Four Cases of a Cerebral Air Embolism Complicating a Percutaneous Transthoracic Needle Biopsy

A percutaneous transthoracic needle biopsy is a common procedure in the practice of pulmonology. An air embolism is a rare but potentially fatal complication of a percutaneous transthoracic needle biopsy. We report four cases of a cerebral air embolism that developed after a percutaneous transthoracic needle biopsy. Early diagnosis and the rapid application of hyperbaric oxygen therapy is the mainstay of therapy for an embolism. Prevention is the best course and it is essential that possible risk factors be avoided.

CT-guided Transthoracic Needle Biopsy with an 18-Guage Automated Cutting Needle: Diagnostic benefits and safety

PURPOSE: We wanted to evaluate the diagnostic benefits and safety of performing CT-guided transthoracic needle biopsy (TTNB) with using an18-gauge automated cutting needle. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 332 patients who underwent CT-guided transthoracic biopsy with an automated 18-gauge cutting needle for 341 thoracic lesions. The histopathologic results, diagnostic accuracy and complication rate were determined. RESULTS: 316 (92.7%) of 34l lesions were histopathologically diagnosed by CT-guided TTNB. The lesions were malignant in 172 patients and benign in 144 patients. The diagnostic accuracy was 92.9%. The sensitivity and specificity for malignant lesions were 93% and 92.3%, respectively. The sensitivity and specificity for benign lesions were 92.3% and 93%, respectively. TTNB induced complications developed for 54 of 341 (15.8%) procedures. The most frequent complication was pneumothorax (41/341, 12%). Nine patients with pneumothorax (9/41, 22%) required chest tube placement. CONCLUSION: CT-guided TTNB with an 18-gauge automated cutting needle could be useful for making the histopathologic diagnosis of malignant and benign pulmonary lesions as the technique provides a big enough tissue sample for histopathologic examination. The procedure-related complication rate was acceptably low.

Usefulness of CT-Guided Automatic Needle Biopsy of Solitary Pulmonary Nodule Smaller than 15 mm

PURPOSE: To evaluate the usefulness of the CT-guided percutaneous lung biopsy for the solitary pulmonary nodules smaller than 15 mm in diameter. MATERIALS AND METHODS: Between April 2002 and May 2003, we evaluated twenty-five patients (11 men, 14 women, mean ages: 52.5 years) who had solitary pulmonary nodules, which we could not discriminate as being benign or malignant on the CT findings. All the subjects had CT-guided percutaenous cutting needle biopsy (PCNB) performed on them at our institution. A definitive diagnosis of benignity or malignancy was established to retrospectively analyze the patient's records. We evaluated the accuracy, sensitivity, specificity and complications of PCNB for the definitive diagnosis of benignity or malignancy. The sensitivity and specificity of PCNB were determined using the Chi-square test, and the correlations with pneumothorax and emphysema after biopsy were analyzed using Spearman's rank correlation coefficient. RESULTS: In two nodules of the twenty-five nodules, no definitive diagnosis could be established. Of the remaining twenty-three nodules, 7 (30.4%) were malignant and 16 (69.6%) were benign. Twenty (87%) of the twenty-three definitively diagnosed nodules were correctly diagnosed with PCNB. Of the twenty nodules, 6 (30%) were malignant and 14 (70%) were benign. The sensitivity and specificity of the malignant nodules were 85.7% (6/7) and 100% (16/16), respectively. The sensitivity and specificity of the benign nodules were 87.5% (14/16) and 85.7% (6/7), respectively. Post-biopsy complication occurred in nine patients (36%): Hemoptysis (n=4, 16%) and pneumothorax (n=5, 20%). However, there was not a statistical significance between pneumothorax and emphysema after biopsy (r=0.3, p=0.15). CONCLUSION: When CT-guided percutaneous lung biopsy of the solitary pulmonary nodules smaller than 15 mm in diameter was performed without an on-site cytopathologist, we know that PCNB can yield high diagnostic accuracy and very few complications.

