RESUMO
PURPOSE: Rapid on-site-evaluation (ROSE) is a technique aimed at improving the diagnostic performance of computed tomography (CT)-guided core needle biopsy (CNB) in lung cancer. The aim of this retrospective study was to investigate the impact of ROSE on the rate of nondiagnostic specimens and on accuracy computed on diagnostic specimens. MATERIALS AND METHODS: During a 3-year period, 417 CT-guided CNBs were performed at our center. The biopsies were retrospectively classified into 2 groups: 141 procedures were assisted by ROSE and 276 were not. All of them were reviewed for clinical, procedural, and pathological data. Pathology results were classified as diagnostic (positive or negative for malignancy) or nondiagnostic. The results were compared with the final diagnosis after surgery or clinical follow-up. Nondiagnostic rate, sensitivity/specificity/negative predictive value/positive predictive value for the ROSE and non-ROSE groups were calculated. Finally, procedural complications and the adequacy of the specimens for the molecular analysis were recorded. RESULTS: The study evaluated 417 CNBs (mean patients' age 71 years, 278 men). Nondiagnostic rates with and without ROSE were 4% (6/142) and 11% (29/276), respectively (P = 0.028). Sensitivity/specificity/negative predictive value/positive predictive value with and without ROSE did not show statistically significant differences, and no difference in major/minor complication rates was observed between the 2 groups. The adequacy of specimen for subsequent molecular analysis was 100% with (42/42) and 82% without ROSE (51/62). CONCLUSIONS: Rapid on-site-evaluation reduced the rate of nondiagnostic specimens by 50% with no change in complication rates or accuracy and increased by 20% the chances of a successful subsequent molecular analysis.
RESUMO
BACKGROUND: COVID-19 is a pandemic disease affecting predominantly the respiratory apparatus with clinical manifestations ranging from asymptomatic to respiratory failure. Chest CT is a crucial tool in diagnosing and evaluating the severity of pulmonary involvement through dedicated scoring systems. Nonetheless, many questions regarding the relationship of radiologic and clinical features of the disease have emerged in multidisciplinary meetings. The aim of this retrospective study was to explore such relationship throughout an innovative and alternative approach. MATERIALS AND METHODS: This study included 550 patients (range 25-98 years; 354 males, mean age 66.1; 196 females, mean age 70.9) hospitalized for COVID-19 with available radiological and clinical data between 1 March 2021 and 30 April 2022. Radiological data included CO-RADS, chest CT score, dominant pattern, and typical/atypical findings detected on CT examinations. Clinical data included clinical score and outcome. The relationship between such features was investigated through the development of the main four frequently asked questions summarizing the many issues arisen in multidisciplinary meetings, as follows 1) CO-RADS, chest CT score, clinical score, and outcomes; 2) the involvement of a specific lung lobe and outcomes; 3) dominant pattern/distribution and severity score for the same chest CT score; 4) additional factors and outcomes. RESULTS: 1) If CT was suggestive for COVID, a strong correlation between CT/clinical score and prognosis was found; 2) Middle lobe CT involvement was an unfavorable prognostic criterion; 3) If CT score < 50%, the pattern was not influential, whereas if CT score > 50%, crazy paving as dominant pattern leaded to a 15% increased death rate, stacked up against other patterns, thus almost doubling it; 4) Additional factors usually did not matter, but lymph-nodes and pleural effusion worsened prognosis. CONCLUSIONS: This study outlined those radiological features of COVID-19 most relevant towards disease severity and outcome with an innovative approach.
