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Objective To explore a precise method with a microwave antenna for puncture of pulmonary nodules and analyze phenomena that affect the puncture results. Methods Clinical data of 107 cases with solitary malignant pulmonary nodules were collected, and the mean length of pulmonary nodules was 13.6±0.6 mm in CT axial position. A thread-hanging method was used to assist the puncture of pulmonary nodules. The procedure was successful when the needle was not withdrawn and inserted into the central region of the nodule. The success rate and complications of the pulmonary procedure were recorded. The incidence of the following phenomena were also documented: needle coercing, needle slipping, needle tip pushing, pulmonary nodule prolapsing, radial nodule deformation, nodular masking, and radial movement distance of needle tip. Results In all of 107 cases evaluated, the antenna puncture was successful in 101 cases (94.4%) but failed in 6 cases (5.6%). Pneumothorax and pulmonary hemorrhage occurred in 23 (21.5%) and 19 cases (17.8%), respectively. The following phenomena occurred: needle coercing in 9 cases (8.4%), needle slipping in 6 cases (5.6%), needle tip pushing in 19 cases (17.8%), pulmonary nodule prolapsing in 15 cases (14%), radial nodule deformation in 14 cases (13.1%), and nodular masking in 5 cases (4.7%). The mean radial adjusting distance of needle tip was 0.7±0.4 cm. Conclusion The thread-hanging method can assist in the accurate puncture of microwave antenna for pulmonary nodules. We should focus and deal with phenomena that may occur and affect the result of puncture.
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@# Objective To systematically evaluate the application effect of CT-guided Hook-wire localization and CT-guided microcoil localization in pulmonary nodules surgery. Methods The literatures on the comparison between CT-guided Hook-wire localization and CT-guided microcoil localization for pulmonary nodules were searched in PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP and CNKI databases from the inception to October 2021. Review Manager (version 5.4) software was used for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies. Results A total of 10 retrospective cohort studies were included, with 1 117 patients including 473 patients in the CT-guided Hook-wire localization group and 644 patients in the CT-guided microcoil localization group. The quality of the studies was high with NOS scores>6 points. The result of meta-analysis showed that the difference in the localization operation time (MD=0.14, 95%CI −3.43 to 3.71, P=0.940) between the two groups was not statistically significant. However, the localization success rate of the Hook-wire group was superior to the microcoil group (OR=0.35, 95%CI 0.17 to 0.72, P=0.005). In addition, in comparison with Hook-wire localization, the microcoil localization could reduce the dislocation rate (OR=4.33, 95%CI 2.07 to 9.08, P<0.001), the incidence of pneumothorax (OR=1.62, 95%CI 1.12 to 2.33, P=0.010) and pulmonary hemorrhage (OR=1.64, 95%CI 1.07 to 2.51, P=0.020). Conclusion Although Hook-wire localization is slightly better than microcoil localization in the aspect of the success rate of pulmonary nodule localization, microcoil localization has an obvious advantage compared with Hook-wire localization in terms of controlling the incidence of dislocation, pneumothorax and pulmonary hemorrhage. Therefore, from a comprehensive perspective, this study believes that CT-guided microcoil localization is a preoperative localization method worthy of further promotion.
