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Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert comp...
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... 18-gauge chiba needle can be used as the guide, followed by insertion of a longer length 20-22 gauge chiba needle (Fig. 2) (5). In our institute, we use the coaxial biopsy set containing a 16 or 19-gauge guiding needle with an 18 or 20-gauge biopsy needle, respectively for obtaining tissue cores (Quick core biopsy set, Cook, Bloomington, IN, USA) (Fig. 3). Needle length should be selected depending on depth of lesion from the skin. In the quick core biopsy set available at our institution the outer guiding needle is 3-4 cm shorter than the inner biopsy needle and this is a very important point to be remembered during the needle selection. A quick core biopsy needle is available with two ...
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... transpulmonary path is employed when a mediastinal lesion could not be approached by the extrapleural route (Figs. 22, 23) (5). Patient positioning is achieved based on lesion accessibility and other precautions are same as a lung biopsy. The needle passes through the lung parenchyma and two layers of visceral ...
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... J Radiol 13(2), Mar/Apr 2012 kjronline.org 226 Lal et al. arteries are injured during the biopsy procedure (Fig. 30). Pneumorrhachis, the presence of intraspinal air, has been rarely reported after anesthetic interventions (18). A single case of pneumorrhachis has been reported following chest tube insertion (18). We have observed this phenomenon in one patient, most likely due to the pulling of air through the nerve root sleeve and into the spinal ...
Citations
... However, these en::es are dis:nct: cavita:on represents progressive gas-filled spaces within an ini:ally solid lesion due to cell loss; lesions with cys:c airspaces are thought to result from various other causa:ve mechanisms, such as :ssue forma:on around a preexis:ng bulla or a check-valve bronchiolar obstruc:on secondary to an inflammatory or neoplas:c process [1,2]. When a pulmonary lesion's air component predominates over its soj-:ssue component─a condi:on primarily ascribed to lesions with cys:c airspaces rather than to cavita:on─operators considering biopsy may have concerns for an increased risk of procedural complica:ons, including pneumothorax, air embolism, parenchymal hemorrhage, or hemoptysis, and possibly of lower biopsy accuracy due to challenges in targe:ng the pathologic :ssue abuang or intermingled with the cys:c airspaces [1,[15][16][17][18]. ...
Background: Concern may exist that pulmonary lesions associated with cystic airspaces are at risk of increased biopsy complications or lower biopsy accuracy given challenges in targeting tissue abutting or intermingled with the cystic airspaces. Objective: To evaluate the safety and diagnostic performance of CT-guided core-needle biopsy (CNB) of pulmonary lesions with cystic airspaces. Methods: This retrospective study included 90 patients (median age, 69.5 years; 28 female, 62 male) who underwent CT-guided CNB of pulmonary lesions associated with cystic airspaces (based on review of procedural images) from February 2010 to December 2022 and a matched control group (2:1 ratio) of 180 patients (median age, 68.0 years; 56 female, 124 male) who underwent CNB of noncystic noncavitary lesions during the same period. The groups were compared in terms of complications, nondiagnostic biopsies (i.e., nonspecific benignities, atypical cells, or insufficient specimens), and CNB diagnostic performance for detecting malignancy using as reference the final diagnosis from a joint review of all available records. For lesions associated with cystic airspaces that underwent surgical resection after CNB, histologic slides were re-reviewed to assess cystic airspace etiology. Results: The final diagnosis was malignant in 90% (81/90) of lesions associated with cystic airspaces and 92% (165/180) of noncystic noncavitary lesions. Patients with lesions associated with cystic airspaces and patients with noncystic noncavitary lesions showed no significant difference in frequencies of complication (all: 40% [36/90] vs 38% [68/180], p=.79; major: 4% [4/90] vs 6% [10/180], p=.78; minor: 36% [32/90] vs 32% [58/180], p=.59), frequency of nondiagnostic biopsies (12% [11/90] vs 9% [16/180], p=.40), or diagnostic performance (accuracy: 94.% [85/90] vs 97% [175/180], p=.50; sensitivity: 94% [76/81] vs 97% [160/165], p=.50; specificity: 100% [9/9] vs 100% [15/15]; p>.99), respectively. All false-negative results for malignancy in both groups occurred in patients with nondiagnostic CNB results. Among lesions associated with cystic airspaces that were resected after CNB (all malignant), the cystic airspaces most commonly represented tumor degeneration (22/31, 71%). Conclusion: CT-guided CNB is safe and accurate for assessing pulmonary lesions associated with cystic airspaces. Clinical Impact: CNB may help avoid a missed or delayed cancer diagnosis in pulmonary lesions with cystic airspaces.
