Diagnostic Yield and Safety of Computed Tomography-guided Mediastinal Core Needle Biopsies.

PURPOSE: Mediastinal masses of various origins can be encountered on imaging in symptomatic or asymptomatic patients. We aimed to evaluate the diagnostic yield and complication rate of computed tomography (CT)-guided mediastinal core needle biopsies in a large population of patients presenting with mediastinal masses and to identify the factors that could influence these results. MATERIALS AND METHODS: In total, 293 consecutive CT-guided mediastinal biopsies, performed in 285 patients with equivocal masses at a single center from 2006 to 2011, were included. Lesion characteristics, technical biopsy parameters, final diagnoses, diagnostic yields (number of biopsies that yielded a complete diagnosis divided by the total number of biopsies), and complication rates were recorded. RESULTS: Malignant diagnoses, including lymphoproliferative disorders (N=151, 53%) and lung cancers (N=54, 19%), were established in 233 cases (82%). Benign lesions were found in 52 procedures (18%), including sarcoidosis (N=19, 7%) and infections (N=17, 6%). The overall diagnostic yield was 87% and was lower for lymphoma residual masses (57%) than for initial diagnosis or relapses of known disease (90%). Complications occurred in 21 patients (7%), but only 2 patients (0.7%) required hospitalization for >12 hours. Neither the diagnostic yield nor the complication rate was influenced by the target characteristics or by technical parameters. CONCLUSIONS: CT-guided core needle biopsy of equivocal mediastinal masses is a minimally invasive procedure that is effective and safe, even in cases of small targets or targets in challenging locations.

Serial computed tomography and lung function testing in pulmonary Langerhans' cell histiocytosis.

Little is known about longitudinal lung function variation in patients with pulmonary Langerhans' cell histiocytosis (LCH). The contribution of serial lung computed tomography (CT) to managing these patients has not been evaluated. This long-term retrospective study included 49 patients who were serially evaluated by lung CT and pulmonary function tests. The lung function variation was categorised as improvement or deterioration. The extent of the CT lesions was correlated with lung function. Lung function deteriorated in ∼60% of the patients. Forced expiratory volume in 1 s (FEV(1)) and diffusing capacity of the lung for carbon monoxide (D(L,CO)) were the parameters that most frequently deteriorated. A subgroup of patients experienced a dramatic decline in FEV(1) within 2 yrs of diagnosis. Airway obstruction was the major functional pattern observed. In a multivariate analysis, % predicted FEV(1)at diagnosis was the only factor associated with the incidence of airway obstruction. The increase in cystic lesions on the lung CTs was associated with impaired lung function but did not anticipate the decline in FEV(1) or D(L,CO). Serial lung function tests are essential for following patients with pulmonary LCH, who frequently develop airway obstruction. A lung CT at diagnosis is informative, but routine sequential CTs seem less useful. A prospective study is needed to characterise those patients with early progressive disease.

Blunt-tip coaxial introducer: a revisited tool for difficult CT-guided biopsy in the chest and abdomen.

OBJECTIVE: We describe a coaxial introducer provided with an additional blunt-tip stylet that allows safe access to difficult-to-reach lymph nodes in the chest, abdomen, and pelvis under CT control. CONCLUSION: Once the thoracic, abdominal, or pelvic wall is crossed by the introducer fitted with the sharp-tip stylet, the blunt-tip stylet replaces the sharp stylet for further progression in the fat toward the target. The soft-tip stylet carries a smaller risk of inadvertent perforation displacing vital structures.

Image-guided core-needle biopsy of peripheral lymph nodes allows the diagnosis of lymphomas.

It is commonly admitted that the diagnosis of lymphomas can be assessed by the image-guided needle biopsy (IGNB) of deep lymph nodes. However, when peripheral lymph nodes are present, surgical dissection remains the standard strategy. The aim of this study was to evaluate the diagnostic yield of IGNB of peripheral lymph nodes in patients with suspected lymphomas. The records of 180 multisampling IGNBs of peripheral lymph nodes in 180 patients were reviewed. One hundred and twenty-three IGNBs were observed at first diagnosis and 57 at progression using large-cutting core-biopsy needles ranging between 18 G and 14 G in size. Immunohistochemistry studies were performed in all cases and at least one biopsy was systematically frozen. A diagnosis of lymphoma with sufficient information such that a therapeutic decision could be made was obtained in 146 of the 152 patients with lymphoproliferative disorders (96%). IGNB was equally effective in making the correct diagnosis of lymphoma at the time of original diagnosis than at relapse. The results did not depend on the biopsy site, lymph nodes size, or needle type. We recommend that IGNB may be performed as an initial procedure for the diagnosis of lymphomas either in the presence of peripheral or deep lymph nodes, as it avoids surgery.

[Breast imaging and biopsy procedures in the diagnosis of breast cancer]. / Imagerie mammaire et procédures biopsiques pour le diagnostic de cancer du sein.

THE INTEREST OF IMAGING: Mammography permits diagnosis of infra-clinical breast lesions with a sensitivity of around 80%. Moreover, with the improvement of the apparatuses and films, the latter permit analysis of the breast areas in most cases. Sonography, indisputable support for the study of dense breasts, is a complement to mammography and clinical examination. Magnetic resonance imaging is the most sensitive technique, but cannot be used in routine controls. The principle images are essentially opacities characterised by enhanced density in the glandular parenchyma (circular or round, asymmetrical opacities of architectural density and disorganisation, stellar and epiculated opacities) and micro-calcifications without specific appearance, revealing when isolated in situ intra-ductal or micro-invasive lesions. THE INTEREST OF BIOPSY PROCEDURES: For non-palpable tumours discovered on imaging, stereo or radio-guided cytological aspirations are proposed so long as the image is not too small. In the presence of infra-clinical images inaccessible to guided cytology, stereotaxy micro-biopsies can be performed. The relative insufficiency of results obtained has led to the proposal of needles of larger calibre used in an apparatus called a mammotome or in the ABBI system, the latter permitting radio-guided surgical excision. PRIORITY GIVEN TO CLINICAL CONTROLS: The technical progress must not lead one to neglect the clinical examination, which, in 5 to 30% of cases, reveals a cancer when the mammography or sonography does not.