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Objective:To investigate the application value of CT-guided localization with medical glue or puncture needle before thoracoscopic pulmonary ground-glass nodule resection.Methods:The clinical data of 92 patients who underwent localization before thoracoscopic resection of pulmonary ground-glass nodules in Beijing Chao-Yang Hospital from June 2019 to November 2022 were retrospectively analyzed. According to the preoperative localization method, the patients were divided into puncture needle group (52 cases) and medical glue group (40 cases). The localization success rate, localization time and incidence rate of complications were compared between the two groups.Results:The success rate of localization in both groups was 100%. In puncture needle group, the guide wire of 1 case (1.9%) prolapsed, but it did not affect the surgical resection. The localization time of puncture needle group and medical glue group was (18±6) min and(14±5) min, and there was a statistical difference between the two groups ( t = 3.06, P = 0.003). The incidence of bleeding and pneumothorax in medical glue group was lower than that in puncture needle group [12.5% (5/40) vs. 38.5% (20/52), χ2 = 7.70, P = 0.009; 35.0% (14/40) vs. 71.2% (37/52), χ2 = 11.96, P = 0.001]. The incidence rate of irritating cough in was higher than that in puncture needle group [50.0% (20/40) vs. 11.5% (6/52), χ2 = 16.50, P < 0.05]. Conclusions:CT-guided localization with medical glue or puncture needle can achieve satisfactory results in the localization of pulmonary ground-glass nodule before thoracoscopic resection and help to improve the accuracy of surgical resection. The incidence rates of bleeding and pneumothorax of medical glue localization are lower than those of puncture needle localization.
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BACKGROUND@#Rapid on-site evaluation (ROSE) is a technique used for simultaneous evaluation of biopsy specimens through rapid cytology staining. Diff-Quik (DQ) staining is the most commonly employed method for cytological rapid on-site evaluation (C-ROSE). However, the utilization of DQ staining for on-site cytological interpretation remains uncommon among pathologists in China, posing challenges to the implementation of C-ROSE. This study aims to assess the application of rapid hematoxylin-eosin (HE) staining and DQ staining for C-ROSE during percutaneous needle biopsy of peripheral lung cancer and evaluate the value of rapid HE staining in C-ROSE.@*METHODS@#Computed tomography (CT)-guided lung biopsies were conducted on 300 patients diagnosed with peripheral lung cancer. The patients were randomly assigned to two groups for C-ROSE using either rapid HE staining or DQ staining, and subsequently the two methods were compared and evaluated.@*RESULTS@#The concordance rate between C-ROSE and histopathological diagnosis was 96.7%. The median staining time for rapid HE staining was 160 s, while that for DQ staining was 120 s, representing a significant difference between the two groups (P<0.001). However, there were no significant differences observed in terms of total biopsy time, concordance rate with histopathology, cytology specimen peeling rate, and incidence of serious adverse reactions between the two groups (P>0.05).@*CONCLUSIONS@#Both staining methods comply with C-ROSE criteria in the biopsy setting of peripheral lung cancer. Rapid HE staining is more aligned with domestic clinical requirements and holds potential for further promotion and adoption in C-ROSE.
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Humans , Lung Neoplasms/pathology , Eosine Yellowish-(YS) , Rapid On-site Evaluation , Biopsy, Needle/methods , Staining and LabelingABSTRACT
@#Objective To compare the effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules. Methods The literature published from the inception to January 2021 about the comparison between electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules in the PubMed, The Cochrane Library, Web of Science, EMbase, Chinese Wanfang database and CNKI database was searched. RevMan (version 5.4) software was used for meta-analysis. Nonrandomized controlled trials were evaluated using methodological index for nonrandomized studies (MINORS). Results A total of six retrospective studies (567 patients) were included in this meta-analysis. MINORS scores of all studies were all 17 points and above. There were 317 patients in the CT-guided percutaneous localization group and 250 patients in the electromagnetic navigation-guided localization group. The complication rate of the CT-guided percutaneous localization group was significantly higher than that in the electromagnetic navigation-guided localization group (OR=11.08, 95%CI 3.35 to 36.65, P<0.001). There was no significant difference in the success rate of localization (OR=0.48, 95%CI 0.16 to 1.48, P=0.20), localization time (MD=0.30, 95%CI –6.16 to 6.77, P=0.93) or nodule diameter (MD=–0.07, 95%CI –0.19 to 0.06, P=0.29) between the two groups. Conclusion Electromagnetic navigation can be used as an effective preoperative positioning method for pulmonary nodules, which has the advantage of lower complication rate compared with the traditional CT positioning method.