... Breath-holding during the procedure is commonly recommended to mitigate respiratory motion effects, although exceptions exist for larger masses, allowing calm breathing or sedation (4)(5)(6)(7). However, guidelines for the specific respiratory phases of pleural puncture vary, ranging from a single breath-hold (6,7) to no specific instructions (1,8). ...
... Previous reviews on the PTNB technique have presented varying information regarding the preferred respiratory phases, including inspiratory or expiratory apnea, normal end-expiration, small inspiration, and quiet breathing, with some lacking specific data (3)(4)(5)(6)(11)(12)(13)(14)(15)(16)(17). ...
... Our study did not identify any significant difference in hemoptysis based on the respiratory phase of pleural puncture. It is well-known that deeper inspiration during the procedure may lead to the tearing of the pleural surface (5,16). The rate of CT parenchymal hemorrhage was lower in the expiratory phase than in the other respiratory phases, although the difference was not statistically significant. ...
... Hiện nay, hầu hết việc sinh thiết phổi xuyên thành ngực thực hiện bằng các thiết bị sinh thiết tự động hoặc bán tự động được gọi là "súng sinh thiết" với kỹ thuật đồng trục bao gồm việc đặt kim dẫn vào vị trí sinh thiết và đủ rộng để đưa kim sinh thiết thực sự đi qua để lấy mẫu với số lần cần thiết, qua đó giảm được số lần phải đâm kim nhiều lần vào phổi, giảm được tỉ lệ biến chứng [19], [20]. Khi được thực hiện đúng kỹ thuật, quy trình này tương đối an toàn với độ chính xác chẩn đoán tương đương với sinh thiết phổi mở [20]. ...
... Hiện nay, hầu hết việc sinh thiết phổi xuyên thành ngực thực hiện bằng các thiết bị sinh thiết tự động hoặc bán tự động được gọi là "súng sinh thiết" với kỹ thuật đồng trục bao gồm việc đặt kim dẫn vào vị trí sinh thiết và đủ rộng để đưa kim sinh thiết thực sự đi qua để lấy mẫu với số lần cần thiết, qua đó giảm được số lần phải đâm kim nhiều lần vào phổi, giảm được tỉ lệ biến chứng [19], [20]. Khi được thực hiện đúng kỹ thuật, quy trình này tương đối an toàn với độ chính xác chẩn đoán tương đương với sinh thiết phổi mở [20]. Vì sinh thiết phổi dưới hướng dẫn của CT là một thủ thuật xâm lấn có khả năng xảy ra các biến chứng, bao gồm cả tử vong [21], [22], nên việc bệnh nhân và gia đình hiểu rõ về thủ thuật cũng như các rủi ro tiềm ẩn là rất quan trọng. ...
Sinh thiết phổi xuyên thành ngực dưới hướng dẫn chụp cắt lớp vi tính là một công cụ không thể thiếu trong việc đánh giá các bất thường ở phổi do độ chính xác chẩn đoán cao trong việc phát hiện khối u ác tính. Sinh thiết phổi xuyên thành ngực đóng một vai trò quan trọng trong việc thu được bằng chứng bệnh ác tính, hướng dẫn xác định giai đoạn và lập kế hoạch điều trị. Bài viết nêu lên tổng quan, hiệu quả và biến chứng liên quan của kỹ thuật sinh thiết này.
... Second, EMN-TTNB under moderate sedation cannot be performed in the prone position because of the registration process using bronchoscopy. When performing CT-guided PCNB or EMN-TTNB under deep sedation, usually the anterior or middle mediastinal lesions are approached from the supine position, and the middle, posterior mediastinal lesions are approached from the prone position (20). Therefore, EMN-TTNB under moderate sedation, the middle, posterior mediastinal lesions have no choice but to approach it in the lateral decubitus position. ...
Background:
Novel approaches using virtual computed tomography (CT) guidance, namely electromagnetic navigation transthoracic needle biopsy (EMN-TTNB), enable physicians to perform percutaneous lung biopsies. However, there are very few studies on the clinical experiences of EMN-TTNB, and in previous studies, the procedure was usually performed under deep sedation. This study aimed to determine the diagnostic accuracy and safety of EMN-TTNB under moderate sedation.
