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OBJECTIVE: To investigate the predictive factors for a non-diagnostic result and the final diagnosis of pulmonary lesions with an initial non-diagnostic result on CT-guided percutaneous transthoracic needle biopsy. MATERIALS AND METHODS: All percutaneous transthoracic needle biopsies performed over a 4-year period were retrospectively reviewed. The initial pathological results were classified into three categories—malignant, benign, and non-diagnostic. A non-diagnostic result was defined when no malignant cells were seen and a specific benign diagnosis could not be made. The demographic data of patients, lesions' characteristics, technique, complications, initial pathological results, and final diagnosis were reviewed. Statistical analysis was performed using binary logistic regression. RESULTS: Of 894 biopsies in 861 patients (male:female, 398:463; mean age 67, range 18–92 years), 690 (77.2%) were positive for malignancy, 55 (6.2%) were specific benign, and 149 (16.7%) were non-diagnostic. Of the 149 non-diagnostic biopsies, excluding 27 cases in which the final diagnosis could not be confirmed, 36% revealed malignant lesions and 64% revealed benign lesions. Predictive factors for a non-diagnostic biopsy included the size ≤ 15 mm, needle tract traversing emphysematous lung parenchyma, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Non-diagnostic biopsies with a history of malignancy or atypical cells on pathology were more likely to be malignant (p = 0.043 and p = 0.001). CONCLUSION: The predictive factors for a non-diagnostic biopsy were lesion size ≤ 15 mm, needle tract traversing emphysema, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Thirty-six percent of the non-diagnostic biopsies yielded a malignant diagnosis. In cases with a history of malignancy or the presence of atypical cells in the biopsy sample, a repeat biopsy or surgical intervention should be considered.
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Adult , Humans , Biopsy , Biopsy, Needle , Diagnosis , Emphysema , Hemorrhage , Logistic Models , Lung , Needles , Pathology , Retrospective StudiesABSTRACT
Objective To analyze the factors related to the occurrence of complications in performing CT-guided percutaneous lung biopsy with 18 G-Bard Magnum needle. Methods CT-guided percutaneous lung biopsy with 18 G-Bard Magnum needle was carried out in a total of 58 patients. The postoperative complications were recorded, and the related factors causing complication were analyzed. Results Successful puncturing was achieved in all patients with a technical success rate of 100%. Postoperative complications included pulmonary hemorrhage (n=11,19.0%), a little amount of bleeding in needle tract (n=7,12.1%), hemoptysis (n=3,5.2%), hemothorax (n=1,1.7%), and pneumothorax (n=10,17.2%). Chi-square test showed that the occurrence of pulmonary hemorrhage bore a close relationship to the lesion’s diameter, the distance between the lesion and the chest wall, the lesion’s location and times of puncturing (P<0.05). The occurrence of pneumothorax was closely correlated with the age, the distance between the lesion and the chest wall, the presence of perifocal emphysema, the lesion’s location and times of puncturing (P<0.05). Univariate analysis indicated that the postoperative complications were liable to occur in the patients whose imaging examination showed perifocal emphysema and lung hilar lesion, and who had more than two independent risk factors (P<0.05). Conclusion CT-guided percutaneous lung biopsy with 18 G-Bard Magnum needle is an accurate and safe technique with relatively higher positive diagnosis rate, but this technique should be carefully used in patients who has perifocal emphysema, or lung hilar lesion, or more than two independent risk factors.(J Intervent Radiol, 2015, 24:792-796)
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Objective: To evaluate the value of an 11-gauge stereotactic vacuum-assisted biopsy (SVAB) device for the diagnosis of breast microcalcifications. Methods: The 11-gauge SVAB was performed in 93 patients with microcalcifications in X-ray mammograms. The patients who were diagnosed as having breast cancer, atypical hyperplasia, unclarified breast lesions and imaging-histologic discordance should require surgical excision. The histopathological results of biopsy specimens and postoperative specimens were compared. Results: Of 97 lesions with microcalcifications, 96 (99.0%) calcified tissues were obtained. The pathological results showed that 71 (73.2%) were benign lesions, 19 (19.6%) were malignant lesions, 6 (6.2%) were atypical hyperplasia lesions. Of the 25 patients receiving surgical excision, 2 (2/13, 15.4%) with ductal cancer in situ had a final diagnosis of invasive breast cancer, 1 (1/4, 25.0%) with atypical hyperplasia lesions had a final diagnosis of ductal cancer in situ , 1 with imaging-histologic discordance had a final diagnosis of ductal cancer in situ . Of 71 patiens with a pathological diagnosis of benign lesions, 49 had a median follow-up of 14.5 months, and no obvious abnormalities were observed. The complications of 11-gauge SVAB included vasovagal reactions (1.0%), bleeding (2.1%) and hematoma formation (3.1%). Conclusion: The 11-gauge SVAB is an effective and reliable method with slight side effects for the diagnosis of breast microcalcifications if it is applied appropriately. For the breast lesions diagnosed as having atypical hyperplasia and ductal carcinoma in situ or with imaging-histologic discordance, the surgical biopsy should be performed subsequently. Copyright© 2012 by TUMOR.
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Objective To evaluate the diagnostic value of computed tomographic(CT) guided percutaneous fine-needle aspiration biopsy(FANB) in mediastinal lesions.Methods The authors retrospectively reviewed the records of 104 patients of the mediastinal lesions who underwent CT guided percutaneous fine-needle aspiration biopsy.The sites of CT guided biopsy in 104 patients included anterior mediastinum(n = 73) ,middle mediastinum(n = 29) and posterior mediastinum(n = 2) .The mediastinal lesions with variation in size from 2.31 cm ? 1.11 cm ～ 14.5 cm ? 10.3 cm(
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Objective To investigate the factors influencing the diagnostic accuracy in CT-guided percutaneous transthoracic aspiration biopsy of lung lesions. Methods CT-guided percutaneous transthoracic biopsy was performed in 435 patients with surgical pathologic confirmation or clinical follow-up.Univariant statistical analysis and multivariant stepwise Logistic regression analysis were used to study the influence of lesion-related factors(benignancy or malignancy,size,location,depth,presence of cavity),procedure factors(laser-guidence,position of patient) and patient-related factors(sex,age,presence of emphysema);with the accuracy of the diagnosis. Results ① 289 lesions were diagnosed as malignant ones and 146 as benign ones.The accuracy of CT-guided biopsy was(83.4%)(363/435).Univariant analysis showed that the diagnostic accuracies for malignant and benign lesions were(88.9%)(257/289) and(72.6%)(106/146),respectively(?~2=(18.71),P=(0.00002)).Laser-group was superior to non-laser group((88.4%) versus(80.9%),respectively,?~2=(4.00),P=(0.0456)).Mean diameters of lesions in correct diagnostic group and non-correct diagnostic group were(3.78)?(1.64) cm and(3.02)?(1.26) cm,respectively((F=)(13.79),P=(0.0002)).②Multivariant stepwise Logistic regression analysis showed that among the various factors influencing the final benign or malignant diagnoses(Wald ?~2=(14.01),P=(0.0002)) and using laser-guidence(Wald ?~2=(3.92),P=(0.0477)) were significantly associated with the diagnostic accuracy. Conclusions Final correct diagnoses(benign,malignant) are closely related to the application of laser-guidence for determining the diagnostic accuracy in CT-guided transcutaneous thoracic needle aspiration biopsy.