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【Objective】 To establish a predictive model for patients with hemorrhage after CT-guided coaxial core needle lung biopsy （CCNB） based on logistic regression. 【Methods】 A total of 489 patients who had undergone CCNB were retrospectively recruited. The potential risk factors of hemorrhage after lung biopsy were analyzed by univariate and multivariate logistic regression， through which we screened the independent risk factors and established a prediction model for hemorrhage. We evaluated the discrimination， calibration and clinical usefulness of the model. 【Results】 There were 141 cases （42.6%） of hemorrhage in the development group and 66 cases （41.8%） of hemorrhage in the validation group； there was no case of severe hemorrhage or hemothorax. Multivariate logistic regression analysis showed that fibrinogen degradation products， pulmonary interstitial fibrosis， largest diameter and puncture depth were independent predictive factors of hemorrhage. Hemorrhage prediction model was established and presented in the form of a nomogram. Discrimination of the model： the AUC was 0.837 in the development group and 0.777 in the validation group. The calibration curve showed good agreement between predicted probability and actual probability of hemorrhage. The unreliability test yielded a P value of 0.849 in the development group and 0.147 in the validation group. The DCA curve showed that the hemorrhage predictive model could increase the benefit of patients. 【Conclusion】 The predictive model of hemorrhage in patients after CCNB based on logistic regression can be used in clinical practice.
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Introduction: CT guided lung FNAC/Biopsy is beingincreasingly used for the tissue diagnosis of lung lesions. CTis the safest and most accurate method of biopsying centrallesions and lesions adjacent to or involving the hila andmediastinal structures. This study was aimed at evaluatingthe frequency of complications following CT – guided lungBiopsy/FNACMaterial and methods: This was a retrospective study. 53CT guided procedures performed during the year 2016 wereincluded in the study. All the patients had a CT examination ofthe chest (plain and contrast) done before the guided procedurewhich was used as a road map. CT examination was doneon a Siemens somatom 148 slice scanner. In some patientstable dose oral contrast was also given done to delineate theoesophagus.Results: The incidence of pneumothorax was 1.06% i.e. only1 patient out of 53 had minimal pneumothorax which wastreated conservatively.Conclusion: CT guided lung FNAC/Biopsy is a safeprocedure if done in expert hands with a multi-disciplinaryteam approach. Complications can be minimised by carefulselection of the patient... considering the site and size oflesion; associated lung conditions etc
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Background: CT guided core needle biopsy is a less invasive method for initial diagnostic workup in the assessment of intrathoracic masses. This study was conducted to evaluate the diagnostic yield of the procedure as well as to demonstrate the spectrum of various disease in our population.Methods: Present study was conducted in a tertiary care hospital for a study period of two years. Patients with intrathoracic mass were included and CT guided biopsies were performed following a protocol. The CT guided biopsies received were examined for histological diagnosis. Immunohistochemistry was carried out where ever routine histopathology was not sufficient for diagnosis. Relevant immunohistochemical panels were applied for lung, mediastinal and pleural tumours according to the histological differential diagnosis. Detailed demographic and clinical profiles along with radiological findings were noted.Results: Total of 138 cases were taken for CT guided FNAC procedure and 123 (89.1%) cases yielded diagnostic biopsy. Lung was the most commonly involved organ followed by mediastinum. Bronchogenic carcinoma was the most common lesion reported in lung and Non-Hodgkin Lymphoma was the most common mediastinal lesion. Lung collapse was most common radiological feature.Conclusions: CT guided percutaneous biopsy is a valuable diagnostic technique providing for early accurate diagnosis and being minimally invasive procedure. Care should be taken while tissue processing and section cutting of intrathoracic biopsies as the biopsies are small and tissue loss should be prevented so that sufficient material is available for immunohistochemistry.
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Objective: To observe the clinical efficacy and toxic side effects of CT-guided Ad-P53 intratumoral injection in patient with recurrent and metastatic female pelvic tumor. Methods: From October 2012 to July 2014, the Gynecological Oncology Division, Tumor Radiotherapy Department of The First Affiliated Hospital of Xi'an Jiaotong University, received 79 patients with recurrent and metastatic pelvic tumor, of whom 28 were subjected to CT-guided Ad-P53 injection therapy. The 28 patients were treated by CT-guided local multi-point injection into the tumor. In each injection, (1-2)×1012VP (viral particles) were used and diluted to 4-8 mL with normal saline; administration once a week and 1-6 times altogether. The 28 patients received treatment 41 times in total, with dosage of (3±1) pieces on average. The treatment was performed with no more radiotherapy or chemotherapy, and considered to come to an end when the tumor regressed or the patient could not tolerate or refused further treatment. Therapeutic evaluation: ① Objective therapeutic evaluation: The efficacy was evaluated one month before and after the treatment, according to the WHO's Response Evaluation Criteria in Solid Tumors in combination with the maximum sectional area of the tumor measured through pelvis MRI scanning and the regression rate (%) obtained. ② Subjective therapeutic evaluation: It was based on the extent of pain relief and vaginal discharge of the patient. Results: The 28 patients all received regular follow-up, with the duration of 6-27 months, and median follow-up time of 17 months by December 2014. Therapeutic evaluation, both subjective and objective, was made one month after completion of the treatment. The results showed that 24 patients achieved notable remission (24/28, 85.7%), with objective clinical benefit ratio (CR+PR+SD> one month) of 82.1% (23/28), and median survival time of 11 months. Twenty-one patients, comprising 91.3% (21/23), experienced worsened conditions, with median progression-free survival of five months. Two patients, whose appetite and sleeping quality were improved after pain relief, received palliative chemotherapy again. Thirteen patients died, comprising 46.4% (13/28). Conclusion: Management of recurrent and metastatic gynecological tumors by CT-guided intratumoral injection of Gendicine allows effective pain relief and improvement in patients' quality of life, and at the same time exhibits high safety level and minor side effects and reduces costs.
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Objective@#To investigate the safety and influencing factors of ct-guided percutaneous lung biopsy in pneumoconiosis patients.@*Methods@#The data of 63 patients with pneumoconiosis who underwent ct-guided percutaneous lung biopsy in our hospital were studied to analyze the incidence of complications and influencing factors of percutaneous lung biopsy.@*Results@#63 cases of pneumoconiosis patients received CT guided percutaneous lung biopsy. There were 29 cases of complications (46.03%) , including 20 pneumothorax (37.75%) , 12 bleeding (19.05%) , and 3 cases of liquid pneumothorax (4.76%) . The single factor chi square analysis showed that there were significant differences in age, depth of focus, puncture position and puncture times (P<0.05) , and there was significant difference between the occurrence of hemorrhage and age, type of focus, size of focus, and the location of puncture site (P<0.05) . The unconditional LogisticL multiple factor regression analysis showed that the depth of the lesion was an independent risk factor for concurrency pneumothorax, and the size of the lesion was an independent risk factor for bleeding.@*Conclusion@#Complications of CT-guided percutaneous pulmonary biopsy are mainly pneumothorax and hemorrhage. Age, focus type, focus size, focus depth, puncture site, and puncture times are all the factors of complications.
