ABSTRACT
BACKGROUND AND OBJECTIVE: Percutaneous lung biopsy for diagnostic sampling of peripheral lung nodules has been widely performed by interventional radiologists under computed tomography (CT) guidance. New technology allows pulmonologists to perform percutaneous lung biopsies using electromagnetic (EM) guided technology. With the adoption of this new technique, the safety, feasibility and diagnostic yield need to be explored. The goal of this study was to determine the safety, feasibility and diagnostic yield of EM-guided percutaneous lung biopsy performed by pulmonologists. METHODS: We conducted a retrospective, multicentre study of 129 EM-guided percutaneous lung biopsies that occurred between November 2013 and March 2017. The study consisted of seven academic and three community medical centres. RESULTS: The average age of participants was 65.6 years, BMI was 26.3 and 50.4% were females. The majority of lesions were in the right upper lobe (37.2%) and left upper lobe (31.8%). The mean size of the lesions was 27.31 mm and the average distance from the pleura was 13.2 mm. Practitioners averaged two fine-needle aspirates and five core biopsies per procedure. There were 23 (17.8%) pneumothoraces, of which 16 (12.4%) received small-bore chest tube placement. The diagnostic yield of percutaneous lung biopsy was 73.7%. When EM-guided bronchoscopic sampling was also performed during the same procedural encounter, the overall diagnostic yield increased to 81.1%. CONCLUSION: In this large multicentred series, the use of EM guidance for percutaneous lung biopsies was safe and feasible, with acceptable diagnostic yield in the hands of pulmonologists. A prospective multicentre trial to validate these findings is currently underway (NCT03338049).
Subject(s)
Biopsy/methods , Lung Neoplasms/pathology , Multiple Pulmonary Nodules/pathology , Pulmonary Medicine/methods , Adult , Aged , Aged, 80 and over , Biopsy/adverse effects , Biopsy, Fine-Needle/adverse effects , Biopsy, Large-Core Needle/adverse effects , Bronchoscopy , Electromagnetic Phenomena , Feasibility Studies , Female , Humans , Image-Guided Biopsy/adverse effects , Lung/pathology , Lung Neoplasms/diagnosis , Male , Middle Aged , Multiple Pulmonary Nodules/diagnosis , Pneumothorax/etiology , Retrospective StudiesABSTRACT
Airway complications after lung transplantation are well described and can lead to significant morbidity and mortality. Treatment options for anastomotic dehiscence include expectant management, placement of endobronchial stents, or surgical repair. The use of fibrin sealant instilled by bronchoscopy to seal a dehiscence has not been well described. Our patient is a 57-year-old man who underwent orthotropic bilateral lung transplantation for end-stage chronic obstructive pulmonary disease. He was found to have a partial bronchial anastomosis dehiscence and was subsequently treated with endobronchial fibrin sealant glue instillation. This case illustrates the successful use of endobronchial fibrin sealant for bronchial anastomosis dehiscence.
Subject(s)
Bronchoscopy/methods , Fibrin Tissue Adhesive/pharmacology , Lung Transplantation/adverse effects , Pulmonary Disease, Chronic Obstructive/surgery , Surgical Wound Dehiscence/therapy , Humans , Male , Middle Aged , Surgical Wound Dehiscence/diagnosis , Tissue Adhesives/pharmacology , Tomography, X-Ray ComputedABSTRACT
Lung cancer screening with annual low-dose computed tomography (CT) decreases lung cancer mortality in high-risk patients, as defined by smoking history (> 30 pack-years) and age (55-74 years). Risks to screening include overdiagnosis, anxiety about indeterminate nodules, and radiation exposure. To be effective, lung cancer screening must combine individualized risk assessment, shared decision-making, smoking cessation, structured reporting, high quality and multi-specialty cancer care, and reliable follow-up; a multidisciplinary approach is crucial. Specialty organizations have outlined both the components of high quality lung cancer screening programs and the proposed metrics that programs should track. Long-term outcomes of lung cancer screening in the general population, further refinement of who to screen, and use of biomarkers for early cancer detection are ongoing research questions.
