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      Core-needle biopsy under CT fluoroscopy guidance and fine-needle aspiration cytology: Comparison of diagnostic yield in the diagnosis of lung and mediastinum tumors. Analysis of frequency and types of complications

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          Summary

          Background

          Patients with pathological tissue mass in thoracic cage found with imaging require histopathological or cytological confirmation of malignancy before treatment. The tissue material essential for patomorphological evaluation can be acquired with fine-needle aspiration biopsies (FNAB) controlled with CT and core-needle biopsy (CNB) under real-time CT fluoroscopy guidance. The purpose of this work is to carry out a retrospective analysis of the two methods with regards to their informativity, frequency and the kind of complications.

          Material/Methods

          From January, 2012 to May 2013, 76 core-needle biopsies of lung and mediastinum tumors were conducted and compared with 86 fine-needle aspiration biopsies(FNAB) of lung and mediastinum tumors, including 30 patients who underwent FNAB and were referred to CNB in order to specify the diagnosis.

          Results

          Complete histopathological diagnosis was made in 91% with the use of CNB and in 37% when FNAB was the chosen method. Early complications were observed in 32% patients who underwent BG and in group of 11% who underwent FNAB. Late complications, however, appeared in 29% patients after CNB and 13% after FNAB. In 24 cases CNB specified the complete diagnosis.

          Conclusions

          Core-needle biopsy in comparison to fine-needle aspiration biopsy has more frequent rate of negligible complications, however, it offers higher diagnostic yield for diagnostic of lung and mediastinum neoplastic disease and allows for more precise diagnosis of focal lesions.

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          Most cited references14

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          Guidelines for radiologically guided lung biopsy.

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            CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate.

            To evaluate the effect of coaxial needle size on pneumothorax rate and the diagnostic accuracy of computed tomography (CT)-guided transthoracic needle aspiration biopsy (TNAB) of pulmonary nodules. Retrospective review of 846 consecutive CT-guided TNAB procedures was performed. A coaxial approach was implemented in all patients by using an 18- or 19-gauge outer stabilizing needle through which a smaller aspiration needle or automated biopsy gun was inserted for tissue sampling. Univariate and multivariate regression analyses were used to analyze coaxial needle size, age, sex, smoking history, lesion size, use of an automated core biopsy gun, number of needle passes, and frequency of chest tube placement. Sensitivity, specificity, and diagnostic accuracy were calculated for 676 patients with at least 18 months of clinical follow-up. Pneumothorax occurred in 226 of 846 patients. Coaxial needle size and patient age had a significant effect on pneumothorax rate. Pneumothorax occurred in 124 (38%) of 324 patients who underwent procedures with 18-gauge needles and in 121 (23%) of 522 patients who underwent procedures with 19-gauge needles (P <.001). The overall diagnostic accuracy was 96% for procedures performed with 18-gauge needles and 92% for procedures performed with 19-gauge needles, with a sensitivity of 95% and 89% and a specificity of 100% and 99%, respectively. Pneumothorax occurred in 153 patients older than 60 years, in 99 patients 60 years and younger (P <.02), in 90 patients older than 70 years, and in 162 patients younger than 70 years (P <.01). The relationship between pneumothorax rate and age as a continuous distribution was not significant (P <.07), nor were the 50- or 75-year age cutoffs (P <.06 and P <.9, respectively). Use of a smaller coaxial stabilizing needle produces a substantially decreased risk of pneumothorax with comparable diagnostic accuracy, sensitivity, and specificity for histopathologic diagnosis of pulmonary nodules. Copyright RSNA, 2003
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              CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure.

              Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles. We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis. The biopsy results were nondiagnostic in 0.6% of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741 of 787 lesions) and 99.1% (211 of 213 lesions), respectively; diagnostic accuracy was 95.2% (952 of 1,000 lesions). For lesions measuring or= 3.1 cm (OR, 4.32; p = 0.007). CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring or= 3.1 cm significantly increased the rate of diagnostic failure.
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                Author and article information

                Journal
                Pol J Radiol
                Pol J Radiol
                Pol J Radiol
                Polish Journal of Radiology
                International Scientific Literature, Inc.
                1733-134X
                1899-0967
                2014
                01 July 2014
                : 79
                : 175-180
                Affiliations
                [1 ]Department of Diagnostic Imaging and Interventional Radiology, Franciszek Łukaszczyk Oncology Center, Bydgoszcz, Poland
                [2 ]Department of Tumor Pathology and Pathomorphology, Franciszek Łukaszczyk Oncology Center, Bydgoszcz, Poland
                [3 ]Department of Radiology of Medical University of Gdańsk, Gdańsk, Poland
                [4 ]Department of Thoracic Surgery and Tumors, Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland
                Author notes
                Author’s address: Przemysław Szlęzak, Department of Diagnostic Imaging and Interventional Radiology, Franciszek Łukaszczyk Oncology Center, Izabeli Romanowskiej 2 Str., 85-796 Bydgoszcz, Poland, e-mail: szlezak@ 123456gmail.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                889948
                10.12659/PJR.889948
                4085119
                e87a4868-511e-4a5c-b01b-b7bbb00ac97b
                © Pol J Radiol, 2014

                This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

                History
                : 25 October 2013
                : 10 December 2013
                Categories
                Original Article

                Radiology & Imaging
                core-needle biopsy,fine-needle aspiration biopsy,ct fluoroscopy
                Radiology & Imaging
                core-needle biopsy, fine-needle aspiration biopsy, ct fluoroscopy

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