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Objective: This study aims to investigate the efficacy and safety of the CT-guided three-dimensional brachytherapy combined with three-dimensional conformal radiotherapy in patients with locally middle- and late-stage cervical cancer. Methods: Ninety-seven patients with stage II A-IV locally middle- and late- stage cervical squamous-cell carcinoma were treated with CT-guided three-dimensional brachytherapy combined with three-dimensional conformal radiotherapy. The short-term response was observed. The survival analysis was conducted by Kaplan-Meier method, and the univariate analysis of prognosis was performed by using log-rank test. The high-risk clinical target volume (HR-CTV) D90, D2cc of bladder, rectum and sigmoid colon and equivalent dose in 2 Gy per fraction (EQD2) were calculated. Results: The overall 2-year survival rate and 2-year progression-free survival rate of 97 patients were 93.8% and 92.1%, respectively. The differentiation degree and tumor size were significantly correlated with the overall survival (both P < 0.05). According to Radiation Therapy Oncology Group (RTOG) acute and late radiation reaction evaluation criterion, rates of grades 1 and 2 acute lower digestive adverse reaction were 15.5% (15/97) and 12.4% (12/97), respectively. The acute gastrointestinal adverse reaction grading was associated with HR-CTV D90 EQD2 (P = 0.027). The rate of grades 3 and 4 late digestive system adverse reactions was 1.0% (1/97). Conclusion: CT-guided three-dimensional brachytherapy combined with three-dimensional conformal radiotherapy in the treatment of locally middle- and late-stage cervical cancer has good efficacy, and the rate of late severe adverse reaction is low.
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Lumbar disc herniation(LDH) is a kind of common and frequently-occurring disease which seriously affects the quality of life of patients.About 60% lumbocrural pain resulted from LDH.Chemical ablation is one of the non-vascular interventional procedures for the treatment of lumbar disc herniation in clinical minimally invasive treatment.It has many advantages such as minimally invasive,effective, low cost,and relieves or cures the pain of patients with lumbar disc herniation.This minimally invasive procedure has the interdisciplinarity characteristics with pain medicine, regional anatomy, radiography and pharmacology, which has been progressively developing from intra-lumbar intervertebral disc injection with oxidized nucleus pulposus,lumbar intervertebral disc with collagenase injection and psoas com-partment block to combined treatment.From C-arm X-ray system guided to CT and MSCT-guided which has the advantages of TLCS,precise localization,three-dimensional reconstruction,safe and rapid and guided treatment.Meanwhile,chemical ablation has serious complications, and the substance use and drug dosage have not been unified.In order to help the medic understand the development of this technology,we re-viewed chemical ablation to serve the patient better.
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We present a case of papillary thyroid cancer (post-thyroidectomy status) on regular treatment with suppressive Levothyroxine therapy. On follow-up at 6 months after radioactive iodine ablation for remnant thyroid tissue, her thyroglobulin, and anti-thyroglobulin levels were 0.06 ng/ml and 670 IU/ml, respectively. Low-dose whole-body I-131 scan was negative. To look for the cause of isolated increased anti-thyroglobulin level, a whole-body ¹⁸F-FDG PET/CT was done which revealed multiple FDG-avid lytic skeletal lesions suggestive of metastases. For confirmation of diagnosis, ¹⁸F-FDG PET/CT-guided metabolic biopsy was done, which revealed Langerhans' cell histiocytosis on histopathological examination.