The Diagnostic Usefulness of CT-guided Needle Biopsy or Aspiration in Infectious Spondylitis

PURPOSE: To determine the diagnostic value of CT-guided biopsy or aspiration of the spine and paraspinal soft tissue in infectious spondylitis. MATERIALS AND METHODS: Between January 2000 and June 2002, 58 patients underwent 67 biopsies and/or aspirations under CT guidance to identify the organism causing infectious spondylitis, and were included in this study. Nine underwent rebiopsy. In all patients, MR images were available before biopsy and/or aspiration. In 63 of 67 procedures, the specimens or aspirates obtained were prepared for culture and smear, and for histological examination, four procedures involved aspiration only. In ten patients with suspected tuberculosis, a polymerase chain reaction test was performed. For all procedures, the transpedicular, transcostovertebral or paravertebral route was involved, according to the level and shape of the lesions, and 14-, 16-, or 18-gauge core biopsy needles and/or 20-gauge aspiration needles were employed. Lesions invloved a paravertebral (n=17), psoas (n=8) or epidural (n=1) abscess; an intervertebral disc (n=20); or a vertebral body (n=21). The levels at the mid-thoracic spine were T4-T10 (n=11); at the thoracolumbar junction, T11-L1 (n=14); at the lumbar spine, L1-L4 (n=25); and at the lumbo-sacral junction, L5-S1 (n=17). In nine of 58 patients, rebiopsy was performed. RESULTS: Diagnosis was confirmed in 22 of 58 patients (38%), and was as follows: tuberculous spondylitis (n=17), pyogenic spondylitis (n=4), and fungal spondylitis (n=1). Thirty-six unconfirmed cases were diagnosed as nonspecific inflammation (n=21), fibrosis involving cortical bone (n=1), necrotic material (n=5) and inadequate specimen without evidence of malignancy (n=9). Only one of the nine cases in which biopsy was repeated was confirmed as tuberculous spondylitis. Diagnosis was confirmed in 7 of 17 paravertebral abscesses (41%), 8 of 21 vertebral bodies (38%), 6 of 20 intervertebral discs (30%) and 1 of 8 psoas abscesses (13%). CONCLUSION: In infectious spondylitis, the overall diagnostic yield of CT-guided needle biopsy and/or aspiration is relatively low, but the procedure seems to be effective for excluding malignancy. In identifying the organisms involved in infectious spondylitis, a paravertebral lesion is in a more favoured location than a psoas lesion.

Diagnostic Usefulness of CT-guided Pe rcutaneous Biopsy of the Spine

PURPOSE: To evaluate the diagnostic value of CT-guided percutaneous biopsy of inflammatory and tumorous lesions of the spine and paraspinal soft tissue. MATERIALS AND METHODS: Twenty-three patients underwent CT-guided percutaneous biopsy of the spine and paraspinal soft tissue. Tentative clinical diagnoses determined before biopsy were tuberculous spondylitis (n=5), pyogenic spondylitis (n=4), butterfly vertebra (n=1), old compression fracture (n=3), discitis (n=1), hemangioma (n=1), metastasis (n=7) and multiple myeloma (n=1). Biopsy was performed at the following levels: cervical-(n=1), thoracic-(n=9), and lumbar-spine(n=13). The approach to biopsy of the spine and paraspinal soft tissue lesions was posterolateral (n=11), posterior (n=2), or transpedicular (n=10). RESULTS: Tissue considered adequate by the pathologist involved was obtained in 21 (91%) of the 23 cases. In 19 cases, pathologic findings supported the clinical diagnoses determined before biopsy. In two cases, pathologic and clinical diagnoses differed. Complications such as severe pain, bleeding, infection, neurologic deficit or damage to internal organs were detected neither during or after the procedure. CONCLUSION: CT-guided percutaneous biopsy is a safe and reliable method of obtaining a diagnosis in many cases involving different spinal and paraspinal 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.

CT-guided Percutaneous Biopsy of the Spine: Transpedicular approach

PURPOSE: To evaluate the efficiency of CT-guided transpedicular biopsy in obtaining diagnostic tissue fromvertebral body lesion. MATERIALS AND METHODS: The authors evaluated 25 patients(27 cases) who underwent CT-guidedtranspedicular biopsy for thoracic and lumbar vertebral lesions. Specimens were obtained from 27 lesions, sevenfrom thoracic spine and others from lumbar spine. Nine patients were men and 16 were women ; their ages rangedfrom 20 to 80 years. A 17-gauge "Osty-Cut" bone biopsy needle(Angiomed) with a hand-grip was used, and the patientwas placed in the prone position. For the analysis of results, pathologic reports were reviewed and follow-upstudies were checked. RESULTS: In all patients, the biopsy needle could be passed under CT guidance through thepedicle to the site of the disease. Pathologic reports indicated 11 malignancies, 11 normal trabecular bones andtwo cases of infectious spondylitis. Three cases were not diagnosed because of insufficient biopsy specimen. Eightcases of normal trabecular bone described in pathologic reports were confirmed by follow-up study. There were nocomplications during and after biopsy, and for pathologic diagnosis this was successful in 24 of 27 cases(88.9%). CONCLUSION: CT-guided transpedicular biopsy of vertebral lesion was safe and efficacious, especially in cases inwhich the posterolateral approach was difficult.

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.