrence (with or without pneumothorax) showed the emphysema scores to be 1.69+/-2.0 and 1.11+/-2.9, respectively; there was thus no significnt difference between the two groups (Z=-0.048, p>0.10). Nor were differences revealed by the pulmonary function test; the scores were 2.45+/-1.2 versus 2.23+/-0.8 in FEV1, and 73.4+/-14 versus 78.8+/-13 in FEV1/FVC. In the group with pneumonthorax, the lesion was significantly deeper, however, (1.92+/-1.6 cm versus 0.75+/-1.0cm; Z=-3.50, p<0.01) and the lesion was significantly smaller (3.37+/-1.7cm versus 4.20+/-2.0cm; Z=-1.86, p<0.10). In the pneumothorax group, the CT emphysema score was also significantly higher (1.94+/-3.9 versus 0.39+/-1.8; Z=-1.513, p<0.10). CONCLUSION: For the prediction of pneumothorax in percutaneous transthoracic fine needle aspiration biopsy, the CT emphysema score is more useful than the pulmonary function test.

Risk Factors of Pneumothorax in Percutaneous Fine Needle Aspiration Biopsy of the Lung

PURPOSE: Percutaneous fine needle aspiration biopsy is known to be a useful diagnostic method for the diagnosis of various pulmonary diseases. Its diagnostic yield is high, and it is safe, but complications such as pneumothorax can occasionally occur. We reviewed the complications arising after needle aspiration biopsy and analyzed the risk factors of pneumothorax. MATERIALS AND METHODS: The medical records and radiographic studies of 157 patients with various pulmonary diseases who underwent needle aspiration biopsy of the lung between 1990 and 1996 were retrospectively reviewed. The clinical features, treatment, and courses of complications were reviewed, and risk factors of pneumothorax such as depth and size of lesion, diameter of needle, number of punctures, and obstructive pulmonary abnormalities were analyzed. RESULTS: Complications occurred in 40 of 157 cases (25.5%), namely pneumothorax in 26 (16.6%), hemoptysis in 11 (7%), hemothorax in two (1.3%), and recurrence of malignancy at the site of aspiration in one (0.6%). When the patients were divided into three groups according to depth of lesion, there were significant difference in the incidence of pneumothorax ; the results were as follows : less than 2cm, 12.9% ; between 2 and 4cm, 24.1% ; and larger than 4cm, 57.1% (p<0.05). In pulmonary function testing, FVC (forced vital capacity) of patients with pneumothorax was less than that of patients without (2.6+/-0.9L vs 3.1+/-0.8L, p<0.05), but FEV1 (forced expiratory volume in 1 second), FEV 1% (percentage of predicted FEV1), FEV1/FVC,and FVC%(percentage of predicted FVC) were not different between the two groups. The incidence of pneumothorax in patients with pleura-attached lesion (9%) was lower than that of those with non-attached lesion (26%, p=0.01). The age of patients, size of lesion, diameter of the needle, guidance methods and number of aspirations showed no significant relationship with pneumothorax. CONCLUSION: In needle aspiration biopsy of the lung, depth of lesion and passage of a needle through aerated lung are significant risk factors of pneumothorax.

US-guided Percutaneous Gun Biopsy of the Liver through the Left Lobe :Easy Compression of the Left Lobe for Hemostasis

PURPOSE: To evaluate the usefulness of US-guided percutaneous gun biopsy through the left lobe of the liverwith compression for the diagnosis of diffuse hepatic diseases and prevention of post-biopsy complications. MATERIALS AND METHODS: In 35 patients with diffuse hepatic diseases, we performed US-guided percutaneous biopsy via the left lobe of the liver. After biopsy, we immediately applied an extrinsic hands-on compression maneuver at the biopsy site. The integrity of tissue architecture and numbers of portal triad visible in each specimen were histologically examined and post-biopsy complications were documented. RESULTS: A histopathologic diagnosis could be made in all patients except one(97.1%). Microscopically, no significant crush artifact or fragmentation was demonstrated in these 34 patients. The average number of portal triad per specimen was about 4.1. Although two patients complained of severe pain at the biopsy site, no serious post-biopsy complication was noted. CONCLUSION: US-guided percutaneous gun biopsy through the left lobe of the liver with compression appears to be an effective and safe procedure for the evaluation of diffuse hepatic diseases.

CT-Guided Percutaneous Automated Gun Biopsy of Pulmonary Lesions: Complications and Diagnostic Accuracy

PURPOSE: To determine the frequency of complications and diagnostic accuracy of CT-guided percutaneous automated gun biopsy, and to compare the results with those reported for fine needle aspiration. MATERIALS AND METHODS: Using automated biopsy devices, 118 CT-guided percutaneous biopsies of pulmonary lesions were performed. An 18-gauge needle was used. Final diagnosis was made with operation or other methods. We retrospectively analyzed the frequency of complications and diagnostic yields of 118 biopsies. RESULT: Four of 118(3.3%) patients developed pneumothorax and two of these required chest tube insertion. Other complications were resolved spontaneously. 106 biopsies (89.8%) yielded sufficient tissue for pathologic evaluation. For cases of malignant and of benign disease, sensitivity was 91.8% and 87.7% respectively ; the corresponding figures for diagnostic accuracy were 88.5% and 78.9%. CONCLUSION: CT-guided automated gun biopsy of the pulmonary lesions is safe, witha pneumothorax rate comparable to that of fine needle aspiration. In the absence of a trained cytologist at the time of biopsy, the diagnostic accuracy of automated gun biopsy of pulmonary lesions compared favorably with the reported accuracy of fine needle aspiration.