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Biopsy , Diagnosis , Follow-Up Studies , Histiocytosis , Iodine , Neoplasm Metastasis , Positron Emission Tomography Computed Tomography , Thyroglobulin , Thyroid Gland , Thyroid Neoplasms , ThyroxineABSTRACT
Objective@#To evaluate the clinical value of computed tomography (CT)-guided 125I seed implantation in the treatment of patients with spinal and/or paraspinal osteolytic metastatic tumors.@*Methods@#The radiation dose distribution was planned for 27 patients with 35 spinal and paraspinal osteolytic metastatic tumors by a treatment planning system (TPS). CT-guided 125I seed implantation was carried out in the patients, and the quality of treatment was evaluated based on CT-imaging follow-up.@*Results@#All the 27 patients underwent CT-guided 125I seed implantation successfully. 12 to 50 125I seeds were injected into each spinal or paraspinal metastatic tumor, 39.15 on average, and the specific radioactive activity of the particles ranged from 0.60 to 0.80 mCi, 0.73 mCi on average. The minimal percentage of the dose received by 90% of the target volume (D90) of the spinal and paraspinal metastatic tumors ranged from 90 to 165 Gy, 115.03 Gy on average. Among the 27 patients, 21 (77.8%) had partial remission (PR) and 6(22.2%)had stable disease (SD). The Numerical Rating Scale (NRS) scores before implantation and at postoperative 3 and 6 months were 7.81±0.74, 2.04±1.10 and 1.81±0.79, respectively, (P<0.05). The assessment of pain intensity before 125I seed implantation and at 3 postoperative months showed obvious improvements in the patients evaluated according to the American Spinal Injury Association (ASIA) impairment scale: 12 (44.4%) patients with ASIA grade C were changed to grade D, 3 (11.1%) from grade C to grade E, 8 (29.6%) from grade D to grade E, 3 (11.1%) with a stable grade D, and 1 (3.7%)with a stablegrade C. The Karnovsky performance scale (KPS) scores before treatment and at 3 months and 6 months postoperatively were 66.30±6.88, 85.93±9.31 and 87.91±8.56, respectively (P<0.05). Their local control rate (LCR) at 3 months, 6 months and 1 year postoperatively were 100%, 92.6% and 51.9%, respectively, and the overall survival rates(OSR) were 100%, 92.6% and 55.6%, respectively.@*Conclusions@#CT-guided 125I seed implantation can significantly relieve local pain, has advantages of less complications and higher local control rate. Therefore, it is a safe, effective and feasible treatment option for patients with spinal and paraspinal osteolytic metastatic tumors.
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Objective To investigate thc clinical effect of midazolam in CT-guided 125I seed implantation.Methods Totally 86 patients who underwent CT-guided radioactive 125I seed implantation were collected from December 2015 to February 2017 in the Second Hospital of Tianjin Medical University and randomly divided into two groups:the test group and the control group.The test group was given intravenous infusion of midazolam and local anesthesia of lidocaine while the control group were given the same amount of saline and lidocaine.The changes of heart rate (HR),mean arterial pressure (MAP),respiration (RR) and oxygen saturation (SpO2) were observed and compared between the two groups at 15 min before the midazolam(T0),15 min after the midazolam (T1),15 min after lidocaine local anesthesia (T2),the moments the lesion was punctured (T3),and after implantation of the seeds (T4) and the end of the operation (T5),respectively.In addition,the body reaction,operation time,the amount of lidocaine,the effect of analgesic and adverse reactions were also observed.Results The levels of HR,MAP,RR and SpO2 in test group were significantly lower than those in control group (t =38.9,31.0,14.1,2.4,P ＜0.05),but there was no significant difference at T1,T2,T3,T4 and T5(P ＞0.05).In control group,HR,MAP and RR were significantly higher than those before operation (t =-23.6,-18.0,-9.5,P＜0.05).The difference ofHR,MAP,RR and SpO2 among T1,T2,T3,T4 and T5 was statistically significant (F =997.3,833.7,120.1,77.5,P ＜ 0.05).In addition,the incidence of adverse reactions was both less in the two groups,and the incidence of response of patients,operation time,the amount of lidocaine and other indicators and analgesic effect in the test group were superior to the control group (-15.4,9.2,-56.3,P ＜ 0.05).Conclusions Midazolam in CT-guided 125I particle implantation can improve the patient's tolerance and shorten the operation time,guarantec security.