Methods:
We conducted a retrospective analysis of patients who underwent EMN-TTNB under moderate sedation between May 2021 and November 2022 at Hallym University Dongtan Sacred Heart Hospital in South Korea. Moderate sedation was achieved with midazolam injection in the bronchoscopy room using the Veran SPiNperc EM guidance system (Veran Medical, St Louis, MO, USA). Clinical data were collected by review of medical records, and diagnostic accuracy and safety were calculated.
Results:
Thirty-two patients were enrolled (mean age 70.8±11.1 years); 56.3% were male. The mean size of the pulmonary lesions was 36.9±17.4 mm, and the median (interquartile range) distance from the pleura was 15.5 (0.0-30.0) mm. The diagnostic accuracy of EMN-TTNB was 75.0% (21/28), excluding four indeterminate cases. Fourteen patients (50.0%, 14/28) had true-positive and seven patients (25.0%, 7/28) had true-negative lesions. There were no severe adverse reactions such as pneumothorax, respiratory failure, or death, except one case of hemoptysis.
Conclusions:
EMN-TTNB under moderate sedation showed an acceptable diagnostic accuracy and good safety profile. The new technology allows physicians to perform percutaneous lung biopsies without the intervention of a radiologist or anesthesiologist.
... The first step towards diagnosing a pulmonary nodule is obtaining a preliminary imaging, mainly by means of computed tomography (CT) or, less frequently, magnetic resonance imaging (MRI); to better characterize the nature of the lesion and to estimate its probability of malignancy, CT with iodine contrast medium and positron emission tomography (PET), also combined with CT (PET-CT), are used (5)(6)(7)(8)(9). ...
... In such situations, as already suggested by the literature, it might have been preferable to have a tangential path to the pleura (therefore longer) which allowed to increase the stability of the needle and to facilitate the correction of the puncture angle thanks to the greater thickness of the crossed tissues (9). ...
Background/aim:
Lung percutaneous needle biopsy (PNB) under CT guidance can be performed with a single-needle or with a coaxial (CX) technique. This study evaluated the CX technique in a large cohort of patients who underwent to CT-guided lung PNB in our Institute over a period of 7 years.
Patients and methods:
We retrospectively collected and analyzed data relative to 700 CT-guided lung PNBs performed from August 2012 to August 2019 in 700 patients (M:F=436:264; mean age=69 years, range=6-93 years) with normal coagulation and pulmonary function. PNB was considered diagnostic if at least one of the collected tissue specimens allowed for histological diagnosis. Pulmonary hemorrhage (PH) and pneumothorax (PNX) were evaluated as present or absent. Statistical analysis was made by Chi-square test of Pearson, Fisher's exact test and Wilcoxon test.
Results:
The CX technique showed a high diagnostic accuracy (93.0%) and allowed the collection of a great number of appropriate tissue specimens with a single pleural puncture (≥3 specimens in 77.4% of cases). PH was the complication more frequent (55.4%), without significant clinical impact. Global PNXs incidence was high (42.9%), but the introducer allowed to aspirate the PNX with a lower percentage of chest tube placement vs. PNXs not aspirated (6.3% and 13.3%, respectively).
Conclusion:
This large retrospective study confirmed the high diagnostic accuracy of lung PNB with the CX technique and allowed identification of significant factors to achieve a greater diagnostic power and decrease complication rates.
... The conventional technique for CT-guided interventional procedures can be performed using conventional CT or CT fluoroscopy. Even if the clinical performance of these conventional approaches is highly reliable in expert hands, [11][12][13][14] conventional techniques require multiple needle adjustments depending on the experience of interventional radiologists, multiple intraprocedural scan acquisitions which prolong the procedure duration, as well as patient radiation exposure and the risk of complications. With an aim to reduce such operator dependence, various devices have been developed and tested from time to time in clinical practice, including the external laser 15 or optical 16 targeting systems that guide the needle path onto the skin surface, electromagnetic tracking with image fusion, 17 and augmented reality system under infrared guidance that display a real-time simulation of needle movements. ...
Purpose This article evaluates the feasibility, safety, and technical success of robot-assisted computed tomography (CT)-guided percutaneous lung biopsy.
Methods CT-guided lung biopsy was performed after clearance from the institutional ethical committee in 60 patients who were assigned to two groups, group A (robot-assisted biopsy) and group B (conventional CT-guided biopsy). The accuracy of needle placement, number of needle adjustments, radiation dose, procedure time, and complications were compared in both these groups.
