Abstract
Amaç: Bilgisayarlı tomografi (BT) eşliğinde transtorasik akciğer biyopsisi konusundaki ilk deneyimimizi değerlendirmek ve komplikasyon oranlarımızı vb. sonuçlarımızı literatür ile karşılaştırmak.
Materyal ve Metod: Akciğer lezyonu olan 33 ardışık hastada 15 cm uzunluğunda 16 gauge yarı otomatik (koaksiyel) biyopsi iğnesi kullanılarak BT eşliğinde 34 transtorasik biyopsi işlemi retrospektif olarak değerlendirildi. Yaş, cinsiyet, lezyonun boyutu, yerleşim yeri, plevraya uzaklık, iğne giriş açısı, hasta pozisyonu, amfizem ve / veya komplikasyon varlığı (pnömotoraks ve pulmoner hemoraji), biyopsi öncesi, sırası ve sonrasında radyolojik bulgular değerlendirildi ve patolojik tanılar hasta dosyalarından elde edildi. Yöntemin tanısal başarısı, başarısızlığı ve komplikasyon oranları not edildi.
Bulgular: Pnömotoraks ve pulmoner kanama sırasıyla 9 ve 7 hastada gözlendi ve 4 hastada her ikisi de vardı. Sadece 4 hastada göğüs tüpü uygulaması gerekti (9 hastanın 4'ü pnömotorakslı). Akciğer kanaması olan hastaların hiçbirine ek işlem gerektirmedi. Biyopsi örneği, tanısal doğruluk oranı % 96.6 olup, 32 hastada histopatolojik değerlendirme için yeterliydi. En sık tanı skuamöz hücreli karsinomdu (11/33), bunu 14 hastada diğer primer akciğer tümörleri, 2 hastada meme karsinom metastazı ve 1 hastada B hücreli lenfoma izledi.
Sonuç: BT eşliğinde transtorasik akciğer biyopsisine bağlı komplikasyon oranımız literatür ile benzer oranlardaydı. Pnömotoraks ve pulmoner kanama beşte/dörtte bir kadar hastada ortaya çıkabilir, ancak bu komplikasyonların tedavisi hastaların çoğunda ek prosedürler gerektirmez ve tanısal doğruluk oranı yüksektir.
References
- DiBardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. Journal of thoracic disease 2015; 7(Suppl 4), S304–S316.
- Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE guidelines on percutaneous needle biopsy (PNB). Cardiovascular and interventional radiology 2017; 40(10), 1501-1513.
- Russo U, Sabatino V, Nizzoli R, Tiseo M, Cappabianca S, Reginelli A, et al. Transthoracic computed tomography-guided lung biopsy in the new era of personalized medicine. Future Oncology 2019; 15(10), 1125-1134.
- Schneider F, Smith MA, Lane MC, Pantanowitz L, Dacic S, Ohori NP. Adequacy of core needle biopsy specimens and fine-needle aspirates for molecular testing of lung adenocarcinomas. American Journal of Clinical Pathology 2015; 143(2), 193-200.
- Sabatino V, Russo U, D’Amuri F, Bevilacqua A, Pagnini F, Milanese G, et al. Pneumothorax and pulmonary hemorrhage after CT-guided lung biopsy: incidence, clinical significance and correlation. La radiologia medica 2021; 126(1), 170-177.
- Gupta S, Wallace MJ, Cardella JF, Kundu S, Miller DL, Rose SC, et al. Quality improvement guidelines for percutaneous needle biopsy. Journal of vascular and interventional radiology: JVIR 2010; 21(7), 969–975.
- Lang D, Reinelt V, Horner A, Akbari K, Fellner F, Lichtenberger P, et al. Complications of CT-guided transthoracic lung biopsy. Wiener klinische Wochenschrift 2018; 130(7-8), 288-292.
- Deng CJ, Dai FQ, Qian K, Tan QY, Wang RW, Deng B, et al. Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review. BMC pulmonary medicine 2018; 18(1), 146.
- Birchard KR. Transthoracic needle biopsy. In: Seminars in interventional radiology. © Thieme Medical Publishers, 2011; p. 087-097.
- Heyer CM, Reichelt S, Peters SA, Walther JW, Müller KM, Nicolas V. Computed tomography–navigated transthoracic core biopsy of pulmonary lesions: which factors affect diagnostic yield and complication rates?. Academic radiology 2008; 15(8), 1017-1026.
- Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. European radiology 2017; 27(1), 138-148.
- Laurent F, Latrabe V, Vergier B, Michel P. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovascular and interventional radiology 2000; 23(4), 266-272.
- Khan MF, Straub R, Moghaddam SR, Maataoui A, Gurung J, Wagner TOF, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. European radiology 2008; 18(7), 1356-1363.
- Branden E, Wallgren S, Högberg H, Koyi H. Computer tomography-guided core biopsies in a county hospital in Sweden: Complication rate and diagnostic yield. Annals of Thoracic Medicine 2014; 9(3), 149.
- Billich C, Muche R, Brenner G, Schmidt SA, Krüger S, Brambs HJ, et al. CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy tract. European Radiology 2008; 18(6), 1146-1152.
- Görgülü FF, Öksüzler FY, Arslan SA, Arslan M, Özsoy İE, Görgülü O. Computed tomography-guided transthoracic biopsy: Factors influencing diagnostic and complication rates. Journal of International Medical Research 2017; 45(2), 808-815.