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Objective To compare the planned radiation dose and the actual dose received after 125I radioactive seeds implantation supported by coplanar template (CPT) in lung cancer patients with mediastinal node metastases 4R,and to evaluate the clinical efficacy.Methods Totally 32 patients with lung cancer with mediastinal lymph node metastases 4R who had been diagnosed via cellular pathology studies were selected from January 2008 to December 2014.The mediastinal lymph node metastases were treated by CPT-assisted 125I radioactive seed implantation.Digital imaging and communications in medicine (DICOM) data were acquired by chest CT scan before implantation,brachytherapy radiation treatment planning system (BTPS) was introduced to carry out the plan,and the prescribed dose(PD) was 120 Gy.CPT was used to control the precision of needle penetration and implantation of radioactive seeds.Computer tomography (CT) was used to ensure the correct position of needles and radioactive seeds.Dose evaluation was performed immediately after implantation and was compared with planned dose using paired t-test.The 6-months postoperative chest CT was conducted to evaluate treatment efficacy according to response evaluation criteria in solid tumors(RECIST Version 1.1).Results All patients went through implantation procedure successfully.Dose evaluation after implantation was as followed.The average dose received (231.9 ±29.6)Gy,the dose received by 90％ of the target(D90) (150.8 ± 16.6) Gy,the dose received by 100％ of the target(D100) (100.4 ± 12.6)Gy,the volume of 100％PD covering the target(V100)(94.1 ± 2.6) ％,the volume of 200％ PD covering the target(V200) (33.0 ± 5.7) ％,the conformal index (CI) 0.75 ±0.06,the external index(EI) (22.7 ± 5.8)％,the average dose received by the superior vena cava (19.3 ± 7.2)Gy,and the average dose received by aorta (12.1 ± 5.1)Gy.Efficacy was followed for 6 months after implantation and the effective rate was 84.37％.There was no serious complications (such as radioactive lung injury,major vascular injury,bleeding,and et al.) occurred in follow-up period.Conclusions CPT assisted CT guided 125I radioactive seed imnplantation in treating mediastinal node metastases 4R can achieve preoperative BTPS,minimize major vascular or organ injury.It is an accurate,effective and safe treatment approach and may be of great value to standardize the procedure of radioactive seed implantation in mediastinal metastases.
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Objective To investigate the efficacy and side effects of radioactive seed implantation in the treatment of non-surgical early stage non-small cell lung cancer (NSCLC) based on CT guidance combined with template.Methods Twenty-one patients with inoperable T1 2N0M0 NSCLC who underwent CT-guided radioactive seed implantation therapy were retrospectively analyzed from December 2010 to October 2016 in the Second Hospital of Tianjin Medical University.All patients were diagnosed by histopathology.All seeds,with the activity of 18.5-29.6 MBq and prescription dose of 120-160 Gy,were completed in an operation of the radioactive seed implantation.The preoperative and postoperative TPS treatment plans and quality verification were corducted.In addition,the local control rate of tumors,overall survival (OS),progression free survival time (PFS),satisfaction rate of dose validation and adverse reactions were evaluated.Results The median follow-up was 25.1 months (range 4.4-72.7months).The local control rate of primary tumor in 1-,2-and 3-year was 100％,95.2％ and 95.2％,respectively.Of all patients,the median OS was 48 months with the median PFS 43.4 months.In particular,the 1-,2-and 3-year survival rate was 100％,91.7％ and 72.9％,respectively.Moreover,the rate of 3-year PFS was 70.2％ and the satisfactory rate of postoperative quahty verification was 100％.The treatment-related adverse events included pneumothorax,bronchial hemorrhage,pleural effusion,cough,pulmonary fibrosis and seed shifts.In all,7 (33.3％) patients had grade 1 adverse events and 4 (19％) patients with grade 2,but no grade 3 adverse event.Conclusions CT and template-guided radioactive seed implantation in NSCLC with T1 2 N0 M0 has a high tumor local control rate and low treatment-related adverse reactions,suggesting that it might provide an alternative way for the treatment of inoperable early stage NSCLC.