Results In group A, the procedure duration was significantly shorter ( p = 0.001), dose length product, lower ( p = 0.001), accuracy of needle placement, superior ( p = 0.003), and complication rates were lower ( p = 0.002) compared with conventional CT guidedbiopsy.
Conclusion Robotic assistance during CT lung biopsy is associated with improved targeting of lesions with more diagnostic yield and less procedure duration, radiation exposure, and fewer complications compared with conventional CT lung biopsy.
... Percutaneous computer tomography (CT)-guided needle biopsy (PCNB) of suspicious pulmonary nodules is a well-established method of obtaining tissue for histopathological examination. 1 Despite its wide use in the United States, this procedure carries with it a set of complications associated with significant morbidity and mortality. 2 Systemic air embolism (SAE) is a rare yet devastating complication of PCNB with longstanding cerebral and cardiovascular effects. ...
... Fluoroscopy and step-and-shoot techniques are used for CT-guided biopsy. Fluoroscopy is useful for smaller lesions and lesions prone to respiratory motion, whereas step-and-shoot is used for large and immobile lesions [2]. ...
... This prevented any unnecessary pleural damage and fissure [18]. Moreover, the coaxial technique seems more advantageous than the single-needle technique [20], and was shown to decrease the risk of pneumothorax development in a retrospective analysis of 485 patients conducted by Zhang et al. [21]. In a 2020 study, Huo et al. looked at 36 articles, including 23,104 patients, and presented the pooled incidence for pneumothorax at 25.9% and 6.9% for chest drain insertion [22]. ...
The purpose of this study is to assess the effect of nine covariates on the occurrence or absence of stable or symptomatic pneumothorax. Forty-three patients underwent CT-guided lung biopsies from January 2020 to January 2022 (24 m, 19 f, median age 70 years). All the interventions were carried out with a semi-automatic 18G needle and a 17G trocar in a prone or supine position. Different covariates were measured and correlated to the rate and severity of the pneumothoraces observed. Nominal two-sided t-test p-values for the continuous variables and Fisher’s exact test results for the categorical variables were conducted. The data included the lesion size, distance to the pleura, needle-pleura angle, age, gender, position during the procedure, and the presence of chronic obstructive pulmonary disease. Patients with an observed pneumothorax had an average angle between the needle and the pleura of 74.00° compared to 94.68° in patients with no pneumothorax (p-value = 0.028). A smaller angle measurement correlated with a higher risk of pneumothorax development. The needle-pleural angle plays a vital role in the outcome of a CT-guided lung biopsy. Correctly adjusting the needle-pleural angle can diminish the pneumothorax risk associated with a CT-guided lung biopsy. The study results show that as the needle’s angle deviates from the perpendicular, the pleural surface area experiencing trauma increases, and pneumothorax is more likely to occur.
... 1,2 Most of the time, it is done with automatic or semiautomatic biopsy devices called "biopsy gun." 3 A coaxial technique involves the placement of a needle initially to the biopsy site and is wide enough to pass the actual biopsy needle through it for the required number of times. 3,4 When performed with the correct technique, this procedure is relatively safe with diagnostic accuracy comparable to open surgical biopsy. 4 As radiologists, it is not only essential to have sound knowledge about the characteristics of the target lesion but also about the biopsy instrument. ...
... 3,4 When performed with the correct technique, this procedure is relatively safe with diagnostic accuracy comparable to open surgical biopsy. 4 As radiologists, it is not only essential to have sound knowledge about the characteristics of the target lesion but also about the biopsy instrument. Familiarity with the needle components helps in selecting the appropriate needle, practicing the correct technique, and planning the best approach for biopsy. ...
... This limits the likelihood of a nondiagnostic sample, improves efficiency, and helps avoid inadvertent complications. 4 In this article, we discuss with illustrations how the needle traverses into the tissue of interest. We also address the potential factors in the outcome of a biopsy procedure with respect to needle penetration. ...
Image-guided Trucut biopsy is a well-established procedure. The length of the side notch in the stylet is the “cutting length,” which entraps the tissue sample and contributes to the yield. The total distance by which the inner stylet protrudes from the outer cannula with the cutting notch open is the “throw length.” It is inevitably longer than the cutting length does not add to the yield of the sample, but potentially to the complication of the procedure. The authors highlight the importance of knowing this distinction to minimize complications during the procedure.
