Utilidad de la biopsia percutánea core guiada por tomografía computada (TC) en lesiones pulmonares: experiencia de 7 años / Percutaneous CT-guided cutting needle biopsy of pulmonary lesions: Retrospective analysis of 153 procedures

Background: CT guided percutaneous biopsy of pulmonary lesions is a widely used technique. Aim: To evaluate the yield and complication rate of CT-guided percutaneous core biopsy of pulmonary lesions. Material and Methods: A retrospective study of 153 consecutive lung biopsies performed in a 7-yearperiod was undertaken. Patients and lesions characteristics were reviewed. The yield for the diagnosis of malignant and benign lesions and the complication rate were calculated. Lesion size and depth from the pleural surface were analyzed as potential predictive variables for occurrence of a false-negative diagnosis of malignancy. The final diagnosis was established by surgical biopsy of the lesion or clinical and imaging follow up. Results: The mean age of patients was 66 ± 14 years and 55% were mole. The final diagnosis of the lesion was malignant in 139 and benign in 14 cases (prevalence of malignancy 90.8%). For the diagnosis of malignancy, the overall yield ofthe biopsy was 91.5%o with a sensitivity of 90.6%>. A specific diagnosis of benign lesions was obtained in 5 out ofl4 biopsies (35%). We did not identify an association between the lesion size or depth and the rate of false-negative diagnosis of malignancy. The pneumothorax rate was 13.7%o (n = 21) and eight (38%) required drainage. The average lesion depth of patients that had a pneumothorax was significant greater than the cases without the complication. No major bleeding complications occurred. Conclusions: Percutaneous CT-guided cutting needle biopsies of pulmonary lesions have an excellent diagnostic accuracy for malignant pulmonary lesions, at a low complication rate.

Osteonecrosis como manifestación inicial de neoplasias sistémicas: presentación de tres casos / Osteonecrosis as primary presentation of systemic malignancies: report of three cases

La osteonecrosis o necrosis avascular del hueso es una complicación frecuente en pacientes con enfermedades neoplásicas tratados con quimioterapia; sin embargo, es una entidad poco común como manifestación inicial de este tipo de patologías. En el presente artículo reportamos tres casos clínicos en los cuales la osteonecrosis fue la forma de presentación de la leucemia linfoblástica aguda y del neuroblastoma diseminado. Al momento de presentación de la osteonecrosis, ninguno de estos pacientes se encontraba en tratamiento con quimioterapia. El diagnóstico de osteonecrosis y de sustitución tumoral de médula ósea puede basarse en los hallazgos típicos en resonancia magnética. En todos los pacientes se realizó una biopsia o aspiración de médula ósea para confirmar el diagnóstico.

Osteonecrosis or avascular necrosis of bone is a well-described and frequent complication of chemotherapy containing corticosteroids, nevertheless only a few cases of osteonecrosis as primary presentation of haematological or other malignancies have been reported in the literature before. We report three cases in which osteonecrosis was the presenting feature of acute lymphoblasticleukemia and disseminated neuroblastoma. None of these patients were under chemotherapy at the time osteonecrosis was found. The diagnosis of osteonecrosis and neoplastic bone marrow substitution can usually be suggested on the basis of characteristic magnetic resonance imaging findings. Biopsy or bone marrow aspiration was performed in all cases to confirm the diagnosis.