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Objective To investigate the successful rate and the therapeutic effect of loosening posterior tubercle of cervical transverse process with CT-guided insertion or blind insertion of small needle knife for cervical spondylotic radiculopathy. Methods Ninety patients with cervical spondylotic radiculopathy were divided into CT-guided insertion group and blind insertion group in the admission order using the random number table method, 45 cases in each group. CT-guided insertion group adopted the insertion of small needle knife following by the guide of CT, and the blind insertion group adopted the insertion of small needle knife following by cervical bony landmarks and muscles. After insertion, the position of the small needle knife in patients of the two groups was located by CT scan. If the needle knife did not arrive to the foci, it will be inserted again following by the guide of CT till successful insertion and location. The successful rate for the two times of insertion was calculated, and the pain scores were evaluated by visual analogue scale(VAS). Results(1) The successful rate for the first insertion of CT-guided insertion group was 73.3％, and that of the blind insertion group was 47.8％, the difference being significant(P < 0.01). The successful rate for the second insertion of CT-guided insertion group was 92.2％, and that of the blind insertion group was 80.0％, the difference being significant (P<0.01). (2) After treatment for one week, pain VAS scores of the two group were decreased (P < 0.01 compared with those before treatment) , and the decrease in the CT-guided insertion group was more obvious than the blind insertion group (P < 0.05). Conclusion CT-guided insertion makes the small needle knife therapy be more accurate and safer, ensures much better therapeutic effect, and brings less pain in the patients.
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OBJECTIVE:To observe clinical efficacy and safety of recombinant human endostatin(rh-endostatin)com-bined with CT-guided percutaneous microwave ablation in the treatment of non-small cell lung cancer(NSCLC)complicat-ed with chronic obstructive pulmonary disease (COPD). METHODS:A total of 80 cases of NSCLC complicated with COPD were selected from our hospital during Feb. 2014-Feb. 2016,and then divided into control group and observation group according to random number table,with 40 cases in each group. Control group was treated by CT-guided percutane-ous microwave ablation. Observation group was additionally given rh-endostatin injection 7.5 mg/m2,once a day,d1-14, added into 500 mL 0.9％ sodium chloride injection,ivgtt lasting for 4 h,for consecutive 14 d,on the basis of control group;7 d later,next course was performed. A treatment course lasted for 21 d,and they received 4 courses of treat-ment. Survival time,clinical efficacy as well as KPS score and lung function indexes before and after treatment,the oc-currence of ADR were compared between 2 groups. RESULTS:Median survival time of observation group(19.8 months) was significantly longer than that of control group(15.2 months),and total response rate of observation group(72.5％) was significantly higher than that of control group (55.0％),with statistical significance (P0.05). After treat-ment,KPS score and above lung function indexes levels of 2 groups were increased significantly,and those of observa-tion group were significantly higher than those of control group,with statistical significance (P0.05). CONCLUSIONS:rh-endostatin combined with CT-guided percutaneous microwave ablation in the treatment of NSCLC complicated with COPD show good clinical efficacy with less ADR,and can significantly improve lung function and quality of life.
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Objective To discuss the clinical application of CT-guided localization of small pulmonary nodules (SPNs) by using double-hook-wire before the performance of video-assisted thoracoscopic (VATS) resection.Methods Before the performance of VATS resection,CT-guided localization by using doublehook-wire was carried out in 54 patients with SPNs (67 small pulmonary nodules in total) and CT-guided localization by using single-hook-wire was employed in 63 patients with SPNs(81 small pulmonary nodules in total).The location success rate and complication rate of the double-hook-wire technique and the singlehook-wire technique were calculated.Results The location success rate of CT-guided localization for SPNs by using double-hook-wire performed before VATS resection in 54 patients was 100％.The incidences of pneumothorax and hemorrhage were 29.6％ (16/54) and 48.1％ (26/54) respectively.In 63 patients receiving single-hook-wire technique,the location success rate for SPNs was 98.4％ (62/63).The incidences of pneumothorax and hemorrhage were 28.5％ (18/63) and 25.4％ (16/63) respectively.Conclusion CT-guided localization for SPNs by using double-hook-wire before VATS resection can reduce the risk of failure in positioning the hook-wire,and this technique is an important supplement for other localization techniques.