- Dere O, Kolu M, Ağyar A, Sarıkaya ZPB, Hocanlı İ, Dusak A. BT kılavuzluğunda transtorasik kesici iğne akciğer biyopsisi: tanısal etkinliği ve komplikasyon oranları. Harran Üniversitesi Tıp Fakültesi Dergisi 2019; 16(2), 227-230.
Abstract
Background: To evaluate our first experience on computed tomography (CT)-guided transthoracic lung biopsy and compare our results including complication rates, etc. with the literature.
Materials and Methods: Thirty-four CT-guided transthoracic biopsies in 33 consecutive patients with lung lesions using a 15 cm long 16 gauge semi-automatic (coaxial) biopsy needle were retrospectively evaluated. Age, gender, size of the lesion, location, distance to pleura, needle insertion angle, patient position, presence of emphysema and/or complications (pneumothorax and pulmonary hemorrhage), radiological findings before, during and after the biopsy,and pathological diagnosis were retrieved from patient files. The diagnostic success and failure of the method, and complication rates were noted.
Results: Pneumothorax and pulmonary hemorrhage were observed in 9 and 7 patients, respectively, and 4 patients had both. Application of a chest tube was necessary in only 4 patients (4 of 9 patients wirth pneumothorax). None of the patients with pulmonary hemorrhage required additional procedures. The biopsy sample was adequate for histopathologic evaluation in 32 patients with a diagnostic accuracy rate of 96.6%. The most frequent diagnosis was squamous cell carcinoma (11/33), followed by other types of primary lung tumors in 14, breast carcinoma metastasis in 2, and B-cell lymphoma in 1 patient.
Conclusions: Our rate of complication due to CT-guided transthoracic lung biopsy seems to be comparable with the literature. Pneumothorax and pulmonary hemorrhage may occur in up to one fifth/fourth but the management of these complications does not require additional procedures in the majority of patients, and the diagnostic accuracy rate is high.
References
- DiBardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. Journal of thoracic disease 2015; 7(Suppl 4), S304–S316.
- Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE guidelines on percutaneous needle biopsy (PNB). Cardiovascular and interventional radiology 2017; 40(10), 1501-1513.
- Russo U, Sabatino V, Nizzoli R, Tiseo M, Cappabianca S, Reginelli A, et al. Transthoracic computed tomography-guided lung biopsy in the new era of personalized medicine. Future Oncology 2019; 15(10), 1125-1134.
- Schneider F, Smith MA, Lane MC, Pantanowitz L, Dacic S, Ohori NP. Adequacy of core needle biopsy specimens and fine-needle aspirates for molecular testing of lung adenocarcinomas. American Journal of Clinical Pathology 2015; 143(2), 193-200.
- Sabatino V, Russo U, D’Amuri F, Bevilacqua A, Pagnini F, Milanese G, et al. Pneumothorax and pulmonary hemorrhage after CT-guided lung biopsy: incidence, clinical significance and correlation. La radiologia medica 2021; 126(1), 170-177.
- Gupta S, Wallace MJ, Cardella JF, Kundu S, Miller DL, Rose SC, et al. Quality improvement guidelines for percutaneous needle biopsy. Journal of vascular and interventional radiology: JVIR 2010; 21(7), 969–975.
- Lang D, Reinelt V, Horner A, Akbari K, Fellner F, Lichtenberger P, et al. Complications of CT-guided transthoracic lung biopsy. Wiener klinische Wochenschrift 2018; 130(7-8), 288-292.
- Deng CJ, Dai FQ, Qian K, Tan QY, Wang RW, Deng B, et al. Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review. BMC pulmonary medicine 2018; 18(1), 146.
- Birchard KR. Transthoracic needle biopsy. In: Seminars in interventional radiology. © Thieme Medical Publishers, 2011; p. 087-097.
- Heyer CM, Reichelt S, Peters SA, Walther JW, Müller KM, Nicolas V. Computed tomography–navigated transthoracic core biopsy of pulmonary lesions: which factors affect diagnostic yield and complication rates?. Academic radiology 2008; 15(8), 1017-1026.
- Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. European radiology 2017; 27(1), 138-148.
- Laurent F, Latrabe V, Vergier B, Michel P. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovascular and interventional radiology 2000; 23(4), 266-272.
- Khan MF, Straub R, Moghaddam SR, Maataoui A, Gurung J, Wagner TOF, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. European radiology 2008; 18(7), 1356-1363.
- Branden E, Wallgren S, Högberg H, Koyi H. Computer tomography-guided core biopsies in a county hospital in Sweden: Complication rate and diagnostic yield. Annals of Thoracic Medicine 2014; 9(3), 149.
- Billich C, Muche R, Brenner G, Schmidt SA, Krüger S, Brambs HJ, et al. CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy tract. European Radiology 2008; 18(6), 1146-1152.
- Görgülü FF, Öksüzler FY, Arslan SA, Arslan M, Özsoy İE, Görgülü O. Computed tomography-guided transthoracic biopsy: Factors influencing diagnostic and complication rates. Journal of International Medical Research 2017; 45(2), 808-815.
- Dere O, Kolu M, Ağyar A, Sarıkaya ZPB, Hocanlı İ, Dusak A. BT kılavuzluğunda transtorasik kesici iğne akciğer biyopsisi: tanısal etkinliği ve komplikasyon oranları. Harran Üniversitesi Tıp Fakültesi Dergisi 2019; 16(2), 227-230.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 28, 2022 |
| Submission Date | February 9, 2022 |
| Acceptance Date | April 27, 2022 |
| Published in Issue | Year 2022 Volume: 19 Issue: 2 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty